An Analysis of Hierarchy and Power Structures in Australian Healthcare

This essay delves into the intricate dynamics of hierarchy and power within the Australian healthcare system. It begins by examining the evolution of healthcare models, contrasting the biomedical model with sociological perspectives, and highlighting the influence of social factors on health outcomes. The essay then explores the hierarchical structures prevalent in Australian healthcare, from senior medical officers to registered nurses, and discusses the impact of power struggles and hierarchical disputes on patient care and professional interactions. It analyzes the advantages and disadvantages of hierarchical structures, considering the roles of trust, ego, and financial power. The essay further investigates the impact of power and hierarchy on the healthcare industry and society, referencing research and government policies. It emphasizes the importance of understanding these dynamics to improve healthcare delivery and outcomes. The essay concludes by highlighting the need for balanced power distribution and inter-professional collaboration to create a more equitable and effective healthcare environment.

Running head: HIERARCHY AND POWER
HIERARCHY AND POWER IN AUSTRALIAN HEALTHCARE SYSTEM
Name of the Student
Name of the University
Author note

1HIERARCHY AND POWER
The graph of healthcare system development and progression has increased largely due to
the advancement in the researches that has been conducted over years by renowned scientists.
Their effective hard work provides evidence based approaches and procedures to handle adverse
diseases and disorders. Besides the Biomedical model of healthcare, sociological and
psychological model of healthcare holds its importance nowadays (Cockerham, 2014).
Furthermore, for a large number of cases, occurrence of health disorder is due to the some social
factors like social pressure, peers attitude, relationship problems and so on. Hence, healthcare
professionals need to consider those factors as well to propose unique and effective healthcare
interventions (Greenhalgh, 2013). However, working in healthcare system nowadays is not so
simple, there are factors like power struggle, and hierarchical disputes exists that makes the
healthcare system difficult for both patients and professionals (Subramanian & Ramanathan,
2012). This essay will discuss and portray the different power and hierarchical disputes and will
enlighten about the advantages and disadvantages of power and hierarchical issues with respect
to different stakeholder of healthcare system.
Application of sociological concepts in critical analysis:
There are different type of interaction exists between health condition at different socio-
economic levels and the society from which these different patients belong. Sociology of health
and diseases help in examining those interactions (Melchiorre et al., 2013). There are different
characteristics of social life and any of them can act as one of the prime domains to affect the
health, moreover affecting mortality and morbidity. Different social organizations like school,
workplace, and social relationships like family, close friends aids to health and illness of
associated person. Sociology of health and ailments focuses on the sociological factors that can
cause different type of illness and diseases whereas sociology of medicinal science completely

2HIERARCHY AND POWER
depends on the relationship between practitioner and the patient and the importance of such
healthcare professionals in society (Drummond et al., 2015). Sociological studies believes that
health imparities occur not only due to biological factors but also due to occurrence of other
factors such as income inequality, lifestyles, food habits, environment and housing, health
behaviors, childhood development, education and level of literacy, social connectedness and
support and many more (Berkman, Kawachi & Glymour, 2014). For example, if a person is
suffering from obesity then there are different factors to add to his condition such as his diet
plan, his physical activities and others. Therefore, to understand the nature of disease and the
level of its intensity, it is important to consider the social factors while diagnosing the disease.
Why Biomedical model is not considered :
Biomedical model is a healthcare model that provides scientific measure for every
disease. According to this model of healthcare, human being is a body and this need to be free
from any type of disease or disorders such as defects, disabilities and pain (Deacon, 2013).
Hence, according to this model, anything that affects the healthy human body is a biological
factor and reason of every disease is biological. Every individual who is sick is considered to be
a body with disease and those bodies can be handled, explored and treated with the use of mind,
knowledge and skills or techniques of the healthcare professional (Carayon et al., 2014). To
handle such patients efficiently, medical professionals need to be appointed with proper
knowledge and the treatment condition and environment need to be technologically equipped and
positive to enhance wellbeing. Biomedical model of health is established in modern western
society therefore, it neglects the traditional healthcare practices and favors the biological factors
to treat disease (Pincus et al., 2016). Healthcare professionals undergo a training session of many
years to gain knowledge about the nuances of healthcare profession and to understand the

