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PROactive Management of Integrated

Services & Environments


Reflect to Reframe

Jane Poppit, Terry Hill



From time to time staff members say no to patients. Each instance is an opportunity to REFLECT. Capturing and creating a non-judgemental space to think through how we came to the decision and whether we could have said yes helps us put the patient first.

We think about:

R – Reframe: What would it have taken to say yes?

E – Easy: Was ‘no’ the easy option?

F – Feeling: What would it have felt like?

L – Listen: Did we listen?

E – Explain: Did we explain?

C – Creative: Where we creative enough?

T – Time: Did we take the time?

Reflecting on these questions encourages staff to think more about their practice and how we can continue to improve. This leads to a culture of “First say YES”. When we do say “no” our responses are kind and considerate. Patients can understand where we are coming from and get a sense of what would need to happen for us to have said “yes”. E.g. leave from the hospital contingent on improvement they make.


Set up a collection box for ‘no slips’

Encourage reporting by putting up a poster above the collection box saying we like to say yes, tell us if we have said “no” to you.

Keep the ‘no slips’ simple – if we said no to you to please tell us about it

For this to be embedded in every day practice, build it into your reflective practice sessions, supervisions and handovers etc.

Evolution of recurring themes, the quality of the discussion and less incidents will allow you to monitor progress over time.

Top Tip:

Maintain a non-judgemental stance at all times and create ownership and delegate responsibility of the process to the frontline staff by encouraging open and honest reflections and dialogue.

Example: On admission to one of our wards a patient expressed the desire to bring his own pillow in as he had neck problems and found his own pillow soothing. Fire safety and infection control regulations state that on the hospital premises all bedding used must be pre-approved. So the answer was a no, but on reflecting staff felt that the pyjamas the patient was wearing was as inflammable as his pillow and exercised their judgement and allowed the pillow bringing the patient’s distress levels down and then seeking necessary permission.

Note: This is not about discarding policies and procedures as they have been put in place for a reason, however when policies override common sense and clinical judgement, staff are encouraged to take a view and put patients first while at the same time keeping an eye on what it means for the rest of the patients.

 No Audit

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