Table 5

 Teamworking around safety issues

Maturity level of safety cultureDimension description
PathologicalIndividuals mainly work in isolation but where there are teams they are ineffective in terms of risk management. There are tensions between the team members and a rigid hierarchical structure. They are more like a group of people brought together with a nominal leader and no direction
ReactiveThere are teams but they are told to work together and only pay lip service to teamworking. People only work as a team following a patient safety incident. Teams get put together to respond to external demands. There is a clear hierarchy in every team corresponding to the hierarchy of the organisation as a whole. Teams do work together, but individuals are not actually committed to the team
CalculativeTeams are put together to respond to government policies but there is no way of measuring how effective they are. There is a risk management team. Teamwork is seen by lower grades of staff as paying lip service to the idea of empowerment. There is little sharing of ideas or information about safety issues across teams
ProactiveTeam structure is fluid with people taking up the role most appropriate for them at the time. Teams are collaborative and adaptable and actively contribute to the risk management agenda within the organisation. There is evaluation of how effective the team is and changes are made when necessary. Teams may include those external to the organisation
GenerativeTeam membership is flexible, with different people making contributions when appropriate. Teams are about shared understanding and vision about safety issues rather than geographical proximity. This way of working is just the accepted way in the organisation. Everyone is equally valued and feels free to contribute. “Everyone is part of the risk management team”, this includes all levels of the organisation from board members through to those who have day-to-day contact with patients