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Reducing Power Distance and Increasing Collaboration Can Reduce Errors and Improve Patient Care

Posted on Mon, Mar 13, 2017
Reducing Power Distance and Increasing Collaboration Can Reduce Errors and Improve Patient Care

By Adam Corley, MD, FACEP, FAAEM

Error reduction, quality improvement, patient safety and staff satisfaction are all impacted by a little-discussed concept known as power distance.

Traditionally in medicine, physicians were thought of as the “captains of the ship,” whose wisdom was unquestioned and whose instructions were to simply be followed. Doctors gave orders to nurses, allied health professionals and patients. Most members of the healthcare team went by their first names, but doctors still required a formal title.

This traditional hierarchy can be called a high power distance environment. Power distance is a term coined by Geert Hofstede, a Dutch social psychologist. In such systems, power relationships are autocratic, paternalistic and draconian. There is little premium put on collaboration, and subordinates are expected accept their lower positions. Authority and authorities (doctors, in this example) are rarely questioned, and their instructions are regarded as certain and inflexible.

In low power distance cultures, power is more evenly distributed, and there is a relatively small emotional distance between those in charge and others. Leaders and their teams are less concerned with status or title and more concerned with collaboration, communication, partnership and teamwork.

Luckily, medicine has begun transitioning from a high to low power distance environment, but we still have a long way to go. We have begun to shed titles between co-workers. We are encouraging all members of the healthcare team to share ideas and strategies with their colleagues. Nurses and allied healthcare workers are encouraged and empowered to challenge physicians if they notice errors or have concerns about the prescribed treatment plan. Physicians have begun to not only accept but to appreciate suggestions from their co-workers.

Medical specialists in fields like emergency medicine, anesthesia and surgery are developing team-based approaches to medicine. While the doctor is most often still at the helm, these highly functional team of RNs, advanced practice providers and other clinicians work collaboratively to deliver care. In most cases, these teams function in a very low power distance environment.

There still are elements of higher power distance that make sense in medicine and should remain. For example, emergent surgeries, CPR, code blue situations and trauma resuscitations still require a more rigid element of hierarchy, given the shortened timeframe for success and critical nature of the work.

Although it makes sense in medicine, a low power distance culture is not right for every field. The military is a classic example of an environment that works well with high power distance relationships. The features of a low power distance culture that make that hierarchy favorable in fields like medicine and aviation would not necessarily work well when fighting a war or keeping the peace.

A 2013 study published in the Journal of Patient Safety estimated that approximately 400,000 people die from preventable harm in medicine each year. We must continue to flatten our medical hierarchies, reduce our power distance and empower and encourage all members of the healthcare team to identify and report errors. Not only do patient’s benefit from the collaborative environment allowed for in a low power distance culture, but doctors and their nursing and allied health colleagues will be much happier practicing medicine this way.

Adam Corley, MD, FACEP, FAAEM, is an emergency physician with more than 10 years of clinical and leadership experience. Dr. Corley serves as Executive Vice President for EmCare’s West Division. He also serves as the medical director for several EMS services and the Anderson County Texas Sheriff’s Department. Dr. Corley lectures and writes on a variety of topics, including decision science and behavioral economics, management of disruptive behavior in healthcare, conflict resolution and healthcare leadership.

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7 Leadership Styles and Why You Need Them All on Your Team

Posted on Tue, Sep 08, 2015
7 Leadership Styles and Why You Need Them All on Your Team

A well-rounded team will have several different and crucial types of leaders. Although not every team or project will have all of the types, they truly make an exceptional team when they work together.
 
By Ginger Wirth, RN
 
Hire right. This is so important for a successful leader. Surround yourself with smart, energetic, innovative and compassionate people. These are the ones that you know you can count on to carry your vision or the vision of the team forward when you are not there. You know that these folks have the best interests of the organization and those that you are serving at heart.
 
A well-rounded team will have several different and crucial types of leaders. Although not every team or project will have all of the types, they truly make an exceptional team when they work together.
 
The key leadership styles are:
 

  1. The Leader:  This person keeps the team on track and knows how to delegate
  2. The Team Player:  Always enthusiastic, willing to compromise and be diplomatic for the betterment of the group or project
  3. The Researcher: This person will always look for the Whys, What Ifs and Hows
  4. The Planner: He or she is self-motivated, organized and great with lists and deadlines.
  5. The Expert: This is the person with the history and past knowledge of the subject or team. This individual is usually great with technology.
  6. The Creative: He or she is the cheerleader for the team. This person looks toward the future of the team, is the one with imagination and thinks outside the box.
  7. The Communicator:  This is the team’s natural salesperson. They are great for getting the message out to everyone and keeping them informed. 

Recognize, reward and celebrate the successes with the team! Make sure you share the wins with the team. It’s important that you also recognize individuals for their contributions and when they are performing well. Take the time to get to know your staff and what their triggers and motivations are. There will be some who want public recognition for a job well done, and others would rather be privately praised. There may be team members who simply are happy knowing the process they were a part of worked well and will make their jobs easier or better. A good leader will make the effort to know this about his/her team. Being able to use this valuable knowledge will ultimately create a stronger more productive group.
 
And lastly, take time to care for yourself as a leader. Too often I’ve seen my most cherished supervisors become frustrated or burnt out simply because they failed to take care of themselves. Remember, you can’t lead the team well or be successful if you’re barely keeping your head above water. I referenced hiring right earlier. Doing this will afford you the time and resources needed to take care of you.
 
All of the exceptional leaders in my professional career have had these qualities. They’ve mentored and coached me to be the best leader that I can be. There is never a day that I don’t reflect on these tips. Their leadership styles helped me be the best resource and leader for my staff and colleagues. But my development as a leader isn’t done; I’m constantly observing and learning from other exceptional leaders that I’m lucky to work and collaborate with throughout my travels. Never stop growing.

Ginger Wirth
 
Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.
 

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