INTERNATIONAL ISLAMIC UNIVERSITY ISLAMABAD

Department of Business Administration

NEG O TI ATI O N AND

CO NFLI CT
M ANAG EM ENT

S TU D EN TS OF MA S TER OF
BU S IN ES S A D MIN IS TR A TION
“O Allah! Take me out from the darkness of doubt (conjecture) and
favor me with the light of understanding. O Allah! Open for us the
doors of your mercy and unfold for us the treasures of your
knowledge. With your mercy, O the most merciful of the merciful." 

(AAMEEN) 
 PROJECT IN BRIEF

Project Title: Negotiation and conflict management

Objectives: To analyze the levels, phases and strategies

of negotiation in the conflict arises due to ban on
Private practice of government doctors.

Submitted To: MA’AM IMRANA FAROOQUI

Submitted by: Sibgha Lodhi

Komal Majeed
Saadia Arshad
Sumbal Khan
Sumaira Mazhar
Aamara Majeed
Razia Sultana
Mubeen Aslam
Sabra Shumaila
Shakila Yousaf

Date of submission: 29-12-2008

FACULTY OF MANAGEMENT SCIENCES

INTERNATIONAL ISLAMIC UNIVERSITY,
ISLAMABAD
(2008)
 BRIEF SUMMARY OF THE CONFLICT

 RELATIONSHIP

INTERDEPENDENT

 CONSEQUENCE

CONFLICT

 TYPE

DYSFUNCTIONAL

 LEVEL OF CONFLICT

INTERGROUP

 STRATEGY

COMPETING/CONTENDING

 NEGOTIATION

DISTRIBUTIVE BARGAINING

 FRAME
OUTCOME BASED
 SUMMARY OF THE CONFLICT

The conflict arises when the NWFP health secretary issued a notification on 09 February,
2002. According to this notification, the private practice of all government doctors,
including teaching staff at any place or premises, except within the boundaries of the
health institutions/hospitals concerned, shall stand banned with immediate effect”. In a
press conference the same day, the acting health secretary, Brig. Habibur Rahman, gave a
grace period of 15 days to the government doctors to wind up their private clinics. He
warned that following the expiry of this period stern action would be taken against
transgressors for misconduct, according to the NWFP Civil Servants Removal from
Service (special powers) Ordinance, 2000.
The ban was a sequel to an earlier notification in June 2001 that made four major health
institutions, the Lady Reading Hospital (LRH), Peshawar, Khyber Teaching Hospital
(KTH), Hayatabad Medical Complex (HMC), Peshawar, and Ayub Teaching Hospital,
Abbott Abad, autonomous both financially and administratively.
The Frontier government’s decision to ban doctors’ private practice and introduce
institution-based practice (IBP) at public sector hospitals from March 1 has created a
wide gulf between the medical profession and the government. The doctors are adamant
in their opposition to the move and term it “a recipe for disaster”.

According to Brig. Habibur Rahman, the government started institution based practice
(IBP) in four major hospitals of the province on a voluntary basis out of good faith and
asked the doctors to spare only two hours a week for IBP. “They did not cooperate and
the plan proved a failure,” he remarked. “That was a half-hearted attempt and the
government had to devise a new policy to deal with the situation and make it a success.”

According to the formula announced by the health department in its notification, the
doctors will get 60 per cent of the revenue generated through the IBP of each
institution. The clinical and administrative support staff is assigned 20 per cent while
the remaining 20 per cent revenue is allocated for the hospitals. The patients are
required to pay 300 rupees as fee to the consultant in IBP.

OBJECTIVE OF THE PLAN:

Objective of the plan is

 Ensuring quality treatment,

 A uniform fee structure

 Maximum utilization of hospital equipment and infrastructure during off-hours

 Creating additional resources and documentation of doctors’ incomes.

The Joint Action Committee, headed by Pakistan Medical Association (PMA), NWFP,
President Umar Ayub, has filed a writ petition against the governor’s order in the
Peshawar High Court (PHC) pleading that the notification is against the law. “Our
meetings with the government so far have failed to bear fruit and find common
ground,” says Umar Ayub.

CONCESSION BY GOVERNMENT:

However, the government extended the ban’s deadline till December 31 at the request
of various doctors and ordered all medical colleges to provide emergency services to
allow in-house private practice. The government’s latest policy on private practice is a
surprise, since earlier announcements were touting the introduction of a legislation to
regulate private laboratories and hospitals.

FINAL DECISION:

The ban was completely failed as senior doctors and professors were not available
during the evening shift. The government said that it is impossible to stop doctors from
practicing privately and there was no point of a ban unless other professionals such as
engineers and teachers were also stopped.
DIFFERENCES
Both sides say they are acting to protect the interests of the patients but this is yet to be
proved.

OPINION OF THE DOCTORS

Many doctors say the health department has banned private practice despite the fact
that the hospitals do have not enough infrastructure, equipment and facilities to
accommodate the influx of patients.

“The ultrasound and X-ray machine at our hospital is a couple of decades old,”
maintains a doctor at LRH claims. “This random act will only lead to disastrous effects,”
says another doctor.

We have filed another petition against the notification in the Supreme Court on the
ground that it is against fundamental human rights.” “The IBP is a recipe for disaster,”
the PMA provincial chief claims.

Doctors used to go to the suburban and rural areas for private practice and provide
healthcare to the people in their villages. Now they cannot to do so and the patients
have to come to the hospital, traveling on dilapidated roads. Also, many doctors charge
less at their clinics than the fees prescribed at the IBP paramedic staff at the hospitals.

