TeamSTEPPS® is an effective tool to level the hierarchy in healthcare communication by empowering all stakeholders
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Healthcare organizations share a love-hate relationship with the mention and use of the term hierarchy. The Merriam-Webster dictionary [1] defines a hierarchy as a classification of a group of peop...
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Junior clinicians may hesitate to report patient safety issues to avoid conflict with their senior leaders, fearing this can jeopardize their future careers.
“Junior clinicians may hesitate to report patient safety issues to avoid conflict with their senior leaders, fearing this can jeopardize their future careers.”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [31]
In the main text (page unavailable), Clapper says juniors may stay silent about a senior’s mistake because they fear negative repercussions, and that fear of retribution can prevent workers from raising safety concerns. The paper does not specify that they fear jeopardizing their future careers. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis reluctance creates communication gaps, resulting in missed chances for valuable feedback and timely interventions.
“This reluctance creates communication gaps, resulting in missed chances for valuable feedback and timely interventions [31].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [31]
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Research works printed but not linked: 10
- Gergerich E, Boland D, Scott MA. Hierarchies in inter- professional training. J Interprofessional Care. 2018; [online ahead of issue] doi: 10.1080/13561820.2018. 1538110 · DOI
- Clapper TC, Lee J, Phillips J, Rajwani K, Naik N, Ching K. Gibson's theory of affordances and situational aware- ness occurring in urban departments of pediatrics, medicine, and emergency medicine. Educ Health. 2018;31(2):87-94. doi:10.4103/efh.EfH 33 · DOI
- Rabøl LI, McPhail MA, Østergaard D, Andersen HB, Mogensen T. Promoters and barriers in hospital team communication. A focus group study. J Commun Healthcare. 2012;5(2):129-139. doi:10.1179/1753807 612Y.0000000009 · DOI
- Clapper TC, Ching K, Mauer E, Gerber LM, Lee JG, Sobin B, et al. A saturated approach to the four-phase, brain- based simulation framework for TeamSTEPPS® in a pedi- atric medicine unit. Pediatr Qual Saf 2018;4(3):1-7. doi:10.1097/pq9.0000000000000086 · DOI
- Clapper TC. Next steps in TeamSTEPPS®: Creating a just culture with observation and simulation. Simul Gaming. 2014; 45(3):306-317. doi:10.1177/1046878114543638 · DOI
- Landgren R, Alawadi Z, Douma C, Thomas EJ, Etchegaray J. Barriers of pediatric residents to speaking up about patient safety. Hosp Pediatr. 2016;6(12):738-43.doi:10. 1542/hpeds.2016-0042 · DOI
- Hughes, AM, Salas E. Hierarchical medical teams and the science of teamwork. Virtual Mentor 2013;13(6):529- 533. doi:10.1001/virtualmentor.2013.15.6.msoc1-1306. · DOI
- Bould MD, Sutherland S, Sydor DT, Naik V, Friedman Z. Residents' reluctance to challenge negative hierarchy in the operating room: a qualitative study. Can J Anaesth. 2015;62(6):576-586. doi:10.1007/s12630-015- 0364-5 · DOI
- Walton MM. Hierarchies: the Berlin Wall of patient safety. Qual Safety Health Care 2006;15(4):229-230. doi:10.1136/qshc.2006.019240 · DOI
- Green B, Oeppen RS, Smith DW, Brennan PA. hierarchy in healthcare teams -ways to flatten gradients to improve teamwork and patient care. Br J Oral Maxillofac Surg. 2017;55(5):449-453.
Cited by
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Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
- Authors
- Clapper, T. C.
- Corresponding author
- Clapper, Timothy C.
- ORCID
- Clapper, Timothy C.
- Venue
- Journal of Communication in Healthcare
- Publisher
- Informa UK Limited
- Published
- 2018-10-02
- Volume
- 11
- Issue
- 4
- Pages
- 241-244
- ISSN
- 1753-8068 (ISSN-L)
- 1753-8076
- OpenAlex
- W2915217420
- Cited by
- 17
- References
- 0
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 2
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Communications In Healthcare (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Social Sciences › Psychology › Social Psychology › Team Dynamics and Performance
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- TeamSTEPPS, interprofessional communication, communication skills training, stakeholder empowerment, healthcare teamwork, organizational hierarchy
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