112 February 2006 Volume 32 Number 2 The Authors Reply On Teams, Organizations, and Safety: Of Course… Of course, Kelly and Short are right. They raise important points about the viability of teams and teamwork in health care systems. They note how the environmental context, the organizational design, the macro- and microsystems, and the cultural system in health care affects teamwork and outcomes—safety, bet- ter decisions, quality, and efficient patient care. The industrial/organizational, human-factors psychology, and the microsystem literatures, which have elegantly demonstrated the impact of organizational barriers and enablers when implementing system interventions, sup- port Kelly’s and Short’s observations. 1,2 We know that individuals, groups, and teams are all influenced and shaped by the context they perform in. Period. Of course the context matters. It shapes our behav- iors, cognitions, and actions, whether personally or pro- fessionally. Implicitly or explicitly, it influences what we do, think, and feel. Work teams are no different, and fur- thermore, teams in health care are no different and are influenced by the policies, procedures, rules, norms, and traditions in place. These are very strong in health care and for teams and teamwork to succeed they must be examined. Period. Of course the organization matters. It sends signals, explicit or implicit, of what is important, of what is val- ued. Organizations and the management within, must, as Kelly and Short imply, send signals that teamwork is important and is a key (not the only one) component to effective patient care. Accordingly, health care providers must put in place policies, procedures, and incentives that support teamwork. Organizations get the behaviors that they measure and reinforce. If health care systems want better teamwork, they need to measure it and rein- force it. Period. Of course, all stakeholders (for example, physi- cians, nurses, pharmacists, technicians, administra- tors, CEOs, CFOs, accreditation agencies) involved must have a shared, valued, and clear “mental model.” They must share the vision that teamwork matters, is needed, is valued, and is in the best interest of health care. Period. Of course, it won’t be easy, quick, or cheap. Significant and important change takes time, resources, and commitment—sometimes even a generation. As we argued in our article, 3 teamwork principles need to be interwoven into the professional education and training from day one of all health care staff—physicians, nurs- es, pharmacist, technicians—and in the board room. Period. Finally, teams are embedded in organizations. For teamwork to work, health care systems need to have all their human resources strategies in alignment—all sup- porting team-based actions. This perhaps is the greatest challenge in health care. Partnering and Reaching Out Kelly and Short highlight important macro-organiza- tional issues that are often ignored by those who implement organizational interventions that are intended to change people at work. The medical com- munity, in our opinion, needs to seek, create, foster, and maintain a partnership with those who study orga- nizational interventions, 4 those who study people at organizations, 5 those who study how to design, deliver, and evaluate training, 6 and those who understand orga- nizational change. 7 This multidisciplinary partnership can only come to fruition if health care researchers and organizations reach out to those sciences that have generated principles, strategies, tools, and guide- lines for promoting effective behavior (including team- work) in organizations. Final Thoughts We thank Kelly and Short for their insightful comments. We did not intend the article 3 to raise the issue of con- text, but we appreciate the opportunity to participate in the dialogue—a dialogue that must engage the entire health care community. Eduardo Salas, Ph.D. David Baker, Ph.D. Heidi King James Battles, Ph.D. Paul Barach, M.D., M.P.H. J Copyright 2006 Joint Commission on Accreditation of Healthcare Organizations