The introduction of IBP has also caused difficulties for patients in remote areas of the
province and in the federally administered tribal areas. . This means increased
healthcare cost in the rural areas where poverty is more pronounced and people cannot
afford medical treatment.

Given the measly pay scales of government doctors, economic compulsions make private
practice inevitably attractive to them, specially when the marketplace has come to
dominate society. The private hospitals and some autonomous institutions in the public
sector, which disallow private practice, compensate their consultants with handsome
salaries.
“The major objective of the government is revenue generation through institutional-
based practice,” they mentioned.

OPINION OF THE GOVERNMENT

The government is determined to implement the plan in the ‘best public interest’.
Talks to bridge the gap have failed not only because the camps have divergent
viewpoints but also because the end sufferers are the patients who have little role to play
in the crisis.
According to government’s view, Doctors were government servants and all the rules
and regulations applicable to other servants were also applicable to them. What would
happen if like the doctors, the government servants of other departments started doing
private practice after performing their official duties?
The administration of various hospitals has also complained that senior doctors are not
paying attention to patients in the morning OPD.

OPINION OF GENERAL PUBLIC:

The NWFP government’s decision to ban private practice of serving doctors is receiving
overwhelming response from the masses, who want the decision to be implemented in all
seriousness.
“The doctors community is fleecing the poor patients and acting as a commercial
group rather than professional,”

People say that private hospitals, which are no match of government-run health-care
outlets, have mushroomed over the years due to the non-professional approach of senior
consultants
BATNA is the best alternative available to a negotiated agreement, when any party has
some better alternative available, they party will opt for that BATNA rather than wasting
time in negotiating with the other party.
According to the conflict we have chosen, doctors have strong BATNA then
government.

THE BEST ALTERNATIVE AVAILABLE TO DOCTORS IS:

If the government does not agree in revocation of the plan, then doctors can connect
themselves to the private hospitals.
Another option could be that all the doctors who want to leave the government job,
combine together and start their own hospital which consists of facilities which
are better than government hospitals.

This course of action will provide leverage to the doctors as compare to government.
In this conflict we also found that the government is using power to impose their action
plan. They simply decided and issued a notification as an order.
No proper mutual consultation has been made between the government and doctors
regarding the implementation of the programme.
THE CONFLICT CYCLE

ANTICIPATION

REFLECTION
WAIT & SEE

SELLEMENT

GROWING

APPLICATION

IN THE OPEN
THE CONFLICT CYCLE

When conflict arises there exist different phases and stages of it. If we put the case of
“BAN OF PRIVATE PRACTICES OF GOVERNMENT DOCTORS” then we will
come across different phases.

The first phase of the conflict cycle is ANTICIPATION. Anticipation phase could be
conscious or planned. Unconscious in a way those doctors were not aware that they will
be stopped from private practices which will create conflict between both the parties. And
planned in this way,that both doctor and government knew that conflicts are arising
between both the parties. And both the parties had good reasons to present for supporting
their view points. So this phase a kind of presents turtle like position where both the
parties are sticking their necks out and now both the parties are aware of the conflict.

The next phase is WAIT AND SEE, where government gave doctors a 15 day notice to
wind up all their private practices. During that period the situation was like a hawk flying
around events and gathering information. Both the parties had no option left other then to
wait and see what happens next.

Then the third phase arises when the conflict is GROWING. The issues are becoming
bigger. The ban was a follow-up to an earlier notification in June. The government started
institution based practice (IBP) in four major hospitals of the province on a voluntary
basis out of good faith and asked the doctors to spare only two hours a week for IBP.
They did not cooperate and the plan proved a failure. So in this stage conflict is taking a
shape of mushroom, as it becomes more apparent and grows more.
Then the fourth phase arises when the conflict is IN THE OPEN. Issues were openly
discussed both sides presented their point of view. The government was determined to
implement the plan in the ‘best public interest.
Doctors presented their point of view that the regulation of private practice by doctors,
was to ensure quality treatment, a uniform fee structure, maximum utilization of hospital
equipment and infrastructure during off-hours, creating additional resources and
documentation of doctors’ incomes.

Now the next phase is of APPLICATION. To resolve the conflict, government had
applied a formula. According to the formula announced by the health department in its
notification, the doctors will get 60 per cent of the revenue generated through the IBP of
each institution. The clinical and administrative support staff is assigned 20 per cent
while the remaining 20 per cent revenue is allocated for the hospitals. The patients are
required to pay 300 rupees as fee to the consultant in IBP.

After this the next phase is SETTLEMENT, where no settlement took place as both the
parties are powerful and no one was willing to compromise.

Now the last stage is the REFLECTION STAGE. Where both the parties learned about
their mistakes. Government realized that they cannot stop the doctors by using their
power influence. And doctors also realized where they were wrong and their conflict
made patients to suffer a lot. So on August 2003, the order was denotified by the
government.
Concern about
Other’s outcomes
High

Contending
(competing/distributive)

Low Concern about own outcomes High

Definition:
Literal meaning:
Frame is a boundary with in which whole picture is displayed and framing refers to the
creation of frames either by simple reading of a situation or by analyzing it.
Technical meaning:
Technically framing is about focusing, shaping and organizing the world around us.
Frames, also known as Lenses or filters help us to interpret about the world and organize
complex problem in to coherent understandable categories.

Frames are built on underlying structure of

 beliefs,
 values and
 Experiences.
Each party has its own perception, relevance of various issues, their priorities,
opportunities and risk involved. Frames are built prior to decision making and affect
decision making.

