Building the Alliance Between Security and Clinical Teams

Authors: William Fox and Simon Whitehorn (UK)

In 2012 Maybo and Brighton and Sussex University Hospitals NHS Trust (BSUH) started a joint initiative to reduce risks to staff and patients linked to aggressive behaviours.

The project data shows year on year reductions in assaults and restraints. Current levels show:

52% reduction in non-physical assaults on staff Trust wide

42% reduction in physical assaults on staff Trust wide

58% reduction in restraints for clinical reasons Trust wide

71% reduction in restraints for clinical reasons within the ‘Specialised Division’ (targeted, high risk units)

31% reduction in calls to Security for assistance with patients exhibiting “challenging behaviour”

Key Success Factors:

  • Thorough research of risks, causes and training needs
  • High relevance to staff
  • Stakeholder workshop to achieve ‘buy in’ of the Chief Nurse and Matrons
  • Follow up and support to wards post training to encourage transfer of learning into working practices 

The Challenge

BSUH identified that a substantial number of reported assaults on staff were related to the clinical condition of a patient, from physical conditions causing acute confusion to mental health issues such as dementia, and sometimes a combination of these. This situation reflected a countrywide analysis by the NHS Business Services Authority of assaults on staff, which identified around 70% were clinically related.

BSUH set out bridge the gap between current NHS conflict management and conventional ‘breakaway’ training and the need to address the complex causes of clinically related challenging behaviours. Maybo was engaged to research and design a bespoke programme to meet NHS conflict management requirements plus build an understanding among staff of how to recognise, prevent and respond to clinically related challenging behaviour.

The initiative set out two complimentary goals:

  • Design and deliver a bespoke training programme to help security and clinical staff teams work together to reduce clinically related challenging behaviours and assaults
  • Reduce the use of restraint and ensure patient safety and dignity is maintained when intervention is necessary

The Solution

Incident data analysis and a staff survey developed a clearer understanding of the nature and causes of challenging behaviours and enabled priority areas to be identified. It also informed key scenarios that would form part of the training.

Using a blended eLearning and direct training delivery approach, staff completed a bespoke eLearning programme to gain underpinning knowledge of conflict resolution followed by a  one day face to face training session. This was delivered on a training ward with wheelchairs, patient trolleys and beds to provide extra realism. It covers conflict management outcomes with additional knowledge input and skills to:

  • Recognise, prevent and defuse conflict and challenging behaviours
  • Avoid clinically related assaults through safer positioning and working practices
  • Safely guide and re-direct confused patients

Security staff had two further days training including safer holding skills, ejection and incident response.

Guidance on how to reduce risks of harm to confused and vulnerable patients plus practical skills, such as positioning awareness and simple re-direction and guiding were included to help staff who are exposed to higher levels of challenging behavior, reduce the risk of assault when going about tasks in close proximity to patients. The training maps to UK National Occupational Standards for Work Related Violence and is City & Guilds Accredited.

Ward based ‘coaching’ and support is vital to the success of the project, helping the transfer of training into working practices and safer behaviours.

“Everyone is now talking a common language about communication strategies, personalised care, de-escalation strategies and where it becomes necessary, safer physical intervention”.

Sherree Fagg, Chief Nurse.


The programme has been rolled out to almost 800 staff on wards experiencing the highest levels of clinical assaults and challenging behavior and BSUH manual handling and dementia trainers have been closely involved to ensure full integration. Pilot courses successfully secured the buy in of key staff and managers.

“The training design was based on a comprehensive Training Needs Analysis informed by a bespoke staff survey and review of incidents. It has been an incredibly thorough and risk/evidence based approach”.

Simon Whitehorn, Security Operational Manager



There is hard data and strong anecdotal evidence to demonstrate this training has delivered results and has informed the development of good practice guidance. Targeting the highest risk areas has produced results with staff in the fully trained Neuro Unit experiencing a greater than 50% reduction in assaults in a twelve month period - from fifteen to six.

Restraints for a clinical reason are down from 87 to 69 over the recording period and security teams are now using low arousal non pain compliant methods.

Staff training evaluations, pre and post training consistently rate the training as ‘excellent’ and comment on its practicality and relevance to their work. The feedback from the initial courses was excellent which spread good news and led to staff asking to get onto the training.

The cross functional commitment of Health and Safety, HR, Clinical Divisions, Safeguarding and Security is essential and has helped to create a positive feedback cycle backed by a drop in assaults and restraints.

This programme is successfully addressing one of the most complex areas of behavioural safety, which can be costly in terms of staff injuries and presents safeguarding concerns. It has delivered improvements in staff safety and made a positive contribution to patient centered care and safety.


Comments from BSUH staff directly involved with the project

“Evaluation of this training by security and clinical staff has been very positive and we have seen a reduction in the number of reported physical assaults of 11% Trust wide so far, and up to a 60% reduction in targeted wards”.

Simon Whitehorn, Security Operational Manager


 “All staff trained felt very positive and more confident in dealing with confused and aggressive patients and I see them putting this into practice. Through training together working relationships have improved and nurses are quicker to call security. The first course I have seen of its kind after 30 years of working with ‘challenging patients’. Thank you“.

Matron Neurosciences


 “Since the training the Adult safeguarding team has seen a reduction in the number of safeguarding alerts raised in relation to allegations of physical abuse due to intervention by staff to manage violent or aggressive behaviour”.

Allison Cannon, Associate Director Quality/Safeguarding Adults


 “In the NHS Security has a complex relationship with Health and Safety and Fire Safety with often competing agendas. This initiative also shows how the BSUH Security Team is always willing to work through challenging safety issues with the Trust Risk Management team to improve the safety of patients, visitors and staff”.

Lyn Allinson, Head of Risk Management


 “The programme we have piloted and implemented has strengthened relationships and had a positive effect on staff confidence and patient’s perception of safety.

Sherree Fagg, Chief Nurse


































Posted by Maybo on July 3, 2017


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