A change of atmosphere in the NHS has left many staff less prepared to challenge management decisions. This is partly reflected in reports of increased bullying at work and of the risks of being a whistleblower. Yet much grief in the NHS (and elsewhere) would be avoided if staff were a little more assertive when decisions affecting them are being taken. Often simple steps can help avoid more difficult situations later on. Roger Kline looks at some common situations and how to negotiate your way through them.