UNIT 8 ASSIGNMENT

 

You were assigned to a group in Unit 4 and placed into groups of 3-5 students for the Unit 8 Group Assignment. Once you are assigned to your groups, you can divide up the project into sections equitably. For example, you may want to go through the rubric and have each group member assigned to write a rubric anchor. Choose a group member to submit the final assignment to the Unit 8 Assignment Dropbox. You can also communicate with your team members in the Team Discussion Area under the Unit 8 tab.
Each team member will also complete and submit the Team Peer Evaluation form located under Course Resources in the Unit.

Purpose:

• Explore conflict management principles and professional integrity through review of healthcare personnel conflict management review.
• This conflict management assignment gives you the opportunity to review common conflict scenarios in clinical practice, and reflect on appropriate resolution strategies.  This gives you a review of an evidence based approach to a training conflict management in healthcare settings.
• Critically access conflict management as it relates to team building in clinical practice

Description:

Students will reference the conflict case management study from the nursing literature. Students will develop a summary and reflection consensus of strategies used to resolve the case review. Support your summary using a minimum of three academically credible sources in addition to the source provided.

Please retrieve and read the following Journal article from the Library.

Forbat, L., Simons, J., Sayer, C., Davies, M., Barclay, S (2017). Training pediatric healthcare staff in recognizing, understanding and managing conflict with patients and families: findings from a survey on immediate 6-month impact. Archives of Disease in Childhood, 102 (3): 250.

Directions:

Students are expected to:

1. Create a 5-10, 6-8, (etc.) slide PowerPoint presentation not including the title slide or reference slide addressing the following:
2. Create a brief and concise overview of the case study within the PowerPoint slides;
3. Reference a minimum of three academically credible sources in addition to the source provided;
4. As a team, develop a Poster Project using PowerPoint, like an executive summary, critically assessing conflict management principles used in the case for clinical practice;
5. Submit the Summary and Poster Slide to the Unit 8 Dropbox

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• conduct a spelling and grammar check to minimize errors.

Your writing Assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 6th Edition format.

2

>Unit 5

– Not submitted or largely incomplete. Work may indicate very little if any comprehension of content.

– Work shows some comprehension but errors indicating miscomprehension may be present.

– Work indicates overall progress toward comprehension. Minor errors may present.

– Work is complete and indicates full comprehension of content.

– 3.9

4

4 25% 1.00

4 25% 1.00

4 25% 1.00

Introductory Emergent Practiced Proficient/Mastered Score Weight Final Score

2 3 4

4

4 35% 1.40

4

4

0

Final Score 160

Unit 8 Assignment Rubric

Total available points =

16

0

Content Rubric

Introductory

Emergent

Practiced

Proficient/Mastered

Score

Weight

Final Score

0 – 1.9

2 – 2.9

3

4

Provides a concise overview of the case study, explaining specific conflict resolution strategies applicable to case study reviewed.

25%

1.00

Explains specific conflict resolution strategies applicable to case study reviewed.

Highlights how conflict resolution strategies were applied.

Submit a PowerPoint Presentation that critically assesses conflict management principles reviewed in the group

Content Score

160

Writing Rubric (everyone starts with 4’s = no deductions)

0-1

Grammar & Punctuation

The overall meaning of the paper is difficult to understand. Sentence structure, subject verb agreement errors, missing prepositions, and missing punctuation make finding meaning difficult.

Several confusing sentences, or 1 to 2 confusing paragraphs make understanding parts of the paper difficult, but the overall paper meaning is clear. Many subject verb agreement errors, run-on sentences, etc. cause confusion.

A few confusing sentences make it difficult to understand a small portion of the paper. However, the overall meaning of a paragraph and the paper are intact. There may be a few subject verb agreement errors or some missing punctuation.

There are one or two confusing sentences, but the overall sentence and paragraph meanings are clear. There are a few minor punctuation errors such as comma splices or run-on sentences.

35%

1.40

Spelling

The many misspelled words and incorrect words choices significantly interfere with the readability.

Many typos, misspelled words, or the use of incorrect words making understanding difficult in a few places.

Some misspelled words or the misuse of words such as confusing then/than. However, intent is still clear.

A few misspelled words normally caught by spellcheckers are present but do not significantly interfere with the overall readability of the paper.

