Development and Psychometric Evaluation of the Wright Normalization of Deviance (NOD) Scale

Area of Science:

• Healthcare quality and safety
• Organizational behavior
• Risk management

Background:

• Normalization of deviance (NOD) describes the gradual acceptance of substandard practices as the norm.
• Limited research exists on NOD incidence in healthcare, and no validated instrument is available to measure it.
• Quantifying NOD is crucial for evaluating interventions aimed at reducing its negative impacts.

Purpose of the Study:

• To develop and psychometrically evaluate the Wright Normalization of Deviance Scale.
• To provide a validated instrument for measuring NOD in high-risk environments.

Main Methods:

• Scale items were derived from qualitative interviews and literature review.
• Expert judges assessed item relevance and clarity.
• A sample of 222 respondents from high-risk environments participated.
• Principal component analysis and Cronbach's alpha were used for psychometric evaluation.

Main Results:

• The scale development process supported content validity.
• Principal component analysis confirmed the intended latent structure.
• The final 27-item scale demonstrated good internal consistency across four dimensions (Cronbach's alphas: 0.72-0.94).

Conclusions:

• The Wright NOD Scale exhibits content validity, construct validity, and strong internal consistency.
• This scale is suitable for use in any high-risk organization, including healthcare, to identify NOD.
• The scale facilitates the application of strategies to mitigate the adverse consequences of NOD.