Positive deviance as a tool for organizational change.(health care industry)

The senior leadership in a hospital wants to increase reimbursement and hires a consulting firm to assist with improving its diagnosis related group (DRG) case mix. The consulting firm brings best practices from its other clients and implements a plan to enhance the DRG case mix.

Clinical documentation specialists hired by the hospital and trained by the consultants will review charts and post queries in the charts for the physicians to answer. Education sessions are held for the physicians. Initially, revenue soars, but after the first year, only minor improvements are seen.

Physicians become resistant to answering the queries. They either ignore them or throw them away. The chief executive officer asks the vice president for medical affairs: "Why won't the physicians cooperate? How can we get the physicians to do what we want them to do?" …