Although a major improvement over either a punitive or blame-free culture, there are limitations in the standard that focuses on intentional violation of safe practices.

Consider these two examples:

• A technologist issuing blood in the transfusion service does not carry out the entire issue procedure in order to get the blood to the trauma patient in the emergency room in a more timely manner.
• A technologist knowingly and maliciously follows a flawed procedure.

It is clear that in both cases the guiding rule or standard should be good judgment and the desire to serve the patient's best interest, not following a particular rule for its own sake.