Normalization of deviance is contrary to the principles of high reliability.

Imelda Wright

Commentary

Normalization of deviance is contrary to the principles of high reliability.

April 12, 2023

Wright I. AORN J. 2023;117(4):231-238.

View more articles from the same authors.

Normalization of deviance refers to the wide adoption of poor practices despite associated safety hazards. This article discusses how normalization of deviance threatens high-reliability and outline strategies to mitigate normalization of deviance in operating rooms (ORs).

PubMed citation

Available at

Related Resources From the Same Author(s)

Implementing No Interruption Zones in the perioperative environment.

December 21, 2016

An examination of factors that predict the perioperative culture of safety.

June 9, 2021

Do calculation errors by nurses cause medication errors in clinical practice? A literature review.

August 26, 2009

Healthcare-associated infections: a national patient safety problem and the coordinated response.

February 19, 2014

Wake Up Safe and root cause analysis: quality improvement in pediatric anesthesia.

July 9, 2014

Improving the quality of drug error reporting.

September 22, 2010

To think is good: querying an initial hypothesis reduces diagnostic error in medical students.

July 28, 2010

Bar coding for patient safety.

August 3, 2005

Clinical decision support: a 25 year retrospective and a 25 year vision.

September 14, 2016

Incorporating indications into medication ordering—time to enter the age of reason.

August 10, 2016

Designing decision support for insulin ordering in a computerized provider order entry system.

March 7, 2007

Evaluation of preoperative and perioperative operating room briefings at the Hospital for Sick Children.

August 26, 2009

Strategies for flipping the script on opioid overprescribing.

November 23, 2016

Patient safety in patients who occupy beds on clinically inappropriate wards: a qualitative interview study with NHS staff.

December 7, 2011

Understanding test results follow-up in the ambulatory setting: analysis of multiple perspectives.

October 24, 2018

What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study.

May 26, 2021

Exploring clinical lessons learned by experienced hospitalists from diagnostic errors and successes.

February 28, 2024

Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies.

June 8, 2022

Perceived bullying among internal medicine residents.

September 4, 2019

Morbidity and mortality conference, grand rounds, and the ACGME's core competencies.

October 25, 2006

Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study.

October 23, 2013

Communication failure: analysis of prescribers' use of an internal free-text field on electronic prescriptions.

March 7, 2018

How do simulated error experiences impact attitudes related to error prevention?

September 14, 2016

Fifteen years after To Err Is Human: a success story to learn from.

January 13, 2016

New unintended adverse consequences of electronic health records.

July 19, 2017

What interventions could reduce diagnostic error in emergency departments? A review of evidence, practice and consumer perspectives.

July 24, 2019

Closing the loop on test results to reduce communication failures: a rapid review of evidence, practice and patient perspectives.

November 25, 2020

Identifying the latent failures underpinning medication administration errors: an exploratory study.

March 21, 2012

Using a risk assessment approach to determine which factors influence whether partially bilingual physicians rely on their non-English language skills or call an interpreter.

August 22, 2012

Orders on file but no labs drawn: investigation of machine and human errors caused by an interface idiosyncrasy.

March 22, 2017

Mentorship for newly appointed physicians: a strategy for enhancing patient safety?

September 3, 2014

Patient errors in use of injectable antidiabetic medications: a need for improved clinic-based education.

November 4, 2020

What does safety in mental healthcare transitions mean for service users and other stakeholder groups: an open-ended questionnaire study.

March 3, 2021

A systematic review of teamwork training interventions in medical student and resident education.

June 4, 2008

Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine.

October 13, 2010

The need for closed-loop systems for management of abnormal test results.

April 25, 2018

Epidemiology of medication-related adverse events in nursing homes.

November 8, 2006

Assessment of a simulated case-based measurement of physician diagnostic performance.

January 23, 2019

What happens to the medication regimens of older adults during and after an acute hospitalization?

September 11, 2013

Essential activities for electronic health record safety: a qualitative study.

