De-escalation Tactics for Leaders and Staff

October 31, 2018 Anjali Arya


Patient X, who has been in the hospital for several weeks treating an internal infection, frequently experiences bouts of anxiety and has had to be restrained after a series of violent panic attacks. One evening when the nurse arrives to take Patient X’s blood pressure, the patient is visibly distressed and lashes out, hitting the nurse.

A patient that is constantly expressing aggressive behavior or a family member that is frustrated over a scenario involving their hospitalized loved one are not easy situations for frontline healthcare professionals to handle; yet, physicians and nurses experience these situations all too frequently. 

Research on the rate of patient aggression across many countries, in a variety of healthcare settings has shown to be especially high. One study of Canadian medical trainees found that 10 to 15 percent of 186 residents had been physically assaulted by patients or family members. To prevent conversations or a distressful incident from escalating, providers should be trained on different conflict resolution strategies. 

“If you can work through these types of scenarios, in the most effective way, you will change your customers into being loyal customers, they’re not just going to be satisfied, they’re going to be highly engaged with your organization,” says Elizabeth “Liddy” Deacon, Assistant Vice President of Patient and Provider Advocacy at Ochsner Health System in Louisiana. 

Liddy holds training sessions to teach healthcare leaders and staff members various de-escalation tactics to calm customers. These educational sessions are part of Ochsner’s pilot phase for their newest service recovery program that aims to help staff identify, based on the level of service received and the frequency, what the correct response would be and a timeline for response. 

The strategies that Liddy teaches are important for staff to learn so that they are well-prepared to confront any situation and deliver a respectable level of service on behalf of the organization. Though Liddy acknowledges that a lot of these pointers are common sense, it can be difficult to react accordingly when the moment presents itself.  Often, many mistakes are made, including the use of jargon, speaking faster than the customer can process, and failing to actively listen. 

When staff know the steps to take, they are more encouraged to take ownership of the situation and be confident in their approach. For a customer that is already angry, five steps to managing this are: 

  1. Listen to the entire story: listen to what the patient has to say, allow them to vent
  2. Seek to understand the person’s plight: empathize with them and their situation
  3. Express your understanding: validate their feelings, not the situation
  1. Share information shedding light on the situation: tell the story using the information you have (don’t speculate!), the customer may not have all the facts or be misinterpreting them
  2. Apologize for the dissatisfaction: try determining what can be done to fix the situation. An empathetic apology is not admitting fault, rather it sympathizes with the person’s feelings. An apologetic apology is admitting fault and should only be done after a complete review of the scenario. 

Following these steps requires healthcare personnel to be in tune with their physical and verbal reactions. Good body language, like maintaining eye contact, placing hands on lap, and sitting at or below eye-level, play an important role in how a person will behave in response to what they are being told.

Liddy also walks staff through difficult phone conversations, providing them with a script and a rule of thumb of giving disrespectful clients two chances to calm down before terminating the call. Situations where staff must disconnect a call or admit fault are tough, but it’s easier for them to walk away knowing that they responded in the way they were trained.  

“Don’t feel bad when you do have to admit fault, because there are going to be times like this when it’s blaringly obvious for patients that we did not perform to our measure,” says Liddy, adding that patients also have their own rights and responsibilities that need to be acknowledged.

Having patient relations/experience teams that make similar de-escalation sessions available to staff may allow medical institutions to see a decrease in the frequency of aggravated customers, said Liddy, explaining as long as no speculations or promises are made to the patient, and healthcare personnel remain kind and transparent these situations can see an improvement. 


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About the Author

As part of the marketing team at RL, Anjali is passionate about innovation in healthcare. When she's not learning about new client initiatives or helping to plan RL Palooza, you can find her escaping to her next adventure.

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