Ripple Effects of Hospital Team Faultlines on Patient Outcomes

Ren Li, Virginia Choi, Michele Gelfand

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Medical errors are rampant across healthcare settings, imposing a significant burden on patient safety. Here, we examined the ripple effects of diversity splits, or faultlines, within hospital teams on patient safety and care. Hospitals consist of hierarchical, mixed-gender, and multiracial units that are prone to conflict. Within a diverse unit, faultlines can occur when multiple attributes (e.g., gender and race) of unit members align and divide a unit into two or more homogeneous subgroups. Yet, little is known about how such faultlines influence patients. Hierarchical path modeling of data collected from 1,102 hospital employees and 4,138 patients across 38 hospital units illustrated that when strong faultlines formed through homogenous subgroups within hospital units resulted in decreased civility among staff. This incivility was related to higher rates of medical error and patient deaths. A 10% increase in unit incivility was linked to a maximum 8.87% increase in healthcare-associated infection rates and a maximum 10.59% increase in mortality rates. However, we found patients within units high on collaborative cultures for managing conflicts—that fostered mutual respect, active listening, and openness to differing opinions—experienced fewer medical errors and lower mortality rates, regardless of strong faultlines. These findings offer an evidence-based, culture-focused approach to reducing medical errors and improving the quality of patient care.

Original languageEnglish
Article number2341120
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number47
Publication statusPublished - 6 Nov 2023


  • culture
  • faultlines
  • hospitals
  • incivility
  • patient safety

ASJC Scopus subject areas

  • General


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