| 1. Top-level commitment | “Top management shows commitment towards addressing human performance concerns” | Management participate in executive walk-arounds and some committee meetings looking at improving handovers |
| 2. Just culture | “Supports reporting of issues up through the organisation, yet not tolerating culpable acts” | Handover rounds are supervised by senior clinicians who support speaking out about concerns of staff about safety |
| 3. Learning culture | “Organisation responds to events with repair and true reform rather than denial” | Communication breakdowns in handover are examined and shared openly and widely |
| 4. Awareness | “Data gathering that provides management with insights regarding the quality of human performance, the extent to which it is a problem and the current state of the defences” | Monitoring of handover is performed routinely (and specifically when changes are made, eg, when new technology is introduced) |
| 5. Preparedness | “Organisation actively anticipates human performance problems and prepares for them” | Foresight, coping and recovery strategies are identified and integrated (ie, staff rotas and workforce requirements are reviewed prior to new mandated reduction in duty hours for junior doctors) |
| 6. Flexibility | “Ability for the organisation to adapt to new or complex problems in ways that maximise ability to solve the problem without disrupting operations” | Allowing certain frontline clinical groups admitting privileges when senior staff are absent in order not to delay patient treatment in emergencies |
| 7. Opacity | “Organisation aware of economic, workload, and safety pressures (see: Rasmussen26) and where effort needs to be invested to ensure that defences are not degraded” | Monitoring of pressures (such as budget cuts) so that strategies may be developed to ensure standards of handover practice are always maintained |