Essex, Ryan ORCID: 0000-0003-3497-3137 , Kennedy, Jack, Miller, Denise ORCID: 0000-0001-9947-0616 and Jameson, Jill ORCID: 0000-0002-9545-8078 (2023) A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations. Nursing Inquiry. ISSN 1320-7881 (Print), 1440-1800 (Online) (doi:https://doi.org/10.1111/nin.12571)

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Abstract

Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons, it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations, defined broadly to address gaps in macro-level healthcare organisational research, specifically focusing on the 1) impact of hierarchy for healthcare workers and 2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide-reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy’s impact on speaking up, that is, how it shaped communication between staff with differential status; not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the wellbeing of those in less powerful positions. These findings also provide insight to the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way that hierarchy was navigated day to day, but spoke to the reasons as to why hierarchy is entrenched and is difficult to shift. A number of studies spoke to the impact that hierarchy had on sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, it is clear that hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.

Item Type:	Article
Uncontrolled Keywords:	hierarchy; health; healthcare
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > RA Public aspects of medicine R Medicine > RT Nursing
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Inequalities Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Professional Workforce Development Faculty of Education, Health & Human Sciences > School of Education (EDU) Faculty of Education, Health & Human Sciences > School of Health Sciences (HEA) Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	04 Jul 2023 10:53
URI:	http://gala.gre.ac.uk/id/eprint/42974

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