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Safety Culture: Is the Unit the Right Unit of Analysis?

All healthcare organizations strive to be high-reliability organizations, with excellent outcomes and very low rates of failure, despite high intrinsic hazard and high throughput. An essential element of being a high-reliability organization is having a strong culture of safety (1-5). Many research groups have been trying to understand and measure what safety culture really means, particularly in the special context of hospital-based care (6-11). In this issue of Critical Care Medicine, Dr. Huang and colleagues (12) extend our knowledge about safety culture in the specific high-hazard setting of intensive care units (ICUs), focusing attention primarily on the comparison of different ICUs within a single hospital.