Organizational Performance

Beyond hierarchies: Pushing the limits of empowerment in your medical practice

Since the COVID-19 pandemic started, healthcare organizations have faced tumult in their workforce strategies, sometimes leaving employees feeling demotivated, powerless or disengaged, severely eroding trust in their leaders and organizations. Reported spikes in employee burnout and declines in morale can significantly impact the culture and overall climate of a workplace. Under such demotivating conditions, the notion of empowerment takes on a different meaning: How do leaders empower their teams amid these overwhelming conditions? To answer this question, we must first understand what empowerment looks like today. 

Empowerment is more than a buzzword; rather, it is the cornerstone of progressive and productive workplaces. Yet in the labyrinth of healthcare organizations, true empowerment can be overshadowed by strict hierarchies and the high stakes of patient care. As we march through an era of unprecedented global health challenges, there is an urgent need to redefine what empowerment truly means within healthcare structures. What we advocate is a shift in perspective — one that sees empowerment not as an edict from the top brass but as an embedded cultural value that every healthcare organization should strive to attain.

In healthcare, the traditionally hierarchical models have served a purpose, ensuring a standard of care, clarity of roles and accountability. But as the industry becomes more complex and demanding, this model has limitations in fostering innovation, adaptability and job satisfaction. Healthcare workers, particularly those at the frontline, often find themselves operating within strict parameters, with little room to exercise their individual talents or professional judgment.

A top-down approach, typical in many healthcare organizations, can lead to a stifling work environment. It does not effectively harness the collective intelligence and experience of the staff, who are best equipped to identify and solve the myriad challenges they encounter daily. When decision-making power is concentrated at the top, innovation is curtailed, and the agility to respond to rapidly changing patient needs is greatly diminished.

The concept of empowerment within organizations traces its intellectual roots to the 1980s. It is a concept that has been explored by scholars and practitioners for about four decades. However, in practice, our views of the concept have remained stagnant. Traditionally, empowerment has been associated with delegation, sharing of power and authority, or granting autonomy to team members. While these conditions are related to empowerment, they are too restrictive in scope to accommodate the complex nature of empowerment. 

Healthcare leaders aiming to transform this view of empowerment need an innovative approach for creating a positive environment that reinvigorates employees’ motivation, drive and enthusiasm for work. For that reason, it is time to embrace a different definition and, perhaps, a reimagined perspective on empowerment. Before exploring a new definition, here are three broad classifications outlining the underlying nature of empowerment:

1. The structural approach
2. The motivational approach
3. The leadership approach. 

Early research on the structural approach observed that empowerment is manifested by granting team members decision-making authority and sharing power.1 This traditional approach focuses on the power holder’s willingness to transfer some authority to others. This implies a unidirectional and transactional way to decentralize decision-making and foster employee participation while still maintaining hierarchical control over resources, information and overall institutional power. 

As a motivational construct, empowerment focuses on enabling rather than delegating to promote personal self-efficacy. With the motivational approach, managerial strategies strengthen self-determination and include identifying conditions that remove powerlessness.2,3 This, in turn, makes employees feel powerful. 

The leadership approach to empowerment focuses on channeling everyone’s energy toward an exciting vision for the future and inspiring employees to a higher organizational purpose.4 This approach to empowerment encourages employees to take on challenges, initiate changes and contribute to the process of transforming the organization. 

While all three approaches have merit and have contributed to organizational success over time, there seems to be a preference for the structural approach. Therefore, in practical terms, the current definition of empowerment is anchored in structural empowerment. This concept emphasizes sharing authority, granting autonomy and access to information, thereby equipping employees with the power to act. 

It is time to reshape our understanding of empowerment. For the purposes of this article, the following definition will guide our thoughts and discussion:

Empowerment is the process of energizing team members by developing a strong sense of personal efficacy, a heightened motivation to initiate change and transform the organization, and a close alignment with organizational mission, vision and values. Empowerment is about creating an environment that encourages all team members to connect their roles with a higher purpose, contribute their unique perspectives and thrive by making an impact on the overall organization.

Despite adopting this new definition, the unaltered truth is that empowerment remains a transformative force with enduring potential to revolutionize organizations. When team members experience empowerment, they are more engaged, motivated and committed to their work and company mission, vision and values. Team members take ownership of their roles, go above and beyond expectations, and exhibit higher levels of satisfaction in the workplace. Empowered employees are not just passive participants, they become active contributors, driving the organization forward.

Now that a definition has been established, let us explore the remarkable benefits of empowerment in medical practices. 

• Empowered employees are more innovative. When individuals have the freedom to explore new ideas and experiment with different approaches, they become catalysts for creativity and problem-solving. Empowerment fosters an environment in which employees feel encouraged to share their thoughts, take calculated risks and challenge the status quo. This culture of innovation leads to breakthrough ideas and solutions that drive the organization’s growth and competitiveness.
• Empowerment boosts employee engagement and productivity. When individuals feel trusted and empowered, they have a sense of ownership and responsibility for their work. This ownership drives intrinsic motivation, leading to increased productivity, efficiency and quality of output. Empowered employees are more likely to go the extra mile, seeking opportunities for improvement and taking initiative to drive positive change.
• Moreover, empowerment enhances talent retention and attraction. In today’s competitive job market, employees are seeking organizations that value their contributions and provide opportunities for growth and development. By empowering employees, organizations create an environment that attracts and retains top talent. Empowerment serves as a powerful strategy to build loyal team members who will find meaning in their work and acquire a sense of inclusion and belonging. 

