Structurational Divergence: A Contributing Factor to Moral Injury Among Health Care Workers

To provide quality patient care, health professionals must be able to effectively communicate interpersonally and in team environments. While a lack of communication and conflict negotiation skills certainly can create obstacles to patient care, the organizational structures in which health professionals do their work also can obstruct communication or make it more difficult. Structurational divergence theory helps identify and explain the negative communication cycles that result when individuals must fulfill obligations from multiple competing systems, each with its own social rules. The structure of health care delivery systems also can result in structurational divergence, as health care workers must often navigate the space between their clinician priorities of improved patient health and the corporate priorities of greater efficiency and profit. This divergence creates tension for the clinician that can lead to burnout and moral injury, especially when the clinician feels forced to act outside the patient’s best interests. Individual efforts to address moral injury are less likely to be successful than collective group action. However, medical education can take steps to prepare students with the knowledge and tools necessary to navigate competing role demands, systemic obstacles, and ethical dilemmas to ensure quality patient care.