Learning from exceptional general practices to improve quality of care
Research type
Research Study
Full title
Learning from exceptional general practices to improve quality of care: applying the positive deviance approach.
IRAS ID
165599
Contact name
Ruth Baxter
Contact email
Sponsor organisation
University of Leeds
Duration of Study in the UK
0 years, 8 months, 31 days
Research summary
Variation in performance exists between UK general practices and there is scope to improve the quality of care provided (The Kings Fund 2011). Traditional improvement approaches are deficit based and focus on poor performance. In contrast, ‘positive deviance’ offers an opportunity to learn from those who demonstrate exceptional performance. The positive deviance approach assumes that within communities such as general practices some individuals or teams succeed despite facing the same constraints as everyone else. The approach is yet to be applied to improving the delivery of evidence based care within general practice.
Anonymised patient data from the ASPIRE research programme will be analysed to identify a sample of general practices with exceptional adherence to clinical recommendations. This ethics application seeks permission to analyse this data and then approach ASPIRE practices to participate in a new study. This study will be conducted in 3 stages:STAGE 1 - Conduct a secondary analysis of ASPIRE data to identify a sample of positively deviant general practices with ‘exceptional’ adherence to clinical recommendations. Exceptional practices will be invited to participate in the new study-we aim to recruit 3 practices in total. During stage 1 ASPIRE adherence data will also be analysed alongside publically available General Practice Patient Survey data to explore whether performance for the ‘clinical effectiveness’ domain of quality predicts performance for the ‘patient experience’ domain of quality.
STAGE 2 - Conduct individual semi-structured interviews and observe practice team meetings to qualitatively explore how general practices deliver high quality, evidence based care. Through analysis we will generate hypotheses about the positively deviant strategies used to succeed.
STAGE 3 – Create a survey based on the qualitative findings and distribute this to all 89 ASPIRE practices to assess whether the hypothesised strategies are unique to positively deviant practices and/or related to higher quality, more adherent patient care.
REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
15/LO/2076
Date of REC Opinion
26 Nov 2015
REC opinion
Favourable Opinion