Become an ICM QAC

Quality Assurance for Training in the Prevention and Management of Conflict and Hazardous Behaviour

Good practice standards may be applied to all training courses which include personal safety responses and restraint with the intention of reducing risk, restraint and restriction, irrespective of the local context. Effective conflict management systems are an essential part of the occupational health and safety framework in many different settings.

What are standards?

The word 'standard' refers to a level of quality or attainment. Standardisation also implies a level of consistency. The International Standard Organisation defines a 'standard' as simply "the best way of doing something". These training standards pay due regard to a variety of relevant national and international standards.

For example, nearly 70 countries were involved in the development of ISO 45001, the management system standard for Occupational Health & Safety (OH&S), which came into force in March 2018. Those standards emphasise a more proactive and preventative approach towards the reduction of risk than previous international standards, reflecting the approach adopted by the Institute for Conflict Management. The objective is for training to enable organisations to become less reliant on reactive hazard control measures wherever possible. That approach involves the incorporation of health and safety throughout the whole management system of the organisation, rather than delegating responsibility to specific safety personnel, as was often the case in the past.

It is crucial that all managers, including those at the most senior level, take a leadership role in the promotion of occupational health and safety. That is also the approach advocated by other organisations, such as the Restraint Reduction Network in the UK.

It is not always possible to eliminate risk entirely but managers and workers should work together to reduce it, so far as is reasonably practicable. In order to do that workers must be competent to do the jobs expected of them. Training standards and quality assurance systems enable employers to better match work expectations and competence, promoting competence and confidence in the workplace in order to improve occupational health and safety.

Openness, clarity and honesty are an important part of this process. It is understandable that organisations attempt to create a narrative to present themselves in the best possible light. They operate in a demanding and competitive environment in which they may be inspected and judged by various outside bodies. Unfortunately, in the past those pressures have sometimes resulted in a gulf between explicit expectations and the reality of what was happening on the ground which was concealed by the use of imprecise language in policies, plans and records. In order to promote the highest possible standards, we need to ensure that they are expressed in clear and unambiguous language.

For example, the phrase 'behaviours that challenge' is used to describe a wide range of behaviours, ranging from mildly annoying to extremely hazardous. When the same words can be used to mean so many different things they can be misleading. The word 'redirection' is sometimes used in health and social care settings to describe a variety of different actions from workers. A person may be redirected in many ways. These range from mild visual or verbal prompts to the use of physical force to move a person from one place to another. To avoid giving a false impression, where physical force is used it should be made clear in policies, plans and incident records.

Campaigns to reduce the use of restraint over the years have sometimes created incentives for managers to use confusing or misleading language. There have been cases where managers have prompted or induced workers to changing the way they recorded certain physical interventions. This can encourage workers to falsify policies, guidance and records by renaming certain restraint methods. The term 'unplanned emergency response' is sometimes used to maintain the pretence that high risk physical interventions are no longer necessary.

After an unforeseen emergency incident has already happened, employers cannot plausibly pretend that the possibility of another similar incident happening in similar circumstances is not reasonably foreseeable. It would be unreasonable to expect untrained staff to use unplanned emergency responses after such an event had already happened.

Responsibility for the establishment of an open and honest occupational health and safety management system extends from top management downwards and needs to include all workers and participants. That is the approach recommended by the International Standards Organisation, in ISO4500,1 2018.

Since 2014, policy and guidance has been directed towards reducing the 'need' for restraint by increasing proactive and preventative approaches. That is one of the reasons why the Institute for Conflict Management was formed. Managing the potential for conflict results in a reduction in the need for restraint. Simply pressuring organisations to reduce the number of recorded restraints, before sufficiently effective proactive and preventative approaches have been put in place, does not constitute competent risk assessment and control. The reduction in risk must precede the removal of safety protections and training.

This will help prevent unreasonable expectations, or wishful thinking, from leading to an increase in unplanned emergency responses and ultimately the falsification of records. That, unfortunately, has been evident in a number of investigations that have followed exposures of poor practice.

Employers and workers share legal duties and responsibilities to promote occupational health and safety. In order to effectively protect all concerned, managers and workers need to be rigorous about maintaining standards and sometimes have the courage to challenge poor practice. A common theme in several high profile cases, in which poor practice was eventually exposed, was that some individuals had been uncomfortable about what was happening but did not feel able to challenge the prevailing culture.

Managers need to enable and encourage workers to think for themselves and challenge inconsistencies and falsehoods, no matter what the source. That means challenging organisations that fail to control the real risk just as rigorously as those which fail to control the excessive use of restraint and restriction.

The regulations require risk assessments to be completed by 'a competent person'. That is normally somebody who knows the relevant local operational circumstances and is able to follow simple thought process, balance risks and choose the most reasonable option of those available. It does not necessarily mean someone with a detailed theoretical knowledge or the mathematical ability to construct complicated matrixes to quantify risk. In some industries, such as engineering and the chemical industry, that is sometimes possible. In those cases, mathematical calculations, expressed in a matrix, can precisely quantify comparative risks.

