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In plain English; normalising things that shouldn’t be regarded as normal.
There is a posh way of describing it. Actually, several.
Normalisation of deviance. The way in which unacceptable practices become normalised within a group, or wider society.
Social normalisation. When society accepts behaviours that were once considered harmful.
Moral disengagement. This refers to a term coined by the Canadian psychologist Albert Bandura, describing the cognitive process when people justify harmful behaviours.
You know the sort of thing; fast food, foulmouthed violence on the TV screens that transfers onto our streets, social media abuse, vaping…
… I’m not sure how these things become the norm. Looking at my own life I think I’d have to put my hands-up to convenience, laziness and probably the lamest excuse of all… that’s just what we all do.
There are more sophisticated answers.
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Gradual desensitisation. Our emotional responses diminish over time.
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Social conformity. People adapt their behaviour over time, particularly in the workplace.
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Normalisation of deviance. When things happen with no obvious bad effect happens.
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Cognitive dissonance. That happens when people are conflicted by what they know is right and what happens in their group or workplace.
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Disengagement. We disconnect from the reality and start using phrases like ‘collateral damage’… which can lead to…
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Euphemistic labelling. Sanitised language, like describing lies as , ‘terminological inexactitude’.
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Boiling frog syndrome. Put a frog in boiling water and it’ll jump out. Put it in cold water and heat it gradually, it’ll stay in an get boiled. The inevitability of gradualness.
Ok, what’s all this about and why does it matter.
It matters because there is an example of all this happening in the NHS, right now.
There's a behaviour happening that once was anathema. So extreme, no one would do it. Then by the force of events. The sheer willfulness of circumstances, it became, shall we say, not-uncommon.
Not uncommon, became common, inevitable and now, it’s the way things are done.
Then the inevitability of gradualness made it a normalised deviance. People were conflicted.
They could do nothing about it and became disengaged. Next, what the NHS is so good at. Euphemistic labelling.
What is it?
‘It’ is described in guidance from NHSE. It even has its own acronym…
T.E.S.
We are in the reality of TES. Guidance otherwise known as; Principles for providing safe and good quality care in Temporary Escalation Spaces.
A euphemism... in plain English, how to look after yer granny in a corridor.
In the words of the guidance;
‘… spaces that are opened as part of winter pressure planning and refer to care given in any unplanned settings…
… such as corridors.’
Who would have thought that something so extreme, undignified, so noisy, so ‘not-what-we-do’, would end up an example of the normalisation of deviance, in NHSE guidance?
So normal, there is even, thanks to the ingenuity of the estates department, a way to screw curtain tracks on corridor suspended ceilings, to turn walkways into cubicles.
Corridor care has become socially normalised across hospitals. The once moral indignation has become moral disengagement.
The guidance is brilliantly written. It’s a masterpiece and talks of;
- quality,
- risk assessment,
- escalation,
- raising concerns
- reporting incidents
- data collection
- measuring harm…
… and the ‘why would anyone think of that’, advice;
‘de-escalation should mirror escalation plans in reverse and use the dynamic risk assessment approach…’
Well of course.
And, there is a sneaky little phrase, squeezed-in. Almost unnoticed;
‘Providers should apply their own processes and incidence reporting systems’.
In other words, mark their own homework.
If that is not; gradual desensitisation, normalisation of deviance, cognitive dissonance and disengagement all in one sentence, tell me what is.
I am not critical of the guidance’ or its author.
I am not critical of NHSE.
I won’t criticise the NHS or the need to get some sort of organisation, shape and guidance in place as a marker or reference point.
The need to manage a practice that has become a stain on the reputation of the NHS and a blot on the landscape of care that once we stood back and proudly admired.
But I do condemn the years of neglect that are to blame for all this, and...
I absolutely denounce the braggadocio of a new government that told us the NHS was safer with them.
It’s not.
They cannot forever denounce their inheritance.
They must grow-up and own it.
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