The HCPs’ office politics playbook

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published May 24, 2024

Key Takeaways

  • Dysfunctional hierarchies in healthcare are marred by negative politics and power plays, which can compromise patient care and contribute to the distress and mistreatment of team members.

  • Signs of a dysfunctional workplace can include gossiping, backstabbing, double talking, and flattering superiors’ egos.

  • Clear communication is the key to a functional hierarchy, with each team member feeling respected and valued.

Hierarchies help facilitate workflow in many types of workplaces, and healthcare is no different.

A functional medical hierarchy contributes to a positive learning environment and enhances patient care. A dysfunctional hierarchy, however, can detract from patient care.

Within multidisciplinary teams, attendings sit at the top of the hierarchy. They play key roles in fostering camaraderie among team members, a functional hierarchy among staff, and help those along the hierarchy positively navigate power dynamics. 

Fostering functional hierarchies

In a functional hierarchy, each healthcare practitioner has the ability and authority to exercise their full potential. Each team member is respected regarding patient care. 

From the patient perspective, there is clear continuity of care, and provider roles are clear to the patient. Every member of the healthcare team should be able to effectively advocate for the patient with regard to their individual scope of expertise.[]

The burden of dysfunctional hierarchies

A dysfunctional hierarchy mediates negative outcomes. Dysfunctional hierarchies dissuade voicing concerns among staff members, foster distress, and support the mistreatment of healthcare workers—especially trainees.

Dysfunctional hierarchies can diminish patient safety and provider empathy, and lead to dissatisfaction among those lower on the hierarchy, such as trainees, while increasing fatigue, stress, and burnout.

When the hierarchy is ineffective or compromised, staff productivity is inhibited, as members of the team may not be motivated to perform well. Instead of excelling and innovating, members of the team preoccupy themselves with the burden of strategizing power plays and counteractions.[] This effort invariably detracts from patient care, with patients missing the full attention and range of services they deserve. 

Negative politics and power plays sap allegiance and loyalty among team members. Team members become suspicious of one another, and the resulting resentment stifles communication.

Signs and symptoms of dysfunction

Individuals can contribute to dysfunctional hierarchies in various ways, including the following. 

  • Gossiping

  • Double talking or telling different stories to different parties to cover their bases or deliberately sow disharmony

  • Backstabbing

  • Power mongering or trying to control every situation

  • Stealing ideas[]

  • Sycophancy

  • Lobbying for self-interest that may be antithetical to adequate patient care

When individuals engage in politics and power plays at work, messages are altered and positive communication is lost altogether. A negative political environment can occur when a third party joins the picture, and the other two parties align to discredit the third person or group of people.

Clear communication is key

As the leader of the team, attendings can optimize team efforts in the best interest of the patient. This can be facilitated through clear communication.

Clear communication is key, with each team member feeling heard and free to contribute their thoughts. Team members should also feel free to report potential issues or errors without fear of retribution. When discussing errors, attendings should use neutral language to focus on the impact to patients.

Leaders should communicate the value of their ideas in ways that appeal and make sense to every member of the healthcare team based on their training and educational background.[] Leaders should make their best attempt at communicating a clear vision for the team as a whole, and direct members toward a unified goal. 

Communication styles can also be adjusted based on the team member. For instance, if a person is known to gossip, then communication with that person should remain impersonal. If someone is contributing to a negative work environment, a higher-up should warn the political player that their actions compromise patient care and will not be tolerated. 

Other steps that can be taken to foster a functional hierarchy include nurturing a climate of cohesiveness and trust and balancing skill sets of different team members to facilitate patient care.

Overall, it’s important to lead by example and acknowledge the success and skill of other team members.

What this means for you

Politics and power plays crop up at work all the time. As the physician leader, it’s important to minimize factors that detract from a functional work environment. Keep all of your efforts focused on harmony for the sake of the patient’s well-being.

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