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Training paediatric healthcare staff in recognising, understanding and managing conflict with patients and families: findings from a survey on immediate and 6-month impact
  1. Liz Forbat1,
  2. Jean Simons2,
  3. Charlotte Sayer3,
  4. Megan Davies3,
  5. Sarah Barclay4
  1. 1Australian Catholic University and Calvary Health Care, Canberra, Australian Capital Territory, Australia
  2. 2Lullaby Trust, London, UK
  3. 3Evelina London Children's Hospital, St Thomas’ Hospital, London, UK
  4. 4Medical Mediation Foundation, London, UK
  1. Correspondence to Sarah Barclay, Medical Mediation Foundation, 36 Westbere Road, London NW23SR, UK; sarah.barclay{at}


Background Conflict is a recognised component of healthcare. Disagreements about treatment protocols, treatment aims and poor communication are recognised warning signs. Conflict management strategies can be used to prevent escalation, but are not a routine component of clinical training.

Objective To report the findings from a novel training intervention, aimed at enabling paediatric staff to identify and understand the warning signs of conflict, and to implement conflict resolution strategies.

Design and setting Self-report measures were taken at baseline, immediately after the training and at 6 months. Questionnaires recorded quantitative and qualitative feedback on the experience of training, and the ability to recognise and de-escalate conflict. The training was provided in a tertiary teaching paediatric hospital in England over 18 months, commencing in June 2013.

Intervention A 4-h training course on identifying, understanding and managing conflict was provided to staff.

Results Baseline data were collected from all 711 staff trained, and 6-month follow-up data were collected for 313 of those staff (44%). The training was successful in equipping staff to recognise and de-escalate conflict. Six months after the training, 57% of respondents had experienced conflict, of whom 91% reported that the training had enabled them to de-escalate the conflict. Learning was retained at 6 months with staff more able than at baseline recognising conflict triggers (Fischer's exact test, p=0.001) and managing conflict situations (Pearson's χ2 test, p=0.001).

Conclusions This training has the potential to reduce substantially the human and economic costs of conflicts for healthcare providers, healthcare staff, patients and relatives.

  • conflict
  • Health services research
  • paediatrics
  • training

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  • Twitter Follow Liz Forbat at @lizforbat

  • Contributors SB, JS and LF designed the work. CS and MD acquired the data. LF, CS, MD and SB interpreted the data. LF and SB drafted the work and revised it critically for intellectual content. LF, JS, CS, MD and SB approved the final version of the manuscript. LF, JS MD, CS and SB agree to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The study was funded by the Guy's and St Thomas' Charity (Grant: EFT120609).

  • Competing interests SB received a grant from the Guy's and St Thomas' Charity, during the conduct of the study; and she is the director of the Medical Mediation Foundation—an organisation which provides conflict management training and mediation in situations where there is disagreement/conflict between patients and healthcare professionals. However, the manuscript focuses on conflict incidence not mediation as a solution.

  • Ethics approval Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Any requests for raw data should be directed to the corresponding author.

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