Department of Surgery, Maine Health Maine Medical Center, Portland, ME.
Department of Surgery, Maine Health Maine Medical Center, Portland, ME.
J Surg Educ. 2024 Dec;81(12):103310. doi: 10.1016/j.jsurg.2024.103310. Epub 2024 Oct 30.
The hospital environment is a complex and unpredictable workplace where different providers share the responsibility of patient care. Differences in opinions, values, and experiences between resident physicians and other care team members may trigger conflicts that affect the safety and quality of patient care. Thus, developing conflict competencies may help to negotiate the complexities of different conflict situations and resolve these conflicts. However, the extent of the knowledge and perception of conflict competence among resident physicians remains to be determined.
A survey and qualitative semi-structured interviews of resident physicians were conducted. Participants were recruited voluntarily. Survey results were analyzed using SPSS 21, and MAXQDA 24 was used to evaluate the interview transcripts with thematic analysis.
Sixty-five resident physicians completed the survey, and 15 resident physicians were interviewed. 61.5% of the survey respondents identified as female, 76.9% were Caucasian, 35.4% of the respondents were from surgical specialties, and 43.1% of the residents were in their second year of training. 53.8% of the participants reported witnessing or experiencing conflicts weekly, with 44.6% reporting resident physician-nurse conflicts. 63.1% of the conflicts were reported as unresolved, with 16.9% reporting that the conflict affected future working relationships, 25.5% of the conflicts were due to failure of communication, 75.4%residents did not have any form of prior training on conflict management, and 83.1% of them reported interest in conflict competence training. Conflicts mainly affected the quality of care (87.3%) compared to patient safety concerns (12.3%). Participants with prior training in conflict competence were more likely to resolve their reported conflict (p = 0.047). The interviews highlighted 5 main themes: sources of conflict, awareness of conflict resolution styles, addressing conflict and outcomes, and the effect on patient care. Sources of conflict included hierarchy and different priorities. 52.2% of the respondents did not know any style of conflict resolution. Addressing conflict included collaboration, avoidance, competition, and prevention. Avoidance was the most common style used by interviewees, followed by collaboration. While most felt that the conflicts affected the quality of patient care, 1 interviewee reported severe adverse events on the patient.
Conflicts are rife in the hospital environment and can affect patient care when unresolved. Resident physicians' knowledge of conflict competence is low and does not reflect the complexity of their working environment. Future training in conflict competence and resolution is warranted.
医院环境是一个复杂且不可预测的工作场所，不同的医护人员共同承担着患者护理的责任。住院医师与其他医护团队成员之间在意见、价值观和经验方面的差异可能会引发冲突，从而影响患者护理的安全和质量。因此，培养冲突管理能力可能有助于协商不同冲突情况的复杂性并解决这些冲突。然而，住院医师对冲突管理能力的了解和认知程度仍有待确定。
对住院医师进行了调查和定性半结构化访谈。参与者自愿参加。使用 SPSS 21 分析调查结果，使用 MAXQDA 24 对主题分析的访谈记录进行评估。
65 名住院医师完成了调查，15 名住院医师接受了访谈。61.5%的调查对象为女性，76.9%为白种人，35.4%来自外科专业，43.1%的住院医师处于培训的第二年。53.8%的参与者报告每周都会目睹或经历冲突，其中 44.6%报告了住院医师-护士冲突。63.1%的冲突未得到解决，其中 16.9%报告冲突影响了未来的工作关系，25.5%的冲突是由于沟通失败引起的，75.4%的住院医师没有接受过任何形式的冲突管理培训，83.1%的人表示对冲突管理能力培训感兴趣。与患者安全问题（12.3%）相比，冲突主要影响护理质量（87.3%）。有冲突管理能力培训经历的参与者更有可能解决他们报告的冲突（p=0.047）。访谈强调了 5 个主要主题：冲突的来源、对冲突解决风格的认识、处理冲突和结果，以及对患者护理的影响。冲突的来源包括等级制度和不同的优先级。52.2%的受访者不知道任何一种冲突解决方式。处理冲突包括协作、回避、竞争和预防。回避是受访者最常使用的风格，其次是协作。虽然大多数人认为冲突会影响患者护理质量，但有 1 名受访者报告称患者出现了严重的不良事件。
医院环境中冲突频繁，如果得不到解决，会影响患者护理。住院医师对冲突管理能力的了解程度较低，且无法反映其工作环境的复杂性。需要对冲突管理能力和解决能力进行进一步培训。
