Normalization of Deviance Is Contrary to the Principles of High Reliability

Area of Science:

• Healthcare safety
• Organizational behavior
• Patient safety

Background:

• Normalization of deviance is a gradual shift from acceptable standards to new norms.
• This phenomenon undermines safety culture in high-risk healthcare settings.
• It conflicts with high-reliability principles, particularly "preoccupation with failure."

Purpose of the Study:

• To explain the conflict between normalization of deviance and preoccupation with failure.
• To propose strategies for mitigating normalization of deviance.
• To enhance high reliability and patient safety in operating rooms.

Main Methods:

• Conceptual analysis of normalization of deviance.
• Review of high-reliability principles.
• Discussion of strategies to foster a safety culture.

Main Results:

• Normalization of deviance and preoccupation with failure are mutually exclusive.
• Failure to address deviance leads to eroded safety standards.
• Implementing strategies can bolster high reliability.

Conclusions:

• Normalization of deviance poses a significant threat to patient safety in ORs.
• Cultivating "preoccupation with failure" is essential for maintaining high reliability.
• Mitigating deviance is crucial for creating safer surgical environments.