Order of Ideas & Length Requirement

Paper has some good information or research, but it does not follow assignment directions and is lacking in overall organization and content.

The order of information is confusing in several places and this organization interferes with the meaning or intent of the paper. However, the paper has a generally discernible purpose and follows assignment directions overall.

The order of information is confusing in a few places and the lack of organization interferes with the meaning or intent of the paper in a minor way.

The overall order of the information is clear and contributes to the meaning of assignment. There is one paragraph or a sentence or two that are out of place or other minor organizational issues. A few sentences may be long and hard to understand. Meets length requirements.

20%

0.80

APA

There is some attempt at APA formatting and citing. There are one or more missing parts such as the cover page or references list. Citation information may be missing. Citation mistakes make authorship unclear.

This is an attempt use APA formatting and citing. There are both in-text citations and reference listings. Citation information may be missing or incorrect (i.e. Websites listed as in-text or reference citations). There is an attempt to cite all outside sources in at least one place. Authorship is generally clear.

There is an overall attempt at APA formatting and citation style. All sources appear to have some form of citation both in the text and on a reference list. There are some formatting and citation errors. Citations generally make authorship clear.

There is a strong attempt to cite all sources using APA style. Minor paper formatting errors such as a misplaced running head or margins may occur. Minor in-text citation errors such as a missing page number or a misplaced date may occur. Quotation marks and citations make authorship clear.

10%

0.40

Writing Deduction

Percentage

100%

Training paediatric healthcare staff in recognising,
understanding and managing conflict with patients
and families: findings from a survey on immediate
and 6-month impact
Liz Forbat,1 Jean Simons,2 Charlotte Sayer,3 Megan Davies,3 Sarah Barclay4

1Australian Catholic University
and Calvary Health Care,
Canberra, Australian Capital
Territory, Australia
2Lullaby Trust, London, UK
3Evelina London Children’s
Hospital, St Thomas’ Hospital,
London, UK
4Medical Mediation
Foundation, London, UK

Correspondence to
Sarah Barclay, Medical
Mediation Foundation,
36 Westbere Road,
London NW23SR, UK;
sarah.barclay@
medicalmediation.org.uk

Received 22 February 2016
Revised 23 March 2016
Accepted 25 March 2016
Published Online First
20 April 2016

To cite: Forbat L, Simons J,
Sayer C, et al. Arch Dis
Child 2017;102:250–254.

ABSTRACT
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.

INTRODUCTION
Conflict is a recognised component of healthcare
provision. Direct and indirect costs associated with
conflict include litigation, reduced productivity,
staff turnover and team morale.1 For patients, con-
flict results in compromised decision-making2 and
undermining trust in clinicians.3 4

Conflict consumes considerable amounts of staff
time, particularly nurses and doctors.5

Communication difficulties are identified as a sig-
nificant contributor to conflict,5 6 as are cross-
cultural difficulties7 and religious beliefs.8

Underpinning each of these causes can be different

understandings of the clinical situation,9 different
interpretations of futility10 and likely prognosis.11

In recent work documenting the incidence and
severity of conflict in paediatric settings, the three
most frequently cited causes of conflict between
staff and patients/family members were: communi-
cation breakdown, disagreements about treatment
and unrealistic expectations.5

Conflict models offer ways of conceptualising
strategies which may facilitate resolution. The
Thomas–Killman’ two-dimensional model proposes
that there is a need to balance assertiveness and
cooperation,12 which includes further facets of col-
laboration, competition, accommodation, avoid-
ance and compromise. Although developed in the
context of business and management-related con-
flict, this model holds value in articulating core fea-
tures of conflict management. The development of
empathy, enabling the other party to maintain self-
respect and self-esteem have been proposed as core
elements of managing conflict.13 Growing recogni-
tion of how conflicts develop and worsen facilitates
awareness of when to intervene to minimise further
escalation.3

While mediation may be a solution14 15 changing
practice, focusing on staff understanding and

What is already known on this topic

▸ Conflict between staff and patients/families in
paediatric hospitals can be a frequent and
severe phenomenon.

▸ Direct and indirect costs associated with
conflict include litigation, lower morale and
reduced trust between staff and patients/
families.

▸ Empathy, communication and collaboration are
recognised features in managing conflict.

