HSC210 Assignment: Hierarchy and Power in Australian Healthcare System

This essay critically examines the intrinsic nature of hierarchy and power within the Australian healthcare system and its influence on healthcare practitioners. It begins by highlighting the hierarchical structure, from intergovernmental cooperation to the grassroots level, and its impact on ...Read More

Running Head: HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 1
Hierarchy and Power: Australian Health Care System
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HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 2
Hierarchy and Power: Australian Health Care System
Across the globe, healthcare delivery and patient treatment have traditionally been
influenced by hierarchical power structures that emerge from inequalities in the access of
socioeconomic elements by different individuals and/or sections of the society (Yang, 2008).
Power hierarchy intrigues are also experienced at the healthcare facility setting in which case
different healthcare stakeholders struggle to control power and control within the healthcare
system. The Australian healthcare system possesses an ingrained hierarchical power structure
and indeed it has become intrinsically important in influencing the delivery of healthcare.
However, this hierarchical power structure has had its benefits and downsides with regard to
different sociological health care orientations, healthcare delivery, as well as impacts and
implications for healthcare practitioners practice and patient outcomes. This paper is focused on
examining how intrinsic are hierarchy and power in the current Australian healthcare system as
well as how this may influence me as a healthcare practitioner. In doing so, insights from
sociological theories; Conflict Theory, Functionalism and Feminism will be employed to
extrapolate arguments through the “structure-agency” sociological discourse concept. Moreover,
the biomedical model will be utilized to underpin these sociological theories given that it does
not support a sociological perspective in healthcare.
The healthcare system in Australia is currently ranked as one of the best healthcare
systems globally by the Organization for Economic Co-operation and Development (OECD)
(OECD health statistics, 2016). Premised on a totally hierarchical structure with its apex
constituted of intergovernmental cooperation and collaboration in decision making of policies
and programs within the Council of Australian Governments (COAG), the Australian healthcare
system trickles down this hierarchical phenomenon to govern not only the interrelationships of

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 3
different healthcare practitioners but also impacting on the quality of healthcare delivery at the
systems grassroots. Australian healthcare System has, by and large, promoted the positive
percolation and administration of authority and powers in producing positive patient treatment
outcomes especially with the advocacy of a person-centered care approach.
Nonetheless, hierarchy and power intrigues will always not lack even within the best
healthcare systems (Nugus, et al 2010). The Australian healthcare system posits its own share of
power and authority intrigues under its elaborate hierarchical system. The ideal healthcare
interdisciplinary relationship, as well as the perfect patient-provider association, is always
composed of mutual respect and faith between these different parties which by extension lead to
healthy partnerships and collaborations. From this proposition, it can be seen that power
hierarchies in healthcare can lead to not only effective practitioner to practitioner relations but
also productive patient-provider associations. However, in the event that hierarchies and power
negatively permeate the healthcare industry, then these ideal positions become entirely
unreachable.
At the healthcare facility level, power hierarchies have been blamed for major medical
mistakes and errors in which case junior practitioner feel intimidated or shy from giving their
opinion on how best patients deserve to be treated and managed. For a long time, there has been
a tussle of power, dominion, and control of medical procedures between specialized doctors,
doctors, registered nurses, physicians, and other senior practitioners and their junior counterparts
such as pharmacist, clinicians, physician assistants, enrolled nurses, cleaners and others. The
control of power by a few healthcare practitioners and steep hierarchical gradient has also been
linked to other major workplace issues such as bullying, intimidation, segregation, and
discrimination (Liberatore, & Nydick, 2008).

