It can escalate quickly. What begins as a simple call to book an appointment suddenly turns tense. Voices rise. Frustration builds.

And for many medical office staff, those moments can feel intimidating and even unsafe.

Glenda Espiritu, a medical office assistant, described one very intimidating patient, noting that the patient was argumentative to the point that she couldn’t take it anymore and began to cry.

Glenda’s experience is all too common. That’s why SWITCH BC [10] partnered with Doctors of BC and the Ministry of Health to develop medical office staff de-escalation tools as part of its Community Physician Health and Safety (CPHS) Program [11]. The program is funded through the Physician Health and Safety Agreement [12], which was renewed in the 2022 Physician Master Agreement.

Speaking about the de-escalation tools, Doctors of BC President Dr Charlene Lui emphasized the central role that medical office staff play in our health care system, adding that the tools provide medical office teams with the support and knowledge to manage challenging interpersonal encounters and promote more inclusive clinical environments, empowering physicians and their teams.

The de-escalation tools include:

• Real-life examples of challenging situations, both in-person and over the phone.
• Step-by-step follow-up procedures.
• An introduction to the HEARD+D technique, including examples to listen to.
• Practical reference sheets.

Developed with input from physicians and medical office staff across the province, these resources are designed to help staff learn skills and build the confidence to use them. The HEARD+D method helps people stay calm and in control during heated situations, says Victoria Schmid, SWITCH BC CEO. She points out that it is not just about managing a moment; it’s about the opportunity for medical office staff to proactively build skills so they feel confident to use them during interactions with escalated patients.

The response to the de-escalation tools has been positive. In the first 3 months after launch, people have accessed the tools nearly 7000 times through the CPHS web portal.

Ms Espiritu says she knows what to do the next time she has a difficult patient encounter and will know how to respond in a way that protects her.

Bhenielyn Villarosa, a primary care assistant, described that she has been gaining confidence in knowing that escalated phone calls can be safely navigated and that there is a tool to refer to when she feels overwhelmed handling phone situations.

The medical office staff de-escalation tools are available free of charge through the CPHS Program web portal [13] in the Violence Prevention section [14]. There, physicians and staff can also access customizable resources for their health and safety programs and request free, voluntary, and confidential clinic assessments from SWITCH BC’s health and safety advisors.
—Meribeth Burton
Communications Director, SWITCH BC

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [15].