What can you learn from a five week-long strike?
by Christer Mjåset
It seemed like a battle you couldn’t win.
Hospitals in Norway spontaneously started interpreting the contracts of consultants and junior doctors in a new manner – claiming this was within legal boundaries. The result meant more frequent shifts for the same pay and a loss of regulation of rest periods. The hospitals said they needed the flexibility to deliver quality healthcare, and it was claimed that the protesting doctors were motivated by lucrative deals in the original contract.
There were several similarities to the recent Junior Doctors’ contract dispute in England; a government trying to cut costs due to a struggling economy and a healthcare system with challenging financial demands. The Norwegian dispute led to a strike involving about 700 out of 14000 Norwegian doctors from 7th September 2016 until 11th October 2016. Against all odds, one week into the strike, 80% of the Norwegian population who were aware of the conflict supported the doctors. How did it come to this? Here are some basic strategies that aided the success of the Norwegian strike.
Work on your message
A large group of people can seldom be told to say exactly what you want them to express. A large group is not easy to coordinate either, so you must depend on people’s ability to mobilize in their own way. To do so, you have to work on your message. The message should be based on what you have in common as a group, and reflect your basic values, condensed down to three simple bullet points. This way, everyone remembers the essence of your message and it is easier for people to communicate it.
Today, people communicate via social media daily. They post pictures, videos, tweets, and write short emotional or sarcastic passages about their lives. They share it with their friends, who again share it with their friends. A post-strike-evaluation showed that 65% of striking doctors used Facebook to update themselves about the dispute. A Facebook post is instant. Fresh. And very often emotional. But more importantly, you notice it – and so does everyone else. I believe our social media focus was the reason we garnered much support. #pasientsikkerhet (patient safety) and #kollektivtvern (protection through collective contracts) were slogans tweeted repeatedly. These hashtags were carefully selected, although I never expected the overwhelming effect these words would have on the public.
Talking face-to-face is the most powerful way to motivate people. Our post-dispute evaluation confirmed this – rally meetings with a union representative held at local hospitals achieved the best scores compared to other measures. This is not new. After Hillary Clinton lost the presidential election against Donald Trump, Barack Obama made a comment on how the Democrats had been “micro-targeting particular discrete groups” during the presidential campaign. He concluded that micro-targeting “sometimes will win you the election but it is not going to win you the broad mandate you need”. In other words, according to Obama, Hillary Clinton did not meet enough potential voters to win the presidency. She simply didn’t travel enough.
The bad guy makes the good guy
To motivate people, you also need an antagonist. In every James Bond movie, there is a scene where the villain presents his cynical side. This makes the viewer appalled by the villain, and cheer even more for James Bond. You can’t control what your antagonist says or how they behave, but you should be aware of the effect an appearance or TV interview might have on your peers and colleagues. During the UK Junior Doctor contract dispute in 2015/16, health minister Jeremy Hunt claimed there were increased mortality rates associated with weekend hospital admission. It turned out he had little evidence for this statement, making him seem unreasonable and allowing the BMA to refute his argument.
Know your opponent
It can be tough to fight the government, as they have resources and power. But they are administered in a top-down manner. It is unlikely that a lower-ranked member of the Department of Health would spontaneously write a media article stating their support for Jeremy Hunt. For a union, it’s the other way around. We depend on the grassroots to mobilise. This means anything can happen.
During the Norwegian strike in Autumn 2016, I took Obama’s words seriously and traveled continuously. I met small groups of colleagues at strikes, made a two-hour introductory speech describing the conflict and what we expected and not expected from people selected to be on strike. Then, I made the people in the group sit down and discuss different options for industrial action. In one of the last towns I visited, a woman stood up after the discussion and said to me: “We are ready now, you can leave whenever you want”. I couldn’t help but smile all the way back to the office. We empowered our union members, allowing them to fulfil their creative potential.
One last thing: Always remember that what you have, as a doctor, is your credibility. In a conflict, it is easy to become emotional. You are attacked from all directions. You are called greedy, stupid, cynical and egoistic. Never respond in the same manner that you are attacked. Be trustworthy; you are concerned about your work and your patients. Because that is the general truth for the majority of doctors I’ve met in my life, and what keeps us going in times of challenge.
Christer Mjåset is the leader of the Norwegian Junior Doctors, an author and a neurosurgeon.