Using Surgeon-Specific Outcome Reports and Positive Deviance for Continuous Quality Improvement

Ivanovic, Jelena; Anstee, Caitlin; Ramsay, Tim; Gilbert, Sébastien; Maziak, Donna E.; Shamji, Farid M.; Sundaresan, R. Sudhir; Villeneuve, Patrick J.; Seely, Andrew J. E.

doi:10.1016/j.athoracsur.2015.04.012

Cited by 27 publications

(46 citation statements)

References 26 publications

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“…This approach argues that effective feedback requires the recipients to actively work with the material and construct and facilitate their own learning on the basis of the data provided, often through social interaction (58). Such close interaction between the feedback providers and recipients is uncommon in the practice feedback literature (2), although examples that merge this approach with clinical data are being explored (59). Activities consistent with this approach might include establishing rapport or trust between feedback providers and recipients (60,61), engaging in self-assessment around target behaviors before receiving feedback (60,61), developing feedback-seeking skills for the recipients (58), creating opportunities to both provide and receive feedback (58), engaging in dialogue with peers as feedback is provided (62), engaging in facilitated conversations or coaching about the feedback (60), and forming explicit plans to address feedback (60,63).…”

Section: Construct Feedback Through Social Interaction Educational Rmentioning

confidence: 99%

Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness

et al. 2016

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Electronic practice data are increasingly being used to provide feedback to encourage practice improvement. However, evidence suggests that despite decades of experience, the effects of such interventions vary greatly and are not improving over time. Guidance on providing more effective feedback does exist, but it is distributed across a wide range of disciplines and theoretical perspectives. Through expert interviews; systematic reviews; and experience with providing, evaluating, and receiving practice feedback, 15 suggestions that are believed to be associated with effective feedback interventions have been identified. These suggestions are intended to provide practical guidance to quality improvement professionals, information technology developers, educators, administrators, and practitioners who receive such interventions. Designing interventions with these suggestions in mind should improve their effect, and studying the mechanisms underlying these suggestions will advance a stagnant literature.

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Section: Construct Feedback Through Social Interaction Educational Rmentioning

confidence: 99%

Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness

et al. 2016

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“…PD has been used to reduce infections caused by methicillin-resistant Staphylococcus aureus in Veterans Affairs hospitals [ 9 ], improve hand hygiene [ 10 , 11 ], and reduce surgical site infections [ 12 ]. However, these studies did not explore the impact on patient safety culture among health care personnel (HCP), especially in the setting of parallel system-wide horizontal infection prevention interventions occurring independent of PD strategy.…”

mentioning

confidence: 99%

Using a Positive Deviance Approach to Influence the Culture of Patient Safety Related to Infection Prevention

Sreeramoju

Durá

Fernández

et al. 2018

Open Forum Infectious Diseases

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BackgroundHealth care–associated infections (HAIs) are a socio-technical problem. We evaluated the impact of a social change intervention on health care personnel (HCP), called “positive deviance” (PD), on patient safety culture related to infection prevention among HCP.MethodsThis observational study was done in 6 medical wards at an 800-bed public academic hospital in the United States. Three of these wards were randomly assigned to receive PD intervention on HCP. After a retrospective 6-month baseline period, PD was implemented over 9 months, followed by 9 months of follow-up. Patient safety culture and social networks among HCP were surveyed at 6, 15, and 24 months. Rates of HAI were measured among patients.ResultsThe measured patient safety culture was steady over time at 69% aggregate percent positive responses in wards with PD vs decline from 79% to 75% in wards without PD (F statistic 10.55; P = .005). Social network maps suggested that nurses, charge nurses, medical assistants, ward managers, and ward clerks play a key role in preventing infections. Fitted time series of monthly HAI rates showed a decrease from 4.8 to 2.8 per 1000 patient-days (95% confidence interval [CI], 2.1 to 3.5) in wards without PD, and 5.0 to 2.1 per 1000 patient-days (95% CI, –0.4 to 4.5) in wards with PD.ConclusionsA positive deviance approach appeared to have a significant impact on patient safety culture among HCP who received the intervention. Social network analysis identified HCP who are likely to help disseminate infection prevention information. Systemwide interventions independent of PD resulted in HAI reduction in both intervention and control wards.

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“…However, this is a subject of active study via positive deviance seminars. 39 Our study is also limited by the lack of data on chest tube drainage volumes, which constitute strict benchmarks for many thoracic surgeons. Finally, we did not quantify the degree of air leak.…”

Section: Limitationsmentioning

confidence: 99%