Positive Deviance Applied for Healthcare Equality


PDI (2017) says positive deviance is based on the assumption that “in every community, there are certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers while having access to the same resources and facing similar or worse challenges” (p. 1). From this definition, the concept can be used to address issues about equality in the provision of healthcare services. Particularly, it could be used to improve the quality of services offered by a Colorado-based organization, Sisters of Charity of Leavenworth (SCL), because its operations are designed to address the needs of underprivileged groups in the society, thereby neglecting those of demographics that do not fit the same profile (SCL Health, 2018).

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Positive deviance could be used to address the problems of SCL by focusing on the actions of people or institutions, which have managed the same issue successfully. The process of implementing this strategy should follow a bottom-up approach where solutions to the problem are internally generated as opposed to externally sourced. Based on this model, SCL needs to follow and meet the guidelines of Baxter, Taylor, Kellar, and Lawton (2016) when implementing the strategy.

Their guidelines include recommendations that emphasize the need to implement solutions using current resources that are acceptable or sustainable to all stakeholders. Using the bottom-up model, the managers of SCL should focus on teaching their staff about what other healthcare institutions or employees have done to improve equality in the provision of healthcare services.

Steps that should be taken from the identification of the problem through to the evaluation of outliers should follow four key stages, as proposed by Baxter et al. (2016). The first one involves the collection of data to identify healthcare organizations that strive to serve underprivileged populations but excel in promoting equality in the same process (Baxter et al., 2016). The second stage should involve a generation of strategies that the organization uses to succeed.

Comparatively, the third process should involve testing the same hypotheses in a larger context, such as that which SCL operates in (Baxter et al., 2016). The last step involves disseminating the positive deviance strategies within the SCL community by involving the help of stakeholders (Baxter et al. 2016).


There are few instances where positive deviance has been used to address issues about equality in the healthcare practice, but the works of Better Evaluation (2018) suggest that the same strategy has been employed to improve guidance adherence in the management of acute myocardial infarction. A recent report that investigated the relationship between food security and antiretroviral therapy use among patients who suffered from HIV/AIDS in Zambia and Kenya also demonstrated the power of positive deviance in community health promotion because its use identified several promising strategies for improving the nutrition of the target population (Better Evaluation, 2018).


Baxter, R., Taylor, N., Kellar, I., & Lawton, R. (2016). What methods are used to apply positive deviance within healthcare organizations? A systematic review. BMJ Quality & Safety, 25(3), 190-201. Web.

Better Evaluation. (2018). Positive deviance. Web.

PDI. (2017). What is positive deviance? Web.

SCL Health. (2018). Quality patient care. Web.