Conflict in a paediatric hospital: a prospective mixed-method study

Abstract

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.

Reducing healthcare conflict: outcomes from using the conflict management framework

“…Staff burn-out is associated with reduced patient safety,20 making it an important focus for interventions. Further, the CMF has the potential to reduce the substantial burden of staff time/cost associated with managing conflict5 and emotional burden on staff and families 21–23. Communication breakdown is a recognised component of conflict escalation4 24 and was evident in the data from this study.…”

“…Frequency and severity of conflicts were collected with a tool used in previous conflict work,5 and completed on a daily basis by the clinical staff. The tool recorded the number, duration, causes and severity of conflict cases, time taken to manage them, and the staff involved in managing the case.…”

“…Time taken up with managing conflict can be considerable,5 with communication breakdown, disagreements over treatment and unrealistic expectations cited as common causes.…”

Best Interest, Harm, God’s Will, Parental Discretion, or Utility

“…After all, disagreements occur daily in pediatric intensive care units (Forbat et al 2016;Studdert et al 2003;Vemuri and Playfor 2006). Routinely, doctors "discuss the nature and likely outcome of a given illness, explore the ramifications of forthcoming decisions, determine patient values, confirm that patients or families understand the information provided them, discuss preferred roles in decision-making, and achieve consensus about treatment courses that are most consistent with patient values, " (Luce 2010(Luce , 1623.…”

Anger and aggression in paediatrics

“…These may be directed towards them, justifiably or unfairly, by patients and families. 1 Paediatricians may sometimes feel the brunt of colleagues' anger or become angry themselves in response to working with others, in clinical situations and with administrative frustrations. Anger may be recognised or suppressed, and it can be constructive or destructive.…”