| Abstract (ENG): |
Hospitals are one of the central pillars of healthcare systems worldwide, becoming even more important
due to the ongoing demographic change. Nevertheless, hospitals face major challenges from external
factors such as the COVID-19 pandemic or digitalization. To meet these changes, resilience and internal
stability are required. However, Germany is already confronted with a considerable shortage of qualified
nursing personnel, exacerbated both by the COVID-19 pandemic and the working conditions as well as
a missing appreciation for nursing. Hospitals in Germany and globally are strictly hierarchically
organized based on power, knowledge and prestige. Despite not being defined formally, nursing is
typically subordinated to the medical profession, and physicians informally rule over nursing work.
Although the negative effects of strict hierarchies on job satisfaction, collaboration, and error culture
are partially known, research lacks an understanding of how exactly hierarchies in hospitals influence
the different professions. Additionally, literature is scarce regarding potential solutions to the identified
problems.
This paper addresses this research gap by examining a German hospital's existing and perceived
hierarchies and attempting to derive possible practical implications. We investigate how the informal
hierarchy within hospitals differs from the formal one and what influence this hierarchy has, especially
on the nursing staff, to outline problems within this profession. Within a qualitative research design, we
conducted eleven semi-structured interviews with experts from the nursing and the medical profession
at a German hospital concerning their perception of the hospital hierarchy.
Our findings illustrate that two forms of hierarchies, formal and informal, are prevalent in German
hospitals and these ultimately influence communication within and between the various professions.
First, the interviewees know the formal hierarchy within German hospitals and see its value, especially
in emergency situations demanding a clear chain of command and responsibilities. The informal
hierarchy is mainly enforced by the medical sector having distinct knowledge and implicit power over
the decision-making process. As a consequence, physicians impose influence on the nursing sector.
Moreover, we discover that the manifested informal hierarchy harms the interaction and communication
between the nursing and medical sector. The hospital context facilitates a harsh and sharp
communication style that negatively impacts the nursing staff. This harsh tone also harms the error
culture since many lower hierarchy-level employees do not dare to admit or address errors with their
superiors for fear of rebuke and reprisal. The higher hierarchical levels place little value on nurses' needs
and sensitivities, resulting in demotivation and discontent.
As one practical implication, we call for a format where physicians and nurses can meet on eye level
without the burden of hierarchy, ideally with a mediator who is not bound to either side. This way,
communication issues can be resolved more easily, giving the nursing staff a greater appreciation from
which, ultimately, patients can benefit. |
| Citation: |
Seerig, Kirsten H. and Haug, Maximilian and Maier, Alexander and Gewald, Heiko
(2023)
Informal Hierarchies - Ramifications for Nursing and Interprofessional Communication in German Hospitals.
In: (Proceedings of the) 13th Conference on Health IT and Analytics (CHITA), May, 4-6, 2023, Washington D.C., USA.
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