Power and Influence in Healthcare

Two of the five bases of power discussed in Module 10 Lecture 5 Power are as legitimate and expert.  Legitimate power is power that results from a formal position.  Expert power is power that results from specialized information or expertise.  Physicians have a hierarchical form of power derived from legitimate and expert power.  Physicians have a formal position that, historically, has led to a certain level of respect.  Physicians also have a position based on knowledge and expertise from with they receive power.  The power and traditional view of physicians as infallible can lead to blind authority.

Cialdini (2009) stated that “the simultaneous blessing and curse of such blind obedience to authority is its mechanical character.  We don’t have to think, therefore we don’t.  Although such mindless obedience leads us to appropriate action most of the time, there will be conspicuous exceptions because we are reacting, not thinking” (p.181).  Blind obedience to authority can result in devastating outcomes for customers in the healthcare settings.  Physicians are human.  Physicians often have tremendous responsibilities to be fulfilled in a limited amount of time.  Blindly accepting the authority of physicians and their orders without checks and balances is not in the best interest of the healthcare organization or its customers.  

   

Cialdini (2009) outlined this concern in stating “the worrisome possibility arises, then, that when a physician makes a clear error, no one lower in the hierarchy will think to question it-precisely because, once a legitimate authority has given an order, subordinates stop thinking in the situation and start reacting” (p.181).  Many nurses, especially new nurses, fear questioning the order of a physician due to the inherent authority and power in place.  Blind obedience results in medication and care delivery errors.  Patients, nurses, pharmacists, etc should all be taught and encouraged to have a comfort level with respectfully questioning an order that appears to be in error.

Electronic health records and electronic order entry has allowed for another form of checks and balances within the healthcare hierarchy.  As a physician enters an order in the computer system, the program alerts the physician if the order entered is questionable or contradictory of best practice.  Medication dosages, routes, frequencies, etc are all checked by the computer system for consistency with current recommendations.  Technological advances provide another opportunity to prevent errors within the healthcare organization due to blind obedience.  Power and influence affect one another.  Many individuals in positions of power deserve the influence they have.  While authority and influence should be respected, all healthcare providers are human and subject to error.  Therefore, systems should be in place to prevent errors and discourage reacting without thinking.

References

Cialdini R B 2009 Influence: Science and practiceCialdini, R. B. (Ed.). (2009). Influence: Science and practice (5th ed.). Boston, MA: Pearson Education, Inc.