Romke H. is the winner of the Prof dr Jac. Geurts Extended Master Organization Studies thesis prize
He won this prize at the Spring Graduation 2022 with a thesis on procedure deviations in the health care sector (1st supervisor: Stefan Cloudt).
Abstract
Normalization of deviance is the process by which employees start to perform deviant practices – such as not checking specified safety indicators at specified times during a procedure – on a continuous basis, which eventually leads to them not recognizing the potential risks of their behavior anymore. In the healthcare sector, this phenomenon might be the cause for many potentially preventable medical incidents, resulting in unnecessary healthcare damages to patients.
This study uses the Delphi-method to investigate which factors enable normalization of deviance to develop in a hospital environment by conducting three rounds of questionnaires and group discussions in which consensus is sought by a group of nurses who discuss the topic and its development. This resulted in a model in which a combination of stable and situational factors, such as respectively the competence of staff and the variability of time sensitiveness, constantly leads nurses to either comply to or deviate from protocols.
When deviance has taken place and is not followed by corrective feedback, it can easily start to get normalized since the behavior does not seem to be noticed by others or because of negative patient outcomes. When this is the case, this deviant action by itself stimulates future deviance through various factors of normalized deviance, such as the institutionalization from supervisor to student. Next to a reflection on this study’s results, recommendations for future research and practice are given.