Beyond winning: mediation, conflict resolution, and non-rational sources of conflict in the ICU

Knickle, Kerry; McNaughton, Nancy; Downar, James

doi:10.1186/cc11141

Cited by 9 publications

(10 citation statements)

References 14 publications

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“…Grounded in the practice of healthcare simulation debriefing, our work describes how trained debriefers use key strategies to engage with conflict and reframe destructive conflict in a way that can facilitate productive learning. Many of the strategies we empirically describe align with the mediation literature, especially with respect to reconciling differences 23 . Our findings extend this understanding by illustrating the application of these strategies and skills within a healthcare simulation context.…”

Section: Discussionsupporting

confidence: 74%

“…Many of the strategies we empirically describe align with the mediation literature, especially with respect to reconciling differences. 23 Our findings extend this understanding by illustrating the application of these strategies and skills within a healthcare simulation context. We have conceptualised these mediation strategies within a framework of moving toward, within, away from and beyond conflict (Figure 1).…”

Section: Discussionsupporting

confidence: 69%

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Approaches to interpersonal conflict in simulation debriefings: A qualitative study

et al. 2021

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Context Conflict during simulation debriefing can interfere with learning when psychological safety is threatened. Debriefers often feel unprepared to address conflict between learners and the literature does not provide evidence‐based guidance within the simulation setting. The purpose of this study was to describe debriefers' approach to mediating interpersonal conflict and explore when, why and how they adopt mediation strategies. Methods We performed a secondary analysis of qualitative data collected as part of a larger study examining simulation debriefers' approaches to debriefing scenarios with different learner characteristics. For this study, we applied thematic analysis to transcripts from simulated debriefings (n = 10) and the associated pre‐simulation (n = 11) and post‐simulation (n = 10) interviews that focused on interpersonal conflict between learners. Results Debriefers described struggling with mediating conflict and the importance of self‐awareness. Specific mediation strategies included intervening, addressing power relations, reconciling unproductive differences, leveraging different perspectives, circumventing the conflict, and shifting beyond the conflict; each of these strategies encompassed a number of particular skills. Situations that triggered a mediation approach were related to psychological safety, emotional intensity, and opportunities for shared understanding and productive learning. Debriefers applied mediation strategies and skills in a flexible and creative way. Conclusions The strategies we have described for mediating interpersonal conflict between learners in simulation debriefing align with notions of psychological safety and may be useful in guiding future professional development for simulation educators.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 69%

Approaches to interpersonal conflict in simulation debriefings: A qualitative study

et al. 2021

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“…While literature on complaints filed with a hospital complaints center hosting professional mediators is rather sparse [27, 28], physicians’ attitudes towards legal complaints have been investigated [29]. This study was to our knowledge a first exploration of the physicians’ lived experiences of a complaint handled in the hospital.…”

Section: Introductionmentioning

confidence: 99%

How physicians make sense of their experience of being involved in hospital users’ complaints and the associated mediation

Schaad

Bourquin²,

Panese

et al. 2019

BMC Health Serv Res

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BackgroundThe growing interest in hospital users’ complaints appears to be consistent with recent changes in health care, which considers the patient’s voice a valuable information source to improve health care. Based on the assumption that the clinicians’ lived experience is an essential element of health care and to neglect it may have serious consequences, this study aimed to explore how physicians experience hospital users’ complaints and the associated mediation process.MethodsA qualitative analysis of experience narrative interviews. Fourteen physicians concerned by complaints which resulted in a mediation provided a comprehensive narrative of their experience with the complaints center. Data were analyzed with Interpretative Phenomenological Analysis (IPA). Interviews were analyzed inductively and iteratively to explore how physicians make sense of their experience.ResultsThe analysis of the physicians’ narratives revealed that being the object of a complaint and to enter a process of mediation is a specific experience of which some physicians benefited and others felt psychologically weakened. The causes of the complaints were at times considered by physicians to be related to medical malpractice, but more often to communicational and relational difficulties, unrealistic expectations of patients, physicians’ attitudes, or the lack of a coherent care plan. The analysis of their narratives revealed that physicians showed a need for reconsidering and elaborating on the reason(s) leading to the complaint, and on the expectations patients/relatives may have had towards medicine and health care professionals. This may be interpreted as an attempt to assign their meaning, such meaning having the potential to ease the distress associated with the experience of complaints.ConclusionMost physicians appeared more aware of the communicational and relational aspects of care after experiencing a complaint situation; however, prior to the complaint, physicians seem to have underestimate these issues, and when they acknowledge that the complaint originated in psychological aspects of care, they still consider it not relevant, since not related to clinical decision-making and management. Mediation as providing the opportunity to restore the clinical relationship should be encouraged at an institutional level as well as support of health care professionals by means of individual or group supervision.

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“…51 These conflicts over the future care of a loved one can easily escalate. 52 But can they be successfully mediated?…”

Section: Medical Futilitymentioning

confidence: 99%

Can 'Medical Futility' Conflicts be Mediated?

Choong¹

2018

Journal of Medical Law and Ethics

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Mr Justice Francis ended his judgment in Great Ormond Street Hospital v Yates, Gard and Gard with the recommendation that 'mediation should be attempted in all cases such as this one'. Although this gave the impression that mediation would be unquestionably beneficial in the Gard case and other 'medical futility' cases where the patient is incompetent, this paper contends that this is not as straightforward as it might at first appear. With the general absence of a middle ground and with the law in such cases frequently on doctors' side, mediation's potential for a satisfactory resolution of medical futility conflicts is arguably limited.

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Beyond winning: mediation, conflict resolution, and non-rational sources of conflict in the ICU

Cited by 9 publications

References 14 publications

Approaches to interpersonal conflict in simulation debriefings: A qualitative study

Approaches to interpersonal conflict in simulation debriefings: A qualitative study

How physicians make sense of their experience of being involved in hospital users’ complaints and the associated mediation

Can 'Medical Futility' Conflicts be Mediated?

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