Upend the Hospital Hierarchy

Alexandra Wilson Pecci, for HealthLeaders Media , March 19, 2013

This structure suggests that each of the branches is equal and illustrates the checks and balances they provide. Their functions are different. How they operate is different. But they are equally necessary to the functioning of the whole government.

In light of that, the current top-down structure of patient care—where power starts with physicians and flows down to nurses—is flawed.

Wouldn't it be nice if hospitals could rethink hierarchies, instead of simply "healing" them? Wouldn't it be nice if hospitals used a circular graph to illustrate the roles of physicians and nurses, showing that both groups are equally responsible and accountable for patient care?

Wouldn't such a change in mentality help squash the notion that nurses can't challenge physicians and instead remind them they can and should challenge them when needed? And wouldn't it remind physicians that nurses aren't being "insubordinate" by doing so?

Adopting such a structure would require a huge shift in mentality; but it wouldn't change physicians' and nurses' roles and responsibilities. It would simply re-affirm the need for checks and balances, and challenge physicians to operate as part of a democracy, not a dictatorship.

Alexandra Wilson Pecci is a managing editor for HealthLeaders Media.

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5 comments on "Upend the Hospital Hierarchy"

Deborah Andrews (4/26/2013 at 2:45 PM)
It really is high time that nurses are viewed as the eyes and ears of the physician when they are not available versus as enemies. Nurses, especially seasoned nurses, have brains and are able to think critically. It's time that nurses receive the respect they deserve from the administration, patients, families, and physicians.

Jim (3/25/2013 at 11:34 AM)
why are there no jobs for RN's with no nursing experience?

Bruce Moskow (3/21/2013 at 3:50 PM)
Really? The US government with full on gridlock as a model for patient care? Was this intended as satire? Dr: Please hand me a 5-0 nylon suture so I can sew up this laceration. Nurse: I think the other Drs use a 4-0 prolene suture for this type of injury. Dr: Lets call a committee meeting and have hearings before a judge to decide this. Or perhaps the clerk at the front desk can be the tie-breaker.




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