Help us Eliminate the Power Gradient at MLH

By Jack Lynch, president & CEO, MLH


In September 2018, we implemented the Power Gradient Reporting and Resolution Policy in response to incidents at MLH and our AHRQ (Agency for Healthcare Research and Quality) Patient Safety Survey. The results of the survey identified that only 52% of our team felt empowered to question authority and speak up for safety.

Eliminating the power gradient is a critical component in ensuring a safe, respectful environment across Main Line Health for both patients and staff. I personally am committed to eliminating any power gradient in my interactions with the entire MLH team. I am also holding leaders at all levels as well as all employees, physicians, and volunteers, to the same standard. Please know that any reported violation of the Main Line Health Power Gradient Reporting and Resolution Policy will be taken seriously and handled in a timely and equitable manner.

The definition of the power gradient is: the extent to which power is distributed unequally or a difference in perceived power that makes expressing concerns, questioning, or clarifying instructions difficult for someone who feels they are in a position with less power. Power gradients can also exist as a result of intimidating and disrespectful behavior that ultimately disrupts the culture of safety and prevents collaboration, communication, and teamwork, which is required for safe and highly reliable patient care.

  • Disrespect and intimidation – a direct violation of the Main Line Health Power Gradient Policy –can manifest in many forms, including the following examples:
  • Inappropriate language (profane, insulting, intimidating, demeaning, or abusive);
  • Belittling or shaming others;
  • Refusal to comply with known and generally accepted practice standards, the refusal of which may prevent other providers from delivering quality care;
  • Not working collaboratively with other members of the interdisciplinary team;
  • Creating rigid or inflexible barriers to requests for assistance or cooperation;
  •   Hitting, pushing, shoving, throwing objects or other attempts at physical intimidation;

In addition to the AHRQ survey, several questions in our annual Employee Engagement Survey address our focus on the power gradient, including:

  •  Staff members are willing to report errors.
  • I can freely speak up to someone with more authority if I see something that may negatively affect patient care.
  • When an error is reported, my department/unit handles it in a fair and just manner.

We will continue to monitor outcomes for these questions as a baseline for departments in MLH that have opportunity to alleviate any power gradient issues. It is important to note that we are taking steps to eliminate these behaviors at MLH, not only as a result of our survey feedback, but also because there has been an increased level in the reporting of inappropriate behavior occurring in our environment.  I encourage you to use our Culture of Safety tools to speak up to the individual directly and immediately as a way to achieve a real time resolution. Once you report a concern, if you experience retaliation or perceive something to be retaliatory you must report it immediately. Retaliation for speaking up will not be tolerated at MLH.

I ask that everyone at Main Line Health treat one another with dignity and respect and take the responsibility to report behaviors that you experience or witness that are disruptive, intimidating or contribute to a power gradient.

For more information, the Power Gradient Reporting and Resolution Policy can be found on the Intranet under Policies and Procedures.



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