Improving Workplace Safety at Duke University Health System

Workplace violence and staff turnover are topics Sara Emory thinks about daily. As the Senior Clinical Director at Duke University Health System, Sara is responsible for maintaining the safety of staff and ensuring they feel safe and confident in their ability to care for patients.

In 2020, Sara noticed a troubling trend. Like most health care facilities that were affected by the pandemic, Duke Health experienced a drastic increase in workplace violence. Sara knew the staff needed additional resources and training to feel safe. After evaluating various options that could benefit every role and risk level system-wide, Sara settled on CPI.

Over 18,000 staff at Duke Health have been trained in CPI proactive de-escalation techniques, helping to improve safety and confidence and increase morale.

We’ll share how CPI helped Duke Health effectively implement system-wide training, illustrate the impact, and show you how to bring CPI training to your health care facility.

Implementing CPI De-escalation Training System‑Wide

The sheer number of staff and services offered at Duke Health, which includes one of the largest hospitals in America, presented a major challenge for selecting a de-escalation training program. Sara explained, “We cover most of central North Carolina. The range of patients that we serve covers a very broad spectrum.” This meant effective, system-wide training would have to be applicable for all staff from pediatricians to emergency care teams, front-desk workers, and beyond.

“We looked at all of the programs that were available,” Sara shared. After comparing options, she and her team elected CPI “because we felt like [the program] addressed things in a very flexible, easily understood, and easily implemented way.”

CPI worked with Sara and the Duke Health team to provide tailored training recommendations. Initially, a few units from each hospital were selected as pilot programs.

“CPI came into our facility, met with our staff, and worked with them to help them tailor how they were using the CPI approach. There are not a lot of programs that have that ability to expand or contract the different elements within the program so that you can modify it for specific patient populations.”

Following the pilot programs, CPI training was quickly adopted across departments. “The way we measure success is based on the sheer volume of people that choose to take a class. People took it because they heard from someone else that it would be helpful. To be honest with you, it grew by word of mouth,” Sarah explained.

Now, over 18,000 staff at Duke Health have received CPI proactive de-escalation skills. The system-wide adoption of CPI training is providing staff with several benefits including increased staff confidence, reduced turnover, and improved hospital culture.

3 Ways CPI Training Has Improved Workplace Safety at Duke Health

Since implementing CPI training, Sara and her team have noticed several benefits that have helped improve workplace safety and satisfaction for staff.

1. Staff now debrief after an event.

“People have recognized the need to talk about what happened. That is probably the most valuable thing, because it helps the staff to decompress after an event.”

CPI calls these post-event or post-incident discussions debriefing. Through candid, honest conversations, staff can revisit what went well and what could be improved. If anyone has any questions or would like to discuss additional concerns or next steps, debriefing offers a safe space. 

Opening the door to discussions like this helps reduce stress for staff and lowers the risk for workplace violence to escalate.

2. Staff now use a common language.

Another vital benefit of having system-wide CPI training is establishing a common language across staff. As Sara explains, “in a lot of medical care situations, if you don’t know the acronyms, it’s very easy for there to be a lot of miscommunications.”

“We, across facilities and disciplines, are sharing a common language, understanding, and knowledge of what is happening. It makes us better communicators.”

By reducing the risk for error, staff are now helping make their workplace safer, more efficient, and more understanding.

3. Staff now have hope and greater confidence.

When staff lack confidence, it can lead to helplessness, thereby causing errors and an increased risk for situations to escalate. Another benefit of CPI training is an increase in staff confidence, both on an individual and system-wide level.

“If you feel helpless, you will shrivel up. But if you feel hopeful, there’s an energy that comes from that. The biggest thing that comes out of the classes is that the staff experience hope. They believe they are going to be able to manage situations and will be safe. And I think staff members do feel more confident.”

These benefits have led to noticeable changes in Duke Health’s workplace safety measures. “We had a 6% increase in our employees stating that they feel safe at work. That might not sound like much; however, we have over 27,000 employees, so a 6% increase is actually a significant increase, and we’re very proud of that.”

The benefits of CPI training extend far beyond providing a “one-and-done” solution. Our training helps change the overall culture of a health care facility—and Duke University Health exemplifies that positive culture change that supports workplace safety and staff confidence.

“I recommend CPI to almost everyone who comes to me and asks,” Sara shared. “There are other programs, but I believe that CPI offers an ability to modify which interventions you use based on whatever group [you’re working with]. In my opinion, you can consistently employ all the techniques and tailor it to what it is your staff wants to be able to address.”

Additional Resources

Download additional tips and information to help improve your workplace safety.

5 Tips for Changing the Culture in Your Hospital

Establishing a culture of safety in your hospital boosts staff confidence and retention. These five tips help establish the foundation needed to make a change.

Download Resource

Top 10 De-escalation Tips for Health Care Professionals

Our free eBook provides strategies and techniques to help you respond to difficult patient behavior in the safest, most effective way possible.

Download Resource

Trauma-Informed Care for Health Care Professionals

This free eBook will provide you with an understanding of trauma, its triggers, and how it affects behavior—allowing you to prevent trauma-induced crises in the workplace and beyond.

Download Resource