Coalitions and conflict in the national health service: some implications for general management

This paper suggests that conflict is an inescapable feature of National Health Service organisational life, and that it is legitimate area of study. It describes a number of powerful coalitions whose interactions can produce conflict as they attempt to influence the distribution of scarce resources. In particular, it focuses on the beliefs and power of a 'practitioner interests' coalition and an 'administrative ethic' coalition. To survive in this world of coalitions, NHS general managers need to assert their own positions. Are they to be agents of the existing coalitions or can they construct their own and achieve its dominance? The paper concludes by discussing how a distinctive general management coalition might emerge.