Hierarchy and Power in the Australian Health Care System

This essay explores the dominance of power and hierarchy within the Australian healthcare system with theoretical perceptions of Marx and Foucault. It discusses the impact of power and hierarchy on nurses in healthcare and the historical background of the Australian healthcare system. The essay also illustrates sociological theories including sub-theories such as interaction theory and theory of conflict.

Running Head: HEALTH CARE SYSTEM IN AUSTRALIA
HIERARCHY AND POWER ARE INTRINSIC TO THE CURRENT HEALTH CARE
SYSTEM IN AUSTRALIA
Students ID:
Name of the University
Authors Note

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Introduction
Background
Hierarchy is a layered social setting that conceptualises higher and subsidiary
relationship's, in rank and direction. In the case of healthcare, the medical pecking order is
one of the examples of an inter-professional hierarchy. Power is the prevalent part of the
material within the organisation that are usually used by the managers in authority. They
utilise power to accomplish objectives and to strengthen their own position. The professional
hierarchy within Australian healthcare is developed when the participants in healthcare work
together to illustrate the practices of medicine.
Power and hierarchies are linked within the level of interpersonal relationships
present amongst the doctors and nurses. In the healthcare system, those hierarchies can
present themselves in the variety of areas. In healthcare professional observes hierarchy and
power among different types of clinical professionals like doctor’s nurses and other medical
workers. Power hierarchies can also take place in between nursing care provider and their
patients. These roles are intrinsic to the Australian healthcare system. The way has been
conceptualised by the relationship in between medicine and health professionals within the
hospital settings.
The essay will explore the dominance of power as well as the hierarchy within the
Australian healthcare system with theoretical perceptions of Marx and Foucault, by
reproducing on healthcare governance and its functionalist impact on nurses through politics
and policy to a mechanism.
To be specific, the approach in the study focuses on the root cause of ill-treatment of
the patients caused by the nursing care providers when they fail to contribute to the social
duty. Apart from these, the study also illustrates sociological theories including sub-theories

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such as interaction theory and theory of conflict. From the use of these theories, the study
provides learning and social interactions on the individuals of the society.
Discussion
Historical background of Australian healthcare system
According to Saks (2015), there are historical, cultural and behavioural justifications
behind the continuation of the state of health affairs. From the historical perspective, gender
divisions are prevalent in healthcare roles, with make doctors seen to be hierarchically
powerful in comparison to the submissive female care providers. This has led to the
imbalance of power and ongoing competitions in the doctor-nurse relationship; however, this
kind of dominance was mostly seen over a period of the last 40 years. Alongside, the
increased dimensions of services provided to the patients, the gender constrained roles and
other cultural stereotypes have broken down across Australian society. Historically, it can be
stated that an ideal healthcare system must consist of a well-functioning and effective team of
inter-professional. As healthcare is one of the most crucial services, it is important to
maintain the harmony and healthy work relation among the different professional staffs in
order to provide quality service to the people. Yet, a number of researches have revealed that
they have noticed a significant amount of dominance of doctors over the nurses in the
workplace. Due to the inter-professional conflict between doctors and nurses, several gaps,
such as competency problems, misunderstanding, incompatibility, gender issues, socio-
economic conflict, and miscommunication, arise. As stated by Ameen (2017), the
relationship between doctor and nurse is more complicated than any other professional
relationships as doctors belong to the upper level of the social hierarchy and therefore employ
power to dominate the nurses in the decision-making processes. This conflict between
professional is becoming a growing concern over the years.

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As researched by Jerng et al., (2017) in a case study, nurses were the ones being
reported most of the time (57%) and the nurse-doctor conflict was the most common
occurrence (67%). Disagreement and interference were the major causes of these conflicts.
Their research demonstrated a few incidents, which were recurring issues. Such as, the nurse
declined the doctor's request to stay with the patient during examination. Doctors are prone to
commenting and insisting on giving opinions on patients and nurse's jobs out of their care
teams. Nurses were also concerned about the wrong work distribution of the doctors and their
unacceptable behaviour. The doctors also demonstrated their authoritative nature while
ordering the staffs of another care team unrelated to him to move a patient from the
emergency room toward without. Hence, it is evident that a power dominance exists between
doctors and nurses do the hierarchical position of the professionals.
The female workforce mostly the nursing care providers play a crucial role in the
Australian system. In Australia, more than 50% of the women are operating in the workforce.
However, within the healthcare industry, almost 75% of the women account for the
healthcare staff in Australian. There are poor stereotypes of women working in nursing and
decision making position present within the healthcare industry. It has been seen from the
historical background that women have been represented as inferior that can affect the
standards of healthcare services and patient protection status.
The healthcare profession has the power to develop collaboration in between
professional as well as a macro level hierarchy of power. Kuper et al., (2017) supported this
approach, with a presentation of business among the healthcare professionals, under the
capitalism of having four different stages. In this the most influential level is the stage of
finance and industrial activities, the second level is the stage of capitalism, and the third is the
medical activities whereas the fourth level in the community members.

