Development and Psychometric Evaluation of the Wright Normalization of Deviance (NOD) Scale.

Objectives: Normalization of deviance (NOD) occurs when individuals and teams depart from acceptable performance standards until the adopted way of practice becomes the new norm. There is little research on the incidence of NOD in health care, and there is no validated instrument to measure it. Identification and quantification of NOD is critical for the evaluation of the effectiveness of interventions designed to reduce its adverse consequences. The objective was to develop and psychometrically evaluate the Wright Normalization of Deviance Scale.

Methods: Items for the scale were drawn from existing qualitative interview data and a review of relevant literature. Expert judges independently reviewed the initial item pool and rated each item for relevance and clarity. A sample of 222 respondents who work in a variety of high-risk environments was recruited via email, social media, and ResearchMatch. Cronbach alpha and item analysis were used to identify problematic items for elimination. The latent structure of the scale was explored using principal component analysis.

Results: The approach to item development and expert judging supported content validity of the NOD. The latent structure identified using principal component analysis was consistent with the dimensions the scale was intended to measure. The final set of 27 items had four dimensions and each had good internal consistency (Cronbach alphas ranged from 0.72-0.94).

Conclusions: The Wright NOD Scale demonstrated content and construct validity along with good internal consistency. It can be used by any high-risk organization, including health care, to facilitate identification of NOD, so that mitigating strategies can be applied.