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Structural integrity
Structural authority

A hospital introduces a new electronic health record system, selected by executives who’ve never used it. Frontline nurses struggle with clunky interfaces that double documentation time, while patients wait longer for care. Despite numerous complaints, concerns never reach decision-makers. The project is declared a success based on implementation metrics, while care quality suffers.

This disconnect between decision-makers and those implementing decisions plagues organizations of all types. Traditional hierarchies act like information filters, with each layer removing critical context before messages reach the top. This results in leaders making consequential decisions based on sanitized, incomplete information.

Without structured representation, teams can become voiceless within their own organizations. Valuable ideas wither on the vine. Preventable problems fester. The rule of law (2) exists on paper, but in practice, different standards apply to frontline teams versus leadership. Despite claims of transparency (32), teams lack visibility into how decisions are made. Over time, this erodes structural and psychological safety (3), as speaking up seems futile or even risky.