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Hospitals- An outdated hierarchical culture

What an organisation states its work environment to be and what it really is can be considerably different!!! For example the culture of hospitals…I have recently contributed a chapter in a new health professional textbook. Its focus is on patient safety and the need for inter-professional communication and collaboration to prevent unnecessary deaths and mishaps, and improve mortality rates. What do I mean by this?

The Outdated Hierarchy of our Hospitals

In a hospital, health professionals such as doctors, nurses, physiotherapists, social workers etc are all required to work together. They need to share their specialised expertise /knowledge to attend to the changing needs of their patient and decide on the best interventions to produce wellness – But this would require all of the inter-professional team to consider each others opinion to be valuable. This would require each member of the team’s expertise to be equally worthy. But is this true?

I want to say “No”; the subtle messages of the healthcare culture highlight a continuing outdated hierarchy. This hierarchy exists on many levels.

  1. Between organisational levels from CEO & their executive team through to the cleaner working the floor.
  2. Between the medical professional that is doctors. A registrar or medical student feeling unsafe to question the opinion/patient treatment of a senior consultant
  3. Between health professionals for example registered nurses not feeling worthy enough to challenge the actions of a doctor.

The research into better patient outcomes and therefore overall system safety highlights this hierarchy no longer serves a purpose and costs the healthcare system billions. Read “Critical Conversations for Patient Safety: An essential guide for health professionals” edited by Tracy Levett-Jones.

Improving Hospital Culture

So what stops the culture from changing when the evidence indicates it’s desperately needed:? Here are some reasons:

  • Poor Leadership- lacking a moral conscience
  • The personal perks of holding a professional title in a hierarchical structure can be enticing.
  • A need for power and control
  • Health professionals lacking self confidence to question and provide solutions
  • A lack of knowledge and skills. WE need to teach health professionals how to communicate between each other.
  • Lack of cultural safety. Punishing those who speak up!
  • A busy and overwhelming healthcare system

The University system is beginning to recognise the need for effective inter-professional communication by implementing new training programs to improve workplace culture across all health professions. But is each individual health professional engaging in the process of self reflection? Is medicine questioning the meaning of its hierarchy? Is climbing the medical hierarchy about a thirst for greater knowledge and therefore creating better outcomes or it about personal entitlement? The battle of Humanity versus ego!!! Or can you have both?

Please feel free to share your opinion!

I am interested in your thoughts!!! Or perhaps what stops you from speaking! Please leave a comment below or share it with your friends and colleagues. I am always eager to hear differing opinions or thoughts.