Create safe environments for employees and patients

Shelby Chapman, MA, Director of Patient-Family Experience at Children's Colorado, says one of the things that they were finding is that a lot of that intervention focused on in-person escalation-particularly physical escalations.

She said leaders were reaching out and saying those tools were great, but they didn't quite fit the escalations they saw. They said they were seeing a lot of verbal abuse online or over the phone, and some of the tools and resources that the organization had in place weren't quite meeting those needs.

"They said, 'We have schedulers who don't want to work in this department anymore," she recalls. "'Our nurses feel it, and we're unsure what to do.'"

When over-the-phone escalations began taking a toll, Children's Colorado started making moral distress rounds and identifying ideas from teams that would be meaningful.

They also instituted a tip sheet with six de-escalation strategiesto reinforce online learning that is easily accessible with helpful phrases, which included:

• Breathe
• Be an active listener
• Use the power of empathy
• Find solutions together
• Ask for help when you need it
• Take care of yourself

"Asking for help when you need it is giving people explicit permission that if you are being verbally abused, if you've tried all of these methods and they're still yelling and using demeaning language, you can end the call," Chapman says.

"So that was really important, and there's some language to approach ending those conversations."

Children's Colorado tried a phone-recording pilot where they combined marketing, an IT infrastructure team, schedulers, nurses, a patient/family-experience team, and a music therapist to update the on-hold music and messaging and record new on-hold messages.

They got creative with their messaging using patients and doctors, with the intention of reminding callers that they are humans caring for humans.

They are still collecting data to see if these small changes are curbing escalations, but one of the procedural changes made was that team members now fill out a form if they've had an escalation and want resources and support from their leaders.

Leaders get an alert to follow up, and they can collect data on escalations that haven't happened before.

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