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Healthcare professional hierarchy and powers emanate when healthcare professionals
start defining the practice of healthcare service delivery. Analyzing healthcare practice in its
varied, complex, and multifaceted components constitute boundary setting between different
healthcare practitioners. Some practitioners may perceive that their power emanate from
legislation, and professional standings as enshrined in the legislative tenets and regulatory boards
governing such professions. As such, certain healthcare professionals may perceive themselves
as the custodians of power in the healthcare hierarchy gradients since they tap the same directly
from the established legislation and regulatory bodies.
Patient outcomes are the most impacted amidst this scramble for power and dominion in
the healthcare facility hierarchical power ladder. One yardstick upon which powers are sort by
different professional associations is their alleging that they can be in a position to elevate patient
treatment outcomes than other healthcare practitioners. The cost of providing health care and the
accessibility of the same by patients are also key factors upon which different healthcare
practitioners base their argument upon while seeking more power and higher ranking in the
healthcare system. The battle for supremacy amongst different healthcare practitioners at the
local, state and the federal level has been incremental and intense but certainly to the advantage
or disadvantage of consumers of healthcare services.
Hierarchies and power inequalities between different healthcare professionals have a
direct impact on the delivery of health care services to patients and their families. This is
especially the case in Australia where person-centered approaches to patient treatment and
management have been emphasized and embraced to be the principal mode of treating patients.
As opposed to the paternalistic viewpoint for patient care exhibited by the traditional patient-

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 5
healthcare provider relationship, patient-centered kind of care demands that healthcare
practitioners are supposed to advance treatment to patients in consultation with them.
Patient-centered care seeks to break power hierarchies not only at the healthcare
providers’ level but also those between patients and healthcare providers (Pulvirenti, McMillan,
& Lawn, 2014). This approach to healthcare goes a long way in eliminating any treatment
procedures and medical mistakes. Balanced patient-provider power relations especially in
decision making on how treatment is supposed to be carried out by and large increase s patient
safety and improved patient treatment outcomes. Healthcare practitioners ought to remember that
under this dispensation, they only bring their nursing, clinical and/or medical expertise and
experience while patients bring on board their perceptions of the quality of life and healthcare
goals they are seeking in their treatment. By merging the two, patients are able to access quality
health care they would wish for as opposed to being dictated upon.
Several sociological perspectives on health and healthcare have been advanced by
different sociological theorists to explain the impact and implications of power hierarchies in
healthcare systems at the patient treatment level, the health facility level and at the society level.
The conflict approach perspective is one such perspective that has been instrumental to this end.
The philosophy informing the conflict approach perspective is premised on the need to have a
fair and just society in which power inequities emanating from peoples’ socioeconomic
differences do not bar anyone from freely accessing quality and affordable healthcare. These
socioeconomic differences impacting on different individuals’, communities’, and social settings
’ ability to equitably access quality healthcare are called Social Determinants of Health (Morteza
Abdollahi, et al., 2008). Society stratification in terms of class, race, religion, wealth and
material wellbeing, regions, and neighborhoods have led to social hierarchies that have aided the

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emergence and sustenance of power imbalances between different society setups leading to
disparities in the supply of positive social determinants of health that promote good health to all.
In a report advanced by the Commission on Social Determinants of Health of the WHO
dubbed “Closing the gap in a generation: Health equity through action on the social
determinants of health" in 2008, the WHO proclaimed that one area that need to be addressed by
nations globally with regard to social determinants of health is daily living conditions of citizens
(World Health Organization, 2008). Daily living conditions such as social protection, access to
quality healthcare, fair employment, and provision of healthy physical neighborhoods can go a
long way in curtailing all the basic social power hierarchies that may exist in the communities.
Other social determinants that need to be balanced off in communities include resources
distribution, political empowerment, gender inequalities, equitable access to health programs and
initiatives and economic inequalities.
The WHO is of the view that the uneven supply of social determinants of health should
not be perceived as a “natural” occurrence but indeed ought to be seen as the outcomes of
inadequate management of social policies. Poor people are most likely expected to undergo
adverse social determinants while more or less wealthier people are likely to experience less
stringent social determinant (Navarro, 2009). These society power hierarchies determine the
quality of healthcare a person is likely to access with less fortunate groups in the society
accessing healthcare that is of low quality than their well-endowed counterparts. For instance, in
Australia, Aboriginal and Torres Strait Islander peoples and people of other cultures are likely to
face some sort of discrimination in their quest for health services based on their cultures and
social class.

