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Collective leadership
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3.4 Case Study 2

Described image
Figure 1

Read the case study in the activity below about how the Positive Deviance Approach improved working relationships to reduce MRSA infection in an American hospital.

Activity 6 Positive Deviance Approach

Timing: Allow around 20 minutes

When reading the article from Singhal, Buscell and McCandless [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , think in particular about the following questions:

  • How did Positive Deviance bring people together?
  • What role did the Chief Executive play?


Positive Deviance was a way to get everyone in the hospital to talk and share ideas. It was people from all levels of the organisation, not just the leaders, working together towards a common goal and to make a difference to the issue of MRSA infection. It helped to break down hierarchical, cultural and social barriers, giving individuals permission to speak up when it was necessary without fear of being ignored or shouted down for speaking out of turn. The improvisations – or improvs as they were called by the hospital staff – allowed individuals to learn from each other in a simulated environment and, therefore, to speak more openly and challenge honestly.

Involving the Chief Executive as the overall ‘leader’ of the hospital ensured that there was buy-in from the top. With the Chief Executive being present and supportive, there was an element of permission giving to everyone else in the organisation to own the problem, change their behaviours, break down barriers, and gradually change the organisational culture (even if this was done subliminally).