Cultural and institutional conditions for high reliability teams

What properties of a work unit make it reliable in high-risk environments, such as intensive care units? We explored the concept of "transactive responsibility system" to explain how organizational, cultural, and knowledge factors are related to patient safety and reliability. Overlapping with division of labor and responsibilities, a transactive responsibility system in a work unit encourages mutual monitoring and sharing of responsibilities. In this paper, guided by the phenomena uncovered in field studies, we review existing literature to understand cultural and institutional conditions for high reliability teams, in particular related to how reliable performance is achieved through active mutual adjustment to detect and compensate vulnerabilities to reliable performance.

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