Reducing conflict and tension across a children's hospital: pre-post service evaluation after multimodal interventions.

OBJECTIVE

To measure healthcare professional-reported conflict and tension across a 10-ward UK children's hospital before and after multimodal interventions.

DESIGN AND

SETTING

Prospective pre-post single-centre study.

PATIENTS: Inpatients with a length of stay ≥5 days.

INTERVENTIONS: Five interventions were introduced between 2020 and 2023 centred around a framework to support families and staff: (1) training >400 staff in early recognition and intervention of conflict via the Medical Mediation Foundation, (2) enhancing the use of the Clinical Ethics Advisory Group, (3) introducing palliative care services for all children, (4) promoting safeguarding surgeries and ward-based safeguarding support for staff and (5) developing a senior multidisciplinary hub to advise teams when tension escalated.

MAIN OUTCOME MEASURES: Twice weekly on-ward surveys of nursing and medical teams over a 4-week period in 2019 and 2024

RESULTS

Post-intervention, prevalence of children with any reported tensions reduced from 65/153 (42%) to 42/138 (30%) (χ2=4.53, p=0.03) with staff-family conflict predominating. While all sources of tension numerically reduced, reduction in unresolved safeguarding concerns reached statistical significance (18%-3%, χ2=17.6, p<0.0001). Top cited reasons in 2024 for staff-family conflict remained: 'communication breakdown', 'treatment disagreements' and 'unrealistic expectations'; and for staff-staff conflict 'communication breakdown'. For children with ≥2 comorbidities, those with any tensions reduced from 42/76 (55%) in 2019 to 31/82 (38%) in 2024 (χ2=4.84, p=0.028).

CONCLUSIONS

We observed an association between multimodal hospital-wide interventions and a reduction in overall tensions. Further studies are needed to assess reproducibility and explore patient and family experience.