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Hierarchy And Power: Australian Healthcare System

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Question:

Discuss about the Hierarchy and Power for Australian Healthcare System.

 

Answer:

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 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 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., 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 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. 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

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 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, 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.

 

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.

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.

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.

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