What this study adds

▸ A 4 h tailored training programme increases
staff ability to recognise conflict triggers and
de-escalate conflicts.

▸ Staff reported that 6 months after the training,
the focus on empathy and communication skills
had led to changes in their practice.

250 Forbat L, et al. Arch Dis Child 2017;102:250–254. doi:10.1136/archdischild-2016-310737

Original article

http://crossmark.crossref.org/dialog/?doi=10.1136/archdischild-2016-310737&domain=pdf&date_stamp=2016-04-20

http://www.rcpch.ac.uk/

http://adc.bmj.com

team-management of conflict, may be more fruitful for man-
aging emerging conflicts and early intervention. Training com-
prises a core mechanism for changing how clinicians respond to
the potential for conflict, particularly when the information can
be used soon after the training.16 Yet paediatric trainees do not
receive adequate conflict management training.17 Kaufman18

outlines a curriculum for teaching medical staff about identify-
ing and responding to conflict, which takes account of time con-
straints, the need for behavioural change, contextual power
structures, assumed skills and the legal parameters of managing
conflict. The paper concludes by stating a need for educational
programmes to be tailored to meet these features.

This paper describes an innovative training course designed
for staff in a paediatric hospital to recognise, manage effectively
and de-escalate conflicts.

METHODS
The training content was developed by SB and JS, based on
understandings of conflict causes, impacts3 and severity5 in
paediatric settings. The training mirrored Gerardi’s1 work on
assessing the conflict, identifying some of the symptoms, under-
lying causes and unhelpful assumptions which may exacerbate
or cause conflict, and Back’s2 description of useful communica-
tion tools such as active listening, empathising and self-
disclosure. The training:
(1) Provided information on what triggers conflict between

parents and health professionals and how to spot the
warning signs,

(2) Included simulation exercises designed to encourage staff to
empathise with patients and families by ‘stepping into their
shoes’,

(3) Taught skills to help staff de-escalate conflicts with families.

The 4-h training sessions were run in multidisciplinary groups
of up to 15 people, over the course of 18 months.

Training sessions began with an opportunity for participants
to discuss in pairs a conflict they had experienced with a parent
or patient, focusing on the impact of the conflict and on the
thoughts and emotions they experienced at the time. The train-
ing sessions also involved simulation exercises, asking partici-
pants to play the part of a parent or health professional, or
begin a conversation with a parent who is exhibiting the warning
signs of potential or escalating conflict such as distress or anger.

Participants and measures
Participant eligibility was determined by individuals being
employed by the hospital (a tertiary paediatric hospital in
England), at any grade or in any role. Nursing staff and non-
consultant doctors were rostered to attend the training by their
managers who encouraged participation of their teams and
ensured that they were allowed time off from their clinical
duties to attend. Training dates were also circulated via the Trust
email so that any member of staff could apply for a training
place. All staff who expressed an interest in the training were
accommodated to attend.

A bespoke questionnaire was designed to determine the
immediate and long-term impact of the training. The question-
naire was administered at three time points: immediately before
the training, immediately after and 6 months later. The first two
were administered by paper copy. The third was sent via an elec-
tronic survey to staff email addresses. Staff who were still
working in the hospital were followed up in person by CS or
MD. All questionnaires sought information on whether staff
were able to recognise the triggers of conflict between families

and health professionals, and whether they had the strategies to
manage conflict. Qualitative prompts asked participants to
reflect on their main learning (‘tell us one thing you learnt from
this training which you have found helpful in communicating
with patients and their families’), and to record ‘any other com-
ments you would like to make about the training and/or its
impact on your practice’. Demographic information regarding
staff role was also collected.

The 6-month follow-up survey collected data on: (A) whether
the training had equipped staff to more readily recognise and
de-escalate conflicts with patients and families, (B) describe one
thing they had learnt from the training which they had found
helpful in communicating with patients and their families, (C)
whether they had experienced a conflict with a family since
doing the training and if so, whether the training had helped
them to (1) recognise the triggers and warning signs (2) to
de-escalate or resolve the conflict.

