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Conflict resolution in anaesthesia: systematic review
  1. Dalal Salem Almghairbi,
  2. Takawira C Marufu,
  3. Iain K Moppett
  1. Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
  1. Correspondence to Dalal Salem Almghairbi, Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, University of Nottingham (Queen’s Medical Centre Campus), Nottingham University Hospitals NHS Trust, Nottingham NG7 2RD, UK; msxda{at}


Background Conflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.

Objective This review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members’ ability to voice their concerns.

Methods We used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.

Results After removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.

Conclusion The evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.

  • speaking up
  • healthcare professional
  • operating theatre
  • patient safety

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  • Contributors IKM suggested the theme of the review and acted as a subject expert in matters of arbitration between authors. DSA and TCM created search strategies and data extraction. DSA drafted and revised the article. All authors contributed to the analysis and interpretation of data and revisions to the manuscript. IKM gave final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests This work forms part of DSA’s PhD thesis, which is supported by scholarship from the Libyan Ministry of Higher Education and University of Zawia. TCM was a PhD student supported by a grant from the Sir Jules Thorn Charitable Trust. IKM is a member of the NICE topic expert group for Quality Standards for hip fracture, Deputy Director of the National Institute of Academic Anaesthesia (NIAA) Research Council and holds grants from the National Institute for Health Research and the Association of Anaesthetists of Great Britain and Ireland and Royal College of Anaesthetists through the NIAA for trials in hip fracture.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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