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

• Enables rapid decision-making in emergencies.
• Clarifies accountability and legal responsibility.
• Supports structured teaching and clinical supervision.

• 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.

• In surgical teams: attending > fellow > resident > nurse > technician.
• In administration: director > department head > unit lead > staff.

• Promote psychological safety.
• Use democratic leadership in non-emergent settings.
• Encourage upward and peer-to-peer feedback.
• Flatten communication during planning, reviews, and QI initiatives.

• team_input
• psychological_safety
• democratic_leadership_style
• communication_culture
• feedback_culture