Power is not a position or title that a person has within an organization it’s not a thing, quality, or trait. To activate people’s agency, this reality must be accounted for not only in co-design and co-production, but also in the distribution of power. People who identify with an in-power group experience the benefits of a system designed for their advancement, while those in the out-power group do not. The outcomes generate systems of oppression, or the cultural values and habits that support the advancement of one group (e.g., white people, men, senior leaders, physicians) through the oppression of another group (e.g., people of color, women, frontline staff, patients). In health care, this includes removing disparities in access, utilization, and outcomes across race, gender, age, sexual orientation or gender identity, socioeconomic status, religion, and other characteristics historically linked to discrimination or exclusion.įrom this perspective, leaders need to look at improvement projects and ask, to what extent are power disparities underlying causes of the problem? The unequal and inequitable distribution of power is the result of choices of individuals and groups in positions of power at the expense of those not in power. It is critical to see and act on the ways that prejudice and power combine to generate inequity at individual, interpersonal, and system levels. All people exercise power in varying degrees and have prejudices and biases, both implicit and explicit.
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