In the span of a generation, NASA has lost two spacecraft and 14 pilots in the collective disasters of the space shuttles Challenger and Columbia. Can you tell me why? Trust me, it’s worth exploring.
The space buffs in the crowed might recall that faulty O-rings in the Challenger’s solid rocket boosters failed and allowed supper heated gasses to escape. The result was a catastrophic explosion and a sullen announcement from my school principal in the middle of sophomore science class. In his quiet monotone, we learned that the mighty Challenger, moments before, had been destroyed and the crew was lost.
Our teacher didn’t know quite what to say, and in the silence that followed, my sixteen year old world got a little smaller.
More of you might recall that Challenger’s sister ship, Columbia, burned up on reentry returning from a mission in 2003. The Columbia’s heat tiles were damaged when a piece of foam insulation dislodged during takeoff and struck the tiles on the wing. Those tiles later failed under the heat of reentry and the craft burned up over the mid-west. Interesting right? But what does all this have to do with EMS? Follow me on this next part.
What you might not know is that NASA had identified both of these failures on previous missions before they caused catastrophes. The degradation of the shuttle O-rings had been noted on prior missions and the manufactured had speculated that the condition would get worse in cold weather.
Minor tile damage had also become common and expected after shuttle take-offs. In both cases, NASA management had slowly increased the amount of damage considered acceptable. With each successful mission, the degree of quality was allowed to deviate downward for the simple reason that nothing terrible had happened before.
In the analysis after the fact, this dynamic was dubbed “The Normalization of Deviance.” Each time a behavior or standard doesn’t lead to a catastrophic result, we are more tolerant of that standard. After all, nothing bad happened last time … right? And it doesn’t just apply to NASA and space shuttles. The normalization of deviance is a natural human tendency and we find it, to one degree or another, in all human systems where standards are created and followed.
And now you may be starting to see where this is going. What does this have to do with EMS?
Short answer: everything.
In the dynamic decision making world of EMS, the normalization of deviance plays a role in everything we do, from our morning check-out to the way we stand when we knock on the patients front door. Each time we deviate from our established standard and nothing bad happens, we become more likely to behave this way again in the future.
If you fail to properly check-out your rig and everything important is still there when you need it, you’re more likely to do it again.
If you drive through the red light at 22 miles per hour and nothing bad happens, you’re more likely to try it again (at 25 miles per hour).
If you decide to not start an IV on your post-ictal seizure patient and they don’t have a second seizure, you’re more likely to pass it off again.
If you don’t properly assess the abdomen of an MVA patient and they don’t have a lacerated spleen, you’re more likely to overlook it again.
And on, and on.
It makes for an interesting contradiction. A history of success and positive outcomes does far more to erode our standards than a single negative outcome. The longer our success, the more nomalization of deviance comes in to play.
Get away with doing something unsafe or substandard enough times and the unsafe and substandard become your standard. And let’s face it, we have a lot of standards in EMS. Both the standards that are visible to the world, like our patient rapport and the cleanliness of our rigs, and our private standards. Things like our reporting accuracy and protocol knowledge.
Each day we walk a razors edge of decision making and performance and it’s worth consideration that every standard we hold is subject to the constant erosion of the normalization of deviance.
What’s an EMT to do?
The first big step might be the simple recognition of how our personal and organizational standards are under constant attack by the process, much like a sand castle on a windy day. If we aren’t constantly alert, and willing to rebuild, our own standard of excellence is bound to erode.
The second, and decidedly more difficult task will be to stand up to the normalization of deviance in our organizations, with willpower and fortitude. It’s never easy to stand against the will of a collective group and to confront others with their own lacking standards is to invite their anger. When the erosion is system wide we may feel like the once gentle breeze of erosion has become a hurricane.
That’s when we decide if our standards are dictated by our environment or our inner path. That’s when our personal standards can shine. It’s worth thinking about.