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Through the 1986 Ottawa Charter for Health Promotion, the WHO envisaged the
objective of achieving “Health for All” by year 2000 by eliminating all negative social
determinants of health (Lee, 2015). The Australian society is a much-diversified society with
people with all manner of backgrounds, cultures, races, tribes, social class, orientations, and
socioeconomic abilities. Australian federal, state and regional governments ought to come up
with adequate measures of eliminating or minimizing all social determinants that have the
potential of discriminating against particular sections of the society.
Parsons’ (1951) functionalist perspective approach argue that healthy conditions and
good medical care are critical for effective society functioning since unhealthy status impairs
people’s abilities to do their duties in the community. When huge numbers of individuals are of
ill-health, then the society is bound to suffer from dysfunctionality and its stability is adversely
impaired. This viewpoint by Parsons is pretty critical in building healthy societies. Besides not
incorporating a viewpoint that people’s ill-health is by and large connected to their social
backgrounds as well as their ability to access quality healthcare, critics also attack his ideology
that when seeking healthcare the relationship between physicians and their patients ought to be
entirely hierarchical in which case the physician gives orders and the patients only have to follow
them. With the emergence of patient-centered approaches to healthcare delivery, such an
argument is completely untenable.
The symbolic interactionist perspective to health and healthcare delivery is of the view
that health and illness are simply social constructions that exhibit little or no objective reality
(Charon, 2010). Moreover, the perspective argues that it is only the society that can perceive
conditions as part and parcel of ill-health. Though giving the society the opportunity to define
what it perceives to be health or ill-health, this perspective has more or less given healthcare

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practitioners an upper hand of impacting what they think constitutes adequate health care to their
patients. For instance, there is a possibility of healthcare practitioners to use complex medical
jargon to explain a patient’ ill-health as opposed to using simple terms that laypeople can
understand. The hierarchical orientation of this perspective creates knowledge inequalities
between patient and their care providers. This by extension bars patients from participating in
their own care as advocated for by the patient-centered approaches.
The constructionist mindset is inclined to the view that knowledge and practices that are
by and large taken to be of normal nature or simply taken for granted can indeed be understood
when subjected to their historical and social contexts (Aksan, Kısac, Aydın, & Demirbuken,
2009). In the healthcare industry, to understand healthcare knowledge, then such knowledge
ought to be socially constructed within the context of a specific authority regime. Indeed, this has
essentially been the basis of critiquing the medicine power relations as showcased by noble
works of Foucault. Foucault oversaw that medical power can operate though diffuse and diverse
local factors as opposed to via central and unified power structures. In doing so Foucault
deduced a means of analyzing society medicalization and by extension showcased that power
and knowledge are significant at comprehending medical organizations as well as the manner in
which the moral character of disease types functions in quotidian sceneries (McHoul, McHoul, &
Grace, 2015).
Arguably, like any other health care system, the Australian healthcare system is subject to
hierarchical power bombardments of its diverse stakeholders. When this happens positive and
negative outcomes can emerge. At the practitioner to practitioner level, interactions need to be
smoothened to allow for mutual relationships between practitioners. This goes a long way in
increasing efficiency and productivity of the healthcare organization and patient health outcomes

HIERARCHY AND POWER: AUSTRALIAN HEALTH CARE SYSTEM 9
(Nugus, et al., 2010). At the patient-provider level, patient-centered kind of healthcare delivery
have been deduced to be more efficient besides having abilities of eliminating power controls
that can impair smooth healthcare delivery. Irrespective of the source of power that informs the
hierarchies in healthcare provision, these powers must be employed for the positivity of patients’
outcomes. At the society level, social determinants of health need to be balanced off between
different community and social setups. This is instrumental in advancing a fair and just society in
which all persons can equitably access healthcare (Yang, 2008). Stakeholders in the Australian
healthcare system need to draw insights from the sociological theories and perspectives in
arriving at their policy decisions. If well managed, hierarchical structures both at the society
level as well as at the healthcare facility setting can lead to positive healthcare outcomes.
References

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Aksan, N., Kısac, B., Aydın, M., & Demirbuken, S. (2009). Symbolic interaction theory.
Procedia-Social and Behavioral Sciences, 1(1), 902-904.
Charon, J. M. (2010). Symbolic interactionism: An introduction, an interpretation, an
integration. Pearson College Division.
Lee, M. S. (2015). The principles and values of health promotion: building upon the Ottawa
charter and related WHO documents. Korean Journal of Health Education and
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Liberatore, M. J., & Nydick, R. L. (2008). The analytic hierarchy process in medical and health
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Morteza Abdollahi, M. D., Mahasti Alizadeh, M. D., Nik, S. A., Shahnam Arshi, M. D.,
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Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self‐
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