AORN J. 2023 Apr;117(4):231-238. doi: 10.1002/aorn.13894.
Normalization of deviance is a phenomenon in which individuals and teams depart from an acceptable performance standard until the adopted way of practice becomes the new norm. This phenomenon is concerning in high-risk areas of health care because it erodes a safety culture. Additionally, it is inimical to the principles of high reliability-specifically, to the first of the five principles: preoccupation with failure. Although all high-reliability principles hold relevance to safety, preoccupation with failure describes a consistent alertness to risk and is critical for preventing adverse events, particularly in high-risk environments such as the OR. This article describes how normalization of deviance and preoccupation with failure cannot coexist and presents ways to mitigate normalization of deviance and bolster high reliability, ultimately making ORs safer for surgical patients.
去正常化是一种现象，在这种现象中，个人和团队会偏离可接受的绩效标准，直到所采用的实践方式成为新的规范。这种现象在医疗保健的高风险领域令人担忧，因为它会侵蚀安全文化。此外，它与高可靠性原则背道而驰，特别是与五个原则中的第一个原则：对失败的关注。尽管所有高可靠性原则都与安全相关，但对失败的关注描述了对风险的持续警惕，对于预防不良事件至关重要，尤其是在手术室等高风险环境中。本文描述了去正常化和对失败的关注如何不能共存，并提出了减轻去正常化和增强高可靠性的方法，最终使手术室对手术患者更安全。
