| Text of Recommendation | The Veterans Integrated Service Network Director conducts a review to determine whether the actions of the Facility Director, Chief of Staff, deputy chief of staff for inpatient operations, and the associate chief of staff for education created and reinforced a culture of fear and failed to adhere to high reliability organizational principles, and takes action as needed. |
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| Recommendation Number | 03 |
| Recommendation Status | Open |
| Significant Recommendation | No |
| Submitting OIG | |
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| Linked Report |
