Research on Status Dynamics in Hospitals Garners Best Paper Award

Hospitals are full of highly educated and motivated people with a wide variety of skills, making it an environment where professional status differences can flourish and, if not checked, affect the work–related behavior of those who feel inferior in rank.

A Yale School of Public Health researcher who explored how health care teams can overcome these interpersonal dynamics (such as might exist between a doctor and a nurse) and work together to improve the quality of care has been awarded a prize for best paper in Positive Organizational Scholarship, an emerging field that focuses on what drives performance in the workplace.

The paper, co–authored by Ingrid M. Nembhard, assistant professor in the division of Health Policy and Administration and at the Yale School of Management, was recognized for its originality, contributions to the field and potential to inspire other research. The award was given by the Center for Positive Organizational Scholarship, Stephen M. Ross School of Business at the University of Michigan.

“We think that our findings are important to academics and practitioners alike…our findings shed light on a potential obstacle to improved quality of care and reveal how that obstacle may be overcome,” Nembhard said. “This insight is timely given the recent recognition of quality problems in health care and practitioners’ interest in understanding why problems exist and how they may be surmounted.”

The paper, “Making it Safe: The Effects of Leader Inclusiveness and Professional Status on Psychological Safety and Improvement Efforts in Health Care Teams,” was published in the Journal of Organizational Behavior in November 2006.

The paper explores the idea of differential status derived from profession and shows that individuals in lower status professions (e.g., nurses) are likely to feel less psychologically safe than individuals in higher status professions (e.g., physicians). The paper further shows that this dynamic affects engagement in quality improvement work. Individuals in lower status professions were less willing to engage in this work because they did not feel it was safe to engage in the behaviors required for quality improvement, for example, questioning current practices, suggesting provocative ideas and participating in experiments that may fail. They feared they would be punished or embarrassed by higher status others. However, this was not true in all teams. The research showed that this dysfunctional pattern can be overcome through the inclusive acts of team leaders, including words and deeds that invite and appreciate the contributions of others.

The research relied upon site visits, observations, interviews and survey data collected in neonatal intensive care units in the United States and Canada. The paper was co–authored by Amy Edmondson of Harvard Business School.

As part of the prize, Nembhard traveled to the December 2008 Biannual Conference on Positive Organizational Scholarship held at the University of Michigan in Ann Arbor, where she gave a keynote address.