March 20, 2019

A mixed methods evaluation of medication reconciliation in the primary care setting.

March 2, 2022

How can the principles of complexity science be applied to improve the coordination of care for complex pediatric patients?

April 19, 2006

Effects of sleep inertia on cognition.

January 25, 2006

Cranky comments: detecting clinical decision support malfunctions through free-text override reasons.

January 16, 2019

Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review.

March 29, 2012

A contemporary analysis of closed claims related to wrong site surgery.

March 29, 2023

Beyond our walls: impact of patient and provider coordination across the continuum on outcomes for surgical patients.

February 21, 2007

Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution.

June 29, 2005

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation.

August 2, 2017

Computerised prescribing for safer medication ordering: still a work in progress.

November 18, 2015

Medicines reconciliation using a shared electronic health care record.

September 14, 2011

Reduced effectiveness of interruptive drug–drug interaction alerts after conversion to a commercial electronic health record.

May 30, 2018

2019 update on medical overuse: a review.

September 25, 2019

Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems.

April 8, 2015

A prescription for enhancing electronic prescribing safety.

December 12, 2018

Characteristics of disease-specific and generic diagnostic pitfalls: a qualitative study.

February 9, 2022

Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes.

April 22, 2015

Standard practices for computerized clinical decision support in community hospitals: a national survey.

July 11, 2012

Beyond the surgical safety checklist: using intraoperative handoff to facilitate team situation awareness in the OR.

October 25, 2023

The effect of documenting patient weight in kilograms on pediatric medication dosing errors in emergency medical services.

May 3, 2023

Current challenges in health information technology–related patient safety.

January 16, 2019

Matching identifiers in electronic health records: implications for duplicate records and patient safety.

March 13, 2013

Associations between in-hospital mortality, health care utilization, and inpatient costs with the 2011 resident duty hour revision.

May 15, 2019

Running a hospital patient safety campaign: a qualitative study.

September 17, 2014

Multifactorial interventions to reduce duration and variability in delays to identification of serious injury after falls in hospital inpatients.

April 27, 2022

Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review.

December 20, 2023

A cluster randomized clinical trial to improve prescribing patterns in ambulatory pediatrics.

June 13, 2007

How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms.

April 20, 2016

Association of health literacy with postoperative outcomes in patients undergoing major abdominal surgery.

October 25, 2017

Improving the specificity of drug-drug interaction alerts: can it be done?

April 6, 2022

Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD).

September 15, 2021

Understanding the multidimensional effects of resident duty hours restrictions: a thematic analysis of published viewpoints in surgery.

August 9, 2017

Learning from errors: analysis of medication order voiding in CPOE systems.

March 15, 2017

Experience of wrong site surgery and surgical marking practices among clinicians in the UK.

November 15, 2006

What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study.

March 28, 2018

Does overlapping surgery result in worse surgical outcomes? A systematic review and meta-analysis.

February 20, 2019

Assessment of the implementation of a national patient safety alert to reduce wrong site surgery.

January 14, 2009

Evaluation of harm associated with high dose-range clinical decision support overrides in the intensive care unit.

January 23, 2019

Patient-led training on patient safety: a pilot study to test the feasibility and acceptability of an educational intervention.

September 4, 2013

A framework for evaluating the appropriateness of clinical decision support alerts and responses.

September 21, 2011

The surgical safety checklist and teamwork coaching tools: a study of inter-rater reliability.

July 30, 2014

Clinical data sharing improves quality measurement and patient safety.

March 24, 2021

Time of day effects on the incidence of anesthetic adverse events.

August 23, 2006

Speaking up about safety concerns: multi-setting qualitative study of patients' views and experiences.

December 15, 2010

The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study.

December 21, 2016

Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training.

September 3, 2014

Prospective evaluation of medication-related clinical decision support over-rides in the intensive care unit.

February 28, 2018

Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools.

February 8, 2012

Are physicians' perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use?

January 11, 2012

Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors.

