en General General Debate Article Debate Article <strong>&nbsp;&nbsp;</strong>&nbsp; Hierarchical leadership is an antiquated practice seen commonly in health care, whereby strictly defined roles and their importance are overemphasized. This can have unintended negative consequences in a pressurised environment. In contrast, flat hierarchies are gaining popularity, as they afford the flexibility and equality that is vital in a caring environment, where no one should be afraid to raise concerns and voice their opinions.<br> Are hierarchical power structures inhibiting hospitals from achieving effective medical leadership and quality care? With increasing pressures on the health care system, is it time to move away from a hierarchical power structure that has been present for over 70 years? To inspire culture change, is it time to explore alternatives, such as a flat hierarchy? Hierarchial Leadership, Leadership In Healthcare, Patient Safety, Reverse Ward Rounds 880 883 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-5891-1&slc_lang=en&sid=1 Navindi Fernandopulle navindif@gmail.com 200319475328460065139 200319475328460065139 Yes MBBS, Bsc Gloucester Royal Hospital, Gloucester, UK