Frames can also be defined as a field of vision. Vision is how one sees a particular thing.
It is based on person’s imagination and intellectual thinking plus his common sense in
compliance with his past experience; learning and knowledge dig out from his data base
of information.

There were two fields of vision in this case:

 Government field of vision:

Private practice should be banned

 Doctor’s field of vision:

Private practice should not be banned.
Institution based practice where doctors were accommodated with two hours of their
private practice.
Doctor’s Field of Vision Government’s Field of vision

Private Private
practice Practice
should be shouldn’t
banned be banned

IBP (Institution Based Practice)

Common Field of vision

Following are the major types of frames:

1. Substantive
2. Outcome
3. Aspiration
4. Conflict management process
 5. Identity
6. Characterization
7. Loss/ gain

With respect to the conflict situation between the NWFP government and Doctors we can
state that there were four types of frames used either by doctors or by the government

The major frames used by the government are:

1. Substantive Frame:
Government used substantive frames as it was fully aware of the problem situation and
wants to deal with the doctors in an effective way. The major stand of the government
was that it is taking this action in best public interest.
2. Aspiration Frame:
Government was more interested in fulfilling the interest and need of the doctors rather
than out come. Government show no interest in providing specific out come of lifting ban
on private practice and instead introduced Institution based Practice so that the major
concern of doctors to earn money should be fulfilled.

3. Procedural Frame:
Government used procedural frame as well. Government devised a method to resolve the
problem. They invite doctors and specialists of their field to resolve the conflict. A
systematic implementation of IBP (Institution Based Practice) was recommended.

4. Characterization Frame:
Government build characterization frame in middle of their negotiation when IBP was
failed. Doctors were held responsible for that unsuccessful implementation of the plan.
Government characterized doctors as being selfish and materialistic whose main concern
was just to earn money even at cost of their patient’s life.
This frame is very much evident in one of the statements given by Brig. Habib-ur-
Rehman, who stated that:

“They did not cooperate and the plan proved a failure”, “That was a half-hearted
attempt and the government had to devise a new policy to deal with the situation and
make it a success.””

Doctors used following frames in the negotiation:

1. Substantive frame:
Substantive frame was used by doctors as well. Doctors were the direct victims of the ban
and they had very clear understanding of what the issue is all about. Their tail wan on fire
and their main source of income was banned. The major stand of doctors was that if they
are banned in the name of public interest then why not government teaching staff and
engineers who do private practice after their job hours. Law should be equal for all the
occupations. Why only doctors suffer from the ban?

2. Outcome based Frames:

Doctors used outcome based frames as they were more interested in out come of
removing ban from their private practice. They were stick to their point and were not
willing to change their position. This strictness from their side was making the
negotiation more of a distributive or win/lose typed.
 3. Identity Frames:
Doctors have identity frame as well. They view themselves as a community and having a
prestige occupation in which they have right to earn their income. They identify
themselves to be justified to earn huge money.
PHASES OF NEGOTIATION
PREPARATION
RELATIONSHIP INFORMATION INFORMATION
BUILDING GATHERING USING

IMPLEMENTING THE CLOSING THE BIDDING

AGREEMENT DEAL

Whenever conflict arises, negotiation takes place to resolve the conflict. And negotiation
is always passed through different phases or stages. The conflict which we have taken has
gone through distributive negotiation.

1. PREPARATION:

Government decided to introduce institution based practice at public sector hospitals,

they made their point clear to doctors that it was important for them to have

 Full utilisation of hospital equipments and infrastructure

 Quality treatment
 A uniform fee structure
 Best interest of patients

For government these were important concerns.

How to move with the other party:
They simply issued a notification to the doctors, and were of the view that doctors
will understand their priorities.
2. RELATIONSHIP BUILDING:

The second phase of negotiation process is building relationship with the other party.
It is very critical process because it shapes the moves of the other stages. It depends
upon the context of one's needs and interest.
In our conflict very little attempt was made in relationship building between the two
parties. Government was strongly committed in implementing the plan, despite of the
opposition reaction of the doctors.
It gave very little concerns to the view point of doctors.
Government thought they have power so they can achieve their goals without taking
consideration of doctors.

3. INFORMATION GATHERING:

Government has gathered all the information to make their point of view justifiable.
They provided all the information about how their decision is in best public interest.
But according to doctors it was a recipe for disaster.

4. INFORMATION USING:

At this stage negotiators assemble the case for they want to make for their preferred
outcomes and settlements, one that will maximize the negotiator's own needs.

Government has used its power to implement the plan and issued a notice to doctors
and forced to introduce institution based practices. They were threatened and were
given grace period of 15 days to wind up their private clinics. Otherwise they were
told that immediate action would be taken against them. According to the N.W.F.P
civil servants removal from service (special powers) Ordinance, 2000.
5. BIDDING: (making moves towards the common grounds)

In our case initiative was taken by the doctors to change the perception of
government, both parties were trying to show that their common interest was to save
patients rights. So they were trying to move towards common grounds and resolve the
conflict, by negotiating in a way that both parties could achieve their interest.

Government made a plan to give 60% of revenue to doctors to meet the underlying
financial need. In this way both the parties tried to convinced each other.

6. CLOSING THE DEAL:

Deal is not closed after bidding.

