Achieving consensus advice for paediatricians and other health professionals: on prevention, recognition and management of conflict in paediatric practice
“…Box 2 provides a high-level summary of the combined recommendations of both ‘Spotlight’ meetings. Topics covered include staff training, particularly in early recognition and management of conflict (an intervention for which there is an emerging evidence base28); support for both parents and staff; team and organisational strategies; and the use of national guidance and frameworks; for example, both RCPCH29 and the Nuffield Council on Bioethics30 have produced guidance on managing disagreements and achieving consensus. Most challenging is the need for an open narrative between clinicians and the wider community about the difficult choices that must be made when what can be done to extend life is not always what should be done.Recommendations from ‘Spotlight on Paediatrics’ meetings
Staff training.
Three aspects were discussed:
Better individual and team training in self-care and recognition of mental health problems.A changed approach to training staff in the advanced communications skills needed to manage difficult conversations and shared decision-making, as well as in early recognition of signs of conflict.Improved training in management of children with complex disabilities, palliative care, ethics and law.
Supporting the workforce.
A wide range of measures were discussed, including new approaches to clinical and personal supervision, debriefing following critical events, better peer and team support structures, and enhancement of social networks in the work environment.
Team/Organisational strategies.
These included strategies for early recognition of potential conflict and breakdowns through ‘ward-walking’, review of complaints to Patient Advice and Liaison Services, shared learning from previous high-profile events, and ‘learning from excellence’.
Supporting parents.
Some resources already exist for supporting parents through the voluntary sector, and these need to be augmented.
“…Box 2 provides a high-level summary of the combined recommendations of both ‘Spotlight’ meetings. Topics covered include staff training, particularly in early recognition and management of conflict (an intervention for which there is an emerging evidence base28); support for both parents and staff; team and organisational strategies; and the use of national guidance and frameworks; for example, both RCPCH29 and the Nuffield Council on Bioethics30 have produced guidance on managing disagreements and achieving consensus. Most challenging is the need for an open narrative between clinicians and the wider community about the difficult choices that must be made when what can be done to extend life is not always what should be done.Recommendations from ‘Spotlight on Paediatrics’ meetings
Staff training.
Three aspects were discussed:
Better individual and team training in self-care and recognition of mental health problems.A changed approach to training staff in the advanced communications skills needed to manage difficult conversations and shared decision-making, as well as in early recognition of signs of conflict.Improved training in management of children with complex disabilities, palliative care, ethics and law.
Supporting the workforce.
A wide range of measures were discussed, including new approaches to clinical and personal supervision, debriefing following critical events, better peer and team support structures, and enhancement of social networks in the work environment.
Team/Organisational strategies.
These included strategies for early recognition of potential conflict and breakdowns through ‘ward-walking’, review of complaints to Patient Advice and Liaison Services, shared learning from previous high-profile events, and ‘learning from excellence’.
Supporting parents.
Some resources already exist for supporting parents through the voluntary sector, and these need to be augmented.
“…Recent high‐profile cases of conflict between parents and health‐care professionals regarding end‐of‐life care in the UK (Charlie Gard, Alfie Evans) and regarding the treatment of brain tumour in the UK (Ashya King) and Australia (Oshin Kiszko) have highlighted conflicts between parents and health‐care staff. Early predictors of intractable conflict include family attempts to micro‐manage care, avoidance and communication breakdown . A UK Royal College of Paediatrics and Child Health consensus paper gave sensible advice on conflict management strategies, including assigning a Lead Clinician, involving palliative care teams early and seeking ethical and legal advice if mediation fails …”
mentioning
confidence: 99%
“…Early predictors of intractable conflict include family attempts to micro‐manage care, avoidance and communication breakdown . A UK Royal College of Paediatrics and Child Health consensus paper gave sensible advice on conflict management strategies, including assigning a Lead Clinician, involving palliative care teams early and seeking ethical and legal advice if mediation fails …”
“…One difficult case, however, meant more time was spent overall on managing conflicts after than before the intervention (1240 vs. 835 min). Early identification of relationship breakdown was crucial, including ‘family micro‐managing care’, ‘communication breakdown’, parents and staff exhibiting avoidance behaviours and demands to choose who cares for their child . Staff who completed a questionnaire scored significantly lower for burnout after than before the intervention ( P = 0.001), but this finding was weakened by the participation of only 9 of 17 staff invited.…”
mentioning
confidence: 99%
“…The UK Royal College of Paediatrics and Child Health has prepared a consensus paper advising conflict management strategies, including assigning a lead clinician, early involvement of palliative care teams and seeking ethical and legal advice if mediation breaks down …”
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