Summary
What is significant is that all three approaches to conflict management are likely to deliver similar outcomes with respect to patient rights/support and medical ethics. This is not surprising, given that equifinality is an important aspect of systems.
However, the internal relationships among the objects of each system could be quite different. Specifically, since law-based CMS operate by assigning blame to one party, the upshot was that patient advocates and doctors adopted adversarial positions about patient rights. Managementbased CMS would likely maintain current organizational systems and relationships without addressing the tensions between professional competence and patients’ rights. We suggest that the governance of a managementbased CMS would then to be entrusted to a self-regulating professional body. Imagining a participation-based CMS is the most challenging, as it would likely foster ongoing fluid, emergent, cross-sectorial, and collaborative partnerships, perhaps leading to longterm change in the goals of the system.Finally, the case underscores how the purpose for implementing a CMS influences decisions about the inclusion and sequencing of conflict management strategies within a CMS. Purpose can include ensuring compliance with legal requirements, minimizing the costs of conflict, avoiding or mitigating a publicly embarrassing c risis, or effecting change within an organizational culture so as to align mission and practice (Lynch, 2001). While a management-based CMS would focus on averting crisis and participation-based CMS on creating conditions for change, in this case, the first three Cs influenced the design of the new law-based health system, which shifted power from doctors to patients. Patients became “clients,” and the third parties that monitor conflicts between clients and providers included “powerful” patient advocates (Cartwright, 1988), women’s health and consumer groups, and, as a last resort, an independent health and disability commissioner. The institutional arrangements have consolidated this change in the distribution of power (Aula & Siira, 2010), which perhaps explains the controversy and division that the commission’s findings and outcomes continue to generate 25 years later.