3HIERARCHY AND POWER
symptoms and help people to recover those symptoms quickly and efficiently. However, the
prime disadvantage of this factor is lack of care (Chow et al., 2012). The patient is only seen as a
body full of disease and not as an individual hence, the relationship between the patient and the
practitioner gets affected. Furthermore, the authorities of such healthcare organizations has a
power gradient and hierarchical division along with the healthcare professionals. Doctor and
other practitioners of the organization holds bigger power than that of the registered nurses and
hence, this gradient affects the care giving process both positively and negatively. Biomedical
model with the help of power gradient provides the exact treatment to recover the patient from
the disease. However, due to the lack of care in the care giving process, interventions including
holistic approaches are preferred. Interventions in which biomedical model of healthcare is
present along with the sociological factors, are preferred. Consideration of social, psychological
and environmental factor is important as these aids in the biological factors efficiently. Different
food and additional habits such as smoking, unhealthy diets, less or no exercise affects the health
in presence of different cultural and social factors (Kuhlmann et al., 2013). Even socio-economic
status including poverty, poor housing and workplace related stress, pollution and life style aids
to the disease condition. Hence, nowadays many researchers considers the biomedical model in
the presence of socio-psychological influence to plan interventions for patient’s treatment
(Aveyard, 2014).
Hierarchy in Australian healthcare and key concepts
Hierarchy in Australian healthcare system is not so new and this primitive work culture
has made the healthcare service as one of the best in the world. Starting from the medical
facilities and healthcare interventions, the highly professional healthcare experts are divided into
hierarchical structure and every Australian organization follows the levels strictly (Shearer et al.,

4HIERARCHY AND POWER
2012). The hospital staffs including senior medical officers, general practitioners registered
nurses and interns as well are part of this hierarchical structure. After the advancement of the
healthcare practices, there are so many chronic diseases, that has become curable and hence, the
professionals are considered as the most powerful person who saves the person with ultimate
power. These representation of doctors and registered nurses affects the hierarchy and power
gradient positively as well as negatively. Nowadays, every hospital or healthcare organization
forms a multi-disciplinary team to function against a chronic disease treatment (Šoltés et al.,
2014). Hence, to treat an obese patient, having cardiovascular disease and osteoarthritis, a
multidisciplinary team having experts of those departments will function for the treatment.
Cardiac surgeon will be there to perform surgery; general physicians will be there to perform
primary diagnosis and checkups. There will be different level of nurses to provide specific care
to the patient such as senior registered nurses, enrolled nurses, dieticians, physiotherapist
podiatrists to help the patient efficiently. All these healthcare professionals are senior medical
officers and are best in their field. Their only aim is to provide the patient with best healthcare
with their own model of treatment. Here plays a silent struggle for power distribution that the
patients and ordinary people cannot understand. There are instances of disagreement and
conflicts on thoughts among these healthcare professionals that affects the wellbeing process of
the patient adversely. According to (), there are several issues with roles and boundaries with the
lack of decision-making ability are observed in the Australian healthcare system. This factor
implements the idea that power and authority are major factor in these multidisciplinary
functioning and affects the patterns of hierarchy as well. Throughout these years, there are so
many researches has been conducted to find out the factors that contributes in the development
of hierarchy in the healthcare organization. Despite of the fact that every healthcare professional

5HIERARCHY AND POWER
takes the same oath of saving patients life by providing quality healthcare. Researchers have
come up with the fact that trust, faith, access and respect to a particular healthcare professional
acts as enablers and ego, dominancy and financial power acts as barriers for power distribution.
Hence, these factors are the prime reason for the rise of power gradient and hierarchy in the
healthcare system (Baghbanian et al., 2012).
Power struggle and hierarchical turfs related debates and issues:
Power struggle and hierarchical turfs is not only seen among the healthcare professionals,
but also exists between the well-known personalities present in the healthcare trustees, higher
authorities and the healthcare professionals, who work under them in the hospitals. According to
some researches, power is divided into two parts in healthcare system (Lopes, Carter & Street,
2015). First power let the authorities control the resources needed for quality healthcare and the
other power let the doctors and other healthcare professionals to take decision about the patient
seeking their help. Their power is less tangible and more symbolic and has the ability to control
ideas and derive meanings. This second type of power distribution makes the healthcare system
unequal. Distribution of power in this unequal system is influenced by professional status, hence
the status of senior medical officers become greater than that of a registered nurse. However, in
the process of care giving, both of them have equal contribution. Hence, to create an
environment of equality distribution of intangible and tangible power should be divided into inter
as well as intra-organizational basis to determine strategies of engagement. Researchers have
recommended including psychological as well as social model of health to create bio-
psychosocial model (Barasa et al., 2014). Hence, during the preparation of such multi-
disciplinary team including experts from every area power imbalance occurs that leads to
conflicts and differences. Such conflicts or turfs may be inter-professional or intra-professional.

