Deescalation Techniques in Pediatric Practice

Many pediatricians are familiar with a patient (or parent) throwing a ‘tantrum’. Parenting, like healthcare, is full of tough conversations. But just as pediatricians can help parents reframe toddlers’ ‘meltdowns’ by thinking about them as opportunities to help a child emotionally regulate, your practice can use the same techniques to de-escalate conflict with patients, parents, and each other.

Whether it’s distress about money, clashes over belief or culture, or simply an emotional outburst unrelated to the topic at hand, anyone can get upset — we’re all human! When working with families in a pediatric practice setting, it can be useful for clinicians and staff to have some de-escalation techniques in their back pockets. When you have the tools to handle a tense situation, it’s possible to help everyone feel calmer, reassured, and heard. Here are some ways to introduce de-escalation into your practice.

De-Escalation at the Pediatric Practice

According to the Department of Homeland Security, de-escalation is a method of conflict resolution that uses communication and listening skills. It’s intended to reduce the potential for violence. In pediatric practice, it’s also intended to maintain positive relationships, restore confidence in clinicians, and get to the heart of the concern at hand.

The basics of de-escalation are simple: communication and listening. Digging into the specifics, in a given conflict situation, this could look like:

• Empathetic listening
• Moving conflict to a private area
• Non-threatening body language
• Allowing time for decision-making
• Setting clear limits (safety is the primary concern)
• Being mindful of your tone, expression, and phrasing (“Thank you” and “please” really can be magic words!)

The Crisis Prevention Institute, which offers training programs for various industries, including healthcare in conflict resolution, suggests that pre-planning and practicing conflict resolution skills like those above are key to success in real situations. For example, knowing which limits are acceptable and which are not can help staff and clinicians react appropriately in a stressful situation.

1. Address the conflict here and now by giving in. You could interrupt and try to handle the conversation by soothing the irate parent and clearing the balance. This might placate the parent for now, but it doesn’t solve the ultimate issue (and not charging for service may be illegal). Interrupting the conversation also removes the opportunity for the staff member to handle the conflict themselves.
2. Resist the parent’s attitude by shutting them down. You might insist that the pediatrician knows best, or that the family leave the office. It is certainly within a physician’s rights not to see a patient due to a conflict of interest. This could be the correct way to go if there is long-standing conflict that does not resolve. However, it’s easy to see how a family could feel rejected and unheard by their pediatrician in this scenario, and still doesn’t resolve the core issue.
3. De-escalate and problem-solve. You can de-escalate the conflict in a few ways. Some people are placated by speaking to a person in an authority position — the office manager or the pediatrician. Staff members with conflict resolution training can also handle the situation using the same techniques described above. Moving the conflict to a different area, listening compassionately, asking clarifying questions, and setting limits (for example, not accepting any yelling or threats) can help lower the tension and get to the root of the parent’s problem: their payment just hasn’t shown up in the mail yet!

Who is De-escalation for?

De-escalation is a practice using communication and listening skills. So who is de-escalation for? It’s for everyone, including colleagues, employees, patients, and caregivers. Acknowledging that everyone is human and has the capacity to get upset, especially under stressful conditions, can help frame the situation in a manner that can help you de-escalate any tension to a level where constructive conversations can be achieved.

Patients
De-escalation techniques for patients will vary slightly based on their developmental age, but they are not altogether different from the techniques that help adults! Developmentally appropriate communication, patience, and empathy can help. Distractions such as toys, stickers, or Mom and Dad can also be helpful.

Parents
Healthcare can be emotional because it deals with many stressful things: the health and well-being of a beloved child, money, culture, and beliefs, among many others. De-escalation techniques with upset parents can help break the tension in your office, help the parent feel heard, address the real issues, and regain confidence and trust in your practice, which can only help the patient’s outcomes.

Employees & Colleagues
For pediatrician-owners and practice managers, mediating conflict is not unheard-of, but it can often be very uncomfortable. According to Forbes, creating a culture that values dialogue and empathy can help everyone resolve conflict before it settles into unspoken and toxic resentment. Other suggestions include recognizing and appreciating different communication styles: some people are more assertive, while others may need time to calm down or write down their thoughts to address the issue.

Addressing conflict at your practice doesn’t only help the specific trouble at hand. It fosters an environment where everyone feels psychologically safe, where staff can feel comfortable voicing their concerns, and where fostering relationships is at the heart of your culture.