Navigating the Hierarchy: Communicating Power Relationships in Collaborative Health Care Groups

Abstract

Interdisciplinary health care groups increasingly face issues related to power and authority in the patient care process. Many of these issues stem from a tension between the historically entrenched hierarchy in health care organizations and the growing pressure of collaborative models of care that require a flattening of this hierarchy, greater mutual respect among disciplines, and more willingness to share power. This project used the framework of text and conversation to explore how groups negotiate this tension through communication. Findings suggest how some groups navigate texts that reinforce the hierarchy alongside texts that challenge it, creating a delicate balance of power that supports collaboration without threatening the position of those at the top of the hierarchy. Other groups primarily use texts that reinforce the hierarchy without consistently using texts that challenge it, which seems to make collaboration more difficult. These findings challenge the idea that equal balance should always be the goal of power sharing in collaborative interdisciplinary groups and offer a more nuanced understanding of how everyday group communication creates and recreates power relationships that impact collaborative care.