Clashes in Hospital Hierarchy

Another issue that can lead to handoff problems is the hierarchical nature of a hospital, said Croteau. “Oftentimes when the handoff has to do with different categories of staff, like physician to nurse and so on, there can be issues of intimidation that can get in the way of patient care,” he said. “If [a doctor’s] attitude is abrupt, intimidating or even worse, abusive, that will inhibit communication. A nurse who might otherwise call for clarification might be reluctant to do so and perhaps just take a guess.”

Madeleine Estabrook, a Boston lawyer who advises hospitals on policy issues, said the cultural climate in hospitals has improved a lot over the past 20 years, but agrees that it’s still something hospitals need to be working on. “It’s still out there,” she said. “There are doctors who won’t talk to other physicians or won’t listen to nurses because they’re nurses.” Croteau suggested that one way to address this issue is by attacking the hierarchical culture at its roots. “We need to be changing the way we train doctors, nurses, pharmacists and so forth and there is activity going on right now to do just that,” he said. “They will learn to work in teams from the outset and not get into that childish mindset that ‘I’m better than you are.’

But this change in culture is not going to happen overnight.” Estabrook, who practices at Edwards Angell Palmer & Dodge, added that some hospitals are creating interdisciplinary teams of caregivers working together across specialty lines for an individual patient. “This can break down stereotypical barriers to people talking to each other,” she said. “I see a lot of hospitals doing this.”

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