Where risk is related to unpredictable and variable human behaviour, that approach is less useful. It is not even possible to accurately quantify many of the medical risks associated with particular restraint skills. That will depend on a number of different factors and estimations of other circumstantial risks.

Estimates made in relation to hazardous behaviour always tend to be imprecise. If the inputs into complicated mathematical models are imprecise, the outputs are also going to be imprecise. The danger is that risk assessments based on estimations, but presented in the form of complicated formulae and mathematical matrixes, can be misleading. Once again, simplicity, clarity and honesty are the best way to promoted better standards.

“Successful risk management is not about ticking boxes or calculating numbers.”

(Dame Judith Hackett - Chair of the Health and Safety Executive, 2012)

In an attempt to simplify complex issues, some authors in the past have translated nuanced legislation into simple bold statements. These have often subsequently been rejected by the Courts. Over the years, several organisations, including government departments and regulators, have had to back-peddle by issuing what they called 'clarifications' after using ill-considered absolutist language, then having some of the exceptions pointed out to them.

The words, 'always', 'never', 'without exception' and 'under no circumstances' are often an indication that the author of guidance has not thought sufficiently deeply about the topic, or is inadequately informed about the range of operational circumstances which might apply. 'Wherever possible' or 'in most circumstances' are often more accurate descriptions of reality.

At the other end of the spectrum are words and phrases that cause confusion because they are so vague. When authors slip into the passive tense, this is often a sign that they do not have a very clear idea, or that they are avoiding clarity to give a false impression.

Authors of policies, guidance, planning and incident records should promote accurate recording by encouraging the use of descriptive language. Quotes should be used to convey who said what, rather than translating the words used into subjective and judgemental language, such as 'abusive', 'aggressive' and 'inappropriate'. Descriptions of what a person actually said and did are more likely to enable the reader to form an accurate mental image. If individuals 'hit', 'bite', 'spit', 'kick', 'slap', 'punch', 'pinch', 'scratch', 'pull hair' or 'throw the television remote', then the authors should just record what happened accurately.

If the terms 'restrictive physical interventions' and 'restraint' are being used interchangeably, as is sometimes stated in policy documents, then the Institute for Conflict Management recommends the consistent use of the less clumsy and ambiguous term - 'restraint'.

Not all 'behaviours that challenge' are hazardous. In the past that term has been used to describe hazardous behaviour. It has also been used as a euphemism to disguise hazardous behaviour. The Institute for Conflict Management recommends the consistent use of the term 'hazardous behaviour' to describe any behaviour which presents a reasonably foreseeable risk of harm to any person. The use of that term also encourages organisations and workers to pay due regard to their legal duties and responsibilities under Health and Safety legislation.

Not all 'physical restraints' involve people using their hands to hold a person. The Institute of Conflict Management recommends the use of the term 'manual restraint' for situations in which people are held. This again reflects the language of Health and Safety, where the term 'manual handling' is already generally understood. In some service settings there is considerable overlap between manual handling and manual restraint. Where that is the case it needs to be clarified by the use of transparent terminology.

'Mechanical restraint' is another imprecise term. Technically, the term 'mechanics' refers to any form of motion and force. Biomechanics refers specifically to the motion and forces involved in the movement of muscle and bones. All physical restraints involve some form of mechanical restraint. In social care, health and education settings, the term has come to be used only to describe restraints involving additional equipment.

When equipment is used reasonably, its purpose is to protect people from injury. The Institute of Conflict Management recommends the use the term 'protective equipment' to describe any equipment used to protect people from harm. Some protective equipment is applied to the individuals who present hazardous behaviour. This can be for their own protection and to protect others. Examples include protective helmets and splints. In security services the application of handcuffs may be necessary.

Other equipment is worn by workers in various service settings for their own protection. This is called 'personal protective equipment'. Examples include helmets, visors, gowns and masks. In security services stab vests may be necessary.

In all settings in which equipment is used, for whatever reason, the Institute for Conflict Management recommends the use of clear language to describe precisely what the equipment is, what it does, who it is applied to and why it is necessary.

Clarity is important because in the past the use of imprecise terminology has caused confusion. For example, the use of a visor may be recommended to protect a worker from spitting. That is 'personal protective equipment' worn by the worker.

A 'spit hood', such as those used by some security services, may be 'protective equipment' but the crucial different is that it is applied to the person exhibiting hazardous behaviour. It is placed over the head of a person who is spitting. The distinction has not always been made clear in the past.

Words are important and they should be treated as such. A recommended glossary of terms is included at the end of this document. If organisations prefer to use their own terminology, they need to ensure that they explain why and explain clearly what the words they use mean.