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Discussion on power and its impact on nursing care provider
According to Ameen (2017), power is a complicated and extensive concept in nursing
that has a decisive influence on the accomplishment of duties and satisfaction of professional
objectives. Power is a completely controversial concept that involves various interpretation.
In the today's world nursing care providers act as a strategic decision maker, manages the
human resource and analyses the quality through which they are able to identify the
complicacies of healthcare areas.
On the contrary, Sharp, Mcallister & Broadbent (2018) stated that a powerful nurse
has the capability to increase the understanding in between patients and the customers.
Nursing care providers have the capability to influence the health policies and protect the
patients against safety by increasing the quality of healthcare. Despite their capability, the
nursing care provider is not perceived as superior or in hierarchical position in comparison to
a healthcare professional.
In several countries, there has been a declining healthcare power that has been seen to
have increased interest in the management of health. However, in Australia, these growing
social traditions are increasingly influencing the dominant position of healthcare professions.
However, utilisation of power dynamics in healthcare may often enable bullying.
Discussion on Hierarchy and its impact on nursing care provider
According to Pinnock et al., (2015), hierarchy is a layered social setting that
conceptualises higher and subsidiary relationship's, in rank and direction. In the case of
healthcare, the medical pecking order is one of the examples of an inter-professional
hierarchy. As stated by Rashid et al., (2017) historically healthcare professionals has
sustained its position of dominance and hierarchy within the health care system through the

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contemporary social trends like managerialism, proletarians and the corporatizing of clinical
activities that are challenging the traditional power of health system.
In the after consequence of large-scale failures in the health care quality in the
healthcare organisation has often been characterised as hierarchy bullying. On the contrary,
Kuper et al., (2017) stated that health professional’s power and hierarchy could also be used
to improve the interpersonal unity by focusing on shared team objectives and increasing
understanding amongst team members. It is due to the complicated structures of hierarchy
that the nursing care providers are negatively influenced in performing their work. Orlowski
et al., (2016) argue that the system of services in healthcare differs from one country to
another; there may be common elements that include a strong mechanism of funding, a
qualified workforce. Marken & Carey (2015) states that all the services of the Australian
health care system are collaboratively funded by the federal government, state, territory as
well as local government and health insurers.
Theory 1
The Foucauldian analysis is a sociological theory that is developed by French
philosopher and sociologist Michael Foucault. Foucault's concept of medical gaze reflects on
the socio-cultural stereotypes and the gender discrimination used in the medical professions.
Therefore, it has been seen since long period that the nursing care providers lack ample
amount of knowledge than doctors because of which they are treated as inferior in their work
field. In this context, one of the most important concepts in Foucault theory is signified as
discourse, discourse is illustrated as the group of statements that refer to the meaning of
language, image and contents that produce a specific version of events for an individual
group (Bish, Kenny & Nay, 2014). Specifically, it is an individual capability to translate
various events related to culture and historical background. On the contrary, Wilkin &

