Do not go gentle: intractable value differences in hospices

As hospices have evolved and grown, from small community-based cottage institutions to larger and more complex healthcare providers, they have begun to acquire staff with characteristics that are significantly different from those of their founding members. Because the timeline of the modern hospice movement is so short, many still have founding members at work, and institutions find themselves employing people with diverse aspirations and motivations. Such value differences would normally be a sufficient basis for conflict in most organizations. In the particular context of hospices, and perhaps other healthcare institutions, such conflict often goes underground, as each protagonist tries to live up to its image of what is appropriate. This narrative research, based in five New Zealand hospices, explores the problem of hidden but unresolved tensions and suggests some possible avenues for management involvement.