Residents' reluctance to challenge negative hierarchy in the operating room: a qualitative study.
Approach to Improving Safety
Setting of Care
In this simulation study, most anesthesiology residents acceded to an attending physician's order to transfuse blood to a patient who had explicitly refused transfusions for religious reasons. Subsequent interviews with the residents revealed that strict hierarchies persist within medical training, despite evidence that hierarchies impair communication and negatively affect safety. This study is reminiscent of one of the earliest studies of the impact of hierarchies on patient safety.