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Respecting political dynamics in health care
  1. Tom Smith
  1. Senior Policy Analyst, Health Policy and Economic Research Unit (HIPERU), British Medical Association, London WC1H 9JR, UK

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    The articles collected for this issue relate to political dynamics within health organisations. The term politics is used in the sense of “the often internally conflicting interrelationships among people in a society” (American Heritage Dictionary of the English Language, 4th edition). In this case the society is health care. There is a tendency in a lot of articles to dismiss such conflict as interpersonal professional intransigence or as inherent resistance to change, rather than to acknowledge the validity of alternative views or to see social settings as inherently political arenas. But as the articles below show, political dynamics are central to organisational life.

    Tensions in change

    An article in the British Journal of Management shows the capacity of political forces to undermine change if they are not openly acknowledged and negotiated. Researchers followed the implementation of a Personal Medical Services pilot of which “the professional, organizational and managerial objectives . . . were the focus of an evaluation [that took place] between 1998 and 2001”. A range of data was collected including unstructured discussions, observation, discussion papers, notes from meetings, and emails.

    Researchers soon found that “very few people had an involvement in the drafting of the document that formulated the aims of the pilot. In the early days of the field work it became apparent that the changes ushered in by the pilot had generated feelings of resentment amongst many staff who reported that there had been little communication or consultation about the planned changed. The nurses in particular had felt alienated by the way the changes were initiated and felt that the doctors had been seen as the only stakeholders whose commitment had been sought.”

    The researchers found most of the drive for the initiative came from the “general manager of Maryport Group Practice (MPG)”. His powerful position came “as …

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