7. IMPLEMENT THE AGREEMENT:

So deal is not implemented.
THE PLANNING PROCESS OF DOCTORS
1. DEFINING THE ISSUES
The doctor defined the issue as the ban on their private practice should be lift and
they should be allowed private practice as they were not in favor of IBP plan. The
contentious issue was the ban imposed on private practice by senior doctors in
government hospitals.
2. ASSEMBLING ISSUE AND DEFINING THE BARGAINING MIX
The provincial government issued directives on Feb 12, banning private practice
of government- employed doctors across the province. To enable the doctors to
wind up their private clinics, a period of 15 days was allowed, after which
disciplinary action will be taken under the NWFP Civil Servant Removal from
Service (Special Power Ordinance, 2000) against those not complying with the
new directives

3. DEFINING INTERESTS
The main interest of doctors was substantive and is directly related to the focal
issues i.e. ban of private practice

4. DEFINING LIMITS AND ALTERNATIVES

Requesting anonymity, senior doctors of the Khyber Teaching Hospital said all the
doctors knew that if they resigned the government would initiate an inquiry into the
tax evasion of their past earnings through private practice.

5. SETTING TARGETS AND OPENINGS

The NWFP government has prepared a list of 300 senior doctors to be sent to
National Accountability Bureau in case they resigned to protest against the
government ban on private practice in private hospitals

6. ASSESSING CONSTITUENTS
A FIELD ANALYSIS OF NEGOTIATION

A B

C
d
 C

A: THE DIRECT ACTORS

GOVERNMENT

B: THE OPPOSITION ACTORS

GOVERNMENT DOCTORS

C: INDIRECT ACTORS

 NWFP GOVERNMENT
 JOINT ACTION COMMITTEE
 PMA

D: INTERESTED OBSERVERS

GENERAL PUBLIC

E: ENVIRONMENTAL FACTORS
MEDIA, DOCTOR UNIONS

7. ANALYZING THE OTHER PARTY

The underlying rationale of this move of government is not clear. It cannot be
denied that a number of cases have been reported where doctors have neglected
 their work in a government hospital to pay more attention to their private patients
from whom they generate lucrative earnings.

8. SELECTING THE STRATEGY

THE DOCTORS were very dedicated and putting their energy to win the war.
The strategies they used were that to resist the ban on private practice, the health
personnel were seen removing the signboards from the private clinics of public
sector doctors at various places in the city.

Despite the ban some of the public sector doctors made arrangements to see
patients in the evening at their homes. The staff at their clinics, in some of the
cases, was seen directing visiting patients to consult the doctors concerned at their
residences.

9. ISSUE PRESENTATION AND DEFENSE

The presentation style for government was very harsh and not clearly ample
supporting facts and arguments, so doctors defend themselves by giving counter
arguments. They present their issues very clearly but supporting facts and
arguments. The doctors opposing points were very strong.

10. DEFINING PROTOCOL

Doctors negotiate with Government through Peshawar High court. Doctors did
not negotiate directly. A joint action committee was formulated to negotiate. The
chairman of doctors’ action committee was Omer Ayub. Doctors also mentioned
some unimportant issues on the negotiation table that was not relevant to the main
issue.
POSITION TAKEN DURING NEGOTIATION
Effective distribution bargaining needs to understand the process of taking a position
during bargaining (the opening offer ) and the role of making concessions during the
negotiation process.
Negotiation was not iterative; third party’s (joint action committee, Peshawar high court)
intervention was present to resolve the conflict.

OPENING OFFER
After banning the private practice of doctors Frontier government introduced institution-
based practice (IBP) at public sector hospitals, which was earlier notified in June 2001.
The government started institution based practice (IBP) in four major hospitals of the
province on a voluntary basis out of good faith and asked the doctors to spare only two
hours a week for IBP.

OPENING STANCE
Competitive strategy was used to influence the doctors as in a press conference, the
acting health secretary, Brig. Habib ur Rahman, gave a grace period of 15 days to the
government doctors to wind up their private clinics. He warned that following the expiry
of this period stern action would be taken against transgressors for misconduct, according
to the NWFP Civil Servants Removal from Service (special powers) Ordinance, 2000.

CONCESSIONS

BY GOVERNMENT
 Permission allowed to hospital to retain and use the hospital share for IBP for
maintenance, provision, up gradation etc of medical facilities of hospital.

 Doctor with 5years to retirement would be exempted from IBP option.

 Doctors would however be allowed to do private practice to the extend of

consultation after the 3years service completion with IBP. Admission and
procedures would not be permitted outside the hospital premises.
 FROM DOCTORS

The doctors tried to convince the government that introducing IBP is not the right
step and the ban on private practice is not fair.

Whereas, the government side asserts it is ready for talks in order to facilitate IBP
and remove the doctors’ apprehension, if any.

FINAL OFFER

The government relaxed the ban and institutionalized private practice within hospitals by
introducing outdoor-patient evening shifts, but the ban has completely failed as senior
doctors and professors are still not available during the evening shift. The government
has said that it is impossible to stop doctors from practicing privately and there was no
point of a ban unless other professionals such as engineers and teachers were also
stopped.

COMMITMENT
There was no formal commitment at all. No commitments were made at that time by
either side.

CLOSING THE DEAL

The government announced in 2003 that it would not ban private practices by public
sector doctors. The implementation of an earlier ban by Dr Mahmood Ahmad Chaudhry,
the interim health minister, failed because of fierce opposition.
 HARDBALL TACTICS

Hardball Tactics were used by both parties to pressurize each other. Both of them used
different choices to deal with the hardball tactics.

