Conflict Resolution Form
How many times in a month will you encounter a patient who has an aggressive manner?
Never
1-3 times a month
1-2 times a week
3-4 times a week
Daily
How often does a disgruntled/aggressive patient leave you feeling flustered/ affect the rest of your day at work?
Never
1
2
3
4
5
6
7
8
9
Always
10
1 is Never, 10 is Always
1
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I feel confident in managing an aggressive/disgruntled patient
2
3
4
5
6
There is always someone to ask for help if I am not sure how to manage an aggressive/ disgruntled patient
7
8
9
10
11
I am aware/ know where to find the surgeries conflict resolution policy
12
13
14
15
16
I understand how to apply conflict resolution in my daily practice
17
18
19
20
21
I am up to date with my conflict resolution e-learning
22
23
24
25
26
Do you think a surgery specific conflict resolution action plan would be useful?
Yes
No
Maybe
If you have any further comments to add/ suggestions of how we can have a good conflict resolution action plan in the surgery please write them below. Thanks
Submit
Should be Empty: