Question

Explain how authority gradients influence teamwork and patient safety?

Answer 1

The term ‘‘authority gradient’’ was first defined in aviation when it was noted that pilots and copilots may not communicate effectively in stressful situations if there is a significant difference in their experience, perceived expertise, or authority. The practice of medicine and medical training programs are highly organized, hierarchical structures that depend on supervision by authority figures.

Communication may be affected when individuals on teams have differing levels of professional stature and seniority, expertise, or experience. This authority gradient may be especially intrusive if senior team leaders wield some influence in the career advancement of those they supervise.

There have been recent high-profile cases in which authority gradients played a role in medical errors. Differences of opinion in patient care are not uncommon. However, residents are often reluctant to voice a dissenting view and attending physicians may be unaware of their trainees’ concerns. Conflict is common in health care teams and, left unaddressed, can impair individual and team performance.

It causes Communication barriers between attending physician and resident, similar barriers are well known between doctor and nurse and probably exist between other professional roles (e.g., specialist and generalist, surgeon and internist, consultant and primary care physician). Nurses have long argued that their voice is not listened to when doctors make rounds. They have fought to gain sufficient recognition in the culture of medicine to be heard and to influence critical patient care decisions. Authority, professional stature, and perceived expertise probably all contribute to some extent to communication barriers.

In the acute care setting, This authority gradient causes communication failures that lead to increases in patient harm, length of stay, and resource use, as well as more intense caregiver dissatisfaction and more rapid turnover.

Authority gradients act as barriers to team involvement, reducing the flow of feedback, halting cooperation, and preventing creative ideas for threat analyses and problem solving. Only the most assertive, confident, and sometimes equally dominant team members will feel able to challenge authority.

A key aspect in improving teamwork and communication in health care is engaging patients and families. ... Health care teams that communicate effectively and work collaboratively reduce the potential for error, resulting in enhanced patient safety and improved clinical performance.