Positive deviance in intermediate care services

The NHS Benchmarking Network is pleased to publish a report on Positive deviance in intermediate care services.

The positive deviance approach originated in the field of international public health and has been used more recently to improve quality and safety in healthcare organisations. The approach focuses on those health care services who demonstrate exceptional (or positively deviant) performance in a particular area, despite facing the same constraints as others and contains four key steps.

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In 2016, the NHS Benchmarking Network funded a study to apply the positive deviance methodology to home-based intermediate care. Following its success, the Network Steering Group took the decision to fund a further study to apply the positive deviance approach to bed-based intermediate care services in 2018.

It was hypothesised that high performing or positively deviant services could be identified from those intermediate care services which demonstrated positively deviant performance in terms of good clinical outcomes for the patient (as measured by a positive change in dependency levels). This report provides readers with a step-by-step process of how to use the positive deviance methodology to identify exceptional performance in a particular area despite facing the same constraints as others.

An initial workshop was held (March 2016), hosted by the University of Leeds and University of York, where the positive deviance methodology was introduced to the NHSBN Support Team. At this workshop, preliminary discussions were held with the two teams from the Universities about the potential application of the methodology. The University of Leeds agreed to act as a “critical friend” to ensure that the NHSBN Support Team were applying the positive deviance principles within the parameters of the methodology.

The report, together with other audit outputs for participants, will help providers to identify those factors which evidence suggests improves outcomes for patients and hence areas for improvement in intermediate care.


The NHSBN support team would like to thank the Network Steering Group and the NAIC Steering Group for supporting the positive deviance study. The NHSBN support teams would also like to thank the 10 intermediate care sites who participated in the study.

For further information, please contact nhsbn.naicsupport@nhs.net or call on 0161 266 2132.