Horizontal Hostility in Healthcare: What It Is and How to Address It
- Dr. Sharon Washington
- Jul 1
- 4 min read
Updated: Jul 2
In the high-stakes, high-stress environment of healthcare, relationships between colleagues aren’t just important—they’re vital. Trust and collaboration are the foundation of effective patient care, team resilience, and professional well-being.
July 01, 2025 Dr. Sharon Washington
Table of Contents
What Is Horizontal Hostility?
What happens when harm doesn’t come from supervisors or institutional leaders—but from peers? Even peers who share your background, your struggle, your marginalized identity?
This is the reality of horizontal hostility (also called lateral violence)—a form of peer-to-peer harm that often goes unnamed, especially when it shows up within diverse healthcare teams. It’s subtle, complex, and deeply rooted in systems that pit professionals against one another.
In today’s equity-informed climate, we must revisit this issue through a sharper, more critically conscious lens: horizontal hostility is not just a personal flaw. It’s often a trauma response—born of internalized oppression, scarcity, and institutional neglect.
Horizontal hostility refers to conflict, undermining, or aggressive behavior between individuals of similar status—often peers or colleagues at the same hierarchical level. It can manifest as:
Passive-aggressive communication
Gossip or exclusion
Withholding information
Undermining someone’s competence or authority
Non-collaboration or refusal to assist
Why It Happens So Often in Healthcare
When this harm occurs between BIPOC healthcare professionals, LGBTQ+ colleagues, disabled clinicians, or others with shared marginalized identities, it lands differently. It’s not “just conflict.” It often reflects internalized colonialism, lateral oppression, and survival strategies shaped by systemic trauma (Taylor Rae Roman, FNHA 2021).
Healthcare institutions are historically hierarchical, rigid, and slow to address structural racism, sexism, ableism, and heteronormativity. In these environments, marginalized staff are frequently overextended, under-supported, and expected to perform flawlessly.
This fosters harmful dynamics:
Scarcity Culture: When few marginalized professionals hold leadership roles, the system whispers, “There’s only room for one of us.”
Survival via Proximity to Power: Enforcing dominant norms becomes a coping strategy for maintaining status or safety.
Distrust: Trauma and neglect erode solidarity among colleagues.
Respectability Politics: Colleagues may judge one another based on assimilation to “professional” norms.
As noted in Indian Health Service literature, lateral violence increases when systems fail to foster cultural safety and collective identity.
Further, for many Black, Indigenous, other racially marginalized groups, LGBTQIA+ professionals, and those with visible and invisible disabilities, we are still fighting against systemic bias to gain access to healthcare institutions, leadership roles, and equal compensation. Coming from the margins of society, and navigating significant distance traveled to medicine, is often traumatizing and exhausting. As I've shared before, members of these groups, particularly BIPOC, are still actively desegregating these institutions. Carrying these burdens, while providing care in hierarchical teams, breeds conflict and there is often a lack of trauma-informed practices, time, or space for addressing these nuances and harms.
The Cost of Horizontal Hostility in Diverse Teams
When left unaddressed, peer-to-peer harm among already marginalized colleagues can result in:
Emotional exhaustion and burnout
Isolation and mistrust
Breakdown in team cohesion
Reduced retention and blocked advancement
Deeper internalization of oppressive norms disguised as “professionalism”
In healthcare, these consequences don’t stay confined to the breakroom. They impact clinical performance, patient outcomes, and organizational culture (American Journal of Medicine, 2024).
What Can We Do Differently?
To address horizontal hostility in healthcare, we must go beyond interpersonal conflict resolution. True change requires engaging with systems, behaviors, and unspoken power dynamics.
1. Name It Without Shame
Talk about internalized oppression, lateral violence, and peer harm without blame. Create safe space for honest conversation about trauma and power.
"To name lateral violence is to reclaim the ability to build solidarity with intention." – CSVANW
2. Interrupt Scarcity Thinking
Challenge the myth of zero-sum success. Build interdependent team cultures where collaboration becomes essential for survival.
3. Support Restorative Dialogue
Use trauma-informed, culturally responsive frameworks to address harm.
4. Reframe Professionalism Through Equity Shift the conversation from tone and behavior policing to impact, contribution, and relational trust.
Download the BRIDGE Framework for accountability and communication tools.
5. Lead with Curiosity and Compassion
When harm occurs between peers, particularly among marginalized colleagues, don’t cancel—connect. Judgment is easy. Transformation is harder—and more necessary.
Upcoming Opportunity: Join the Conversation
🌟Friday, July 11 at 12pm EST
Webinar: Interrupting Bias from Patients — Scripts & Strategies for Clinicians
Learn how to hold boundaries, affirm your identity, and repair harm without losing yourself.👉 RSVP Here
Partner with SWC
We offer:
✅ Customized team coaching to address peer conflict and equity fatigue
✅ Equity-centered leadership development for healthcare professionals
✅ Curriculum and climate reviews for inclusive workplace culture
✅ 1:1 coaching for marginalized professionals navigating high-stress team dynamics
🔗 Book a consultation — Use code Session1FREE to try your first coaching session at no cost.
Final Thoughts
Horizontal hostility is not personal drama—it’s a social wound, mirroring histories of oppression and institutional failure. But with the right language, tools, and accountability practices, we can shift from harm to healing.
As one guide reminds us:
"Transformation happens when solidarity replaces shame."–numberanalytics
Let’s stop turning on each other—and start turning toward each other—with clarity, courage, and care.
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