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Accountability should follow evidence, not hierarchy. But when status, relationships, tribal belonging or institutional value influence who receives context, scrutiny or protection, accountability itself becomes a governance risk.
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Healthcare’s deepest divisions may exist within professions themselves. ISI examines hidden hierarchies, protection, power and their implications for accountability, organisational justice and patient safety.
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Healthcare has invested heavily in teamwork, yet patients still experience fragmented care. This paper argues the deeper problem is professional tribalism and introduces governance frameworks to help boards protect the patient journey across organisational boundaries.