Hospitals as cultures of entrapment: A re-analysis of the Bristol Royal Infirmary

Karl E. Weick, Kathleen M. Sutcliffe

Research output: Contribution to journalReview articlepeer-review

187 Scopus citations


High performance is often attributed to an organization's culture. However, culture can just as easily undermine performance when it blinds decision makers to important performance issues and entraps them in unfortunate courses of action from which they cannot disengage. The dynamics of cultural entrapment are explored in the case of the Bristol Royal Infirmary, in which pediatric cardiac surgeries continued for over a fourteen-year period despite evidence of poor quality care and performance that was far below that of other comparable pediatric surgical centers. A single organizational process of behavioral commitment explains how the cultural mindset originated and why it persisted. The sequence of small, public, volitional, and irrevocable action; socially acceptable justification for that action; and the potential for subsequent activities to validate or threaten the justification created a causal loop that stabilized subsequent action patterns.

Original languageEnglish (US)
Pages (from-to)73-84
Number of pages12
JournalCalifornia Management Review
Issue number2
StatePublished - 2003
Externally publishedYes

ASJC Scopus subject areas

  • Strategy and Management


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