Encouraging a flatter hierarchy in clinical environments.
Jenny Crompton
Helping senior nurses and allied health professionals, manage the challenges of professional relationships, so they can reduce the associated stress and anxiety in the workplace.
Traditionally those working in healthcare environments have been subjected to the hierarchical whims of those residing at the top of the tree. Generally, consultant medical staff, managers and the like who commanded respect, and obedience from everyone beneath them.
That could be described as the old days, when nurses unsurprisingly gained the title of hand maidens pampering to those occupying these roles.
Whilst I appreciate there has to be some kind of hierarchy in large organisations. In this instance I’m talking about promoting better professional relationships and improved collaborative working by reducing those barriers. ?
As senior nurses and AHP’s you know a rigid clinical hierarchy is detrimental to patient care in the long term.
How many times have you been on the receiving end of a consultant’s wrath? Or being reprimanded for approaching a sensitive subject or voicing your opinion? To not speaking up on ward rounds, because he /she has to have the last word?
What’s the impact? You stop trying to engage, or when you do, you get the same result. So the impetus do the best for your patients changes.
There are many benefits in trying to accomplish this levelling out of the hierarchies. More open communication, team work, and job satisfaction. To better patient outcomes from shared decision-making, and acknowledging the value of individual team members.
Where there are kind and honest conversations, staff feel appreciated and are more likely to address difficult subjects. They know when they are being respected for what they bring to the table, and can trust those around them to have their backs. Built upon through consistency and commitment to the cause.
However, it has its challenges. Resistance from those accustomed to traditional chains of command, driven by age, gender, culture, personality or profession can make it difficult. Or how they view their perceived importance in an organisation.
Whilst there has to be clear lines of responsibility and accountability for each profession, wouldn’t it be more desirable and sustainable if we were also working towards equality in our working relationships?
In healthcare its often the consultant who assumes “overall responsibility.” A title that was originally coined in the early days of the NHS. ?When the traditional male medical model drove care and the structure of a hierarchy. Often modelled in training then perpetuated down through the generations, potentially reinforcing biased attitudes.
Just because someone holds the title of consultant, registrar, director, manager, team leader does not entitle them to overlook or justify how their behaviour or performance affects others. (Dale and Peyton 2022).
Some individuals are prone to narcissistic or authoritarian tactics. An approach no longer appropriate in today’s diverse and inclusive society.
There is no room for ego and self-importance in patient care!
What stops us taking the initiative? “Mr X wouldn’t like that” “I’ll get shouted at” “I just want to do my job without fear of a back lash”
I’ve experienced being talked at, rather than being asked questions, attempting to take part in a dialogue that has ended up with a load of answers or statements that felt like a threat, to questions I hadn’t even asked! It certainly stopped me from trying to engage further. ?
Leadership by the few, is not a sustainable concept, just think of all the brilliant minds, experiences and capabilities of other professions involved in patient care that might be missed if that person is not willing to communicate to other staff, or discounts their opinions (Frederiksen 2022).
Whilst there is a growing emphasis on shared decision-making and distributed responsibility, there are still those few who consider themselves to be at the top of the tree, and behave in a negative manner.
Everyone is busy, we know that. We understand that long hours and increased pressure in healthcare environments often results in frayed tempers, decreasing empathy and patience. Some individuals easily switch to a defensive mode, effectively shutting the door on achieving open conversations.
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Having that awareness does not make it OK to continue. It requires a willingness to learn.
In her TED talk Gitte Frederiksen perfectly demonstrates the benefits of developing a network rather than a hierarchy, in order to get the best out of everyone. With individuals letting go of a bit of power in order to encourage a more dynamic workforce. Imagine how engaging that would be!
On the whole nowadays the structure of a service or organisation is to have more collaborative team-based approaches. The increase in specialized roles and interdisciplinary care reflects this need and challenges the notion of a single point of responsibility.
Employees want to feel safe and protected, and to look after each other, rather than being on the receiving end of outdated practices (Sinek 2014).
Dale and Peyton (2019) in their work on physical intelligence, state that the single most important thing we can do as professionals is to respect each other’s point of view. A challenging thing to do when our brains are hard wired to notice the difference between us as individuals. Often preferring to connect to those who are like us. ?
What can you do about it?
It takes courage to step up and try to make a change, and courage to step sideways and think about these challenges differently.
-????????? Encouraging psychological safety in the workplace
-????????? Providing education in emotional intelligence
-????????? Seeking to understand other people’s view-points first
-????????? Being aware of your own contributions to a relationship
-????????? Learn about the field of physical intelligence in influencing behaviour
-????????? Think network, rather than hierarchy
-????????? Encourage listening and asking questions with curiosity.
I believe there is still a long way to go, to achieve more equal relationships in healthcare, but the more we practice and challenge the easier it will become.
If you would like to discuss your own challenges please drop me a message and let’s arrange to talk.
Dale, C and Peyton, P. (2019) Physical Intelligence