Improving Standards

If you google the words 'everyone's responsibility' the search returns thousands of pages relating to safeguarding and security. Whether it is vulnerable children and adults that need to be protected, data, cyber security, or the health and safety of workers and others the message is clear. Nobody escapes responsibility.

Although this sounds good in theory, in practice when nobody in particular is responsible the result can be that nobody actually takes responsibility for taking action. Then, when things go wrong, nobody accepts responsibility.

We are interested in promoting effective action. To that end, we believe that those concerned with improving standards of provision need to clarify their own specific roles and responsibilities.

The UK Management of Health & Safety Regulations 1999 require organisations to have a clear structure and reporting process with an appointed person responsible for ensuring that it works. The UK Health and Safety Executive.

The International Standards Organisation sets general standards such, as ISO900 for a quality management system and ISO45001 for occupational health and safety. Organisations may be certificated against those standards by UKAS approved certificating bodies.

The Restraint Reduction Network (RRN) developed its own standards which have been adopted by NHS England for health and social care.

The Security Industry Association (SIA) is responsible for regulating the private security industry.

There are different statutory regulations which apply to children's services and adult services. Even within children's services, there are different regulations for schools, children's homes, foster carers, and colleges.

There are different regulatory bodies with specific responsibilities to conduct inspections under their own frameworks.

The Health and Safety Executive provides advice, conducts investigations and has legal powers to prosecute organisations which breach of the Health and Safety At Work Act 1974 in respect of training in conflict management and the prevention and management of hazardous behaviour. (See Case 42026700 - Castlebeck Care Holdings 2014 fined £100 000).

In addition, there are consultants, campaigners and professionals who have their own opinions about what constitutes good practice. We should be wary of those who uncritically attempt to apply ideas from one service sector into other contexts without fully appreciating the differences.

Ultimately it is for the Courts to determine what is good practice and what is unacceptably bad practice.

The Courts are led by the views of responsible bodies of professional opinion with competence and experience within each sector. Where there is a range of responsible professional opinion on any matter, it is the legal duty of an expert witness to inform the Court of that range of opinion.

Quality Award Service

The Institute for Conflict Management will provide a quality award service for members who can provide evidence that they meet the standards set out in the ICM Standards.

The Role of The Institute for Conflict Management

The Institute for Conflict Management membership includes experts with relevant personal experience, expertise and competence across a range of different service sectors.

The Institute for Conflict Management membership represents a responsible body of professional opinion involved in promoting good practice in the prevention and management of hazardous behaviour across a wide range of service settings.

The Institute for Conflict Management also contributes to the HSE Partnership on Work-related Violence.  The ICM was commissioned chair the development of the National Occupational Standards for Prevention and Management of Work-Related Violence. These standards enable members to promote and support good practice across a wide range of different service settings.

• The Institute for Conflict Management will provide members with an efficient and effective system for sharing evidence of good practice and compliance with these standards.
• The Institute for Conflict Management will accept evidence in a range of formats including, but not limited to, hard copy documentary evidence, in-person observation and interview, digital documentary evidence, video observation and interview.
• The Institute for Conflict Management will provide an assessor who will make the process of providing evidence as efficient as possible.
• The Institute for Conflict Management will provide members who meet these standards with a dated quality award for the year in question. The institute will issue a digital logo showing the year in which the organisation was vetted. To maintain the full support of the institute, organisations need to conduct a light touch annual review and be fully vetted every 3 years. Organisations may choose to be fully vetted each year, in which case, they get a new logo each year.
• The Institute for Conflict Management will continue to develop and improve these standards to ensure that they continue to reflect good practice in the light of national and international developments in legislation, guidance and case law.

The Institute for Conflict Management believes that many training organisations and their clients will benefit from the process and improve their own policies and practice at the same time.

What Training Organisations Need to Do 

It is often not necessary for training organisations to create new documents specifically for the quality award process.  This is desirable wherever possible as the process itself should not significantly distract from the purpose of the candidate organisation's work. 

The UK Health and Safety executive has made clear that risk assessments need to be completed by 'a qualified and suitably competent person'. That does not necessarily mean an external specialist in the theory of health and safety. It means somebody who knows their own organisation, what the standards are and how they should be applied. In many small settings that is a local manager or worker. The competent person needs to be able to explain to outsiders how they ensure the standards are met. 

Training organisations should treat these standards as a checklist and decide how they can best demonstrate compliance with each section. 

Training organisations who believe they meet the standards can apply to be assessed for a quality award online, via the Institute for Conflict Management Website. 

How To Complete The Quality Award Process 

Training organisations will be allocated to an Institute for Conflict Management assessor to discuss the quality award process. 

Training organisations will need to provide all the evidence requested and any additional evidence which may be necessary to clarify issues. 

The ICM Board and Assessors are committed to making the process simple and straightforward, avoiding the need for additional unnecessary documentation wherever possible.