Using Positive Deviance to Improve Patient Care and Teach Leadership
Elisha Brumfield, DO; Robert G. Badgett, MD; Ali Jahansooz, MD
University of Kansas School of Medicine – Wichita
AAMC Integrating Quality Conference, 06/2021
Background: Positive deviance (PD), a form of workforce empowerment consistent with complexity science (CS) leadership, has been successfully used in clinical care, but has not been applied to medical education. We implemented PD to expose trainees to the method.
Local problem: Perception of inefficient handling of test results.
Methods: The PD items (CS category) in the seminar were: goal setting (community building), collect each resident’s tactics (information gathering), identify deviants and determine unique tactics (information sensemaking), develop best practice (information using). At each step of the seminar, residents’ opinions were collected with a RedCap survey. Forest plots showed our overall proportion of lab results handled within 2 days (timely rate, TR), the TR of each resident, and heterogeneity (I2) of the group. Intervention: Trainees attended PD seminars consisting of 7 to 8 residents.
Results: Baseline TR was 52% (range 0% to 97%; I2 = 85%) with a mean of 7.4 days. Residents’ predicted mean was 8 days. Residents voted for a TR goal of 2 days. After collecting and showing each member’s tactics without attribution, 72% of residents voted to encourage the deviants to identify themselves. After the seminar, 83% of residents either agreed or strongly agreed with “Overall, this component of our curriculum compares favorably to other components” (p = 0.96 for comparison of this same question to other components in our last year-end curriculum survey).
Lessons: 1) the RedCap survey with real-time group feedback, helped guide the seminar, and 2) 3 sessions seemed necessary before teachers were able to guide discussions.
Conclusions: Initial use of PD to empower learning on a mundane task, the residents’ experience is similar to established components of our curriculum. The finding that 28% of residents did not agree with identifying the positive deviants in their teams suggests that not all residents were comfortable with PD. Measurement of the impact on clinical workflow is pending. The empowerment created by the PD approach could potentially reduce the burnout previously reported with quality improvement. The additional benefits of exposing trainees to a leadership strategy that empowers front lines and may improve well-being should become an area of keen interest in medical education.
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