While the benefits of empowerment are substantial, it is crucial to push the limits of structural empowerment within organizations. By doing so, organizations can unlock even greater potential and foster a culture of creativity and continuous improvement. Following are leadership strategies to push the limits of empowerment. 

Connect role with purpose

One of the first steps should be connecting each employee’s role with the organization’s overall purpose. This means providing employees with a clear understanding of how their work contributes to the organization’s mission and vision. This results in employees taking ownership of their responsibilities and feeling empowered to make decisions that align with the company’s values. It is crucial for leaders to clearly communicate the overall vision and mission of the organization, and how each employee’s role plays a critical part in achieving them. Connecting the role with a purpose can create a sense of belonging. This, in turn, will help both the employee and the organization commit to mutual growth in the long term. 

Encourage independent thinking and problem-solving

Challenge employees to think independently and make decisions within their areas of expertise. Encourage them to voice their opinions, challenge assumptions and propose new ideas. By providing space for diverse perspectives, organizations can tap into the collective intelligence of their workforce.

Growth and development

Empowerment requires employees having the necessary skills and knowledge to succeed. Medical practices must invest in growth and development programs that enhance employees’ competencies, boost their confidence and equip them with the tools needed to make informed decisions. Continuous learning is essential for empowering employees to reach their full potential and connect their roles with the mission, vision and values of the organization.

Foster collaboration and shared decision-making

Empowerment should not be limited to individual decision-making. Practice leaders should encourage collaboration and shared decision-making through cross-functional teams and interdisciplinary projects. By involving employees in decision-making processes, medical practices benefit from diverse perspectives, collective wisdom and enhanced buy-in.

Embrace risk-taking and experimentation

Practice leaders should encourage employees to take calculated risks and embrace experimentation as an opportunity for growth and learning. They must foster an environment where mistakes are seen as valuable lessons, and employees are supported in their development journey. Experimentation allows the team to test new ideas and quickly pivot if needed. Teams that are empowered to experiment are more likely to find new and innovative solutions and take ownership of implementing them.

Reframe failure

In an empowering climate, failure takes on a new meaning in an organization. Failure is viewed as an opportunity to learn and adjust, which, in turn, can lead to unexpected outcomes. The team members build on mistakes and quickly regain confidence after experiencing disappointment or failure. This mindset shift allows for a more positive outlook and fosters an environment where employees feel comfortable taking risks, knowing that even if they fail they will learn from the experience.

Promote trust and transparency

Trust is the foundation of empowerment. Practice leaders can cultivate trust by being transparent in communication, sharing information and involving employees in the decision-making process. To help employees feel valued and invested in the organization’s success, build a culture in which open and honest dialogue is encouraged and feedback is welcomed as a tool for improvement. Practice leaders can also provide regular updates on the organization’s progress towards its goals, ensuring that everyone is aligned and working toward the same objectives.

Pushing the limits of empowerment may come with its challenges. It is important to address these challenges head-on to create conditions that support and sustain empowerment.

One challenge is overcoming resistance to change. Empowerment requires a shift in mindset and a departure from traditional hierarchical structures. Effective change management strategies, clear communication and leadership support are essential to navigate this challenge.

Another challenge is establishing clear accountability. Empowerment should not lead to ambiguity or a lack of accountability. It is crucial to define roles, responsibilities and decision-making boundaries. This clarity ensures that empowered employees understand their areas of influence and remain accountable for their actions.

Resistance from middle management can also pose a challenge, as they may feel threatened by empowered employees, fearing a loss of control or diminished importance. Engage middle managers in the empowerment process, highlighting their role as facilitators and coaches. It is important to ensure they understand the benefits of empowerment for both employees and the organization.

Pushing the limits of empowerment in any organization is a transformative journey that can unlock untapped potential, foster innovation and drive sustainable growth. By understanding the new meaning of empowerment, recognizing its benefits and overcoming challenges, organizations can create an environment where employees thrive, take ownership and contribute to the organization’s success.

Practice leaders should embrace empowerment as a catalyst for change, continuous improvement and increased engagement. Furthermore, practice leaders must empower employees with the autonomy, skills and support they need to make informed decisions. It is also essential to foster an environment that encourages risk-taking, collaboration and open communication. 

Empowerment is not a destination but a continuous journey. It requires commitment, trust and ongoing evaluation. By pushing the limits of empowerment, practice leaders and team members can create a culture that fosters creativity, innovation, engagement and a sense of belonging. 

1. Menon S. (2001). “Employee empowerment: An integrative psychological approach.” Applied Psychology, 50(1), 153-180.
2. Conger J, Kanungo R. (1988). “The empowerment process: Integrating theory and practice.” The Academy of Management Review, 13(3), 471-482.
3. Menon.
4. Ibid.