Conflict management programme

The Medical Mediation Foundation (MMF) Conflict Management Programme has been developed and tested since 2010 based on initial research funded by a Department of Health programme designed to support children’s palliative care projects. Our experience and research working with health and care teams led us to develop a formal Conflict Management Framework (CMF).

The framework has helped us to provide a strategic and consistent response to conflict and to identify this at an early stage.

– Matron, Leeds Children’s Hospital

This research (Forbat et al. 2015) found that if not recognised and managed early, paediatric conflicts tend to escalate through three distinct phases (mild, moderate, severe) and can have long-lasting impact. Further research (Forbat et al. 2016) carried out as part of a pilot conflict management programme at the Evelina Children’s Hospital reported that more than 448 hours of clinical time across two 12 week periods were taken up in managing conflict between staff and patients/families in the hospital. Staff cited communication breakdown, disagreements over treatment and “unrealistic expectations” as the most common causes. Conflicts were most frequent in general paediatrics, neurology and neonatology.

The clinical impact of conflict includes an increased frequency in difficult decision-making regarding the benefits versus the burdens of treatment and increasingly complex decisions regarding the merit of intensive or life-sustaining treatments. This can lead to communication breakdown between clinicians, patients and relatives, as well as between clinicians themselves. These cases are damaging financially and emotionally and the effects on all involved are long-lasting, as a number of high profile UK court cases since 2015 have shown.

What is the Conflict Management Programme?

The MMF Conflict Management Programme has been designed to address these issues. It involves two core components:

  • i. training multidisciplinary teams to identify and understand the warning signs of conflict and to engage with families appropriately and empathically and
  • ii. the use of a structured Conflict Management Framework to support clinicians to intervene in situations where conflict is escalating.

Where did it start?

The programme has evolved from the initial pilot at Evelina London in which more than 700 health professionals were trained to understand and recognise the underlying causes of conflict and use mediation skills to de-escalate and resolve it. Six month follow up of a cohort of 313 of these staff found that of those who had experienced a conflict with a family since doing the training, 95% said it had helped them to recognise the warning signs of conflict and 91% said it had helped them to de-escalate or resolve it.

Development of the programme since 2015

The programme developed further in 2015 following debriefing carried out with staffat Southampton Children’s Hospital who were involved in managing the case of Ashya King. Feedback from this group of staff stated that what would help them manage future conflict cases was a clear pathway to follow as a team when conflict arose. With input from the Southampton team, MMF developed The Conflict Management Framework (CMF) with the aim of providing clinical teams with the confidence and skills to manage conflict proactively and enable them to work collaboratively with parents so that the focus of care remains on the child.

The Programme in Australia

The CMF was piloted on a children’s cancer ward in the Princess Margaret Hospitalin Perth, Australia, in 2017 and shown to reduce the incidence of conflict and staffburnout and improve communication between staff and families. It was tested further during 2018/19 in 4 UK sites. Outcomes from this additional testing were published in 2021 by the British Medical Journal Paediatrics Open and showed a significant reduction in time spent on managing conflict and that using the CMF provided staff with clear guidance on managing conflict as a team.

How the Programme can create sustained culture changes

Learning from the pilot in Perth and from the UK pilot has shown that for the CMF to engender sustained culture change and become ‘business as usual’ with regard to managing conflict effectively, the following core elements must be in place:

  • Adequate senior support and buy-in from medical and nursing staff
  • Investment in champions who are visible and experienced
  • A critical mass of the trained workforce so that confidence grows in individual and team abilities to manage conflict situations when they arise.
  • A cohort of key staff trained to deliver the training themselves as part of a “train the trainer” programme. This will ensure sustainability of the conflict management training.
  • Level 1 - Learn the essentials of recognising and understanding conflict between families and health professionals
  • Level 2 - Learn how to manage conflict as a team using the MMF Conflict Management Framework
  • Level 3 - Embedding the MMF conflict management culture throughout your organisation.