3.1. Leadership as Position: Authority Gradient (e-Learn)

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Watch this drama scene taken from the BBC drama Holby City. It's an interaction between a junior and consultant surgeon.

• How would you describe this leader's style?
• Would you like to work for someone like this? Why/why not?
• What are the potential advantages and drawbacks of this style?
• What type of culture is he creating?
• What do you think the impact would be on the member of staff, the wider team and on the service provided?

In the video clip there was a big difference in the authority of the senior and junior members of the team.

This difference in authority is called the Authority Gradient.

The term 'Authority Gradient' was first defined in aviation when it was noted that pilots and co-pilots did not communicate effectively in stressful situations if there was a significant difference in their experience, perceived expertise, or perceived authority. A number of aviation, aerospace and industrial incidents have been attributed, in part, to the Authority Gradient in the particular team. This is now being applied to patient safety and preventing medical and clinical errors (Cosby & Croskerry 2004).

The concept of the authority gradient was introduced to medicine in the Institute of Medicine report To Err Is Human (2000). A large difference in power is referred to as steep gradient, and a small difference as shallow gradient.

Shallow gradient

Generally-speaking, shallow gradients are good for creating a healthy team climate. They can generate solutions when the problem is unclear or where the remedy is not routine or obvious.

Shallow gradients, where the leader is approachable, make people confident to speak up if there is a problem and more likely to engage in a constructive challenge in the patient’s interest.

Steep gradient

Steep gradients are often appropriate in a crisis or where immediate action is required, where the leader uses their authority to make rapid decisions and direct what needs to happen. However, this may add risk because the decision-maker is making decisions alone, without input from his or her team which could be beneficial.

Implications

In a shallow Authority Gradient team, the sense of being valued will provide the team with a vital pool of goodwill. This would become very useful when the leader needed to exert steep authority in particular circumstances.

In contrast, if something goes wrong in a team with a steep Authority Gradient, the team members are unlikely to respond to the sudden request to share their concerns.

Captain Phil Higton is a former British Airways pilot who now specialises in teaching safety improvement in healthcare and other industries. He emphasises the importance of paying attention to the Authority Gradient:

"There is no cost associated with aiming for a shallow Authority Gradient at work except the surrender of a little pride on the part of the boss and a willingness to be something other than a unit of labour from the juniors. The improvement in working atmosphere and team performance can bring huge improvements in safety." (International Society for Quality in Healthcare webinar, May 2012)

While trying to achieve a shallow Authority Gradient appears to be the ideal state for everyday team working, there are some cultural factors and other aspects which can increase the gradient.

For example, the cultural values of yourself or your colleagues may mean that team members don’t want to speak up because they are afraid of challenging elders or people in authority. Some team members may be concerned that they will cause the leader to lose face if a colleague suggests there might be a problem with what they are doing. Team members could feel that they don’t have the confidence and skills to raise concerns constructively and effectively without damaging relationships or reputations.

All these sensitivities underline the importance of proactively and explicitly developing a shallow Authority Gradient and a pool of goodwill with colleagues.

So how can you create a shallow Authority Gradient? Every time you ask a team member’s opinion, share knowledge, invite questions, admit fallibility or delegate responsibility; this way you are helping to develop a shallow Authority Gradient. 

In teams where you are not in the position of authority, you can contribute by:

• actively engaging in dialogue with colleagues about difficult issues
• be open to challenge
• questioning with curiosity rather than judgement
• developing your skills and confidence to disagree where necessary.

 Civility Saves Lives 

Another approach to thinking about creating a shallow Authority Gradient is by considering the work by Mr Chris Turner, an Accident and Emergency Consultant - https://www.civilitysaveslives.com/

The idea is that incivility in teams impacts on patient safety, therefore Turner and the other clinical professionals involved with this initiative believe that ‘good teams save lives.’ 

Take a look at the Civility Saves Lives website and think about how you work within your team and organisation.  

Do the senior leaders show civility or incivility? 

The Authority Gradient can also be quite subtle. Below you can read excerpts from a historic blog of Rob Webster, now CEO at the West Yorkshire ICS. It illustrates his never-ending quest as a leader to reap the benefits of a shallow Authority Gradient.

To read more on Rob’s blog, visit https://www.wypartnership.co.uk/blog 

Let's look at the key points regarding Authority Gradients.

• Authority Gradient refers to the difference in authority between senior and more junior team members.
• Teams led by a domineering leader experience a steep Authority Gradient.
• In steep Authority Gradients, other team members are more reluctant to express concerns, ask questions or clarify instructions.
• Shallow Authority Gradients make it easier for every team member to comment and contribute, therefore improving patient safety and quality of care.
• People are more likely to respond to the request to share concerns in a shallow Authority Gradient team than in a steep Authority Gradient, particularly when we are civil towards each other
• Cultural norms can affect how people interpret and work with Authority Gradients.
• The Authority Gradient can be reduced by engaging in mundane conversations to build relationships, engaging in dialogue, being open, questioning with curiosity rather than judgement and developing your ability to disagree where necessary.

Use your Action Learning Set (ALS) discussion forum Action Learning Set (ALS) (or Inquiry Application Group (IAG) for GMTS participants) to share experiences of a relationship at work where you have had an unapproachable manager.

Think also about any experience you have of a shallow Authority Gradient, where your manager has been very approachable.

• What effect did both these have on the work you were doing?
• What are the advantages and disadvantages of each?

Make time to ask some members of your team how approachable they think you are. It may be that this can be discussed as part of your feedback, or you may just choose to ask them in passing.

From your work on the Authority Gradient, what new insights do you have about your own behaviour as a leader?

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