Handling Healthcare Personnel Behavior-Related Deviance to Uphold Patient Safety and Quality

By Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST

This article originally appeared in the Jan-Feb 2026 issue of Healthcare Hygiene magazine.

Patient safety and quality of care are primary topics of contemporary healthcare systems, as they have a direct impact on patient outcomes, organizational performance, and the trust of the population. Despite technological progress and intellectual standards of care, patient safety incidents are still taking place in terrifying proportions. Such incidents are mostly blamed on human error, but Tariq, et al. (2024) have proved that the root cause is the failure of systems. The normalization of deviance is one of the most alarming failures in the system because over time the unsafe practices develop into a routine. This article presents the argument that deviance is a normal state of affairs in patient safety and quality of care and that deviance can only be dealt with through strong leadership, psychological safety, and well-designed systems, but none through enforcement of policies.

The events associated with patient safety involve medication errors, patient falls, healthcare-associated infections, and delays in the diagnosis. These happenings are very infrequent since one person does not succeed; rather, they come out of complex arrangements in which minute variances compound without being noticed. When such deviations do not cause immediate harm, then normalization of deviance emerges. Employees might start to consider unsafe practices as normal due to the lack of any negative consequences in the previous instances (Wright, 2023). Eventually, standards are compromised, and unsafe habits become institutionalized in clinical practice.

Clinical settings that demand high levels of pressure are highly open to normalization of deviance. The problem of staffing, a high workload, and the necessity to spend more time on productivity promote shortcuts and workarounds. Sometimes staff can rush to work and overlook safety checks or even disregard protocols to accomplish work fast. Unless leaders act on these acts, they become normal. New workers tend to acquire unsafe behaviors through observation of old workers, a fact that perpetuates the issue among crews and divisions.

Unsafe practices are enabled by several conditions in an organization. The lack of leadership visibility conveys a message that safety is not a priority. Leaders are no longer present in clinical areas and therefore have not been able to assess risks and assist staff. Psychological safety is of importance as well. The fear of being blamed or punished does not make employees report about any mistakes or near misses. The lack of the proper system design aggravates the situation (Wright, 2023). Inefficient workflows, insufficient staffing, and unreliable technology complicate adherence of clinicians to safe practices regularly.

The effect of the normalization of deviance on patient safety and quality of care is harsh. It adds variability in care processes and the exposure to potential harm that can be avoided. Patient quality is compromised, expenses escalate, and employee morale goes down (Sedlar, et al., 2023). Distrust in the healthcare organization is destroyed with the course of time. The following impacts demonstrate the urgency of prevention-based measures.

To deal with the normalizing of deviance, there is a need to enforce policies and procedures. The change of ingrained behavior cannot be done with policies alone. There is a need to have visible and active leadership to guarantee safety expectations. Top management should be able to hear lower-level employees and take action on safety issues. The psychological safety should be provided to make the staff feel free to speak. To promote safe practice, system design must lessen complexity and workload. Constant monitoring can determine unsafe drift in time.

Normalization of deviance is a silent yet powerful risk to the quality and safety of the patients in the healthcare environment. It takes more than rules and policies to prevent the unsafe practices from turning into the standard operations. In order to facilitate safe care, healthcare institutions should encourage visible leadership, psychological safety, and systems. An efficient and proactive safety culture is a key to attaining sustainable patient-focused quality-based care.

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is an independent consultant and principal of Ketchum Konsulting, LLC.

References:

Sedlar N, et al. (2023). A qualitative systematic review on the application of the normalization of deviance phenomenon within high-risk industries. J Safety Research. 84, 290-305. https://doi.org/10.1016/j.jsr.2022.11.005

Tariq RA, et al. (2024). Medication Dispensing Errors and Prevention. NIH.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519065/

Wright I. (2023). Normalization of Deviance Is Contrary to the Principles of High Reliability. AORN Journal. 117(4), 231–238. https://doi.org/10.1002/aorn.13894