Training paediatric healthcare staff in recognising, understanding and managing conflict with patients and families: findings from a survey on immediate and 6-month impact
Abstract:This training has the potential to reduce substantially the human and economic costs of conflicts for healthcare providers, healthcare staff, patients and relatives.
“…Notably listening and perspective-taking were both cited as important, reflecting what Ranjan et al 27 refer to as frequently neglected communication skills. This study has successfully extended previous work where training was offered as a stand-alone intervention11 by adding the CMF as a framework that staff can adopt when they identify conflict.…”
Section: Discussionmentioning
confidence: 82%
“…Four days of training in conflict management, using an approach and materials with proven efficacy,11 were provided by the study team prior to commencing use of the CMF. The first 3 days provided 6 hours of training to senior clinicians and managers across the hospital, including approximately 10 staff from the paediatric oncology team.…”
The CMF substantially reduces the incidence of conflicts and is an acceptable approach for staff. Continued use of the framework would require it to be fully integrated into the working of the ward, which would need to include senior medical buy-in. Further refinements to the framework have been made and will be tested in four UK sites in 2018/2019.
“…Notably listening and perspective-taking were both cited as important, reflecting what Ranjan et al 27 refer to as frequently neglected communication skills. This study has successfully extended previous work where training was offered as a stand-alone intervention11 by adding the CMF as a framework that staff can adopt when they identify conflict.…”
Section: Discussionmentioning
confidence: 82%
“…Four days of training in conflict management, using an approach and materials with proven efficacy,11 were provided by the study team prior to commencing use of the CMF. The first 3 days provided 6 hours of training to senior clinicians and managers across the hospital, including approximately 10 staff from the paediatric oncology team.…”
The CMF substantially reduces the incidence of conflicts and is an acceptable approach for staff. Continued use of the framework would require it to be fully integrated into the working of the ward, which would need to include senior medical buy-in. Further refinements to the framework have been made and will be tested in four UK sites in 2018/2019.
“…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.
“…Training professionals in communication skills, as well as in how to recognise, understand and manage conflict,40 might therefore help avoid or quell disputes.…”
Section: From the Courtroom (Back) To The Clinicmentioning
Law's processes are likely always to be needed when particularly intractable conflicts arise in relation to the care of a critically ill child like Charlie Gard. Recourse to law has its merits, but it also imposes costs, and the courts' decisions about the best interests of such children appear to suffer from uncertainty, unpredictability and insufficiency. The insufficiency arises from the courts' apparent reluctance to enter into the ethical dimensions of such cases. Presuming that such reflection is warranted, this article explores alternatives to the courts, and in particular the merits of specialist ethics support services, which appear to be on the rise in the UK. Such specialist services show promise, as they are less formal and adversarial than the courts and they appear capable of offering expert ethical advice. However, further research is needed into such services - and into generalist ethics support services - in order to gauge whether this is indeed a promising development.
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