A systematic review of the use of positive deviance approaches in primary care.

The positive deviance approach is focused on identifying people/organizations performing particularly well, in spite of having similar challenges and resources to others, and learning about how they work so well. Recently, this approach has been used in healthcare to learn about how to improve the quality and safety of care for patients. This review aims to explore how the positive deviance approach has been used in primary care settings and to summarize the findings from this research. Overall, 27 studies were included in the review. We found that studies typically focused on identifying positive deviants (i.e. those performing particularly well) and finding out what helps them do that, without looking to see if these same practices work elsewhere or teaching others about them. The positive deviance approach was used to improve several different parts of primary care including; care effectiveness, management of chronic diseases, preventative care, prescribing, and health promotion. Several success strategies were identified from the studies' findings and were organized into a framework describing what practices contribute to particularly good performance in primary care. This framework will be useful for those looking to improve quality of care in primary care.