Choices, limits and realistic next steps

Offering a small number of realistic choices can reduce escalation. Choices give the patient some control, but they must be genuine, safe and within the staff member's authority.

Offer real choices

A real choice is something the practice can actually deliver. Vague promises or "I'll see what I can do" when there is no option can increase anger later. Clear, specific options are usually more effective than open-ended discussion.

• "We can use the call-back route or I can check the next routine slot."
• "We can speak here briefly or use a quieter space with my colleague nearby."
• "I can explain the complaints route after we deal with today's request."
• "I can help if we speak without swearing."

Set behaviour limits early

Limits work best when stated calmly, linked to safety and easy to act on. Saying "You are being rude" sounds like a judgement; "I cannot continue while you are shouting at me" is clearer and tells the patient what will change.

• Name the behaviour: shouting, swearing, threatening, leaning over the desk.
• State the limit: what cannot continue.
• Offer the condition for continuing: speaking calmly, stepping back, using the agreed route.
• Know the next step: supervisor, pause, end call, alarm, incident process.

Do not bargain with safety

If a patient is threatening, violent or discriminatory, safety measures take priority over offering choices. Limits are ineffective unless the practice can follow through, so staff need to know what support is available.

Behaviour Limits

Choices only de-escalate if they are real, safe and within your authority.