Organizational and Cultural Determinants of Surgical Safety

  • Kathleen M. Sutcliffe


This chapter explores some basic ideas concerning organizational and cultural determinants of safety. Our goal is to be descriptive rather than prescriptive—to deepen the understanding of some basic organizing concepts and the mechanisms through which they exert their effects. We begin by examining some often overlooked assumptions about the nature of open systems to highlight the challenges that underpin all efforts to achieving safe and reliable care. We outline two key management logics and then discuss basic organizational properties and processes that are found in the safest and most highly reliable of organizations. We then turn to the issue of safety culture, how it is defined, how it controls, and how it is developed. We suggest that safety culture is less a stable property of organizations and their units, and more of a contingent and dynamic process reinforced through actions and conversations.


Organizational determinants of safety Cultural determinants of safety High-reliability organizing Organizational culture Safety culture Safety climate 


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Carey Business School, Johns Hopkins UniversityBaltimoreUSA

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