Dismantling the Totem Pole: How to Achieve a More Egalitarian Hospital Culture

June 6, 2018 | Strategic Insights for Health System


​Fostering a culture in which all employees are treated as equals does more than ensure a happier work environment, it also improves patient outcomes, according to a May 31, 2018, article in the New York Times. The author, a surgeon and Times columnist, describes how "powerless" she felt in the face of antiquated practices while training at a large hospital in the 1990s. Many of the hospital's long-standing procedures were negatively impacting patient care, she felt, but the author and her fellow trainees "understood our place at the bottom of the hospital totem pole" and did not openly question them. "This hospital is like an elephant," the author recalled a fellow trainee saying. "When she goes to the right, you must go to the right. When she goes to the left, you must go that way, too." However, the author said, studies have consistently shown that a more open and egalitarian hospital culture can improve patient outcomes. For instance, the author said, heart attack patients treated at a hospital where nurses "feel powerless" and senior management is rarely involved in patient care have worse outcomes than those treated at hospitals where nurses are regularly asked for their input and executives regularly meet with clinicians to review patient results.

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