Normalization of deviance

Cultural Threat 1 Production Pressure Cultural Threat 2 Complacency Cultural Threat 3 Normalization of Deviance Cultural Threat 4 Tolerance of Inadequate Systems and Resources Cultural Defense 1 Committed Safety Leadership Cultural Defense 2 Vigilance... 

A second group have looked to organizational and cultural characteristics. A classic example of this approach is Diane Vaughan s analysis of the Challenger space shuttle explosion, when safety standards were progressively eased and finally ignored to the point of disaster. Her evocative phrase the normalization of deviance perfectly captures the gradual erosion of standards, the tacit acceptance by the people concerned and the eventual loss of any sense of where the boundary of safety lies. 

The study of patient safety is the study of complexity. The study of complexity invites us to understand key concepts that can be applied to patient safety. Basic concepts from the fleld of patient safety are sharp and blunt end active and latent failure the Swiss Cheese Model of Accident Causation slips, lapses, and mistakes and hindsight bias and the fundamental attribution error. Key concepts from organizational analysis, such as normalization of deviance, diffusion of responsibility, tightly coupled work processes, and sensemaking, introduce practical lessons from high-reliability organizations. Application of specific lessons to health care are explored in Chapter Five. 

Normalization of deviance is the acceptance of, or failure to recognize, faulty and risk-prone processes because they are so familiar, pervasive, and entrenched in the work environment. This results in failure to attend to problematic conditions. Diane Vaughan describes the role of normalization of deviance in her book about the 1986 accident, noting that normalization of deviance is common in... 

Work-aroimds and interceptions of failure have become commonplace in the highly complex environment of health care, normalized as how we do things here. A prime example of normalization of deviance in health care is the excessive work hoirrs for residents, a tradition described by Leape as the hazing period that must be endirred because those before have done so. Another example is the er-... 

Normalization of deviance is the phenomenon of accepting aberrations as a natural course of doing business and is a symptom or defense of people working in a hazardous environment of unmitigated risk. 

The speaker told carefully crafted stories and then asked the course attendees to define where normalization of deviance could be discovered in their own practice. The organizer of the minicourses reported, "It was eye-opening for participants to understand how this behavior [normalization of deviance] occurs in a practice setting, that it isn t unique but is evidenced in everyday life and is a danger in health care." The content of the discussions was bold and rich in detail as new knowledge was applied and routines of everyday practice were reframed. 

Risk categories are identified. The team pinpoints the hazards of the unit and how normalization of deviance may have affected responses to risk-prone conditions. Team members discuss situations in which they have felt out of control and times when they have not thought that the resources available to them would allow them to recover. 

The reminders help us avoid normalization of deviance," says Luther. "It s a reminder for people to speak up when they may not have spoken up before to protect patients from potential harm."... 

Accident/Near miss/System breakdown/ Good catch/How safety was created/ Hazardous situation/Accident wait/Happen/ Normalization of deviance... 

Interaction, decisions, and the normalization of deviance. As managers and engineers made each decision, continuing to launch under the circumstances they had made... 

Incremental changes, incremental acceptance of less and less safety in each decision, is not associated to a rationale for standing up and saying Wait a minute, we ve got a major problem, and this is clearly going to lead to an accident. Nevertheless, if we let those increments occm, we end up with normalization of deviancy and eventually we end up with disaster. 

Official act indicating the normalization of deviance accepted risk. 

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