Violence Prevention
- Review Operational Guide and Practice De-escalation
- Print and Practice HEARD+D Tools
- Review De-escalating Video, Audio, and Script Scenarios
- Listen to On-Phone Scenario-Based Examples
De-escalation for Medical Office Staff
Violence prevention is everyone’s responsibility. It is important to build relationships with patients and colleagues, as well as communicate in a respectful manner that avoids contributing to escalating behaviour. De-escalation tools for Medical Office Staff (MOS) are designed to decrease the intensity of a situation. The goal is to settle the person who is escalating so that discussion and problem-solving become possible.
Using De-escalation for Clinic Safety
People coming into clinics are often stressed, unwell, or worried about a loved one. They may have trouble communicating or may not act as they normally would. Responding with a calm, respectful, and helpful tone can make a big difference.
Having tools and strategies to support people, when they are escalating, helps protect physicians, staff, patients, and clinic visitors.
Review Operational Guide and Practice De-escalation
Review the De-escalation for MOS operational guide and practice De-escalation Dos and Don’ts. Read through these frequently to increase your familiarity and decrease your reliance on the poster during an incident. We recommend printing the posters and posting them somewhere visible to you (and not the patient) at your workstation.
De-escalation and violence prevention start with empathy and awareness. Consider how your awareness of other peoples’ life experiences, including trauma, violence, and culture, can help reduce risk and help you:
- Understand cultural influences on behaviour.
- Avoid stereotypes and microaggressions.
- Identify and be aware of your own biases.
- Respect diversity and inclusivity.
- Address cultural barriers.
Implement HEARD+D
Review and understand the HEARD+D steps.
Practice physical and verbal responses to a patient who is frustrated, angry, aggressive, or threatening so you are prepared in advance.
Assess, at any time during a conversation with a patient, if you sense escalation, whether the patient is frustrated, angry, aggressive, and/or threatening.
Follow the HEARD+D method when communicating with the patient. If the patient becomes aggressive, or threatening, go to STEP 5.
Document the incident and alert your manager (STEP 6) if you interacted with an aggressive or threatening patient.
Print and Practice HEARD+D Tools
Incident Reporting
Every interaction with an aggressive or threatening patient should be documented in the patient’s medical record in an objective, clear, and non-judgmental manner to alert other staff and help prevent future incidents. Any encounter involving a physician requires the physician to document the incident firsthand.
Additionally, if you, as an MOA, interact with an aggressive or threatening patient, you should notify your manager immediately and complete the clinic’s incident report form to support internal tracking and appropriate follow-up actions.
The Incident Report Form should be used to document an incident that caused an injury (e.g., psychological, physical, or both) or had the potential to cause an injury (i.e., a near-miss) to staff while at work.
When documenting a violent incident in the clinic’s incident report form:
- Describe the person’s behaviour clearly, and in an objective, factual, and non-judgmental
way. If subjective judgements are ever included, ensure to record all objective facts and
observations that informed your judgement. - Include date, time, location, context, contributing factors, and any de-escalation actions. Indicate what you did in each step of the HEARD tool.
- Consider the 5 W’s: Who, What, Where, When, and Why.
- Do not include patient medical information (unless there is a public safety risk) when reporting to the police.
Review De-escalating Video, Audio, and Transcript Scenarios
Listen to On-Phone Scenario-Based Examples
Benefits of Strengthening Your De-escalation Skills
Reduce stress: Staff will feel more prepared and confident in handling challenging situations, helping to reduce cumulative stress.
Minimize absenteeism: Staff may feel more empowered to stay at or return to work following a stressful event.
Improve patient relationships: Using calm, clear communication will enhance patient satisfaction.
Maintain a safe environment: By preventing situations from escalating, staff will help ensure a safer, more welcoming clinic atmosphere, while enhancing workplace health and safety.
Increase overall efficiency: With effective communication, staff will have more time to focus on care.
The de-escalation tools were developed with valuable input from a diverse and representative group of Medical Office Staff and Physicians across British Columbia. We extend our sincere thanks to those who shared their feedback and expertise.
