By Mariam Krikorian Atkinson, PhD

When I first set out to write this post about unclear roles in healthcare, I found myself thinking back to my early days in graduate school. I had just begun an observational rotation in the hospital medicine department at a local children’s hospital. At the time, I didn’t yet have a defined research focus, but the hospital medicine department chair offered simple guidance: “Come observe for a few weeks and see what stands out.” So I did, week after week with notepad in hand, watching how care was delivered across a highly skilled, deeply committed team.

It didn’t take long for a pattern to emerge. Multiple clinicians each with overlapping expertise were often involved in the same aspects of care. While this redundancy sometimes added value, it just as often created confusion— duplicated efforts, missed handoffs, and uncertainty about who was ultimately responsible. That experience shaped my early research and led me to a central question that still resonates today: in complex care environments, who’s actually in charge of what?

Years later, in both my academic work and consulting practice, I see this same issue surface again and again. Healthcare teams are collaborative by design, yet many organizations still struggle with inefficiency, frustration, and breakdowns in coordination. The root cause is often surprisingly simple: unclear roles.

What Unclear Roles Actually Cause

Unclear roles are more than just an inconvenience. They create predictable problems.

The Assumption Underlying the Problem

In many clinical settings, there’s an implicit belief that everyone knows what they’re supposed to do. In reality – roles shift across contexts and responsibilities overlap. Seldom are expectations made explicit.

Roles matter because they help get the right person involved in the right situation. A 2026 study by Jillian Chown and Carlos Inoue, examining more than 15 million births in Brazilian hospitals, found that introducing a specialized nursing role helped hospitals better match patients with providers whose expertise fit their needs. Rather than simply adding another type of clinician, the new role created a clearer pathway: nurses could handle lower-risk deliveries while physicians focused on more complex cases. The lesson is simple. Having the right expertise on a team isn’t enough- you also need a clear way to connect that expertise to the right patient at the right time.

Unclear roles can also make it difficult for organizations to see the capabilities they already have. When leaders don’t have a clear picture of who can do what, the answer can too easily become adding more staff, when the better answer may be figuring out how to use existing expertise more effectively.

Unclear roles happen all too often for many reasons. But health care is especially prone because the work is so dynamic and interdependent. Static role definitions don’t hold up in real work environments.

What High-Functioning Teams Do Differently

It’s not about rigidly defining roles; it’s about designing roles that make ownership and expertise easier to navigate, then continuously clarifying them as circumstances change. Three main recommendations for doing this:

To make all this second nature, at the end of any discussion, ask: “Who owns the next step?” It sounds basic but taking a moment to this eliminates a huge amount of ambiguity.

Role clarity isn’t simply about assigning tasks to individuals. Roles can also serve as infrastructure for coordinating expertise, making it easier to know not only who owns a task, but who is best positioned to handle it. In other words, role design works best when it is aligned with the way work actually flows.

Bottom Line

Unclear roles don’t just create inefficiency and frustration, they create risk. When people aren’t sure who owns what, work slows down and details get missed. In health care, “I thought someone else was handling it” can have some very real consequences.

I’ve seen this over and over again in my consulting work. In one organization, several highly capable clinicians were involved in the same patient population, but responsibilities had gradually blurred. This resulted in duplicated work in some areas and gaps in others. The solution wasn’t more rules. It was clarifying who owned what, when responsibilities shifted, and who needed to be brought in.

Role clarity isn’t about drawing rigid lines around people’s jobs. It’s about creating enough clarity for people to work together effectively. When there’s an opportunity, ask “Who owns the next step?” Ask it at the end of a meeting, handoff, or clinical discussion, and ask it again when circumstances change. A few seconds of clarity can prevent hours of confusion later.

References

Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS: Strategies and tools to enhance performance and patient safety. U.S. Department of Health & Human Services. https://www.ahrq.gov/teamstepps/index.html

Chown, Jillian, and Carlos Inoue (2026). “Specialized Roles and Task Allocation in Organizations.” Organization Science .

Hackman, J. R. (2002). Leading teams: Setting the stage for great performances. Harvard Business School Press.

The Joint Commission. (2017). Root causes of sentinel events. https://www.jointcommission.org

Krikorian (Atkinson), Mariam Lisa (2016). “Who’s the Physician in Charge? Generalist and Specialist Jurisdictions in Professional Practice.” PhD diss., University of Southern California.