Chain of Command

Chain of command is an authoritative structure used to resolve administrative, clinical, or other patient safety issues by allowing clinicians to present a concern through the lines of authority until a resolution is reached. A formal chain of command provides staff with guidance, examples of actions to be taken and exceptions, direction for unresolved issues, and expectations for documentation. Furthermore, an effective chain of command facilitates, rather than impedes, communication, teamwork, and collaboration between decision makers and frontline clinicians. (Pennsylvania Patient Safety Advisory)

Chain of command policies mandate that healthcare professionals advocate for intervention on behalf of a patient whom they feel is at risk, typically by questioning physicians' orders, or lack thereof. Although healthcare professionals are often apprehensive about challenging a physician's order, doing so is sometimes appropriate, and even necessary, to prevent errors. Chain of command supports this challenging communication. (Joint Commission "Communication")

Invoking the chain of command appropriately does more than protect specific patients, it also builds trust and enhances the organization's culture of safety. Clinicians who pursue the chain of command instead of ignoring or working around an issue raise awareness of the issue and contribute to preventing similar situations in the future. (Case di Leonardi)

Situations in which the chain of command may be indicated include the following (Guthrie County Hospital):

Source: Guthrie County Hospital. Clinical chain of command—addressing concerns related to patient safety and quality online. 2015 Jan [cited...