This post is about conflict management, personal safety, and Dynamis training. Gerard O’Dea talks to Vanessa about a recent train-the-trainer programme for a children’s hospital — and what it really takes to manage conflict in that setting.
Preparing for the programme
Vanessa: What was the training course and how did you prepare for it?
Gerard: We were asked to help by providing a trainer programme addressing conflict in a children’s hospital. Essentially, we were there to prepare their in-house training team so they could deliver a programme for all the different staff — at varying levels of cooperation — who might interact with visitors or patients while keeping everyone safe.
🎙️ Prefer to listen? Click the player below to hear the full interview.
What the team was facing
Vanessa: What particular problems and challenges were the team experiencing?
Gerard: When you start a training needs analysis at a hospital, you might expect many of the issues to sit between clinical staff and patients — helping confused people in the corridors, asking people to take medication. But at this hospital we quickly found, as we do at many hospitals, that there’s so much more going on.
There are so many people who visit hospitals that you end up considering all sorts of scenarios. To start with, there are various levels of staff: the gatekeepers who make sure people get to the right place, porters, reception staff, security. Then you have clinical staff — nurses, doctors, specialists. Each fills a different role, so the conflicts they encounter are really varied.
We did some surveys with the team, identified the challenges, and then — as we always do — we started the training with an in-depth discussion about the most common, most risky, and most challenging situations they were seeing. We used those as the curriculum for the training programme.
Vanessa: So it’s quite specific to the experiences the team themselves were telling you about?
Gerard: Yeah, absolutely. We have to do that, to make sure the training is relevant, appropriate, and beneficial.
The scenarios we built
We often talk about having four or five core scenarios. With this team, because they are trainers who need to cover everything that goes on at the hospital, we ended up isolating nine different scenarios to use across training sessions.
A typical example
Vanessa: Could you share an example of one of those scenarios?
Gerard: One of the recurring challenges at a children’s hospital is dealing with parents. They’re stressed, afraid, worried about their kids, and may have very high expectations of what the hospital and staff can do.
One of the scenarios we worked on early was a parent who wanted an extra bed put into their child’s room so they could stay over, rest when needed, and be there when the child wakes up. Of course, you can’t have an extra bed in every room — there aren’t enough beds or space. The hospital rules say no. The tricky bit comes when staff sometimes have to make exceptions, quite justifiably in some cases.
That makes it a great scenario to work on. There are things staff can do before they walk through the door to prepare themselves and reach what we call emotional equilibrium. Then, when they encounter the parents, they have a set of tools — non-escalation, how to present themselves, how to make first contact in a way that’s more likely to go in a good direction. We know people respond to clinicians’ use of language very strongly.
Then there’s listening carefully, empathising, and trying to find a solution — even when there are rules, procedures, and policy to navigate. That one scenario became a really solid foundation for managing conflict effectively and communicating professionally.
The most inspiring moment
Vanessa: What was the most inspiring moment from your perspective as the trainer?
Gerard: On a train-the-trainer course, the key moment comes when you start giving instructor candidates more opportunities to teach. People walk in on day one often anxious about becoming a trainer — and especially about becoming a trainer of physical interventions. Not everyone has a background in physical skills training.
Two-thirds of the way through, you give them a longer block to teach. You see them stand up in front of a group, instruct the skills, run the practices, and give feedback. That’s the moment.
It’s testament to being able to take people on that journey — from being unsure if they can do it, to actually doing it for the first time, really competently.
Explore our Hospital Violence Management courses or our Trainer-level courses.
Three pillars of the approach
Vanessa: Did the team have particular parts they appreciated?
Gerard: To make the hospital violence reduction training programme as robust and broad as possible, we covered a full suite of conflict management methods.
1. Non-escalation and de-escalation
Non-escalation covers everyday interactions — with visitors, patients, or colleagues from other departments — so they don’t deteriorate. De-escalation is what more senior staff do when they’re called in after something has gone wrong: a complaint, an issue, an upset person. They have to slow things down and forge a compassionate connection with the person in front of them.
