When Doing Wrong Feels So Right: Normalization of Deviance

Journal of Patient Safety
Mary R Price, Teresa C Williams

Abstract

Normalization of deviance is a term first coined by sociologist Diane Vaughan when reviewing the Challenger disaster. Vaughan noted that the root cause of the Challenger disaster was related to the repeated choice of NASA officials to fly the space shuttle despite a dangerous design flaw with the O-rings. Vaughan describes this phenomenon as occurring when people within an organization become so insensitive to deviant practice that it no longer feels wrong. Insensitivity occurs insidiously and sometimes over years because disaster does not happen until other critical factors line up. In clinical practice, failing to do time outs before procedures, shutting off alarms, and breaches of infection control are deviances from evidence-based practice. As in other industries, health care workers do not make these choices intending to set into motion a cascade toward disaster and harm. Deviation occurs because of barriers to using the correct process or drivers such as time, cost, and peer pressure. As in other industries, operators will often adamantly defend their actions as necessary and justified. Although many other high-risk industries have embraced the normalization of deviance concept, it is relatively new to health care. It is ...Continue Reading

References

Nov 11, 2005·BMC Health Services Research·Thomas V Perneger
Feb 18, 2010·Business Horizons·John Banja
Jul 19, 2013·Journal of Patient Safety·John T James
Sep 14, 2013·The Milbank Quarterly·Mark R Chassin, Jerod M Loeb

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Citations

Aug 28, 2016·Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen·David L B Schwappach
Jun 22, 2019·Autism Research : Official Journal of the International Society for Autism Research·Matthew S GoodwinMatthew Siegel
Dec 14, 2019·European Radiology·Boel HanssonIsabella M Björkman-Burtscher
Jun 4, 2019·Behavioral Sciences & the Law·Skip Simpson, William H Reid
Mar 16, 2021·Western Journal of Nursing Research·M Imelda WrightPaul Clark
Apr 4, 2021·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Joseph P ForesterJ Allen Meadows
Feb 25, 2021·ANS. Advances in Nursing Science·M Imelda WrightBecky J Christian

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