Hierarchies in interprofessional training.

Adverse patient outcomes are often the result of conflict or poor communication among healthcare professionals. Use of interprofessional care teams can improve healthcare and delivery of services. Healthcare systems have been historically hierarchical in nature with physicians regularly taking a leadership position. The presence of hierarchy can be a source of conflict in interprofessional healthcare teams. This article analyzes qualitative data from a four-day interprofessional training for family medicine residents, pharmacy students, nurse practitioner students, and counseling psychology students. Data was collected through journals, participant observation, and focus groups. Findings from this study demonstrate three key themes related to hierarchy: (1) tension regarding the idea that the physician is the team leader or "quarterback," (2) experiences of marginalization by team members while working in interprofessional teams, and (3) the tendency for issues regarding hierarchy to go unresolved. Additionally, authors briefly address structures within healthcare that contribute to hierarchy as well as a discussion of alternative models of teamwork and healthcare delivery.