Positive deviance and hand hygiene of nurses in a Quebec hospital: What can we learn from the best?

Background Although it is well known that hand hygiene is the most effective measure to prevent health care–associated infections, hand hygiene adherence is low in Quebec, as it is elsewhere. For this study, an innovative framework was used to explore the clinical practice of nurses regarding hand hygiene and the factors that influence it: positive deviance, or the idea that there are people who find better solutions to problems than their peers. This study investigated positive deviance at the level of the care team to shed light on group dynamics. Methods We conducted focused ethnographies on 2 care units—a medical-surgery unit and a palliative care unit—at a Montreal university hospital. Data collection consisted mainly of systematic observations and individual interviews with nurses. Results The results show that positive deviance related to hand hygiene is instigated by social cohesion within a care team, created, in this study, by the mobilizing leadership of the head nurse in the medical-surgery unit and the prevailing humanist philosophy in the palliative care unit. Conclusions In health care, it can be useful to apply the positive deviance approach to care teams instead of individuals to better understand the ideologic and structural differences linked to better hand hygiene performance by the nurses.