Purpose – The purpose of the present study is to introduce the elements characterising the work context of high responsibility teams (HRTs) operating in high reliability contexts such as medicine or aviation. Based on these elements, the authors reflected on the function of teamwork in these contexts, which is strongly dominated by a notion of flexibility under complexity, based on the technical, normative, and governance dimensions of teamwork. Design/methodology/approach – Problem-centred interviews (n ¼ 11) based on semi-structured guidelines were conducted. Subsequently, a survey was conducted using a questionnaire inventory in six different HRT work contexts (n ¼ 551). Findings – The interviews and survey results show significant differences regarding, for example, hierarchy or stress posed on the HRTs. However, they also demonstrate relevant similarities regarding, for instance, dimensions of complexity occurring in the teamwork contexts. Both differences and similarities influence how the support systems of the teamwork dimensions should be set up. Research limitations/implications – The study provided an excellent overview of similar and differing characteristics of the work context of different HRTs. However, it represents six specific HRTs and might not be generalisable to teams in other high reliability organisations, such as in the energy sector. Practical implications – It is recommended that the characteristics of work contexts in HRTs should be taken into account in order to set up support systems of teamwork dimensions that enable teams to transfer the prevalent safety discourse into safety practice. Originality/value – The innovative approach, which combines qualitative and quantitative data, provided insights that can be used to support team functioning in the team’s specific work context.