What methods are used to apply positive deviance within healthcare organisations? A systematic review.
What methods are used to apply positive deviance within healthcare organisations? A systematic review.
复制标题
哪些方法用于在医疗保健组织中应用积极的偏差？系统评价。
DOI：
10.1136/bmjqs-2015-004386
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发表时间：
2016-03
影响因子：
5.4
通讯作者：
Lawton R
中科院分区：
文献类型：
--
作者：
Baxter R;Taylor N;Kellar I;Lawton R
积极偏离方法关注那些表现出色的人，尽管他们面临着与其他人相同的限制。“积极的越轨行为”被识别出来，并产生了关于他们如何成功的假设。这些假设经过测试，然后在更广泛的社区中传播。积极的偏差方法越来越多地应用于医疗机构，虽然有限的指导存在和不同的方法，不同的质量，使用。本文系统地回顾了积极偏差方法在医疗保健中的应用，探讨了积极偏差的定义、现有应用的质量以及其中使用的方法，包括工作人员和患者参与的程度。从7个电子数据库中识别出2014年9月之前发表的同行评审文章，报告了在医疗保健中使用积极偏离方法的实证研究。一个先前定义的四个阶段的过程中，积极的偏差在医疗保健被用作数据提取的基础。质量评估是使用一种经过验证的工具进行的，并遵循叙述性综合方法。818篇文章中有37篇符合纳入标准。积极的偏离方法在北美最常用于二级保健，并用于解决与保健有关的感染。研究主要是确定积极的越轨行为，并产生关于他们如何成功的假设。所遵循的方法和程序界定不清。研究质量低，文章缺乏细节，很少包括比较组。积极偏差的应用通常缺乏工作人员和/或患者的参与，所使用的方法往往需要大量的资源。需要进一步的研究，以开发高质量的，但实际的方法，涉及工作人员和病人在积极的偏差方法的所有阶段。必须评估积极偏差的功效和效率，并与其他质量改进方法进行比较。CRD 42014009365。
The positive deviance approach focuses on those who demonstrate exceptional performance, despite facing the same constraints as others. ‘Positive deviants’ are identified and hypotheses about how they succeed are generated. These hypotheses are tested and then disseminated within the wider community. The positive deviance approach is being increasingly applied within healthcare organisations, although limited guidance exists and different methods, of varying quality, are used. This paper systematically reviews healthcare applications of the positive deviance approach to explore how positive deviance is defined, the quality of existing applications and the methods used within them, including the extent to which staff and patients are involved. Peer-reviewed articles, published prior to September 2014, reporting empirical research on the use of the positive deviance approach within healthcare, were identified from seven electronic databases. A previously defined four-stage process for positive deviance in healthcare was used as the basis for data extraction. Quality assessments were conducted using a validated tool, and a narrative synthesis approach was followed. 37 of 818 articles met the inclusion criteria. The positive deviance approach was most frequently applied within North America, in secondary care, and to address healthcare-associated infections. Research predominantly identified positive deviants and generated hypotheses about how they succeeded. The approach and processes followed were poorly defined. Research quality was low, articles lacked detail and comparison groups were rarely included. Applications of positive deviance typically lacked staff and/or patient involvement, and the methods used often required extensive resources. Further research is required to develop high quality yet practical methods which involve staff and patients in all stages of the positive deviance approach. The efficacy and efficiency of positive deviance must be assessed and compared with other quality improvement approaches. CRD42014009365.