Does the Implementation of Clinical Pathways Affect Hierarchical Structures Within a Surgical Department? A Qualitative Study

Ronellenfitsch, Ulrich; Loerbroks, Adrian; Schwarzbach, Matthias

doi:10.9738/intsurg-d-17-00028.1

Cited by 1 publication

(1 citation statement)

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“…Eekholm et al (2021) suggested that assertive nursing leadership helped to put nursing care on the agenda, making it visible and taking time away from other activities that support the work of doctors, reclaiming time and professional identity. In a study that examined the implementation of a clinical pathway on hierarchical structures within a German surgical department (Ronellenfitsch et al 2019), participants felt that it had impacted hierarchical structures, giving staff in lower hierarchical positions more autonomy by providing detailed instructions in relation to care, for example. Another study spoke to how hierarchy may be shifted or challenged.…”

Section: Negotiating Hierarchymentioning

confidence: 99%

A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations

et al. 2023

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Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro‐level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide‐reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well‐being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.

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Section: Negotiating Hierarchymentioning

confidence: 99%