The normalisation of dysfunction: a multi-site reflexive thematic analysis of interprofessional conflict in Indian public and private hospitals

Interprofessional conflict among healthcare workers is a recognized contributor to patient safety failures and workforce attrition globally, yet contextually grounded qualitative evidence from the Indian health system remains scarce. This study explored the nature, sources, impacts, and resolution strategies of interprofessional conflict in Indian hospital settings across multiple states and institutional types. This study constitutes Phase Two of a programmatic mixed-methods investigation; a preceding quantitative study (Phase One; January to December 2024) established the prevalence and correlates of conflict at these sites. A constructivist reflexive thematic analysis (Braun and Clarke, 2006/2022) was conducted using 19 semi-structured in-depth interviews (IDIs) with healthcare workers recruited via purposive sampling from government teaching hospitals, private tertiary teaching hospitals, private medical college hospitals, and government hospitals in Arunachal Pradesh, Gujarat, Rajasthan, and Telangana between December 2025 and February 2026. Participants included junior resident doctors, senior residents, consultants, professors, staff nurses, and nursing in-charges/superintendents. Thematic saturation was reached at the fifteenth interview. Analysis followed six phases, with independent coding by two analysts and systematic negative case analysis. Reporting adhered to COREQ guidelines. Six overarching themes and 20 sub-themes were generated. Communication failure was the most universally endorsed conflict source (100%, n = 19), followed by hierarchical power dynamics (95%, n = 18) and resource constraints (89%, n = 17). All participants reported deterioration of team dynamics; 74% reported adverse effects on patient care. Formal conflict resolution infrastructure was absent across all four states (95%, n = 18). Junior staff disproportionately relied on avoidance as coping mechanism. Gender-based discrimination was a contextually specific sub-theme reported exclusively by female participants (16%, n = 3). Conflict was identified as a catalyst for systemic improvement by 74% of participants. Interprofessional conflict in Indian hospitals appears to be structurally produced and inadequately managed. Participants most consistently identified mandatory curriculum-integrated conflict resolution training and systemic communication infrastructure as priority interventions. These findings provide a qualitative evidence base that may inform curriculum reform under the NMC AETCOM framework and health system strengthening in comparable LMIC settings, though the transferability of specific priorities beyond the four sites studied here should be assessed locally.