The normalization of deviance in healthcare delivery

Abstract

Many serious medical errors result from violations of recognized standards of practice. Over time, even egregious violations of standards of practice may become "normalized" in healthcare delivery systems. This article describes what leads to this normalization and explains why flagrant practice deviations can persist for years, despite the importance of the standards at issue. This article also provides recommendations to aid healthcare organizations in identifying and managing unsafe practice deviations before they become normalized and pose genuine risks to patient safety, quality care, and employee morale.

Opportunity, Motivation, and Ability to Learn from Failures and Errors: Review, Synthesis, and Ways to Move Forward

“…Latent errors can lower failure reduction because a near-failure without an adverse outcome can strengthen an erroneous behavior.. The lower the likelihood that an error will lead to a failure, the more the error is accepted and the lower the motivation to correct the error or to learn from it is (Dillon & Tinsley, 2008;Banja, 2010). The motivation to reduce errors is also compromised because risk perception changes when actors experience errors without negative effects (a train driver falls asleep but wakes up before missing the signal, or, if the driver misses the signal, no other train is on the line, thus, there is no collision-the conclusion is that being tired on the job is not such a dangerous thing).…”

“…After all, some procedures or regulations are probably outdated or ineffectual and ignored for good reasons. In health care, normalized deviance often involves the violation of safety rules that impede work flow and signal a lack of trust in operators (Banja, 2010). Normalized deviance can also come from institutional logics that became dominant over time inside an industry despite their clashing with broader order values and beliefs that lie outside of the industry (Roulet, 2015;Shymko & Roulet, 2017).…”

Compression force behaviours: An exploration of the beliefs and values influencing the application of breast compression during screening mammography

“…Similar to the patient empowerment above, the use of white lies, although considered to be helpful by some of the practitioners to the final outcome, could also be viewed as a form of deviant behaviour, as described by Murphy (2009) 28 with respect to medical imaging. From a nursing perspective, Banja (2010) 29 felt that any form of deviant behaviour can become 'normalised' within an institution and quickly established as part of the daily routine. It is therefore important to recognise it as being part of the unit's culture.…”

Opportunity, Motivation, and Ability to Learn from Failures and Errors: Review, Synthesis, and Ways to Move Forward

“…This suggests that spurious success also lowers the motivation to learn from others' errors: Knowing that other firms in the industry experience similar errors without adverse consequences signals that these errors pose no real risk and thus require little attention. When latent errors start being accepted by organizational members as not leading to adverse events, we obtain what is called normalization of deviance (Banja, 2010;Vaughan, 1996).…”