The normalization of deviance, the gradual process by which the unacceptable becomes acceptable in the absence of adverse consequences, is a concept forwarded by Columbia University Sociology Professor Diane Vaughan in her book “The Challenger Launch Decision.” In the book, she details a series of deviations to established safety protocols that were considered within the bounds of acceptable risk but eventually led to the Challenger exploding. Since then, scholars have used the theory of the normalization of deviance to explain everything, from errors in health care to a cruise ship crash.
Studies have shown that the individuals deviating from standard protocols don’t set out to break the rules. These people simply find the path of least resistance from the beginning of a task to its completion. This natural tendency to find short cuts to reduce workload is normal. That’s why, in higher-risk activities (such as skydiving), it becomes important to set standards and enforce the rules.
Consequently, what we are searching for in skydiving is an abnormal state of exceptional performance. In his article, “There is No Such Thing as ‘Normalization of Deviation,’” in the February 2016 online periodical Taproot.com, author Mark Paradies posits that instead of accepting inferior performance because it is natural, organizations should strive for the normalization of excellence. He writes that an excellent safety culture requires recognizing that three elements—technical competence, responsibility and facing the facts—are necessary and must be continuously reinforced.
Technical competence, or what skydiving instructors would call proficiency, means a fundamental understanding of how the job should be performed. This means that beginning skydivers must gain an understanding of the material in the first-jump course and all training leading to the A license. Later, it means continuing those processes through the B, C and D licenses. Rating holders must fully understand the training received in the rating course, meet the standards set by the drop zone where they work and continue to refresh their training as new information becomes available. USPA helps rating holders achieve and maintain proficiency through standardization meetings, for example, because real proficiency is a never-ending cycle of obtaining knowledge and applying that knowledge to the tasks at hand.
The concept of responsibility encompasses total accountability. Responsibility does not stop at the individual; it takes an entire team to produce satisfactory results. For example, when a jumper experiences a malfunction due to a packing error, the blame often quickly falls to the packer. However, unless the packer is a certified rigger, the packer is performing their duties under the supervision of a rigger, who is accountable to the Safety and Training Advisor, who is accountable to the drop zone owner. The rigger’s responsibility is to watch over the packer and also set standard operating procedures for each task. Total accountability means that every individual in the chain of responsibility is accountable for their share of the failure. In this instance, that includes the packer making the error, the rigger not enforcing the standard, the S&TA not holding the rigger accountable and the drop zone owner not holding the S&TA accountable. Total accountability starts at the manifestation of a problem and traces the problem through the chain of responsibility.
Facing the facts sounds like an easy concept to embrace, but without negative consequences, it is human tendency to hope things will work out despite suspicions to the contrary. The adage, “The Basic Safety Requirements are written in blood,” is a reminder that lives were lost learning the lessons contained in them. Although not upholding these standards does not always lead to negative results, not following the BSRs will inevitably lead to history repeating itself.
Facing the facts means having the correct mindset and being dedicated to standards. The people in charge must set the example and require their subordinates to do likewise. Let’s look at one of the recently added BSRs: “Any person making a tandem skydive may not perform a turn of more than 90 degrees below 500 feet AGL.” Although this rule had significant opposition, in the end, the USPA Board faced the facts that it would undoubtedly prevent severe injuries and save lives.
Skydivers must use these three attributes—proficiency, total accountability and facing the facts—together. Dedication to the normalization of excellence requires each of us to look for the slightest deviation from a standard, not only the wild disregard of a standard. Changing the main closing loop at 10-percent wear is the standard. If someone waits to change it at 15-percent wear, this is a deviation from that standard. This means the person packing the parachute needs retraining, and the people supervising the drop zone need to re-evaluate their inspection and training procedures. Not stopping immediately and correcting a deviation leads to the deviation getting larger. This could eventually lead to an environment that allows enough closing loop wear to lead to one eventually breaking, a horseshoe malfunction and the consequences that follow.
People always try to find the most comfortable, quickest way using the least effort to get things done. Drawing hard lines makes it obvious when those people are not meeting standards. As a rating holder, instead of focusing on what you do not want to achieve—the normalization of deviance—focus on what you need to achieve—the normalization of excellence. This is the path to a state of constant extraordinary performance.
Ron Bell | D-26863
USPA Director of Safety and Training