Hics Committee approved this study (reference SS) and NHS Permissions were granted from all trusts.Findings is going to be published in peerreviewed, scientific journals, and presented at academic conferences.Trial registration number This study is registered around the UK Clinical Study Network Study Portfolio (reference quantity).Strengths and limitations of this studyThis could be the 1st identified study to apply the positive deviance method inside the UK’s National Wellness Service (NHS).Triangulating routinely collected security data with staff and patient perceptions of security will facilitate assessment of no matter if positively deviant wards happen to be appropriately identified (concurrent validity).A theoretically underpinned framework are going to be used to guide qualitative information collection.The study will likely be performed inside a single area of the UK and so quantitative analyses are limited in power plus the positively deviant elderly medical wards identified may not demonstrate exceptional efficiency on a national scale.College of Psychology, University of Leeds, Leeds, UK Good quality and Safety Investigation Group, Bradford Institute for Well being Research, Bradford, UK Centre for Healthcare Resilience and Implementation Science, Australian Institute of Overall health Innovation, Macquarie University, Sydney, New South Wales, Australia Correspondence to Ruth Baxter; [email protected] Within healthcare, security is at the moment defined as the absence of dangerous incidents orevents.Healthcare organisations thus concentrate on identifying the causes of these events and eliminating them.This reactive, deficitbased strategy, commonly known as Security I, will not typically clarify why and how safe patient care is delivered.An option approach, referred to as Security II, proposes that healthcare organisations must also concentrate on guaranteeing that `as lots of items as you can go right’.It can be argued that protected care is delivered routinely for the reason that clinicians continually adjust their behaviours for the different circumstances they face.Primarily based on this strategy, human things are considered vital in offering flexibility and resilience rather than being prospective sources of error.Traditionally, procedures utilized to improve patient safety (+)-MCPG manufacturer address Security I.By way of example, incident reporting, clinical auditing and excellent improvement approaches such Statistical Approach Handle all determine, and aim to resolve, `defects’ or unacceptable variation in processes.Regardless of substantial efforts to improve, there’s small proof that patient care is becoming any safer.In contrast, asset primarily based approaches draw on strengths and sources which exist withinBaxter R, et al.BMJ Open ;e.doi.bmjopenOpen Access communities.`Positive deviance’ adheres towards the principles of Safety II and gives an assetbased approach to quality improvement.The strategy is increasingly becoming made use of inside healthcare organisations to enhance high-quality and safety outcomes on the other hand restricted guidance and evidence exists to assistance its application.Positive deviance approach The good deviance strategy originated within international public overall health literature and has been employed to address a variety of intractable complications for instance female genital mutilation and infection avoidance in drug customers.Most renowned constructive deviance was made use of in Vietnam throughout PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21447296 the s to sustain a reduction in extreme childhood malnutrition over years.The good deviance approach identifies and learns from those who demonstrate exceptional functionality.It can be built on the premise that solut.