Kim Sara, Frans Elise, Bohannon Isaac, Barr Karen, Buttrick Elizabeth, Fehr Ryan, Shannon Sarah E
J Healthc Qual. 2018 Jul/Aug;40(4):177-186. doi: 10.1097/JHQ.0000000000000081.
Unresolved conflicts in health care threaten both clinician morale and quality of patient care. We piloted a training model that targeted clinicians' conflict resolution skills.
Sixty clinicians from local hospitals were randomized into an intervention group (n = 30), completing a 3-hour conflict resolution training session, and a control group (n = 30) without training. The training included facilitated practice with actors, coaching, and feedback. Evaluation of 60 participants' conflict resolution skills was done in videotaped simulations with actors portraying interprofessional colleagues. Global ratings and checklist items developed for assessing clinicians' performance mirrored steps in the conflict communication model.
The intervention group's performance exceeded the control group on global scores, 7.2 of 10 (SD = 1.6) versus 5.6 (SD = 1.5), p < .05, and checklist scores, 9.3 of 11 (SD = 2.9) versus 7.9 (SD = 1.5), p < .05. Two checklist items showed statistically significant differences: (1) subjects opened the dialogue on a neutral ground before jumping into conflict discussions (intervention: 97% and control: 73%, p < .05) and (2) subjects elicited the colleague's story before sharing their own story (intervention: 70% and control: 27%, p < .05).
The pilot results suggest that a health care-specific approach to conflict resolution can be effectively taught through facilitated practice, coaching, and feedback.
医疗保健中未解决的冲突会威胁临床医生的士气和患者护理质量。我们试点了一种针对临床医生冲突解决技能的培训模式。
将来自当地医院的60名临床医生随机分为干预组(n = 30),完成3小时的冲突解决培训课程,以及未接受培训的对照组(n = 30)。培训包括与演员进行模拟练习、指导和反馈。通过与扮演跨专业同事的演员进行录像模拟,对60名参与者的冲突解决技能进行评估。为评估临床医生表现而制定的整体评分和清单项目反映了冲突沟通模型中的步骤。
干预组在整体评分上超过对照组,分别为10分中的7.2分(标准差 = 1.6)和5.6分(标准差 = 1.5),p <.05;在清单评分上分别为11分中的9.3分(标准差 = 2.9)和7.9分(标准差 = 1.5),p <.05。两个清单项目显示出统计学上的显著差异:(1)受试者在进入冲突讨论之前在中立基础上开启对话(干预组:97%,对照组:73%,p <.05);(2)受试者在分享自己的故事之前先了解同事的情况(干预组:70%,对照组:27%,p <.05)。
试点结果表明,通过模拟练习、指导和反馈,可以有效地教授针对医疗保健领域的冲突解决方法。