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Overview of Hierarchy in Healthcare Organizations


Discuss about the Demography of Corporations and Industries.

Hierarchy is a pervasive feature in an organization. In most organizations its basic functions and forms are often taken on a light note/for granted. Status and power are two different concepts and they give a differentiation in the hierarchical differentiation. Hierarchy seems to be one of the fundamental features in social relations. The leaders in groups emerge naturally from interactions, a few individuals in the central gather/collect majority of the status in an organization/group. The resources are distributed unequally across the persons or groups. The roles and positions awarded to different persons are given sources or amount of powers which is conferred by the individuals or groups occupying the position. The health care system is an organization. It has hierarchy, status and power. There are individuals that rules/leads the others. The heads are responsible in resources allocations and policy formulations.

Organizations are made up of stratified structures. The stratified structures are inform of pyramids whereby there is a decrease of individuals as one ascends on the pyramid and also an increase of power and status as one goes up the pyramid. Even when an organization adopts heterogeneity (Carroll & Hannan, 2010; Powell, 2011) these are the practices in an organization and culture which aims at dodging and suppressing hierarchy (Morand, 2011; Rothschild-Whitt, 2013), it is so noticeable that hierarchy rises up against all these pressures (Leavitt, 2015; Tannenbaum, 2014). Hierarchy is in all organizations in the world, despite all the sociological models to try and minimize it (Fiske, 2012). It is never absent and it emerges between and within the groups (Leavitt, 2015; Sidanius & Pratto, 2009)

Social hierarchy is an explicit or implicit rank order of groups and individuals with the respect to valued social dimensions. The term rank is used to mean that at least one of the groups/individuals is subordinate to one of the individuals or groups (Blau & Scott, 2012). The members of the social groups are either involved in coming up/constructing a formal system that ranks individuals and groups and assigns them duties or it is engaged in a process of informality interactions where the rank ordering of groups and individuals develops organically.

Social dominance theory has been used by researchers to find out what social norms and customs exist and how they were produced at first.

According to Sidanius and Pratto, (1999) social structure seemed to be affirmed based on dissimilar test backed up by unspoken hierarchy of groups. The multiple hierarchy are established on economic status, age, and race. This hierarchies determines the equitability to the allocation of available resources. For example in the western society the male Caucasian is more in control than other minority groups. The male Caucasian will distribute resources according to their own interest and welfare, they take advantage of opportunities without regard for the consequences of others.

Levels in the Healthcare Hierarchy

In summary, in every institution, group or organization there has to be a hierarchy whether formally or informally formulated. Every group or individual is at a point superior and at other points subordinate.

Australia is acknowledged to be one of the best and high ranked globally, this is because of the high quality services, medical facilities and professional workers. It follows a strict hierarchal structure, it entails the following.

They form the upper most level in the hierarchal structure of the Australian health facility. Senior medical officers can either be nominated in a staff grade position or a non-specialist officer. Non specialist officer are usually not qualified to perform specified function or practice a specified skill but work under the management of a specialist. Staff grade position senior medical officers who practice specified medical field. Senior medical officers are subdivided into the following. One, general practioners. Two, staff specialist. Three, career hospital doctors.

The subdivisions of the resident medical officer include the following. Senior house officer a third year post graduate student and who has not been selected as a registrar. Two, junior house officer who is a second year. Three an intern who is a first year post graduate student. They usually learn by observing what the doctors do.

The nurses who are more experienced and their qualifications jobs are excellent are placed at the top followed by those nurses with lesser skills and experience.

Chief nursing officer is usually highest level in the pyramid who acts as a supervisor and an administrator. They usually make decision for the nursing staff.

The director of nursing come after the chief nursing officer and his or her function is to recruit and place nurses at various position.

This position comes after the director of nursing, they are responsible for the management and attend on the needs of the patient and members of the family.

This are nurses who have completed their training. This are the specialist who have met educational demands than the other nurses in their category. There are two subcategory in this category, first is the nurse practitioner whose function is collaborating with physicians and are qualified to determine and treat common illness. Second, is clinical nurse specialist who have specialized in specific areas such as surgery and pediatric.

Their main function is directing and making a schedule on nursing care on a specified unit. They are the first people to be alerted if there is a problem with the bed side nurse.

Social and Organizational Functions of Hierarchy

They occupy the largest sector in health care. They usually in contact with patients and their function are to observe the patients progress by taking the vital signs and recording.

