BackgroundConflict in healthcare is a well-recognised but under-examined phenomenon. Little is known about the prevalence and causes of conflict across paediatric specialties.ObjectiveTo report the frequency and characteristics of conflict in a paediatric hospital.Design and settingAn explanatory sequential mixed-method approach was adopted. A bespoke questionnaire recorded frequency, severity, cause and staff involved in conflict prospectively. Data were recorded for the same two 12-week periods in 2013 and 2014, in one UK children's teaching hospital. Data were analysed using descriptive statistics and correlation, the findings of which informed the construction of a semistructured interview schedule. Qualitative interviews were conducted with six key informant healthcare professionals to aid data interpretation; interviews were analysed thematically.Results136 individual episodes of conflict were reported. The three most common causes were ‘communication breakdown’, ‘disagreements about treatment’ and ‘unrealistic expectations’. Over 448 h of healthcare professional time was taken up by these conflicts; most often staff nurses, consultants, doctors in training and matrons. The mean severity rating was 4.9 out of 10. Qualitative interviews revealed consensus regarding whether conflicts were ranked as low, medium or high severity, and explanations regarding why neurology recorded the highest number of conflicts in the observed period.ConclusionsConflict is prevalent across paediatric specialties, and particularly in neurology, general paediatrics and neonatology. Considerable staff time is taken in managing conflict, indicating a need to focus resources on supporting staff to resolve conflict, notably managing communication breakdown.
This training has the potential to reduce substantially the human and economic costs of conflicts for healthcare providers, healthcare staff, patients and relatives.
ObjectiveTo implement and evaluate the use of the conflict management framework (CMF) in four tertiary UK paediatric services.DesignMixed methods multisite evaluation including prospective pre and post intervention collection of conflict data alongside semistructured interviews.SettingEight inpatient or day care wards across four tertiary UK paediatric services.InterventionsThe two-stage CMF was used in daily huddles to prompt the recognition and management of conflict.ResultsConflicts were recorded for a total of 67 weeks before and 141 weeks after implementation of the CMF across the four sites. 1000 episodes of conflict involving 324 patients/families across the four sites were recorded. After implementation of the CMF, time spent managing episodes of conflict around the care of a patient was decreased by 24% (p<0.001) (from 73 min to 55 min) and the estimated cost of this staff time decreased by 20% (p<0.02) (from £26 to £21 sterling per episode of conflict). This reduction occurred despite conflict episodes after implementation of the CMF having similar severity to those before implementation. Semistructured interviews highlighted the importance of broad multidisciplinary leadership and training to embed a culture of proactive and collaborative conflict management.ConclusionsThe CMF offers an effective adjunct to conflict management training, reducing time spent managing conflict and the associated staff costs.
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