Module 1 of 2 · 90 minutes
Enabling risk, holding a standard and escalating in time
By the end of this module you will be able to
- Complete a risk assessment that enables rather than forbids
- Give specific, timely feedback on a colleague's practice
- Judge when to escalate and what information to carry
- Reflect in a way that changes what happens next
Amara I have written a risk assessment and the conclusion is that she should not go into the garden alone. Good assessment?
Nadia Probably a failed one, and I say that gently. If the answer at the bottom is do not, the assessment has usually been used to find a reason to stop something rather than a way to allow it.
Amara But she has fallen in the garden.
Nadia Then the question is what makes it safer, not what makes it stop. A different surface, a rail, a time of day when someone can see her from the window, shoes that grip. And the column everyone leaves out.
Amara Which is?
Nadia The benefit. What she loses if the garden goes. Write that down beside the risk and the whole document changes character, because now a reader can see there were two things at stake and not one.
Amara A newly promoted senior has to raise a colleague's tone with a resident. Yesterday they were peers.
Nadia Same day, privately, describing the behaviour rather than the person. Not you were rude. What was said, the effect it had, then a question: what happened?
Amara Why ask, when the senior witnessed it?
Nadia Because they witnessed thirty seconds in a corridor. That colleague may be in the worst week of their life. Without the question you never learn it, and they conclude you are somebody who tells rather than asks. After that you stop hearing anything.
Amara And holding it for supervision next month?
Nadia It stops being feedback and becomes an ambush. Nobody can act on something three months old, and they will spend the meeting wondering what else has been stored up.
Amara Escalation. It is two in the morning, she is a bit off, not herself, nothing I can point at. I do not want to be the one who rings for nothing.
Nadia Ring. Please. In fifteen years I have never seen anybody in trouble for escalating something that turned out to be nothing, and I have read a great many serious incident reports containing the words, I thought I would mention it in the morning.
Amara What do I actually say?
Nadia What you saw, when it started, how it differs from her normal, what you have already done, and what you are asking for. That last part is the one people leave off, and it is what turns a worried call into a useful one.
Amara And not herself is enough to go on?
Nadia From somebody who knows her, it is often the most valuable thing said all night. Deterioration in an older person is quiet before it is loud: new confusion, not eating, not wanting to get up. You are the instrument that detects that, and no observation chart replaces you.
The written material
Positive risk taking
A risk assessment that ends in do not is usually a failed risk assessment. The purpose is to work out how somebody can do the thing that matters to them with the risk reduced to a level everybody has seen and accepted, not to find a reason to stop it.
A defensible assessment names the risk, names the benefit, lists what reduces the risk, records who was involved in the decision including the person themselves, and sets a date to look at it again. The benefit column is the one people leave out, and leaving it out is what makes an assessment read as though the only thing at stake was harm.
Holding a standard among people you work beside
The hardest part of a first supervisory role is that yesterday these were your colleagues and tonight you have to say something about how one of them speaks to a resident.
Three things make it survivable. Be specific about behaviour rather than character: what was said or done, and the effect it had. Do it now rather than saving it for supervision, because a same day conversation is normal and a three month old one is an ambush. And do it privately, every time, without exception.
The failure mode to avoid is becoming the senior nobody tells anything. That happens when raising something with you is unpleasant or unpredictable, and once it happens you stop hearing about problems while they are still small.
Escalation, and the cost of waiting
Escalation fails in one direction far more than the other. Almost nobody is criticised for escalating something that turned out to be nothing. A great many serious incidents contain a person who thought they would mention it in the morning.
Carry the right information when you do it: what you observed, when it started, what has changed from this person's normal, what you have already done, and what you are asking for. The last one is missed most often, and it is the difference between a useful call and a worried one.
Deterioration in an older person is often quiet. New confusion, reduced intake, not wanting to get up, a change in continence: these are the signs that precede the obvious ones, and the person who notices them is usually the one who knows the individual well.
Reflection that changes something
Reflective accounts written to satisfy a form describe an event and conclude that lessons were learned. Nothing follows and nothing changes.
A useful reflection names one thing you would do differently and one thing you will now do, and is short enough to be true. If you cannot say what will be different next Tuesday, you have written a report, not a reflection.
Knowledge check
The knowledge check and your certificate need a free account, so that your progress and results can be saved as evidence.
The learning itself stays free and open. You are reading all of it right now without an account.