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Surgical team training has demonstrated the opportunity for stakeholders to professionally engage one another through leveling of the authority gradient to prevent patient harm.
The issue of undue deference to the pilot operating the plane is a question for the National Transportation Safety Board, which is looking into whether there was an "authority gradient" between the pilot at the controls of the Asiana plane and the pilot who was supposed to be monitoring him and a third pilot in the jump seat, neither of whom intervened.
Asked why the supervising pilot, who was assigned to oversee the flying pilot's first trip to San Francisco in a 777, did not intervene, Ms. Hersman said the investigators were "certainly interested to see if there are any issues where there are challenges to crew communication, if there is an authority gradient where people won't challenge one another".
"We're certainly interested to see if there are any challenges to crew communication, if there's an authority gradient where people won't challenge one another," Hersman said.
In this process we aimed to challenge any perceived authority gradient or hierarchy of communication.
In addition, the existence of an authority gradient and status differentiation amongst different types of health care providers might not only affect the quality of patient care but also hinder or bias the peer evaluation process at some institutions [ 23].
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How might providers understand the challenges faced by patients in speaking up against authority gradients and engaging with their providers to practice participatory medicine and shared decision making?
The human factors framework describes an intricate interplay between human factors (other healthcare workers, shift work, handovers, staffing, authority gradients, polices and protocols, training and supervision of residents) with the physical environment that influences an individual's performance.
Wider societal hierarchies and cultural norms, including those relating to age, gender and education, resulted in particularly steep authority gradients.
In addition, hesitance in speaking up or failure to indicate or correct errors can be caused by disproportionate authority gradients, excessive professional courtesy, and/or deficiencies in resource or task management [ 10].
Linking social capital refers to: "norms of respect and networks of trusting relationships between people who are interacting across explicit, formal or institutionalized power or authority gradients in society".
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com