Rebels with a cause : How positive deviance works for quality of care

Research Aim: How do healthcare rebels do ‘quality work’, design alternative forms of care delivery and account for their practices?
Methods: Selection of rebel-groups based on interviews. Ethnographic observational study of three rebel-groups in three Dutch hospitals with different institutional backgrounds (academic, large ‘top clinical’ teaching and general).
Conclusion: Rebels build their own micro systems of providing and organizing care. They have a strong focus on quality of care and quality of life, and adjust their care accordingly. Rebels walk the tight rope by coloring outside the lines while safeguarding legitimacy and organizational trust.