Subscribe to RSS
DOI: 10.1055/a-1200-2696
“Quod licet Chefarzt …”: The Impact of Perceived Hierarchy on Working Atmosphere and Quality of Work in Orthopaedic and Trauma Surgery. Results of a Survey Among 799 Orthopaedic and Trauma Surgeons in Germany
Article in several languages: English | deutsch
Abstract
Introduction Surgical departments are discredited as guardians of traditional structures of hierarchy. Hierarchy and working climate have a large share in human factor, being made responsible for 70% of avoidable errors in medicine. Aim of this study was the assessment of these topics amongst physicians in the field of orthopedics and traumatology.
Material and Methods A questionnaire of 10 questions was digitally handed to DGOU members. 799 questionnaires were answered.
Results We found significant differences in the assessment of hierarchy and working atmosphere amongst the physician groups. Working atmosphere was perceived as not appreciative by registrars only. All groups were in favor of a hierarchy rather close to, but nut absolutely on equal terms. All groups attach high influence of working atmosphere on quality of daily work.
Discussion Literature shows that hierarchic differentiation can increase performance of a team, while rigid hierarchy structures can lead to mistakes. Although hierarchy in orthopedics and traumatology seems to be less pronounced than assumed, hierarchy has great influence on daily work.
Conclusion In order to achieve a safety oriented medical environment, it will be of great importance to define hierarchy structures in clinics and to utilize them efficiently as a part of safety culture.
Publication History
Article published online:
03 August 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Gabler Wirtschaftslexikon. Das Wissen der Experten. Springer Gabler. Online (last access: 15.01.2020): https://wirtschaftslexikon.gabler.de/definition/hierarchie-35110/version-258599
- 2 Green B, Oeppen RS, Smith DW. et al. Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care. Br J Oral Maxillofac Surg 2017; 55: 449-453 doi:10.1016/j.bjoms.2017.02.010
- 3 Singer S, Meterko M, Baker L. et al. Workforce perceptions of hospital safety culture: development and validation of the patient safety climate in healthcare organizations survey. Health Serv Res 2007; 42: 1999-2021 doi:10.1111/j.1475-6773.2007.00706.x
- 4 Gaba DM. Structural and organizational issues in patient safety: a comparison of health care to other high-hazard industries. Calif Manage Rev 2000; 43: 83-102
- 5 Hoffmann B, Rohe J. Patient safety and error management: what causes adverse events and how can they be prevented?. Dtsch Arztebl Int 2010; 107: 92-99 doi:10.3238/arztebl.2010.0092
- 6 Singer SJ, Rosen A, Zhao S. et al. Comparing safety climate in naval aviation and hospitals: implications for improving patient safety. Health Care Manage Rev 2010; 35: 134-146 doi:10.1097/HMR.0b013e3181c8b20c
- 7 Rall M, Gaba D, Howard S. et al. Human Performance and Patient Safety. In: Miller RD, Erikson LI, Fleisher LA, Wiener-Kronish JP, Young WL. eds. Millerʼs Anaesthesia. Philadelphia: Elsevier Churchill Livingstone; 2009: 93-150
- 8 Seemann R, Munzberg M, Stange R. et al. [Interpersonal competence in orthopedics and traumatology: why technical and procedural skills alone are not sufficient]. Unfallchirurg 2016; 119: 881-884 doi:10.1007/s00113-016-0229-6
- 9 Münzberg M, Rüsseler M, Egerth M. et al. [Safety culture in orthopaedic surgery and trauma surgery – where are we today?]. Z Orthop Unfall 2018; 156: 579-585 doi:10.1055/a-0588-5647
- 10 Swaab RI, Schaerer M, Anicich EM. et al. The too-much-talent effect: team interdependence determines when more talent is too much or not enough. Psychol Sci 2014; 25: 1581-1591 doi:10.1177/0956797614537280
- 11 Van Vugt M, Hogan R, Kaiser RB. Leadership, followership, and evolution: some lessons from the past. Am Psychol 2008; 63: 182-196 doi:10.1037/0003-066x.63.3.182
- 12 Anderson C, Brown CE. The functions and dysfunctions of hierarchy. Research in Organizational Behavior 2010; 30: 55-89 doi:10.1016/j.riob.2010.08.002
- 13 Ronay R, Greenaway K, Anicich EM. et al. The path to glory is paved with hierarchy: when hierarchical differentiation increases group effectiveness. Psychol Sci 2012; 23: 669-677 doi:10.1177/0956797611433876
- 14 Guzzo RA, Dickson MW. Teams in organizations: recent research on performance and effectiveness. Annu Rev Psychol 1996; 47: 307-338 doi:10.1146/annurev.psych.47.1.307
- 15 Stout RJ, Salas E, Carson R. Individual task proficiency and team process behavior: whatʼs important for team functioning?. Military Psychology 1994; 6: 177-192 doi:10.1207/s15327876mp0603_3
- 16 Alkov RA, Borowsky MS, Williamson DW. et al. The effect of trans-cockpit authority gradient on Navy/Marine helicopter mishaps. Aviation, Space, and Environmental Medicine 1992; 63: 659-661
- 17 Stern Z, Katz-Navon T, Naveh E. The influence of situational learning orientation, autonomy, and voice on error making: the case of resident physicians. Manage Sci 2008; 54: 1553-1564
- 18 St Pierre M, Scholler A, Strembski D. et al. [Do residents and nurses communicate safety relevant concerns? Simulation study on the influence of the authority gradient]. Anaesthesist 2012; 61: 857-866 doi:10.1007/s00101-012-2086-1
- 19 Singer SJ, Gaba DM, Falwell A. et al. Patient safety climate in 92 US hospitals: differences by work area and discipline. Med Care 2009; 47: 23-31 doi:10.1097/MLR.0b013e31817e189d
- 20 Naveh E, Katz-Navon T, Stern Z. Readiness to report medical treatment errors: the effects of safety procedures, safety information, and priority of safety. Med Care 2006; 44: 117-123
- 21 Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine: national, organizational and professional Influences. Farnham, UK: Aldershot; 1998
- 22 Kasch R, Wirkner J, Meder A. et al. [Who stays loyal to orthopaedics and trauma surgery? Results of a nationwide survey]. Z Orthop Unfall 2016; 154: 352-358 doi:10.1055/s-0042-104119
- 23 Froehlich S, Goebel F, Meder A. et al. [Quality and satisfaction with the surgical medical clerkship from a student perspective]. Z Orthop Unfall 2018; 156: 639-645 doi:10.1055/a-0609-6781
- 24 Bundesärztekammer (BÄK). Ergebnisse der Ärztestatistik zum 31. Dezember 2015. Medizinischer Versorgungsbedarf steigt schneller als die Zahl der Ärzte. Online (last access: 23.03.2020): http://www.bundesaerztekammer.de/ueber-uns/aerztestatistik/aerztestatistik-der-vorjahre/aerztestatistik-2015
- 25 Bundesärztekammer (BÄK). Ergebnisse der Ärztestatistik zum 31. Dezember 2018. Montgomery: Es ist höchste Zeit, den Ärztemangel ernsthaft zu bekämpfen. Online (last access: 23.03.2020): http://www.bundesaerztekammer.de/ueber-uns/aerztestatistik/aerztestatistik-2018