Responses were recorded on either a 5-point Likert scale, or
as a simple yes/no binary. Analysis was primarily conducted
using descriptive statistics, to enable reporting of percentages,
mean, mode and median scores. Respondent identifiers were
not used, prohibiting treating responses as paired data. Pearson’s
χ2 and Fischer’s exact tests were used to examine a priori
hypotheses (significance set at p=0.05) regarding the impact of
the training on ability to recognise signs and triggers from pre
training to 6-month follow-up and on differences between
nursing and medical professionals. Data were organised as fre-
quency counts and percentages of people who answer in each

Table 1 Study participants

Staff group Baseline/post 6 months

Administrator 11 5
Chaplaincy 1 4*
Clinical nurse specialist 35 18
Consultant 28 15
Manager 5 6
Matron 5 3
Non-consultant doctor 87 15
Nursing assistant 9 10
Other 61 34
Paediatric nurse practitioner 9 4
Staff nurse 368 156
Therapist 27 16
Ward sister 65 27
Total 711 313
% of total trained 100 44

*In some staff categories there are greater numbers at 6 months than baseline/post
assessment. We believe that some respondents coded themselves as ‘other’ at first
assessment and then identified differently at follow-up.

Table 2 Quality and relevance of training

Quality of training n (%) Relevance

n (%)

Excellent 506 (71.2) Very relevant 609 (85.7)
Good 181 (25.5) Relevant 92 (12.9)
Satisfactory 11 (1.5) Not relevant 2 (0.3)

Poor 1 (0.1) Missing data 8 (1.1)
Missing data 12 (1.7)
Total 711 (100) 711 (100)

Forbat L, et al. Arch Dis Child 2017;102:250–254. doi:10.1136/archdischild-2016-310737 251

Original article

Likert category at each time point, to report observed and
expected frequencies.

Qualitative data collected from free-text prompts were ana-
lysed drawing on thematic analysis, adopting a five-stage process
of familiarisation, identifying a thematic framework, indexing
the data, synthesising across respondents and data interpretation
to form key themes.19 Analysis was informed by a position of
theoretical freedom, rather than a priori hypotheses regarding
the likely content or themes arising from the data.20 Analysis
was conducted by an experienced qualitative researcher, with
discussion of emergent themes with the wider team.

The study was conducted in one tertiary paediatric teaching
hospital in England. Data collection commenced in June 2013
and ceased on 30 May 2015, with the training provided from
June 2013 until November 2014. This study was deemed by the
hospital’s Research and Development team to be service evalu-
ation and consequently was not reviewed by a health service
research ethics committee.

RESULTS
Seven hundred and eleven staff were trained and completed
baseline data, 313 of whom completed questionnaires at
6-month follow-up. Table 1 provides details of respondents’ staff
role and the number of completed surveys at each time point.

Staff rated the quality of the training very highly, with 98.5%
rating it excellent or good, and 99.8% rating it very relevant or
relevant as indicated in table 2.

Participants were asked about their ability to recognise trig-
gers for conflict and use of skills to manage conflicts. Table 3
summarises the binary yes/no responses and illustrates an

improvement from baseline to immediate-post training assess-
ment. Table 4 illustrates the observed and expected frequencies
across the Likert scale for recognising triggers. Fisher’s exact
test indicated a significant difference between the scores 4 and 5
in the pretraining responses compared with the 6-month
follow-up data (43.7% vs 57.8 and 6.7% vs 29.1%, p=0.001).
Figure 1 illustrates changes in staff ability to recognise triggers
from baseline to 6-month follow-up

Table 5 demonstrates the observed and expected frequencies
across the Likert scale for pre and 6-month follow-up data.
Pearson’s χ2 test indicated a significant difference between the
scores 4 and 5 in the pretraining responses and the 6-month
follow-up responses (20.1% vs 58.5 and 3.1% vs 17.9%
respectively, p=0.001). Figure 2 illustrates changes in staff
ability to deal with conflict from baseline to 6-month follow-up.

At 6-month follow-up, participants were asked if the training
had equipped them to recognise and de-escalate conflicts with
patients/families. The majority (n=283, 90%) reported that the
training had had this impact.

Six months after the training 178 staff respondents (57%)
had experienced conflict. Of those 178, 169 (95%) said that the
training had enabled them to recognise the triggers for the con-
flict. One hundred and sixty-two (91%) reported that they had
also been able to de-escalate the conflict as a consequence of the
training.