6HIERARCHY AND POWER
Situational power struggle can also be observed in which knowledge and medical dominance
decides the relationship between healthcare experts and patients inside the organization. Hence,
it is important for the healthcare professionals to resume dialog and decide steps necessary for
the wellbeing of the patient.
Impact of power and hierarchy on the society and healthcare industry
The hierarchy in the organization affects it positively as well. Sometimes, it is important
to have a hierarchy in the author of the organization to make it functional. This hierarchy is
designed to benefit the patient as well as the healthcare employees. Authority hierarchy help the
team members with accountability, guidance and communication. Death of patient with chronic
disease is normal for the healthcare professionals. However, sometimes the families of such
patient start blaming the doctors for the death of patient. Authority hierarchy, at that moment,
takes the accountability of the loss and help the doctor to learn from the experience. Hierarchy
also helps to guide the fresh employees to understand the job and perform it with efficiency. The
hierarchy division also helps to create an effective communication between departments,
professionals and patients that helps to manage every department efficiently. Researches have
often used different theories such as research dependency theory and transaction cost analysis to
find out types of associations that is present among wide range of healthcare organization
throughout Australia. These organizations try their best to maintain the hierarchical system and
to do that they reduce the dependency to maintain their autonomy in their organization.
Researchers have used even the transaction cost analysis to determine the role of government in
the distribution of power and hierarchy.
Research analysis

7HIERARCHY AND POWER
From researches, it has become evident that Australian healthcare system contains two
levels of government to make and propose different types of planning, services and policies. This
system is completely out of focus and lacks the integration between departments to create
policies enhancing healthcare. The healthcare professional of Australia is divided into two
healthcare settings (Duckett & Willcox, 2015). Public as well as private healthcare system
consists of these healthcare professionals. These healthcare sectors are different from each other
depending on the size, healthcare provided, complexity and funding techniques (Renedo et al.,
2015). These different funding techniques and distribution of resources, technologies and support
creates a hierarchical inequality. Therefore, the power distribution is dependent not only upon
the level of professionals and healthcare organization, but also on the amount of funding and
government support, one organization is offered. These organizations has lack of collaboration
among them and hence, the power is distributed unevenly. General physicians and other
healthcare workers in private healthcare system works based on fee-for-service, whereas, in the
public healthcare system they work based on government funding (Kim & Chung, 2014). Hence,
there is a lack of proper and effective communication and relationship building opportunities.
Power dynamics are often explained by three factors. The first factor is the usage of
different professional strength to protect the autonomy and reduction in the dependency. These
factors helps to maintain power distribution in public as well as private sector of healthcare. there
are so many government driven policies have been introduced to support inclusion of healthcare
professionals in the share of decision making and applying power to enhance patient condition.
However, such instances are very rare till date (Lopes, Carter & Street, 2015). It has been seen
that general physicians, who work in healthcare organizations did not engage with the other
allied professionals. This low level of collaboration creates disputes in professionals leading to

8HIERARCHY AND POWER
tension and stress among the relationship of different individuals. Researchers have also stated
that the internal authorities mention the general physicians as their hospitals secondary service.
Before making any important announcement, the authorities did not ask for the opinion of the
physicians and this creates conflicts and stress between the healthcare professionals in the
workplace. These aroused power conflicts are effects of authority of making referral decision.
Professional hierarchies as well as the traditional power relations are experienced by all of them
and are called the dark side of organisational relationships (Barasa et al., 2014). Power is
proposed to be experienced in levels such as intra-organizational, inter-organizational and
departmental to shift the power from excess to balanced state.
In conclusion, it can be said that to ensure patient safety, healthcare institutes should
engage themselves in a collaboration in every level of healthcare. This collaboration will help the
organization to attract patients due to positive peer review and word of mouth. This essay
discussed about the social and psychological model of healthcare collaborating with biomedical
model of health. However, the biomedical model of healthcare is most dominant and conflicts
with social and psychological model, the combination of these three is helpful for patients to
attain well-being. It is evident that the team that has been formed based on honesty and trust are
collaborating in nature. Collaboration can be of different types such as collaboration between
healthcare professional and authority, authority and technicians, doctors and registered nurses,
patients and healthcare specialists and so on. Better collaboration, bond and trust between the
healthcare professionals determines better chances of effective treatment and reduction of their
sufferings and quick service. This essay discussed about the power struggle and hierarchy and
the negative effects of these two on the healthcare professionals. Hierarchy is important for the
healthcare system and it can affect the organization negatively and positively as well. However,

