Positive Deviance Theory: Leveraging Compliments Data to Guide Strategic Planning for Patient Experience Improvement in a Large Rural Health Care System

Abstract

Background: Patient-centered care (PCC) has been called for as a solution to improving care quality and patient outcomes. Patient experience, termed care experience, is a measurable aspect of PCC and aligns with coproduction. Identifying patterns of positivity and high performers is a Positive Deviance approach that can inform strategic improvement of the care experience.

Objective: To identify the characteristics of positive deviances from voluntary, unsolicited compliments from patients and family members about their care experiences.

Methods: The authors conducted a mixed-method analysis, including content and a thematic analysis of unsolicited comments from patients and families, submitted between January 2021 and January 2022. After removing duplicates and miscategorized comments, 213 compliments were included in the analysis using a single, blinded inductive coding to synthesize thematic statements.

Results: The main campus received the most compliments by location (89%); the most widely used patient sentiment was thankful (36.8%). Compassionate (26.8%), together with six others: competent (11.6%), communication (10.6%), cared for (8.5%), care team (8.0%), and supportive (8.0%), made up approximately 80% of drivers of care quality. Physicians (37.3%) and nurses (34.2%) were the most complimented personnel, although surgery (17.0%) were the most complimented services team. Similar characteristics were reported for exemplary individuals and their associated care teams.

Conclusion: The results align with previously reported work by the Beryl Institute and CMS 5-star rating on key drivers of patient experience. This approach provides a method by which exemplars can be identified within health systems, and that information is used to guide improvement and organizational planning.

Keywords: Human Experience of Care; Patient Center Care; Patient Experience of Care; Positive Deviance; Quality Improvement; patient experience.

Figure 1:

Flow chart of thematic analysis process.

Figure 2:

Pareto chart displaying components that makeup care quality.

Figure 3:

Pareto chart of patient sentiments.

Figure 4:

Pareto chart of service personnel.

Figure 5:

Pareto chart of service teams.