Prioritisation and escalation
Compare harm, delay and responsibility
Use these questions to work out what needs attention first:
| Question | Why it changes priority |
|---|---|
| How serious could the harm be? | A severe consequence can outweigh a minor inconvenience. |
| How soon could it happen? | An immediate threat may make an otherwise useful discussion too slow. |
| What evidence is available? | Clear observations and uncertain reports need different handling, but both may require action. |
| What happens during the delay? | Waiting is an active choice with consequences. |
| Who can intervene effectively? | The most useful person may be nearby and clinically responsible, rather than the most senior person in the organisation. |
| What can I safely do while help arrives? | Asking for help does not remove your immediate responsibilities. |
These questions need judgement rather than a calculation. A severe but speculative possibility does not automatically outrank an established current problem.
Address the immediate risk and its cause
If there’s an immediate serious risk, do what you safely can and get appropriate help. If the risk is lower and the facts are uncertain, start by clarifying what’s happened or arranging a supported discussion. Where a concern remains unresolved, follow it up and escalate appropriately. This reflects the GMC’s advice to act without delay on serious danger and to follow through on concerns.
Check whether an option addresses the immediate problem, its cause, or both:
- A rota discussion may improve next week but fail to secure cover now.
- A safety report may support learning but fail to obtain today’s urgent review.
- Reassuring an upset colleague may help them feel heard but leave their unsafe workload unchanged.
Both can matter. Give each option credit for the part it actually addresses.
Match escalation to the need
Escalation means involving someone who can help address the concern. Before choosing it, identify what it’s for: clinical assistance, practical cover, advice, investigation, safeguarding or support.
A registrar contacted for urgent clinical help serves a different purpose from an educational supervisor asked about a recurring training issue. Occupational health may help with work-related health needs; it does not substitute for someone arranging safe cover on the current shift.
Do not make private confrontation a compulsory first step. Urgent danger, serious misconduct, harassment or a power imbalance can justify another route. Conversely, do not treat every ordinary disagreement as a regulatory matter.
Example: A colleague is delayed by an unexpected admission and asks for help with routine work. Exploring tasks and redistributing work may fit. If the colleague is about to perform a procedure they say they cannot safely do, obtaining competent supervision or an alternative operator addresses the new risk. Friendship and seniority do not settle that comparison.
Check what broad principles mean here
“Patient safety” must refer to a specific risk, rather than justify every intrusive or coercive action. A patient’s informed choice can include refusing recommended care; see patient decisions.
“Be supportive” should also refer to a concrete effect. Concealing a problem can leave both the colleague and patients less protected.
References
Ready for the next chapter?
Keep track of what you’ve read on this device.