Hierarchy [Neurosurgery Wiki]

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===== Hierarchy =====

**Definition:**  
Hierarchy is the structured ranking of [[role]]s and [[authority]] within a healthcare [[team]] or institution, which defines lines of [[responsibility]], [[supervision]], and [[decision-making]].

==== Positive Aspects ====
  * Enables rapid decision-making in emergencies.
  * Clarifies [[accountability]] and legal [[responsibility]].
  * Supports structured teaching and clinical [[supervision]].

==== Risks and Challenges ====
  * May suppress [[open communication]] and [[input]].
  * Can create fear of speaking up, especially among junior staff.
  * May reinforce status differences that reduce [[teamwork]] and safety.

==== Examples in Healthcare ====
  * In surgical teams: attending > fellow > resident > nurse > technician.
  * In administration: director > department head > unit lead > staff.

==== Strategies to Balance Hierarchy ====
  * Promote [[psychological safety]].
  * Use [[democratic leadership]] in non-emergent settings.
  * Encourage upward and peer-to-peer feedback.
  * Flatten [[communication]] during [[planning]], [[review]]s, and QI initiatives.

==== Related Pages ====
  * [[team_input]]
  * [[psychological_safety]]
  * [[democratic_leadership_style]]
  * [[communication_culture]]
  * [[feedback_culture]]