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Abstract
Objective To test a new conflict management framework (CMF) to help staff identify and de-escalate conflict between staff and patients/families.
Design Before/after study that reports staff quality of life, frequency/severity of conflicts and qualitative interviews on using the framework. Data were collected from May 2017 to September 2017.
Setting A paediatric oncology department day-patient and 23-bed inpatient ward.
Intervention A two-stage CMF used by staff during daily handovers to identify and then manage conflict cases with families.
Results Staff found the CMFto be helpful in identifying and de-escalating conflicts. The number of conflicts reported decreased by 64% from baseline to follow-up. Communication regarding conflict identification improved. Reports of staff burn-out decreased between the two time-points (n=55 at baseline, n=31 at follow-up; p=0.001). Scores on compassion and secondary traumatic stress did not change.
Conclusions 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.
- multidisciplinary team-care
- conflict
- ethics
- health services research
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Footnotes
Contributors LF and SB designed the work. LF acquired the data. LF and SB interpreted the data, drafted the work and revised it critically for intellectual content. LF and SB approved the final version of the manuscript. LF and SB agreed 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 This study was funded by Princess Margaret Hospital, Perth, Australia.
Competing interests SB is the director of the Medical Mediation Foundation, an organisation that provides conflict management training and mediation in situations where there is disagreement/conflict between patients and healthcare professionals. However, the manuscript does not focus on mediation as a solution.
Ethics approval Approval for this study was granted by the Western Australia Children and Adolescent Human Research Ethics Committee and the R&D Department prior to study commencement (PRN: RGS00041). Interview quotes are presented without identifiers to preserve the confidentiality of the interviewees.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Any requests for anonymised raw data should be directed to the corresponding author.
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