Chain of Command Issues in Health Care

A chain of command is an aspect of organizational structure that is meant to show a clear line of responsibility from the top position in an organization all the way down to the bottom. A chain of command is established so that everyone knows whom they should report to and what responsibilities are expected at their own level. In the health care field, there sometimes can be problems within the chain of command, including how well people know it and observe its use.

Time Factors

• One of the biggest issues facing the health care field's chain of command structure is time. Often, a patient's illness or injury requires immediate action, leaving doctors and nurses without the proper time to follow the chain of command. For instance, if a patient is going into cardiac arrest, then the hospital may not have the time necessary to call the patient's private doctor and wait for her decision. If the patient's life is saved and all turns out well, there usually are few problems with this approach; however, if a doctor makes a bad decision while breaking the chain of command, then the issue of who is at fault can become a finger-pointing contest, negating the responsibility and accountability that a chain of command is meant to enforce.

Employee Complaints

• If an employee has a dispute with another employee who is at the same level of responsibility, the traditional response is for the person above them to resolve the issue. However, if a nurse has a problem with a doctor that's her boss, although he is supposed to report his complaint to his immediate supervisor, this is the very person with whom he has a problem. This type of confrontation is difficult, and it leads many employees not to report problems because they may be afraid that their superior will take retaliatory measures.

Contradictions

• A chain of command establishes which employees are subject to the authority of other employees; for instance, nurses are supposed to obey the medical directives given to them by doctors. However, hospitals also have established rules and administrative protocols that staff are supposed to follow to the letter that may conflict with the nurse/doctor chain of command. In some cases, nurses may have increased responsibilities that are conducted without physician overview. If someone in a higher position issues an order that is contrary to the policies of the hospital, then there can be a significant problem, especially if the element of too little time also plays a part. This may lead to individuals on the lower end of the chain of command having to modify or outright refuse orders given by their superiors in order to keep their jobs.