Introduction

Collaboration of different professional groups is an important dimension of the quality and efficiency of healthcare services that directly impact on patient outcomes. However, the relationships between the two largest professional groups in healthcare – nurses and doctors – have been traditionally hierarchical. In its classical version, professionalism is characterised by strategies of social exclusion, closure and demarcation. In particular, medical ‘tribalism’ and the interprofessional relationships between doctors and nurses have always been an area of conflict, although these relationships are also subject to general trends of inclusion and participation. Changes in social context – such as democratisation, women's emancipation and higher levels of education – challenge the rigid structure of healthcare systems. New demands on healthcare and citizenship rights create a new need for more collaborative relationships; across countries, professionalism is in a process of transformation towards more inclusive forms (Saks and Kuhlmann, 2006).

This chapter discusses the nurse–doctor relationship in the Slovenian healthcare system. It is argued that options for, and barriers to, collaboration are not only shaped by organisational context and governance structures, they are also embedded in ‘culture’ and modelled by professional identity and individual attitudes. An important element of changing or sustaining a hierarchical structure of interprofessional relations is the perception that members of these two professional groups hold about themselves and each other. In Slovenia, no systematic ‘map’ and database exist on interprofessional relationships between nurses and doctors. In 2004, however, both professional associations – the Nurse and Midwifery Organisation of Ljubljana (part of Nurses Association of Slovenia – NAS) and the Slovenian Medical Association (SMA) – agreed to support research into the perceptions that these two professional groups hold about each other and their relationship.

This chapter focuses on the empirical findings of this study. It places the individual perceptions and actor-based changes in the Slovenian healthcare system in the context of the historical formation of Roman Catholic culture and the experiences of centralised bureaucracy of the socialist era. The concept of individualisation and self-determination and the notion of trust (see also Calnan and Rowe, this volume) serve to explore the complexity and cultural embeddedness of professional relationships in healthcare.

Different cultures of doctors and nurses: working together apart

Collaboration in healthcare calls for the participation and more equal relationships of all players involved. It touches on the role of the individual in society and broader societal changes towards ‘individualisation’.