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A participation failure where some voices are structurally amplified while others are structurally muted, regardless of the merits of their positions. Asymmetric participation corrupts institutional learning by biasing information flows. IOA identifies and corrects asymmetric participation before it causes systemic distortion.
A hospital's quality improvement process structurally favours physician voices over nursing voices, not through explicit policy but through meeting scheduling, documentation requirements, and professional hierarchies. The resulting 'improvements' miss nursing-visible problems.
Section 4.1: Participation and Procedural Legitimacy