Disagreements aren’t just common, they’re part and parcel of everyday life. In health and social care those involved can have completely different agendas and priorities. Avoiding disagreements in conversation obviously doesn’t resolve them but maybe sometimes it becomes the favoured option. Addressing disagreements can be difficult because it can feel effortful to find the right words and people are worried about upsetting others or making things worse. It can also be seen as negative or suggestive of failure if we’ve haven’t been able to sustain a conversation without a disagreement or an argument.
Conflict can be stressful, time consuming and difficult to deal with. A person’s confidence or skills at dealing with these situations can also be a barrier to a more open discussion. Additionally, power imbalances often exist in care settings or with age differences when working with children and young people. These issues highlight just how difficult it is for CYPs to speak up. . How often are important issues left unspoken and what affect does this have on CYP experience of care?
Whilst no one wants a difficult conflict or a huge argument, encouraging people to discuss difference might help to find a more productive way to move forward and might even improve rapport, build trust and respect. I try to provide the opportunity for CYPs and families to disagree and share their thoughts but I wonder if I could be more explicit and supportive to counteract the various barriers CYPs face when speaking up honestly in health and social care.
CYPs tell us they find it hard to speak up because they’re worried they will come across as difficult, be labelled as such and that this will affect their care. Disagreeing can feel like displeasing someone or being unhelpful. This is on top of an already potentially difficult situation of, for example, talking about a sensitive health issue, or addressing a room full of intimidating professionals.
If unspoken, disagreements can come out in different ways. For example, a CYP might agree to a plan but not be able to attempt it or complete it for important reasons that weren’t discussed. Or they might refuse but be unable to explain why. These examples could potentially be resolved with earlier discussion about different opinions. What can we do to help open up these channels of communication more?
How can we manage disagreements and how can we do this in a way that empowers young people?
It’s important to openly acknowledge when people disagree, make sure people know it’s OK, you’re OK with it and that it’s helpful to discuss it. Transparency and being explicit can encourage more discussion and help things move forward more effectively. It’s only to be expected that people are going to disagree at times. We all have varying opinions about things, have different lives and backgrounds. Maybe accepting and understanding these differences can help things to move forward more effectively.
We often talk about avoiding conflict by using good communication skills. Be kind, be human, listen, find out what’s important to them, find out about expectations early on and address them, help improve understanding of each other’s perspectives. This is all useful, good advice but it’s often easier said than done. Using the Me first communication model can be a good starting point and for more ideas, check out the Me first website for Top Tips and resources and have a look at our recent Twitter chat about reaching agreements.
Professionals often try extremely hard to engage CYPs in their care but I wonder if there can sometimes be an underlying purpose whereby we’re trying to get CYPs on board with our agenda rather than trying to help them with theirs or find more “middle ground”. If we’re able to do this, it may help us to reach agreements. Motivational interviewing or an approach of health coaching could be beneficial here.
At Me first we often talk about conflict and disagreements. We take time to discuss issues that come up, reflect on how challenging they can be and discuss what tips and resources we have available to help solve these difficulties. We would like to create a culture where children and young people are always at the centre of their care, professionals and parents collaborate with them to direct and manage their care. Conflict that arises can be hugely costly in terms of money, time and stress and can hinder getting desired results.
What techniques or tips do you have to help reach an agreement between CYPs, professionals and parents? How can parents and professionals help the CYP and each other to get on the same page? Please also send us your thoughts or tips –we’d love to hear from you.
Rachel Naunton
Specialist Paediatric Physiotherapist and Me first Practice Facilitator