Transforming training into practice with the conflict management framework: a mixed methods study

Abstract

Objective: To implement and evaluate the use of the conflict management framework (CMF) in four tertiary UK paediatric services.

Design: Mixed methods multisite evaluation including prospective pre and post intervention collection of conflict data alongside semistructured interviews.

Setting: Eight inpatient or day care wards across four tertiary UK paediatric services.

Interventions: The two-stage CMF was used in daily huddles to prompt the recognition and management of conflict.

Results: Conflicts were recorded for a total of 67 weeks before and 141 weeks after implementation of the CMF across the four sites. 1000 episodes of conflict involving 324 patients/families across the four sites were recorded. After implementation of the CMF, time spent managing episodes of conflict around the care of a patient was decreased by 24% (p<0.001) (from 73 min to 55 min) and the estimated cost of this staff time decreased by 20% (p<0.02) (from £26 to £21 sterling per episode of conflict). This reduction occurred despite conflict episodes after implementation of the CMF having similar severity to those before implementation. Semistructured interviews highlighted the importance of broad multidisciplinary leadership and training to embed a culture of proactive and collaborative conflict management.

Conclusions: The CMF offers an effective adjunct to conflict management training, reducing time spent managing conflict and the associated staff costs.

Keywords: ethics; health services research; qualitative research.

Figure 1

Data collection, implementation and oversight of the conflict management framework (CMF).

Figure 2

Violin plots for each site for severity, time and cost of conflict, pre CMF (red) and post CMF (blue) implementation. Vertical lines within each violin plot represent the median (thicker vertical line) and quartiles (thinner lines) for each site. Interquartile ranges are shaded darker red/blue. These violin plots provide additional information about conflict at each site compared with box-and-whisker plots, with the width of each violin plot indicating the number of conflict episodes clustering at each time or cost value. CMF, conflict management framework. GBP, pounds sterling.