Measuring team hierarchy during high-stakes clinical decision making: development and validation of a new behavioral observation method.
Hierarchy based on expertise is appropriate in some situations, but hierarchy based on factors not related to expertise (i.e., gender or discipline) hinders safe patient care. In this study, teams of first-year residents and nurses participating in a training session were recorded on audio and video. Using the status characteristics and expectation states (SCES), transcripts and videos were coded separately by statement type (e.g., directive, question) and gender and discipline. Statement types by gender and status varied slightly between transcript and video, but were largely consistent with expectations, suggesting the SCES framework could be applied to larger teams and studies.