Fig. 2

Adaptation of the premises of BWT to hospital context. Here visible signs of disorder in a healthcare facility signal a lack of control or concern for the environment. This may lead staff to violate minor rules of the workplace, such as hand hygiene rules or not securing medical equipment. These behaviors then perpetuate further visible signs of disorder and other staff violations. Over time, the reinforcing relationship between disorder and violations increases the risk of harm to patients as the system migrates to one of “normal illegal” [4]