INTIMIDATION:
The doctors have quickly identified their goals and responded well against this tactics by
using “intimidation”. The emotional poly the government has used was by saying that
they are doing this for the well being of the patients. The government is determined to
implement the plan in the ‘best public interest’.
Govt. has used a warning style in giving grace period of 15 days and said doctors to wind
up their private clinics, also failing that will result in confiscating doctors’ license.
(NWFP Civil Servants Removal from Service (special powers) Ordinance, 2000). That
comes under use of anger or threatening the other party.
Another argument in favor of their intimidation was that there are complaints about the
rude behavior of orderlies and the administration of various hospitals has also complained
that senior doctors are not paying attention to patients in the morning OPD.
They have also justified their stance by saying that the dialogue with the doctors is being
held to discuss facilitation of IBP, not its revocation. But in reality the doctors were
opposing the idea of forming IBP. Here Govt. has tried to ignore the real issue and agreed
upon discussing the matters regarding improvement in the facilities of IBP.
Whereas on the other side doctors have dealt with the situation by “responding in kind”.
They have closed their clinics throughout the province in accordance with the
notification, and were up in arms against the ban. They have held talks with the NWFP
governor and many other officials to bring home to them that the doctors are not ready to
accept the notification.

BOGEY:
Another hardball tactics being used was bogey. Doctors highlighted another issue of less
importance in to the scenario. THEY alleged that the government had decided to privatize
33 per cent beds in various wards of the teaching hospital. It meant that 900 students of
the college would be left with only 700 beds, against the council’s guidelines which
suggested five beds per student.
Also they mentioned the poor teaching facilities at saidu medical college, Bolan medical
college, Gomal medical college etc.

OTRHER TACTICS USED BY GOVERNMENT:

To prevent the PDA from strikes and protests, the government came very hard on the
doctors and scores of them were arrested .Not only was that but the PDA was also
disbanded.
The government first banned the PDA and then started institutional private practice in
order to pre-empt any effective protest by the doctors
In the process, three of its activists — one sitting president, one former president and
another activist — were terminated from services.
“Now, the government is free to implement any decision because there is no one to
offer resistance,” a doctor said.

OTHER TACTICS USED BY DOCTORS:

“The teaching staff of the KMC is instigating their students to stage protest
demonstrations against the ban on private practice of the government-employed
doctors’’

The senior doctors were trying to involve students of the Khyber Medical College (KMC)
for their vested interest.
Then Threat of resignation was given to government. Omar Ayub claimed that it was not
a verbal threat.
 Influence – seeking communication

Is the influence target motivated and bale to carefully process the message?

Message content Message

-Make offer attractive characteristics
-frame the message -Message order
-make message -distractions
normative
-agreement in principle Source characteristics

Message structure -credibility

-One /two-sided -attractiveness
messages -authority
-message components Context effects
-repetition
-conclusions -reciprocity
-social proof
Persuasive style -scarcity
-active participation -reward/ punishment
-vivid
language/metaphors
-receiver fears
-receiver expectations

Central attitude Peripheral attitude

change change
-internal commitment -simple compliance
-relatively enduring -relatively short-lived
-resistant to -risk of
counterinfluence counterinfluence
 PERIPHERAL ROUTE TO INFLUENCE

The peripheral route was adopted by the doctors in this conflict. This route was adopted
by the doctors because the Government was not trying to understand the point of view of
doctors. The Government was trying to impose IBP.

ASPECTS OF PERIPHERAL ROUTE:

There are some aspects that foster or shape the peripheral route.

MESSAGE CHARACTRISTICS:

1. Message Order:
The order of the message used by the doctors was more use of Primacy. i.e., they put
the option of private practice on the top just to have advantage of primacy effect.

2. Distractions:
Strikes of doctors create a distraction effect in the conflict. Doctors criticize the
government rules very openly Many doctors says the health department has banned
private practice despite the fact that the hospitals do have not enough infrastructure,
equipment and facilities to accommodate the influx of patients.

SOURCE CHARACTRISTICS:

1. CREDIBILITY
Qualification of doctors and their respectful profession made them credible and
responsible. People respect them and believe them due to their services.

2. ATTRACTIVENESS
Intense need of doctors make them attractive to the people .People are also
emotionally concerned with doctors.
 3. AUTHORITY:
The doctors themselves have a good authority in a social context. But in this
conflicting situation they also had the support from Umer ayub the president of PMA
(Pakistan medical association). The governor General of NWFP also supports doctors
in this conflict.

CONTEXT EFFECT

1. RECIPROCITY:
The government gives doctors the option that if they stop private practices and joined
IBP in public sector hospitals they will get 60% share from government by IBP and in
response offer services for IBP.

2. COMMITMENT:
The doctors are very committed with their profession and they want to cure people and
decrease their difficulties by providing quality treatment. They opened clinics in rural
areas to provide them medical services that are not possible otherwise.

3. SOCIAL PROOF:
The doctors have filed another petition against the notification in the Supreme Court on
the ground that it is against fundamental human rights.” “The IBP is a recipe for
disaster,” the PMA provincial chief claims. The introduction of IBP has also caused
difficulties for patients in remote areas of the province and in the federally administered
tribal areas. . This means increased healthcare cost in the rural areas where poverty is
more pronounced and people cannot afford medical treatment.

4. SCARCITY:
Scarcity of well qualified doctors and the latest equipments also create a big hurdle.
There is no excess of supply in the Pakistan. Resources are limited so they must be
utilized in the best way.
 5. PUNISHMENT:

The doctors have no option but to tender their resignations if the situation persists and
no common ground is reached to resolve the issue,” he warns. , the doctors argue that if
it is best in the interest of patients then why they force to close the clinics.

CENTRAL ROUTE TO INFLUENCE:

The central route is adopted by the Government in this conflict. The objective of the plan
was to ensure quality treatment, a uniform fee structure, maximum utilization of hospital
equipment and infrastructure during off-hours, creating additional resources and
documentation of doctors’ incomes.