For mental health and emergency department staff, there’s also crisis management — recognising when someone is in crisis and needs a more specific, empathetic methodology.
2. Protective physical interventions
On top of that, we build a platform of physical skills — what we call protective physical interventions. From low-level prompting and guiding, through personal safety tactics (how to protect yourself if someone lashes out), to holding tactics for lower-risk situations with children, and on up to stabilising someone in higher-risk encounters. A full spectrum is needed to cover the range of incidents at a children’s hospital.
3. Scenario-driven training
Because this was an instructor course, the third pillar was the scenario-driven training approach (scena). Very unique to the way we do things, based on work we do with Professor Chris Cushion at Loughborough University. We teach trainers to deliver training in-context.
💡 The three pillars: non-escalation and de-escalation, protective physical interventions, and scenario-driven training. The participants told us they found value in all three — and they support each other.
One area that stands out for me is breakaway skills and self-protection. We’ve boiled it down into something simple that can be learned relatively quickly. Give me an hour and I can teach something that helps people stay safe. Give me three hours, a full day, or two days, and I can build on that — but it’s building on the simple things, not spreading wider across more skills.
On the number of techniques
Vanessa: So a lot of content, because there are numerous ways you could be assaulted?
Gerard: That’s right. Historically there have been about 15 techniques — somebody decided somewhere in the teens was the right number of different ways you could be assaulted. Being hit, being grabbed, grabbed by the arm, grabbed by the hair.
But we’ve broken that down, looked at how those assaults develop and how the human body works, and put it together so the breakaway system is really quick to learn initially. It can then be refined over time. Most learners, and definitely the trainers, appreciate that — because it cuts down the number of things to remember.
In a serious physical confrontation, you can’t stop to try and remember. You just have to act — get free, break away, get to safety.
Challenges and surprises
Vanessa: Were there any particular challenging moments or surprises?
Gerard: The constant challenge with conflict in a children’s hospital — anywhere in the world — is language barriers and cultural differences. What’s persuasive in one culture can appear aggressive in another. A redirection in one culture can look like fobbing someone off — or be very triggering — in another.
One example: in a redirection, we might say to someone who’s being abusive or resistant, “I understand you’re feeling frustrated.” But in some cultures, naming that frustration out loud can itself be a trigger. So when trainers are considering these things for the first time, it can be pretty tricky to navigate.
Recommendations for other organisations
Vanessa: Are there any recommendations you’d make to other healthcare organisations?
Gerard: Should hospitals be working on communication skills with their staff? I think the answer is yes.
About two-thirds of the way through this course, we brought in a group of novice learners — a bunch of ED nurses — and let our new instructors loose on them. What was really interesting is that many of those nurses had never had any input on communication skills or personal safety skills, probably since their initial training.
Small things — being aware of distance and positioning, body language, how you make that first interaction with a patient — set the tone for how things progress. We get a lot of those ideas from our partners at Vistelar. This is a core idea: setting and reinforcing the social contract at every touchpoint to reduce conflict.
The library principle
Our colleague Joe Lashley tells a story about the library principle. People who arrive at a library — we can assume they know how to behave. Everybody knows the rules.
But people arriving at the emergency department are very stressed, have many expectations, and don’t necessarily have any prior learning about how to behave in an ED. Our staff have to help them.
📌 Gary Klugiewicz: We have to set a supportive atmosphere from the very beginning. Training can really help with that.
If hospitals just hope or assume their nurses, clinical staff, and gatekeepers can effectively communicate with everyone walking in — some for the first time — that’s a real issue. If we’re trying to improve patient satisfaction scores, reduce conflict, or bring restraint incidents down, this is the first place to start. Not personal safety as a first topic. Not physical interventions.
How do you set up the social contract? How do you educate the people coming into your hospital about how we’ll treat each other?
This guide on conflict management, personal safety, and Dynamis training is part of our ongoing work with schools and academies.