long-term care infection prevention
By Cindy Fronning , RN , GERO-BC , IP-BC , AS-BC , RAC-CT , CDONA , FACDONA
Normalizing Deviant Behavior in Healthcare
When I first heard the term “ normalization of deviance ” my first thought was “ What are they talking about ?” As I continued to research the topic it became much clearer , and I found that it truly is something to which we in healthcare need to pay attention .
Diane Vaughan , a sociologist and a professor at Columbia University , used this phrase when describing the Challenger disaster . She found that the underlying cause of the space shuttle tragedy was related to the decision to continue to fly the space shuttle with a known design flaw of the O-rings .
Wikipedia describes the phrase of normalization of deviance as a term used by Vaughan to describe the process in which deviance from correct or proper behavior becomes normalized in a corporate culture . Vaughan defines this as a process where a clearly unsafe practice comes to be considered normal if it does not immediately cause a catastrophe : “ a long incubation period [ before a final disaster ] with early warning signs that were either misinterpreted , ignored or missed completely .”
When putting this into the healthcare perspective , how would this phenomenon happen ? What would it look like ?
The American Society for Healthcare Risk Management ( ASHRM ) states on a safety tip sheet that “ Normalization of deviance is the gradual process of
deviating from standard operating procedure ( SOP ) for various reasons and the deviation becomes the norm as no immediate adverse outcomes occur . Normalization of deviance in patient care has the potential for devastating outcomes . It plays a unique role in healthcare as the very safety practices and a larger culture of safety meant to prevent deviation from SOP are not as widespread as early patient safety movement proponents anticipated .” So , again , I asked myself , what would this look like ? Not gowning when appropriate , improper application or failing to replace gloves , failing to confirm resident identify and using unapproved abbreviations are common deviations in healthcare . It can start small and can easily become the norm as more staff members do it and then mentor and train new staff . It doesn ’ t seem like a rule violation . Some might not even know there is a rule . It seems harmless to those involved .
Consider hand hygiene in a nursing home . For years we have had rules regarding when hand hygiene should be performed , how to perform it , and what soaps or alcohol-based handrubs ( ABHRs ) should be used . Many facilities have perfect policies and procedures written , which provide this information to the staff who are directed to follow them . However , in many facilities there was a lack of sinks or not enough ABHR stations or dispensers . Individual containers
Normalization of deviance in patient care has the potential for devastating outcomes .
It plays a unique role in healthcare as the very safety practices and a larger culture of safety meant to prevent deviation from SOP are not as widespread as early patient safety movement proponents anticipated .”