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Oct 2, 2023 · Physical and verbal abuse against healthcare workers is increasing in the United States, with more than two nursing personnel being assaulted every hour. Workplace violence is four times more common in healthcare settings than in private industry.
- What Are Problem Solving and Escalation?
- What Is A Problem and What Is A Solution?
- Where Are Problems Identified?
- Problem Triage: More on Different Types of Problems
- Applying The Model For Improvement to Advance Problem Solving
- What About Immediate Problems That May Compromise Patient Safety?
- Plan-Do-Study-Act “Ramp”: Learn to Use An Escalation Procedure For Urgent Issues
- Learn More About Cus
- Additional Reference Tools to Support Problem Solving and Escalation
Effective systems to support safety standard work depend on the existence of well-understood and widely used problem solving and escalation protocols. Staff must know how to solve problems noted in daily huddles and other venues (problem solving), and they must be able to distinguish the severity of a given problem and respond appropriately (escala...
A problem is an undesirable gap between an expected state and the actual state of a system. A solution closes the gap between the undesirable state and the expected state (Table 1). Consider two broad types of solutions you might encounter in your daily work. Type 1 solutions close the immediate gap. Type 2 solutions prevent the problem from recurr...
Daily huddles serve as a major forum to identify problems. As part of the standard huddle agenda, staff raise safety concerns from the previous day, anticipate issues for patients on the current day, and also raise any other issues. Supervisors have an opportunity to consider whether issues raised count as type 1 or type 2 problems and take action ...
The frontline manager and frontline staff must be able to distinguish between type 1 and type 2 problems. The following flow diagram (Figure 1) and description can help. Figure 1. Problem Triage Imagine that a staff member identifies a problem. Some problems will require immediate management attention, such as problems that compromise the safety of...
You can introduce Plan-Do-Study-Act (PDSA) cycles, described in Module 1, to improve problem solving in your facility. Your goal will be to reduce recurring problems and coach staff in how to distinguish between different problems. For example, you may structure a PDSA to review all problems identified in a given week and to categorize each problem...
The AHRQ Safety Program for Ambulatory Surgery has provided tools to help frontline staff address issues that arise in the course of clinical work that may compromise patient safety. In particular, the CUS (“Concern-Uncomfortable-Safety Issue”) method serves as a communication framework to flag problems that arise (Figure 2). If your organization h...
You can also apply PDSA thinking to improve the integration of CUS thinking into your work. The PDSA cycles below (Table 2) will help you think about how you can hardwire CUS and also structure improved followup to any CUS events. Figure 4reminds you that many improvement projects involve a series of PDSA cycles. Figure 4. PDSA Ramp Table 2. PDSA C...
Speaking Up Training Kit CUS Pocket Card: This card should be customized and distributed to staff and physicians as a reference for how to use structured language. We recommend laminating the card. CUS Scenarios for Role Playing: This sheet contains multiple scripts using the TeamSTEPPS® concept called CUS for individuals to use. We recommend that ...
Reporting Your Concern: SBAR Structure
Adapted by clinicians at Kaiser Permanente from a U.S. Navy method, SBAR (Situation, Background, Assessment, and Recommendation) is an effective and efficient way to communicate important information. SBAR offers a simple way to help standardize communication and allows parties to have common expectations related to what is to be communicated and how the communication is structured: S=Situation (a concise statement of the problem) B=Background (pertinent and brief information related to the s...
Analogy to Clinical Escalation
Escalation for safety issues is like the challenge of escalating clinical care for a patient who needs clinical “rescue.” The barriers to escalation in clinical rescue are the same as the barriers you face in escalating a safety concern: 1. Missing or unclear escalation protocols. 2. Inability to identify the appropriate point of escalation. 3. Availability of senior staff to address the issues 4. Fear of negative response 5. Insufficient tools and methods for communication 1 Kaiser Permanent...
De-escalation is a first-line response to potential violence and aggression in health care settings.1 The Centers for Disease Control and Prevention (CDC) has noted a rise in workplace violence, with the greatest increases of violence occurring against nurses and nursing assistants.2 A three-year study in the American Journal of Nursing noted th...
Aug 18, 2022 · The Bureau of Labor Statistics reports that the rate of injuries from violent attacks against medical professionals grew by 63% from 2011 to 2018, and hospital safety directors say that aggression against staff escalated as the COVID-19 pandemic intensified in 2020.
Jun 15, 2012 · Team training concepts, with their origin in industries such as aviation [3], have been introduced into healthcare with the aim of enhancing non-technical skills such as leadership [4], situation awareness [5], communication, and decision making [6, 7].
- Johan Bergström, Sidney Dekker, James M Nyce, Isis Amer-Wåhlin
- 2012
Sep 11, 2024 · As defined by the National Institute for Health and Care Excellence (NICE), de-escalation in healthcare refers to “the use of techniques (including verbal and non-verbal communication skills) aimed at defusing anger and averting aggression.”
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De-escalation strategies, such as taking a timeout and responding instead of reacting, can help in some situations. When incivility escalates, physicians must discern when it is time to get...