MESSAGE CONTENT:

1. MAKE OFFER ATTRACTIVE:

The government started institution based practice (IBP) in four major hospitals of the
province on a voluntary basis out of good faith and asked the doctors to spare only two
hours a week for IBP. The doctors will get 60 per cent of the revenue generated through
the IBP of each institution. The clinical and administrative support staff is assigned 20
per cent while the remaining 20 per cent revenue is allocated for the hospitals. Except
IBP many other facilities were also offered to the Doctors. i.e.

 Provision of finances, logistics and human resources

 Flexible timings and utilization of side rooms
 Extra funds to improve the infrastructure
 Attractive fee structure
 Share distribution formula.
 Modification of rules and 3rd party evaluation
2. FRAME THE MESSAGE:
Govt highlights the commonalities among doctors and Govt side. The government used
outcome based framework. Govt introduced the IBP plan to set up a common ground
between the parties. Govt was even willing to offer maximum profit share to the doctors.
They offered provision of logistics, finance and human resource to the Doctors just to
bring them to common interests.

3. MAKE MESSAGE NORMATIVE:

Government negotiators tried to frame the message close to the human and social values
of the society. They said that all of the orders passed by the Govt are in large interest of
the society. The poor patients who can not afford the fee structure of the private hospitals
should be given same treatment in the government hospitals. Doctors should take care of
every patient and treat him well thinking it to be their first obligation towards the society.
Unequal treatment is against the basic human rights and our religious values as well.

4. SUGGEST AN “AGREEMENT IN PRINCIPLE”:

To enhance the process of negotiation government tried to reach an agreement of IBP
(Institutional base practice) with the Doctors. The ultimate goal was not to sign IBP but
this agreement was only used to speedup the negotiation process in a positive manner.

MESSAGE STRUCTURE

1. ONE-TWO SIDED MESSAGE:

Both the parties did not reach any of consensus because not only the approaches were
different but the government has designed the message one sided only. Government was
not mentioning the interests of the Doctors and they passed the orders of closing the
private clinics without being considerate of the Doctors.

2. MESSAGE COMPONENT:
Government broke down the whole plan into smaller pieces to make the implementation
easy.
Phase 1: (3 yrs) Doctors will be divided into three categories to implement IBP in OPDs.
Phase 2: (3-5 yrs) Doctors would be advised to close their private setups.
Phase 3: (Beyond 5 yrs) Government will enforce strict rules against any private
practice.

3. REPETITION:
Government was repeating their core order against private practice in every press
conference and in every meeting just to make it vivid and make the other party clear what
is expected out of all this discussion?

4. CONCLUSIONS:
The government concluded all their orders naming them “Best interest of humans” and a
necessity for the equitable treatment of all patients. They also ensured their acts to be the
strict follower of the health laws.

PERSUASIVE STYLE

1. Vivid language:
All government negotiators used very simple language to make their idea clear. They
simply named the whole idea “a basic human right” and we are here to protect these
rights.

2. Incite Fear:
When the implementation process was observed to be very slow government used few
threats in their conversation as “A grace period of 15 days is given to the Doctors and
after this period government will be fully authorized to take stern action against private
practioners.”
 Ethical concerns of the conflict

Government

Rule Ethics:

Government was taking all its actions on the basis of existing rules and laws for the
Health sector in Pakistan. They were of the view that the law does not support the private
practice of any government Doctor outside the premises of the hospital so their practices
should be banned immediately. For the demonstration of their action they also rely on
rules and said that government is authorized to take stern action against any transgressor
of misconduct according to the NWFP Civil Servants Removal from Service (special
powers) Ordinance, 2000.Government strictly followed rule ethics through out the
process and tried to adjust the Doctors according to the Law while the Doctors were
trying to adjust law according to their actions.

Doctors

Social Contract Ethics:

Doctors defended all their actions and decisions on the basis of social contract ethics.
They were supporting themselves by saying that private practice remained the custom of
This society and we have always been appreciated by the society for this overtime
service. In private clinics we provide quality health services to the patients and all those
facilities are available there which a patient can not get in the government hospitals. They
were also justifying themselves by saying that for private practice Doctors even go to the
remote areas where government health facilities are not available. They were of the view
that all this is done for the well being of the society and community so it should not be
banned.

Unethical Practices Followed

By Government

BLUFFING:

Government used insincere threats and promises through out the process. The very first
statement which was passed from the government side was that “We are offering the
grace period of the 15 days to all government Doctors to wind up their private clinics”.
Warning was that “Following the expiry of this period stern action would be taken
against the transgressors of the misconduct”. This was nothing else than a bluffed
statement because Doctors did not wind up their clinics within that grace period and yet
no action was taken against them.
Government used insincere threats in their talks as well when according to the “The Post”
Oct 10, 2008 supreme court passed the statement to transfer all the Doctors to their
homes who are not honest to their profession and are not serving the society well yet we
have seen no Doctor to be transferred to his home on the basis of this statement.

By Doctors

Misrepresentation of the opponent’s network:

Doctors exaggerated a lot in misrepresentation of the government. They simply called the
whole process “A recipe of disaster”. Doctors also claimed the government to be
involved in unequal treatment of employees in the different departments. They supported
their argument by saying that if government employees in educational sector are not
banned for any overtime private lectures why should we banned for any private practice?
By strikes and all other destructive activities what Doctors achieved was only to damage
the credibility of the government.
 SEQUENCE OF EVENTS

FEBRUARY 12, 2002

The conflict arouse on February 12, 2002 when the notification was declared. The
provincial health department put a complete ban on government doctors’ private practice,
and asked the serving doctors of all cadres to close their private clinics within 15 days.
“The government will take disciplinary action if the doctors did not abide by the
order”
“The private practice of all government doctors, including teaching staff at any place or
premises, except within the boundaries of the health institutions/hospitals concerned,
shall stand banned with immediate effect,” said a notification issued by the NWFP health
secretary on 12 February 2002.

FEBRUARY 13, 2002

The NWFP government’s decision to ban private practice of serving doctors received
overwhelming response from the masses, who want the decision to be implemented in all
seriousness. “The doctors’ community is fleecing the poor patients and acting as a
commercial group rather than professional,” commented one attendant.

FEBRUARY 21, 2002

The problems faced by doctors are that, in the absence of an effective organization of
doctors, the medical community in Frontier is finding it hard to cope with the situation
emanating from the government’s decision to ban their private practice.

“In the absence of a strong representative body, we feel in very awkward position to
pursue our case,” said a professor at Khyber Teaching Hospital, Peshawar.
 According to him, a few years back, the government banned Pakistan Doctors
Association (PDA), the representative organization of the 5,000 doctors of the province.
Now, the doctors have no alternative forum to press the government to bring it to
negotiation table, the doctor said

AFTER 15 DAYS i.e. MARCH 1, 2002

only a small number of the public sector doctors opted to turn up to begin private practice
in the government-run hospitals in the evening as a large number of such doctors neither
attended their private clinics nor the government hospitals, showing disrespect to the
health department’s notification dated Feb 9,2002.
“It [the institutional-based private practice] is compulsory for the public sector
doctors ... and all those who chose to stay away from the same would be acted
against in accordance with the law,” said the secretary Habibur Rehman at a press
conference on Friday.

Earlier, the health personnel were seen removing the signboards from the private clinics
of public sector doctors at various places in the city.

However, despite the ban some of the public sector doctors made arrangements to see
patients in the evening at their homes. The staff at their clinics, in some of the cases, was
seen directing visiting patients to consult the doctors concerned at their residences.

MARCH 4, 2002

The resistance from the doctors, a majority of whom had adopted the line of non-
cooperation deepened the crisis.

It was highlighted in the DAWN NEWS that “the underlying rationale of this move is
not clear. It cannot be denied that a number of cases have been reported where doctors
have neglected their work in a government hospital to pay more attention to their private
patients from whom they generate lucrative earnings. But simply asking them not to see
patients privately will not improve the working of the hospitals.”

MARCH 9, 2002

Doctors challenged ban on practice. The ban on private practice of government doctors
was challenged in the Peshawar High Court. The petitioners prayed to the court for
declaring the provincial government’s notification of Feb 12, 2002— through which the
Institutional Based Practice was introduced and private practice was banned— as
illegal and against the law.

Petioner’s views: It was stated that in consequence of the impugned notification the
public had been deprived of the option of getting treatment at private clinics other than
the government hospitals. The petitioners contended that by imposing the ban only in the
NWFP, the province had been discriminated as no such restriction had been imposed in
other provinces of the country.
Respondents in the petition were NWFP government, Federation of Pakistan and the
Pakistan Medical and Dental Council.

Involved parties:

1. PMA-PAKISTAN MEDICAL ASSOCIATION:

They started launched struggle on behalf of doctors. It was a non-elected and non-
representative body and according to senior consultants “to expect something
extraordinary from it, would tantamount to seek relief from a wrong source.”
“It is a toothless body and has no roots among the doctors community, therefore,
we don’t think that it would deliver as far as this issue is concerned” said by a
Surgeon.
2. JOINT ACTION COMMITTEE
They are trying to pressurize the provincial government to lift the ban on their private
practice. The chairman of the doctors’ joint action committee was Omar Ayub.

3. NWFP GOVERNMENT
4. PDA-PAKISTAN DOCTORS ASSOCIATION

MARCH 19, 2002

PESHAWAR HIGH COURT:

On march 19,2002, A two-member bench of the Peshawar High Court on Tuesday
sought comments from the NWFP government in reply to a writ petition challenging
the ban on the private practice by government doctors and the introduction of
institutional-based practice by the government.
The bench, comprising Justice Khalida Rachied and Justice Abdur Rauf Lughmani,
took up for preliminary hearing the petition filed on behalf of the teachers’
associations of all the medical colleges and the Post-Graduate Medical Institution
(PGMI) in the province

The petitioners are: Khyber Medical College’s Teachers Association President Dr

Siddiqur Rehman, General-Secretary Dr Ijaz Khattak, PGMI Teachers Association
President Dr Arshid Jawed and General-Secretary Dr Jalil Khan. They claimed that
they represented all the teachers of Khyber Medical College, Ayub Medical College,
Saidu Medical College, Gomal Medical College, the PGMI and Lady Reading
Hospital.

Petitioners view point:

The petitioners’ counsel, Qazi Muhammad Anwer argued that
 “Keeping in view the standard and capacity of the government hospitals; it
would be difficult for the hospitals to cater to the needs of those patients who
sought treatment from private doctors.”
  it would be a great injustice with the poor patients, as preference would be
given to the private patients, who visited those hospitals
 “The major objective of the government is revenue generation through
institutional-based practice,” he maintained.

View point of bench:

 Doctors were government servants and all the rules and regulations
applicable to other servants were also applicable to them.
 The bench asked what would happen if like the doctors, the government
servants of other departments started doing private practice after
performing their official duties.

