Case Study [PDF]


Hospitals are fluid and dynamic environments requiring multifaceted solutions to unique challenges. At Gundersen Lutheran Medical Center in northwestern Wisconsin, making sure staff are properly trained to adapt to change and continually improve patient care techniques is a key goal.

At the heart of that training is Dave Mischel, a nurse in the hospital's psychiatric unit who has been responsible for implementing CPI training. While the training was initially conducted in those departments dealing with the most acute patients, it has since been extended to a wide variety of employees involved with patient care, including all RNs, social workers, CNAs, and EMTs.

"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," says Mischel.

Early on, Mischel recognized the need to equip staff with the ability to prevent and de-escalate situations as a key objective of the training he oversees. The hospital sought to assemble a set of tools that staff could use to diminish the need for use of restraints. Mischel helped select CPI as the most comprehensive instructional offering and has since consulted with other hospitals on structuring their training programs.


Following implementation of CPI training, Gundersen Lutheran has seen a marked decrease in the need for and the use of restraints or seclusion. "It's an evolving process, but a lot of the credit to date is due to CPI," says Mischel.

Mischel credits CPI's programs in 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," Mischel says. "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."

He traces a clear change from initial skepticism about the processes taught by CPI to a broad acceptance and enthusiasm. "I now receive calls asking what can be done differently to deal with a particular patient or situation."

CPI training has resulted in greater cooperation and improved quality care, according to Mischel. Where departments once operated more autonomously, the CPI training has instilled a common language and approach that transcends and helps break down silos. Staff now coalesce to deal with aggressive and anxious patients in a unified fashion, and then collectively debrief and plan for how to best improve.

Creating a shared approach has also led to more unified thinking and decreased reaction time when dealing with volatile situations. "We are a better team as a result of the 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."

Another factor in the success of the programs has been the flexibility and adaptation inherent in CPI's curriculum. Using a hybrid approach that includes both classroom and individualized online instruction allows Gundersen to train staff in an affordable and efficient manner. "CPI has been most receptive and responsive to our requests for a program that best accommodates the unique needs of our facility and staff."