# Leadership in Healthcare (CRM)

*Tom Geraghty · Power, Safety & Human Error, History & Foundations*

An essay on how leadership and management in healthcare might evolve by drawing on aviation and Crew Resource Management. As healthcare systems grow in scale and complexity, hierarchies and management layers become necessary for operational capability, but they also create sometimes steep power gradients — and it is these power dynamics that can worsen rather than improve patient outcomes, through their impact on psychological safety and the resulting safety silence among those at the sharp end (drawing on Green et al. 2017, O'Donovan & McAuliffe 2020, Grailey et al. 2021). The piece examines why people don't feel safe to speak up in healthcare's power structures, how leadership and organisational structure shape psychological safety, and what the future might hold for mitigating these effects — with aviation's CRM as the central analogue, since aviation faced and substantially addressed the same authority-gradient problem. Grounded in the author's own work with healthcare organisations. Referenced in the Reducing Power Gradients piece as further reading on the aviation-to-healthcare translation.

- **This page:** https://explore.psychsafety.com/n/the-evolution-of-leadership-and-management-in-healthcare-lessons-from-aviation-and-crew-resource-management/
- **Read the full article on psychsafety.com:** https://psychsafety.com/the-evolution-of-leadership-and-management-in-healthcare-lessons-from-aviation-and-crew-resource-management/
- **Interactive map:** https://explore.psychsafety.com/?node=leadership-healthcare-crm

## Connected concepts (6)

- [Communication Failures: An Insidious Contributor to Medical Mishaps](https://explore.psychsafety.com/n/sutcliffe-lewton-rosenthal-2004.md) (paper)
- [Crew Resource Mgmt](https://explore.psychsafety.com/n/crew-resource-management-and-psychological-safety.md)
- [Typologies of Power](https://explore.psychsafety.com/n/typologies-of-power.md)
- [Psychological Safety in Healthcare](https://explore.psychsafety.com/n/psychological-safety-in-healthcare.md)
- [Reducing Power Gradients](https://explore.psychsafety.com/n/reducing-power-gradients.md)
- [Sharp & Blunt End](https://explore.psychsafety.com/n/the-sharp-end-blunt-end-of-education.md)