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Boudeau (2015) stated that the other necessary concept of Foucault’s theory is power.
Foucault in this context believed that there is a strong connection between power and
knowledge. This relationship is highly evident in the healthcare profession, that consists of a
group of people who have expertise skills and they tend to obtain power from this knowledge.
Lastly, the perception of Foucault has a potential influence on the perception of health and
illness. In this context, Foucault's theory perceives medicine as a part of social, political as
well as financial trends that depend competently on the gaze of the individual and society as
the power of control.
Theory 2
Conflict theory of Karl Marx can be used in this study to explain the hierarchy and
power between different social classes that do not emphasise on the demographics of women
and the middle class. The workforce working in healthcare is inclusive of predominant
females that 78.3 % (Salter, 2016). In this context, an example of power and hierarchy can
be explained by representing the fact by which the doctors maintain the dominance in health
care through subordination and sexual classification of the workers. Allied health
professionals are essentials in the Australian system of health care as they work in practice
with the individual care receivers. As stated by Waring et al., (2016) the primary emphasis of
the allied health professionals is on providing patient centred care through the treatment and
by diagnosing a broad range of health conditions. Women in context account for 70-80% of
the allied health workforce including the duties like Aboriginal and Torres Strait Islander
health professionals and psychological professional (Pinnock et al., 2015). However, these,
duties are insurance to the Australian health care system that is mostly represented by the
relationship in between medicine and allied health practitioners. In this context, nursing care
providers and health are limited in their practising scope in spite of having the capability to
perform tasks similar level to the doctors.

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This is due to the predominant power and authority of the health care practitioners
that are prevalent in the clinical organisation for a long period. Since power is the primary
requires managing the structure within a healthcare organisation. Therefore, decision-making
authority is formally given to the higher authority of the organisation. As stated by
Hutchinson & Jackson, (2015), certain power and responsibilities come from the individual's
position. In this respect, the national health act provides the division of power for the
privileges that demonstrated the classification of power. Therefore, the overall perspective of
Marxist presents the prevalence of power and hierarchy within the Australian system of
healthcare.
Power and Australian system of healthcare
Criticism asserts that conflicting theory of health and medicine is far more harsh and
critical towards care provider’s motivation. Scientific medicine has highly helped to improve
the health status of the people around the world. According to Thomson et al., (2015) the
theory is concerned with the development of the meaning of health and sickness through the
ongoing process of communication. From this perspective, people tend to develop a
subjective notion of a variety of illness.
Scully (2015) pointed that healthcare in a capitalist society like Australia is not
capitalist as delivers value and is distributed ins accordance to the requirement of the market,
rather it offers a dominant class relationship in between employees. Wilkin & Boudeau
(2015) argues that the use of “class” may be appropriate here as it disregards the view of
minority community members who are systematically disadvantaged in terms of education,
employment and legal system. As such, medical dominance is dependent on the interest of
the healthcare professional correlated with the dominant class . It can be argued that without

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capital, the healthcare professional is powerless. This is because power is authorised for the
bourgeois, not the healthcare profession.
Impact of power and hierarchy on nurses in health care
It can be said that throughout history, doctors and nurses have shared a complicated
relationship with each other that has often been influenced by social condition, gender and
power within the Australian healthcare. As stated by Mannion & Davies, (2015), it is quite
possible from the study that it is the strong opinion of the doctors that they hold in themselves
about the nurses could have inflicted the status of the nurses during the period of pre
nightingale decade. It was since then that the nursing care provider were considered to be ill
paid and unfit in comparison to other occupations. Since then, the nursing professional went
through a process of professionalism where the roles were refined and formal reputations
were redefined. However it is the dominance and power structures if the doctor within
Australian healthcare for which nursing skills were devalued in the healthcare. In this, nurses
were expected to remain quiet and were expected that the ward rounds were operated
smoothly without them. There were two major factors, which influenced the nursing work,
one is education and another is professional responsibilities that were inferior to the doctors.
Conclusion
From the study, it is evident that power and hierarchy is intrinsic within the system if
Australian healthcare that are mostly inculcated within the social stereotype of designation
and knowledge. However, it is evident that the healthcare professionals in Australia tends to
dominate over the nursing care provider, by which they plays an intrinsic role in acting as a
source of power and hierarchy in the healthcare system in Australia. However, from the
perspective of capitalism theory, the power of medical system lies in the level of capitalism.

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This is because authors in the study have explained that medical systems tend to collapse and
conflict with business.
Although, the approach taken by the healthcare professionals helped to protect the
wellbeing of the society, but the problems and challenges faced by the nurses due to power
and hierarchy structures remained prevalent. As a result of which nursing care providers in
Australia has never been valued like the doctors. May be it is the Australian society, that is
highly equipped with healthcare facilities not only through medical facilities but also through
government provisions and social faculties, but it lacks proper structures of hierarchy and
power amongst nurses. It can be this argued that hierarchy and power are evident in the
health care system in Australia because all the people present in the society are dependent on
health care provisions.

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