Normalization of Deviance in the Perioperative Setting: A Systematic Literature Review

ABSTRACT Normalization of deviance is a major contributor to medical errors that impair patient safety in the perioperative setting; it is influenced by the culture of patient safety, which is the shared values, beliefs, and norms of employees that guide their actions and behaviors. The purpose of our systematic literature review was to summarize the descriptions of normalization of deviance to generate evidence‐based strategies to minimize patient harm. Some of our findings include strategies for improving communication and interdisciplinary team dynamics as one approach that can mitigate normalization of deviance. An organizational culture of safety that blends a blameless and nonpunitive response to errors must be combined carefully with a just culture. Additionally, organizational cultures that support “writing up” all minor events, including those not related to reckless behavior or potential major patient injury, should be avoided, because this practice can harm overall morale and impair communication regarding near‐miss events.