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Research Questions

  1. Is de-escalation training effective in managing violence towards NHS staff?
  2. What are the benefits and key methods used to provide the training?
  3. What are the key types of training and content within the evidence base?
  4. What are the factors of success in deploying training from the evidence base?

Violence in the workplace is a major issue for healthcare providers. As a way to help staff manage, reduce or prevent violence from occurring, NHS Improvement asked RAND Europe to conduct an analysis of de-escalation training to support the development of this type of training within health settings.

The study focused on individual skills-based training to help reduce workplace violence and assessed whether de-escalation training is effective in managing violence towards NHS staff, benefits and key methods used to provide training, key types of training and its content, and factors of success in deploying training.

To answer the research questions the research team conducted a rapid evidence assessment (REA) of de-escalation training literature. Given the availability of existing reviews evaluating the efficacy of de-escalation training in healthcare settings, our approach was to perform a review of existing de-escalation training reviews and other individual skills-based approaches to aggression management within the last 10 years (2009–2019).

The study found that training may help staff manage patient violence and aggression although de-escalation training may not in itself reduce the number of violent or aggressive incidents. Additionally, evidence shows de-escalation training contributes to a significant reduction in lost workdays, improved staff retention, reduced complaints, and reduced overall expenditure. Given these limitations, using comprehensive approaches to managing violence in the NHS may be more effective than de-escalation training alone. The quality of available evidence on de-escalation training is limited. Any efforts towards implementing de-escalation training would benefit from the inclusion of evaluation in their design.

Key Findings

Training may help staff to manage patient violence and aggression.

  • When staff have the appropriate knowledge, confidence and skills for handling aggressive or violent patients they may be less likely to experience negative outcomes such as injuries.

De-escalation training may not in itself reduce the number of violent or aggressive incidents.

  • Evidence on whether de-escalation training is effective at reducing violent incidents is mixed, with few studies evaluating long-term effects of training. When reductions in violence were reported, they were not always sustained throughout a given study period, which may indicate there is a need for periodic interventions.

De-escalation training has been shown to contribute to a significant reduction in lost workdays, improved staff retention, reduced complaints, and reduced overall expenditure.

  • Key individual benefits from the training additionally show improved knowledge and confidence in identifying and handling aggressive patients. Providing staff with the tools to handle violent situations when they do occur is suggested to limit the negative impact of aggression and violence.

A comprehensive approach to managing violence in the NHS may be more effective than de-escalation training alone.

  • The limited evidence on the efficacy of individual skills-based training suggest that a combination of factors such as security measures, environmental design and policy interventions, in addition to individual skills-based training, may be more beneficial.

Recommendation

  • There are relatively few rigorous evaluation studies that provide for robust comparison and the quality of available evidence is limiting. Any efforts towards implementing de-escalation training would benefit from the inclusion of evaluation in their design. This would inform the development of the programme as well as support the knowledge base in general for de-escalation training.

Table of Contents

  • Chapter One

    Background and context

  • Chapter Two

    Study design and methods

  • Chapter Three

    The effectiveness (or otherwise) of de-escalation training in healthcare and other settings

  • Chapter Four

    Conclusions

  • Chapter Five

    References

  • Chapter Six

    Appendix

Research conducted by

The research described in this report was prepared for NHS Improvement and conducted by RAND Europe.

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