Data from baseline and 6-month follow-up were analysed to
determine if there were differences between nurses’ and doctors’
responses to the training, in reporting scores of 4 or 5 (able or
very able) to recognise and deal with conflict. Neither analysis
approached significance at baseline or follow-up (recognise con-
flict, p=0.459; deal with conflict, p=0.725). Consequently, the
training appeared to have comparable impact across staff groups.

Analysis of the qualitative data identified five core themes, and
a further six minor themes. The five core themes were: communi-
cation and listening, recognising warning signs/triggers, improve-
ments in practice, empathy and perspective taking. Participants
identified that being aware of early warning signs and triggers
was key learning from the training, impacting practice:

The training has been a key factor in the fact that I have not
experienced any conflicts in the last few months. Early recogni-
tion of triggers has helped me avoid conflict developing. (Clinical
nurse specialist)

The training was so useful! Our department faces conflict daily.
The training came into use three times the day after the course.
All three were potentially explosive situations which I felt very
able to manage. I think little updates/refreshers to the training
would be most valuable. (Paediatric dental specialist)

Table 3 Learning about identifying and managing conflict

I can:

Baseline
(n=711)

Post
(n=711)

6 months
(n=313)

n (%)

Recognise the
triggers of conflict
between families
and health
professionals.

Yes: 349 (49)
No: 354 (50)
Missing data: 8 (1)
Mean: 3.5

Yes: 682 (96)
No: 20 (3)
Missing data: 9 (1)
Mean: 4.4

Yes: 272 (87)
No: 41 (13)
Mean: 4

Use appropriate
skills and strategies
for recognising and
dealing with conflict
at different levels of
severity.

Yes: 163 (23)
No: 540 (76)
Missing data: 8 (1)
Mean: 3

Yes: 640 (90)
No: 62 (9)
Missing data: 9 (1)
Mean: 4.2

Yes: 239 (76)
No: 74 (24)
Mean: 4

Table 4 Ability to recognise triggers

Ability to recognise triggers scores
1: not very able–5: very able

Time period 1 2 3 4 5 Total

Pretraining
6-month follow-up

Count 3 29 316 307 47 702
Expected count 2.1 21.4 245.5 337.5 95.4 702
% within time period 0.4% 4.1% 45.0% 43.7% 6.7% 100.0%
Count 0 2 39 181 91 313
Expected count .9 9.6 109.5 150.5 42.6 313
% within time period 0.0% 0.6% 12.5% 57.8% 29.1% 100.0%

Total Count 3 31 355 488 138 1015
Expected count 3.0 31.0 355.0 488.0 138.0 1015
% within time period 0.3% 3.1% 35.0% 48.1% 13.6% 100.0%

252 Forbat L, et al. Arch Dis Child 2017;102:250–254. doi:10.1136/archdischild-2016-310737

Original article

Many staff reported specific strategies from the training
which they were using routinely, reinforcing the positive impact
of the practical nature of the training. One such strategy derived
from the training, but not explicitly suggested to participants,
was to manage the environment in which difficult conversations
took place, for example, moving a parent from the ward to a
room to enable a more private conversation. In response to the
prompt ‘One thing I learnt was…’ staff offered the following
responses:

The ability to remove a parent from a tense environment to a
side room where she/he may be able to express himself/herself in
confidence and without interruption and to be listened to
actively. (Staff nurse)

Effective listening, and not hesitating to apologise and not give
false hope. (Staff nurse)

Not confronting them, but allowing the patient/relative to vent
their frustrations and focus your efforts on understanding the
cause of their frustrations rather than denying or opposing their
views. (Non-consultant doctor)

Learning how to develop an empathic approach by ‘stepping
into the shoes’ of patients and families was reported by many
respondents as having a profound impact on their approach to
engaging with them:

[The training] made me try to put myself in the shoes of patients
and their relatives, and to think about things from their perspec-
tive much more. (Consultant)

To see it from the families’ perspective more. Even if I may not
fully agree with the argument/issue I now empathise more with
the stressful situations the families are in. (Staff nurse)

DISCUSSION
This tailored training, delivered to staff in a paediatric hospital,
resulted in a significant improvement in the ability to identify
and manage conflict with patients and relatives. Unresolved
conflict over goals of care that escalate may require external
interventions such as independent mediation or court inter-
vention.21 22 This training therefore has the potential to
reduce the need for such costly and stressful involvement of
third parties.

