A Unified Approach to De‑escalation Training at Gundersen Medical

Looking for a Better Way to Train Staff

At Gundersen Lutheran Medical Center in northwestern Wisconsin there were two key goals for staff training. The first was to make sure that staff were trained in a way so they could quickly and efficiently adapt to changes. And the second was to equip staff to continually improve patient care techniques.

Dave Mischel, a nurse in the hospital’s psychiatric unit, was tasked with finding training that met those goals.

Mischel explained the need for advanced training at hospitals, “The changing patient population, with increased census of those with mental illness and drug and alcohol problems, coupled with emerging federal guidelines that encourage reductions in the use of seclusion and restraint, led us to realize the need for a new training regimen.”

To do this, he partnered with Crisis Prevention Institute (CPI) as they were the most comprehensive instructional offering and had consulted with other area hospitals on structing their training programs.

A Unified Approach to Improve Hospital Culture

Initially Mischel helped Gundersen roll out CPI training in departments dealing with the most acute patients. However, it was quickly extended to a wide variety of employees involved with patient care including all RN’s, social workers, CNA’s and EMT’s.

Following this implementation, Gundersen Lutheran has seen a marked decrease in the need for the use of restraints. “It’s an evolving process, but a lot of the credit to date is due to CPI,” Mischel told us.

Mischel credits CPI’s programs for empowering staff to be more adaptive. “We cannot simply declare a single approach for each and every patient. The training allows us to develop a care plan that best addresses a patient’s special circumstances and personality.”

“It may be somewhat of an overused cliché, but I truly believe that CPI’s training has changed our instructional culture. Staff attitudes have changed for the better.”

“They feel safer due to increased confidence in their ability to competently circumvent and prevent complications. The fear has gone away—both the fear of the unknown and the fear of making a misstep, and that is a huge thing.”

Another positive culture shift has been increasing coordination among departments. Before CPI, departments often operated autonomously. Now, CPI has instilled a common language and approach that transcends and breaks down those silos. Staff come together and handle difficult situations with patients in a unified fashion, and they collectively debrief and plan for how best to improve.

Mischel noted how, “We are a better team as a result of CPI training—it has brought us closer together as a staff, improved communication lines, and resulted in collaborative brainstorming about how we can provide better patient care.”

This kind of rapid expansion of training was possible thanks to CPI’s flexible training options. Mischel explained, “CPI has been most receptive and responsive to our requests for a program that best accommodates the unique needs of our facility and staff.” At Gundersen, staff are trained in a hybrid approach that includes both classroom and online, on-demand instruction.

Originally published in 2010.