9HIERARCHY AND POWER
the negative effects prevails the positive ones. Hence, proper steps need to be taken to through
policies and programs on an urgent basis to address the latent power struggle in Australian
healthcare system and proper steps need to be taken to minimize the harmful effect and promote
collaboration in every level of caregiving process.

10HIERARCHY AND POWER
References
Aveyard, H. (2014). Doing a literature review in health and social care: A practical guide.
McGraw-Hill Education (UK).
Baghbanian, A., Hughes, I., Kebriaei, A., & Khavarpour, F. A. (2012). Adaptive decision-
making: how Australian healthcare managers decide. Australian Health Review, 36(1),
49-56.
Barasa, E. W., Molyneux, S., English, M., & Cleary, S. (2014). Setting healthcare priorities in
hospitals: a review of empirical studies. Health policy and planning, 30(3), 386-396.
Berkman, L. F., Kawachi, I., & Glymour, M. M. (Eds.). (2014). Social epidemiology. Oxford
University Press.
Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden,
R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and
patient safety. Applied ergonomics, 45(1), 14-25.
Chow, M., Herold, D. K., Choo, T. M., & Chan, K. (2012). Extending the technology acceptance
model to explore the intention to use Second Life for enhancing healthcare
education. Computers & Education, 59(4), 1136-1144.
Cockerham, W. C. (2014). Medical sociology. John Wiley & Sons, Ltd.
Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity,
utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846-
861.

11HIERARCHY AND POWER
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W.
(2015). Methods for the economic evaluation of health care programmes. Oxford
university press.
Duckett, S., & Willcox, S. (2015). The Australian health care system (No. Ed. 5). Oxford
University Press.
Greenhalgh, T. (2013). Primary health care: theory and practice. John Wiley & Sons.
Kim, J., & Chung, K. Y. (2014). Ontology-based healthcare context information model to
implement ubiquitous environment. Multimedia Tools and Applications, 71(2), 873-888.
Kuhlmann, E., Burau, V., Correia, T., Lewandowski, R., Lionis, C., Noordegraaf, M., & Repullo,
J. (2013). “A manager in the minds of doctors:” a comparison of new modes of control in
European hospitals. BMC Health Services Research, 13(1), 246.
Lopes, E., Carter, D., & Street, J. (2015). Power relations and contrasting conceptions of
evidence in patient-involvement processes used to inform health funding decisions in
Australia. Social Science & Medicine, 135, 84-91.
Melchiorre, M. G., Chiatti, C., Lamura, G., Torres-Gonzales, F., Stankunas, M., Lindert, J., ... &
Soares, J. F. (2013). Social support, socio-economic status, health and abuse among older
people in seven European countries. PloS one, 8(1), e54856.
Pincus, T., Chua, J. R., & Gibson, K. A. (2016). Evidence from a Multidimensional Health
Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to
Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid
Arthritis. Journal of Rheumatic Diseases, 23(4), 212-233.

12HIERARCHY AND POWER
Renedo, A., Marston, C. A., Spyridonidis, D., & Barlow, J. (2015). Patient and Public
Involvement in Healthcare Quality Improvement: How organizations can help patients
and professionals to collaborate. Public Management Review, 17(1), 17-34.
Shearer, B., Marshall, S., Buist, M. D., Finnigan, M., Kitto, S., Hore, T., ... & Ramsay, W.
(2012). What stops hospital clinical staff from following protocols? An analysis of the
incidence and factors behind the failure of bedside clinical staff to activate the rapid
response system in a multi-campus Australian metropolitan healthcare service. BMJ Qual
Saf, bmjqs-2011.
Šoltés, V., & Gavurová, B. (2014). The functionality comparison of the health care systems by
the analytical hierarchy process method.
Subramanian, N., & Ramanathan, R. (2012). A review of applications of Analytic Hierarchy
Process in operations management. International Journal of Production
Economics, 138(2), 215-241.