RESULT:
The bench dismissed another petition, filed by Advocate Moazam Butt on behalf
of an organization, Ideological Force of Pakistan, challenging the ban on the
private practice by the doctors.

The bench observed that the petitioner was not an aggrieved (hurt) party and it
had no locus standing to file the petition.

MARCH 20, 2002

Chairman of the doctors’ joint action committee, Omar Ayub, claimed that it was not a
verbal threat. “I have separate resignations of 153 doctors including district
professors, associate professors, assistant professors and senior registrars’,” he said.
“But the doors are still open for negotiation with the government to find a solution to end
the doctor-government standoff. If the dialogue failed than we will hand in the
resignations after consulting the lawyers,” he maintained. Overall 15 – 16 doctors
resigned from different hospitals of Peshawar.
But on the other hand the senior doctors of the Khyber Teaching Hospital said all the
doctors knew that if they resigned the government would initiate an inquiry into the tax
evasion of their past earnings through private practice.

“The doctors have no option but to tender their resignations if the situation persists
and no common ground is reached to resolve the issue,” they warned.

MARCH 21, 2002

Students of Khyber Medical College blocked the main Jamrud Road for an hour on
Thursday, in protest against the ban on private practice of the public sector doctors.
The protesters, including girls, demanded of the government to solve the matter amicably
and save their studies from being affected. The Students Action Council of the college
had organized the protest.
Later, a meeting was held in front of the Khyber Teaching Hospital, where SAC leaders
announced boycott of the classes for Thursday.
Student leaders threatened that if the issue was not resolved in consultations with the
doctors, they would draw further line of action, which, they said, also included boycott of
the academic activities for an indefinite period.
Speaking at the meeting, SAC Chairman Kamran Khan accused the government of
playing with the future of medical students by forcing the 157 doctors of the teaching
hospital to resign from their jobs.
He said the rulers were pursuing dictatorial policies, which were destined not only to
harm the medical education, but also the poor patients.
The medical college would be deserted, and the Pakistan Medical and Dental Council
would derecognize the college, leaving hundreds of the students high and dry.

RESULT:
The speakers suggested that the government should implement the Private Practice Act
1984, and Drug Rules Act 1976, in letter and spirit to regulate the medical practice and
education in the country, and avoid harassment to the doctors. Pledging to continue their
struggle to force the government for holding talks with their teachers and solve the matter
amicably, the students dispersed peacefully.

AUGUST 22, 2003

The NWFP government had decided to amend the law for re-instating doctors who had
resigned after the introduction of the Institution-based Practice (IBP) in the province.

The government had already prepared a draft of an amendment to the Medical Health
Institutions and Regulations of Health Care Services

The draft is likely to be presented before the provincial cabinet for approval in its next
meeting. The proposed amendment will be called NWFP Medical Health Institutions
and Regulation of Health Care Services (first amendment) Act, 2003

A 15-member parliamentary committee appointed by the NWFP Assembly examined the

issue in detail and the report of the committee, favored lifting of the ban on private
practice. The committee   recommended that the IBP was affecting the working of
hospitals and draining expertise from the medical institutions, therefore it should be
reversed.
 Direct Interview (face to face and telephonic)

Indirect interview

DOCTORS:

PROF. DR SAQIB LODHI

DR. HABIB JADOON (resigned to protest IBP)

PROF. ANWER SHARIF (took leave for 1 year to protest IBP)

PROF. MUHAMMAD JAVED (took leave for 1 year to protest IBP)

DR. ALRUBA TAIMOOR

DR. SAADIA IRUM

DR. FAHD KHAN

DR. HASSAM

PROF DR. JALAL

DR.NAZIA

PRESIDENT PMA:

An indirect interview from Pakistan Medical Association (PMA), NWFP, President

Umar Ayub.

The sample is taken from different hospitals that are affected by Government decision.
The hospitals that were affected are

-Lady reading hospital (LHR), Peshawar

- Khyber Teaching Hospital (KTH)

- Hayatabad Medical Complex (HMC), Peshawar

- Ayub Teaching Hospital, Abbottabad

We took four doctors from Ayub teaching Hospital, two from Khyber Teaching Hospital,

two from Lady Reading Hospital and two from Hayatabad Medical Complex.

News Papers

Websites

Open ended Questionnaire

Analysis of Interview and secondary Information

Implementation of negotiation concepts on the conflict

Questionnaire
 1. Why did government take that action of banning private practice of

doctors in your opinion?

2. Is there any recorded data about the complaints from patients against

doctors?

3. Is there any record of taking this action in past as well?

4. Was that kind of strong resistance from doctor’s side was expected by

government or not?

5. Hundreds of patient’s suffer from this Ban and Boycott from

government and doctors? How do you justify your standing?

6. Did doctors were taken in confidence before taking this decision?

7. What methodology was adapted to devise Institution Based Practice?

8. Did suggestions from doctors were taken before devising IBP?

9. What was the loop whole in IBP?

10. What was the major negotiating strategy initially adopted by both the

sides?

11. What BATNA both the parties had in case of failure of the negotiation?

12. Did you declare any commitment in order to influence the other party?

13. Why did the negotiation failed in your opinion?

14. What post learning out comes you find in this conflict?

References:
 http://www.dailytimes.com.pk/default.asp?page=story_9-1-2005_pg7_27
 http://server.kbri-islamabad.go.id/index.php?
option=com_content&task=view&id=1543&Itemid=4
 Doctors associated with different hospitals of NWFP
 DAWN NEWS PAPER
 Government officials
 Medical mayhem.ht
THANK YOU