Monday, July 25, 2016

Identifying “Bright Spot” Regions in Healthcare

Today HealthLandscape is releasing the Geospatial Brief, “Where are “Bright Spots” for AppropriateDiabetes Preventive Care?” Using appropriate Diabetes preventive care as a case study, Brief #3 provides an example of how geospatial methods can be used to identify high-performing (“bright spot”) regions. This blog reviews “bright spots” approaches that have been previously used in the healthcare field.

A recent Editorial by long-time primary care advocate Thomas Bodenheimer advocates for finding the “bright spots” in primary care, so that we can “learn from them, and arrange for the bright spots to illuminate the dark corners,” (Bodenheimer, 2014).  Bodenheimer and his colleagues at Stanford’s Clinical Excellence and Research Center (CERC) define “bright spots” as physician groups that are successful at providing high quality care while keeping healthcare costs low. In-depth study of these “bright spots” allowed CERC to identify ten features of primary care delivery associated with higher quality care and lower spending (CERC, 2014). The work of CERC builds from the positive deviance (PD) approach, which is an asset-based framework for identifying organizations or individuals that are successful despite facing more difficult or similar circumstances than others, determining the features which make them successful, and applying the features to other organizations or individuals (Pascale et al., 2010).  The PD framework has been applied in several different healthcare settings, including medical homes (Gabbay et al., 2013), hospitals (Bradley et al., 2009), and local health departments (Klaiman et al., 2014). While they are not referred to as PD or “bright spot” approaches, the Veterans Affairs (VA) is also pushing forward with innovative strategies for improving care for the Veteran population (Elnahal and Littlefield, 2016).

Positive deviance approaches offer great potential in the healthcare field. By identifying successful strategies for improving care and reducing costs, we can apply these strategies and target scarce resources to areas of need.  Using appropriate Diabetes preventive care as a case study, Geospatial Brief #3 details geospatial approaches for identifying “bright spot” regions. This research builds on the first two HealthLandscape Geospatial Research Briefs, which explore the relationship between preventive care, preventable hospitalizations, and spending, and identify priority regions for improving preventive care (Topmiller, 2016a; Topmiller, 2016b).  Future research can use the results of these geospatial briefs for in-depth study of “bright spot” regions, and then apply lessons learned to priority regions.

Michael Topmiller
GIS Strategist 

Bodenheimer, Thomas S., (2014). Find the" bright spots." Joint Commission journal on quality and patient safety/Joint Commission Resources40(4), pp.147-147.

Bradley, Elizabeth H., Leslie A. Curry, Shoba Ramanadhan, Laura Rowe, Ingrid M Nembhard, and Harlan M Krumholz, 2009. Research in action: using positive deviance to improve quality of health care. Implementation Science 4:25.

Clinical Excellence Research Center (CERC), Stanford University, 2014. “America’s Most Valuable Care: Primary Care.” Clinical Excellence Research Center at Stanford University, Bright Spots Research.

Elnahal, Shereef, and Patrick Littlefield. “VA Diffision – spreading and implementing best practices to improve care for our nation’s Veterans.” (blog, March 2, 2016). Accessed at

Gabbay, Robert A., Mark W. Friedberg, Michelle Miller-Day, Peter F. Cronholm, Alan Adelman, and Eric C. Schneider, 2013. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home. Annals of Family Medicine 11(S1): S99-S107.

Klaiman, Tamar A., Athena Pantazis, and Betty Bekemeier, 2014. A Method for Identifying Positive Deviant Local Health Departments in Maternal and Child Health. Frontiers in Public Health Services and Systems Research 3(2).

Pascale, Richard, Jerry Sternin, and Monique Sternin, 2010. The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems. Harvard Business Press, United States of America.

Topmiller, Michael, 2016a. “Do Regions with More Preventive Care Have Lower Spending and Fewer Hospitalizations?”  HealthLandscape Geospatial Research Brief #1. 
Accessed at

Topmiller, Michael, 2016b. “Where are “Hot Spots” of Medicare Spending and Preventable Hospitalizations and “Cold Spots” for Preventive Care?”  HealthLandscape Geospatial Research Brief #2. 

Accessed at

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