This ethnography explored the organizational culture of a busy urban pediatric emergency department (ED) in the United States. EDs uniquely combine extreme patient acuity, high census, a high-stress unpredictable environment, and fast-paced complex communication. We found that tribalism characterized the organizational culture and was exacerbated by resource scarcity, changing leadership, and high patient volume. Tribalism affected work climate and job satisfaction but is entrenched and difficult to change. We examine the historical, social, and institutional factors that contributed to tribalism and the ways in which tribalism characterized how providers and staff perceived and recreated interprofessional dynamics. This study contributes to existing work on tribalism in health care by looking at factors that impact perceptions of “us vs. them” and ways tribalism was manifested in the day-to-day practice of team-based care.

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