3.5.j Attending to Power Imbalances: A PCDM Key Element

On any team, power and conflict are dynamics that will affect the way the team functions (12). These can influence interpersonal behaviour, adherence to team processes and protocols, and impact safety or satisfaction with care. Teamwork failures usually originate from non-technical aspects of performance. This is most common in situations where professional hierarchy is upheld and maintained, or when there are frequent transitions of power among providers. There are unique challenges to managing human relationships and personalities, and power and conflict can explain and predict team dynamics. In situations with perceived hierarchy, people are more likely to defer to that hierarchy and mitigate their speech, for example, rather than risk challenging someone in a position of authority (12).

A key part of the PCDM process, is to attend to power imbalances by creating an equal environment. The first step in addressing issues of power and conflict in a shared decision making process is to acknowledge that they exist and that they may, now or in the future, impact team dynamics. This is done verbally while simultaneously working to create a safe work and safe communication environment. This means inviting contribution from everyone and avoiding assumptions about a team member's experiences, stories, and approaches to decision making. Staying curious will enable a positive team dynamic and avoid team dysfunction.