Education And Debate

Management for Doctors: Conflict, power, negotiation

BMJ 1995; 310 doi: (Published 14 January 1995) Cite this as: BMJ 1995;310:104
  1. Liam Donaldson, regional general manager and director of public healtha
  1. a Northern and Yorkshire Regional Health Authority, Newcastle upon Tyne NE6 4PY

    Conflict, how it arises and how it is resolved, is closely related to where power lies within a hospital, health authority, or medical practice and how this is influenced by external factors. This is asubtle and complex process which differs enormously from one health care organisation to another, over time, and from issue to issue. Power can influence change in predictable and conventional ways. For example, in the choice of a new member of the medical staff of a hospital, the head of the relevant clinical department and his or her consultant colleagues are likely to be the principal determinants of the type of person chosen. On the other hand, a major and unforeseen impact on the organisation might be produced by a quite junior member of staff whose power derives from the possession of information which could be passed anonymously to local media and arouse public concern.

    Conflict exists whenever individual or group interests diverge within an organisation, and if its values or goals are at odds with those of the external environment. These considerations apply to the operation of both private and public sector enterprises, but in the public sector the influence of the wider public and political dimension makes the process of setting and achieving objectives in an orderly way much more complex. In health care organisations the potential for conflict arising through internal and external factors is always present. The resolution of such conflict is often the route to progress or the way in which major change takes place. It is one of the jobs of management to understand the potential sources of conflict and to be able to predict how, when, and why they will arise. Similarly, effective management of change is not possible without a clear understanding of the sources of power within the …

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