A hierarchy serves both social and organizational functions. By being able to identify the functions of a hierarchy one is able to identify wide ranges of hierarchical features, its genesis and the factors that sustains it. Hierarchy do have dysfunctional and unintended consequences (Leavitt, 2005). An example is when hierarchy in an organization creates the condition that requires compliance that leads to corruption and amoral reasoning (Brief, 2009). There are two main social functions of hierarchy. One the social coordination and order. This is whereby the hierarchy provides solutions to different problems in an organization by arranging people in groups that works towards the attainment of the same goal. With hierarchy there is provision of an antidote to chaos and uncertainty. It fulfils the sociological need/desire of humans to have order, stability and structure (Frenkel-Brunswik, 2013). This function is covered by (Weber, 1946).  He talked on bureaucracy.  He suggested that it is a functional reaction so as to be able to function in the modern world. With bureaucracies there is division of labor (Stinchcombe, 2014). The specialized roles in the division of labor it all gave a connection in the hierarchy. The roles of a supervisor are well laid down. These roles facilitates in coordinating the organizational actions. When the roles at different stages of the hierarchy are not well stipulated it leads to frustrations, inefficiency and confusion at work. This affects the coordination (Greer & Caruso). This incoordination makes the institution to be less efficient and less effective (Groysberg, Polzer & Elfenbein, 2017). With hierarchy it not only raises the institutional/departmental performance but it also fosters a satisfying work relation between the groups. The dominance submissive relationship (Wiggins, Trapnell & Phillips, 2016) it illustrates that individuals/groups prefers to coordinates when one is submissive and the other one is dominant (Tiedens & Fragale, 2013). The second function is the individual incentives. With hierarchy all the individuals/ groups strives to be in a higher rank. This is because the higher ranks gets higher psychological and material comfort and reward. It is a source of motivation to the employees (Tannenbaum, 2014). When one is at a higher rank they are more exposed to greater opportunities and also it gives them a way to satisfy their other needs/desires. Weber (1946), found that the motivational functions of a hierarchy are of beneficial to the organization. With hierarchy comes power. People at higher ranks poses more powers than those at lower ranks.

Negative Consequences of Hierarchy

Unlike the ancient days, we the health care providers relies on our clinical supervisors. This was not the case before. There was learning through observation. One student was assigned to one health care provider and could observe the student and teach him or her. It was possible for the teacher to comment on the performance of the student and the development of the professionalism. This is not the case nowadays. The clinical instructor is assigned so many students that they rarely comment accurately on the performance and career development.

The attainment to high ranks above depends on the relationship one builds with the supervisors so as they can give a good performance and competence report. This leads to a shift in focus. One prioritizes building a relationship with the supervisor than accomplishing the clinical objectives.

Due to specialization and powers of the supervisors, we, the juniors are afraid to point out the mistakes they makes. This is due to the fear of receiving a negative/unfavorable reports which could cause one their employment or a chance to continue or get training. Most of the time when a mistake is pointed out it may indicate lack of knowledge and no one would like to do that to the supervisor.


Hierarchy exists in all organizations no matter how much people, groups tries to fight it. It is important to have hierarchy although it also has its own negative consequences. For example in medical hierarchy it is evident it has its benefits and disadvantages to the trainees. There is little attention to the trainers nowadays. Reporting of errors and mistakes has reduced. This compromises the quality of patient care.


Blau, P.M. (2012). Exchange and power in social life. New Brunswick, NJ: Transaction Books.

Brief, C., (2009). Collective corruption in the corporate world: Toward a process model. In M.E. Turner (Ed.), Groups at work: Theory and research (pp. 471–500).

Carroll, G., & Hannan, M.T. (2011). The demography of corporations and industries. Princeton, NJ: Princeton University Press.

Eagly, A.H., & Karau, S.J. (2011). Gender and the emergence of leaders: A meta-analysis. Journal of Personality and Social Psychology, vol. 60(5), pp.685–710.

Fisek, M.H., & Ofshe, R. (2017). The process of status evolution. Sociometry, vol. 33(3), pp. 327–346.

Fisek, M.H., & Ofshe, R. (2017). The process of status evolution. Sociometry. Ed. 33(3), pp.327–346.

Frenkel-Brunswik, E. (2013). Intolerance of ambiguity as an emotional perceptual personality variable. Journal of Personality, vol.18, pp.108–143

Greer, L., & Caruso, M,. (2017, August). Are high power teams’ really high performers? The roles of trust and status congruency in high power team performance. Paper presented at the annual meeting of the Academy of Management, Philadelphia, PA. G

Groysberg, B., Polzer, J.T., & Elfenbein, H.A. (2017). Too many cooks spoil the broth: How high status individuals decrease group effectiveness. Manuscript submitted for publication.

Morand, D.A. (2011). The processes and effects of programs of status-leveling in organizations. Paper presented at the annual meeting of the Academy of Management, Washington, DC. N

Schmid Mast, M. (2012). Dominance as expressed and inferred through speaking time: A meta-analysis. Human Communication Research, vol. 28, pp.420–450.

Schmid Mast, M., & Hall, J.A. (2014). Who is the boss and who is not? Accuracy of judging status. Journal of Nonverbal Behavior, vol. 28(3), pp. 145–165.

Stinchcombe, A., (2012). Creating efficient industrial administrations. New York: Academic Press.

Stinchcombe, A., (2014). Stratification and organization: Selected papers. New York: Cambridge University Press.

Tannenbaum, A., (2014). Hierarchy in organizations. San Francisco, CA: Jossey-Bass.

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