Evidence-based methods of addressing conflict are required,
since conflict regarding treatment and goals of care is a marker
for increased risk of complicated bereavement for families23 and
is an independent predictor of burn-out in staff.24 Previous
research has demonstrated the impact of conflict management
training on reducing employee stress25 and consequently points
to the potential for positively impacting morale.26 The impact
on the quality of care has yet to be established. Indeed, conflict
can be construed positively as a way of energising and prompt-
ing initiation of new conversations to manage hostility.27 The
findings support other calls for training on conflict management
to be built into healthcare infrastructure.28

Although simulation training has been criticised,29 the
blended approach to this training, including role play, appears
to have had a substantial positive impact on attendees’
self-reported ability to recognise and then manage conflict

Table 5 Ability to deal with conflict

Ability to deal with conflict
1: not very able–5: very able

Time period 1 2 3 4 5 Total
Pretraining
6-month follow-up

Count 19 156 365 140 22 702
Expected count 14.5 109.3 300.9 223.4 53.9 702
% within time period 2.7% 22.2% 52.0% 19.9% 3.1% 100%
Count 2 2 70 183 56 313
Expected count 6.5 48.7 134.1 99.6 24.1 313
% within time period 0.6% 0.6% 22.4% 58.5% 17.9% 100%

Total Count 21 158 435 323 78 1015
Expected count 21.0 158.0 435.0 323.0 78.0 1015
% within time period 2.1% 15.6% 42.9% 31.8% 7.7% 100%

Figure 1 Ability to recognise triggers. Figure 2 Ability to deal with conflict.

Forbat L, et al. Arch Dis Child 2017;102:250–254. doi:10.1136/archdischild-2016-310737 253

Original article

situations with patients and families. The use of self-report
measures is a recognised methodological weakness.30 31 The
lack of control or comparison group, for example using other
communication skills development approaches32 or compas-
sion,33 which are known to reduce patient distress,34 compro-
mises claims about this intervention being superior to other
communication interventions. Since participant identifiers were
not used in any of the survey cycles, paired analysis was not
possible. This limits the ability to track individual transform-
ation over the training and follow-up timeline. The lack of
paired data also precluded fine-grained analysis of which staff
groups’ responses reflected greatest levels of reported change;
this is particularly salient since conflict is not experienced uni-
formly across staff groups.5

The training was offered only on a one-off basis, and further
evaluation should be conducted on the additive value of a
refresher course. Further evaluation could include additional
measures to record impact on staff performance, such as impact
on number of conflicts experienced, changes in family/patient
satisfaction with care (to allow for comparison with staff reports
of being able to de-escalate 91% of conflicts), alongside mea-
sures to report any impact the training had on intrastaff conflict.

The study focused on conflict between staff and patient and
families, and consequently did not examine intrastaff conflict.
Some of the training may have had a positive impact on this,
but it was not measured. Loss to follow-up at 6 months may be
partially explained by some staff (notably doctors in training) no
longer working at the hospital and therefore being less engaged
in the ongoing evaluation. Respondents returning questionnaires
at 6 months may be a skewed sample of those most satisfied or
highly impacted by the training, despite identical reminders
from two members of the team.

CONCLUSION
With an established need for interventions which help manage
conflict5 this training provides an evidence-based approach to
training healthcare staff. The training has the potential to reduce
the human and economic costs of conflict, by furnishing staff
with the appropriate skills and knowledge to identify and then
de-escalate potential and actual conflicts.

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.

REFERENCES
1 Gerardi D. Using mediation techniques to manage conflict and create healthy work

environments. AACN Clin Issues 2004;15:182–95.
2 Back AL, Arnold RM. Dealing with conflict in caring for the seriously ill: “it was just

out of the question”. Jama 2005;293:1374–81.
3 Forbat L, Teuten B, Barclay S. Conflict escalation in paediatric services: findings

from a qualitative study. Arch Dis Child 2015;100:769–73.
4 Chan TC, Bakewell F, Orlich D, et al. Conflict prevention, conflict mitigation, and

manifestations of conflict during emergency department consultations. Acad Emerg
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• archdischild-102-250_10081

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
Introduction
Methods
Participants and measures
Results
Discussion
Conclusion
References