Konflikter i sygehusvæsenet

af Bjarne Friis Pedersen

The subject of this thesis is Conflicts in the hospital system, written by a female doctor and a male nurse. We both have considerable experience working in hospitals and can provide numerous examples of conflicts that have had a negative impact on the main task of a hospital – treating and caring for patients. Our thesis statement is Conflicts between doctors and nurses in the hospital system. How to understand conflicts at the interpersonal level and within the parameters set by society at large. Our aim is therefore to reach a greater understanding of the factors that lead to conflicts between doctors and nurses. Our focus in this context is on the significance of values, communication, power, cooperation and competition. Another issue we look at is the importance of the framework, i.e. the hospital system, and society at large.

The starting point for our thesis is Getting to Cooperation: Conflict and Conflict Management in a Norwegian Hospital by Morten Skjørshammer, Norway. He concludes that conflicts have a direct impact on the main task of a hospital, and points out a lack of empirical studies regarding the way in which hospital professionals deal with negotiation and differences. Skjørshammer states that out of 105 published studies, only one includes both doctors and nurses. We therefore chose to study his work – along with others listed in our references – to further understand the significance of hospital relations and hospital parameters regarding conflicts. We also searched for recent literature to elucidate our thesis statement, but we did not conduct any empirical surveys.To our surprise, we found very little modern literature about conflicts between doctors and nurses. The most important literary source is a PhD dissertation entitled Power and Conflict between Doctors and Nurses by Maureen A. Coombs, UK.

We also describe the importance – as far as conflicts are concerned – of the historical and organisational framework in which hospitals are embedded, societal models and management systems. Our analysis tools in connection with the available literature involve theories about practitioners who reflect, relational aspects, ethics, power, psychodynamic processes, gender, cooperation and competition, and conflict strategies. Our conclusion is that the paternalistic, historical framework at the root of the hospital system is significant as regards conflicts. Biomedical discourse dominates, and the doctors’ more technically rational values stand in contrast to the nurses’ more emotionally charged values. Doctors are more individualistically inclined, whereas nurses are more closely tied to their workplace and the fellowship it provides. In order to maintain harmony, nurses do not openly challenge the power of doctors.

We recommend that hospital staff should give priority to a closer examination of the assumptions, values and power relationships that are present within their workplace. How can they deal with conflicts? How are they affected by stereotypes? How can they better allocate time to dialogue and reflection? Our recommendation to the hospital authorities is that they encourage staff members to work through the emotions they experience in connection with the difficult situations that sometimes arise when caring for patients. We also encourage initiatives that promote dialogue between doctors and nurses, so that cooperation between the two groups is improved – for the ultimate benefit of patient care.