August 16, 2017

Effects of interorganisational information technology networks on patient safety: a realist synthesis.

December 9, 2020

Recommendations for the safe, effective use of adaptive CDS in the US healthcare system: an AMIA position paper.

April 21, 2021

Developing a reliable and valid patient measure of safety in hospitals (PMOS): a validation study.

June 25, 2014

Personal health records: a randomized trial of effects on elder medication safety.

January 8, 2014

Real-world virtual patient simulation to improve diagnostic performance through deliberate practice: a prospective quasi-experimental study.

December 15, 2021

Effectiveness of interventions designed to promote patient involvement to enhance safety: a systematic review.

June 2, 2010

Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention.

February 15, 2017

Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.

December 2, 2020

Effect of different interventions to help primary care clinicians avoid unsafe opioid prescribing in opioid-naive patients with acute noncancer pain: a cluster randomized clinical trial.

September 7, 2022

Design and impact of a novel surgery-specific second victim peer support program.

January 29, 2020

Related Resources

Support and recovery strategies for second victims.

April 3, 2024

Scoping review of the second victim syndrome among surgeons: understanding the impact, responses, and support systems.

March 27, 2024

Remote assessment of real-world surgical safety checklist performance using the OR Black Box: a multi-institutional evaluation.

March 20, 2024

Creating a just culture in the perioperative setting.

March 13, 2024

The ritualisation of the surgical safety checklist and its decoupling from patient safety goals.

March 13, 2024

Handbook of Perioperative and Procedural Patient Safety.

February 7, 2024

Making surgery as safe as it should be: a qualitative study.

December 20, 2023

Sentinel Event Alert 68: updated surgical fire prevention for the 21st Century.

November 8, 2023

Perioperative team-based morbidity and mortality conferences: a systematic review of the literature.

October 11, 2023

Look-alike medications in the perioperative setting: scoping review of medication incidents and risk reduction interventions.

October 11, 2023

Understanding the root cause analysis process to increase safety event reporting.

July 5, 2023

The role of an assistant nurse in implementing the WHO Surgical Safety Checklist: perception and perspectives.

July 5, 2023

So many ways to be wrong: completeness and accuracy in a prospective study of OR-to-ICU handoff standardization.

July 5, 2023

Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.

June 14, 2023

Use of technology to improve the adherence to surgical safety checklists in the operating room.

May 31, 2023

Proactive patient safety: focusing on what goes right in the perioperative environment.

May 24, 2023

TQIP Mortality Reporting System Case Reports.

May 10, 2023

The high cost of retained surgical items.

April 26, 2023

Clinicians' perspectives on proactive patient safety behaviors in the perioperative environment.

April 26, 2023

Distractions in the operating room: a survey of the healthcare team.

April 5, 2023

WebM&M Cases

Medication Handling and Compounding Errors in the Operating Room.

March 15, 2023

Surgical fire in the United States: 2000-2020.

March 15, 2023

Compliance with and barriers to implementing the surgical safety checklist: a mixed-methods study.

March 8, 2023

Cognitive biases in surgery: systematic review.

March 1, 2023

Guidelines in Practice: prevention of unintentionally retained surgical items.

December 7, 2022

A multicenter collaborative effort to reduce preventable patient harm due to retained surgical items.

November 30, 2022

Potentially inappropriate medication administration is associated with adverse postoperative outcomes in older surgical patients: a retrospective cohort study.

September 14, 2022

Crisis recovery in surgery: error management and problem solving in safety-critical situations.

September 14, 2022

WebM&M Cases

Perioperative Anaphylaxis After Insertion of a Latex Drain in a Patient with Known Latex Allergy

August 31, 2022

Preventing retained surgical items.

August 3, 2022

See More About The Topic

Operating Room

Quality and Safety Professionals

Surgery

Medical/Surgical Nursing

Surgical Complications

Normalization of deviance is contrary to the principles of high reliability.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Normalization of deviance is contrary to the principles of high reliability.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site