From Anomaly to Strategy: Leveraging Positive Deviance to Enhance Patient Safety Culture at a Regional Public Hospital in Indonesia

Abstract

Background:Patient safety culture is a critical determinant of healthcare quality and risk mitigation. This study aims to assess the patient safety culture at RSUD Pambalah Batung Hulu Sungai Utara using a positive deviance lens to identify and leverage internal strengths. Methods: A descriptive quantitative design was employed, involving 337 staff members selected from a total population of 526. The official HSOPSC instrument endorsed by the Ministry of Health, covering 10 dimensions, was used. Data were analyzed using AHRQ’s scoring classification.  Results: The overall culture score was 68.4% (moderate). Top-performing dimensions included teamwork within units (79.2%), organizational learning (76.4%), and communication about error (72.1%). The lowest scores were found in non-punitive response to error (46.5%), staffing (48.2%), and event reporting (53.4%). The Surgery Unit (IBS) and Laboratory were identified as positive deviants. Conclusion: The emergence of high-performing units suggests the critical role of micro-leadership, localized climate, and peer-led strategies in cultivating a resilient safety culture. Positive deviance offers a replicable pathway to strategic cultural transformation.