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Conflict in a paediatric hospital: a prospective mixed-method study
Liz Forbat1, Charlotte Sayer2, Phillip McNamee3
1School of Health Sciences, Australian Catholic University and Calvary Health Care, Canberra, Australian Capital Territory, Australia.
Insights
Healthcare conflict is common in pediatric settings, especially in neurology. Communication breakdowns and treatment disagreements are key causes, consuming significant staff time and requiring better resolution strategies.
Area of Science:
- Healthcare Management
- Pediatric Medicine
- Conflict Resolution
Background:
- Conflict within healthcare settings is recognized but not well understood.
- Limited data exists on the prevalence and origins of conflict across pediatric subspecialties.
Purpose of the Study:
- To quantify the frequency and characteristics of conflict within a pediatric hospital.
- To identify the primary causes and staff involved in pediatric healthcare conflicts.
Main Methods:
- An explanatory sequential mixed-method design was employed.
- Prospective questionnaire data on conflict frequency, severity, and causes were collected over two 12-week periods.
- Qualitative interviews with key healthcare professionals were conducted to interpret quantitative findings.
Main Results:
- 136 conflict episodes were reported, with communication breakdown, treatment disagreements, and unrealistic expectations as primary causes.
- Conflicts consumed over 448 hours of healthcare professional time, involving nurses, consultants, and doctors in training.
- Neurology, general pediatrics, and neonatology showed the highest conflict rates.
Conclusions:
- Conflict is prevalent in pediatric specialties, particularly neurology.
- Significant staff time is dedicated to managing conflict, highlighting the need for improved conflict resolution support.
- Addressing communication breakdown is crucial for mitigating healthcare conflict.
Background:
Conflict in healthcare is a well-recognised but under-examined phenomenon. Little is known about the prevalence and causes of conflict across paediatric specialties.
Objective:
To report the frequency and characteristics of conflict in a paediatric hospital.
Design And Setting:
An 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.
Results:
136 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.
Conclusions:
Conflict 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.
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