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The development of a positive deviancy strategy to identify excellence in patient experience

Fraser Rubens, Li Chen, Tim Ramsay, Alan Forster, George Wells, Sudhir Sundaresan


Rationale, aims and objectives: Patient experience is recognized as a key target of quality improvement to foster patient-centered care. Identification of excellence in patient experience could highlight behaviors that may be shared to improve quality. The objective of this study was to develop a strategy to identify positive practice deviants in patient experience at the surgeon level.

Methods: Patient experience surveys were analyzed from 1707 discharged surgical patients. Multilevel hierarchical regression models were developed to predict topbox scores of global rating and physician communication. The influence of the surgeon outlier from the larger group was determined by identifying the random effect of the cluster and measuring the intra-class correlation (ICC).

Results: In 2 services with greater than 20 surgeons, positive deviants were identified in the physician composite score (random surgeon effect <0.05). Removal of the surgeons from the analysis of the composite measure resulted in a 69% decrease in the ICC (7.54% to 2.3%) in the first service and a 32% decrease in the ICC (6.83% to 4.59%) in the second service and the random surgeon effect was no longer significant in either service (p>0.05).

Conclusion: This study has illustrated the application of a process which can identify positive deviants at the provider level for the delivery of excellence in patient experience.


Clinical communication, excellence, patient-centered care, patient experience, person-centered healthcare, positive deviance, surgery

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