This objection usually comes from a medical consultant, a quality lead or a finance manager, and it’s a fair question. The way to win it is not to overclaim. A case that names its limits is more believable, and it protects you when someone checks.
Who asks, and what do they need to hear?
Clinicians want to know it works in their setting. Finance wants to know it pays back. Give each the part of the evidence that answers their question.
- The consultant or quality lead needs the trial evidence for their type of unit, and the standard it helps meet.
- The CFO needs the link from fewer incidents to lower cost, and a plan to show it locally.
What does the evidence show, by setting?
Strong in mental health, promising in emergency departments, unproven on general wards. Use the row that matches your service.
| Setting | Study | Result | Strength |
|---|---|---|---|
| Mental health, UK (31 wards) | Bowers et al. 2015, randomised trial | Conflict down 15%; containment down 26.4% against control wards | Strong |
| Mental health, Victoria | Fletcher et al. 2017, 13 trial and 31 comparison wards | Seclusion down 36% at 12 months; no fall in comparison wards | Moderate |
| Mental health, NSW (8 adult acute wards) | Dickens et al. 2020 | Conflict down 23%; containment down 12% | Moderate |
| Emergency departments, Victoria | Safer Care Victoria pilot, 2021 | About 30% lower odds of a code grey | Promising |
| General and aged acute wards, Victoria | Safer Care Victoria pilot, 2023 | No significant difference on any measure; only 4 of the 10 interventions were used | Not shown |
Training on its own is a different question. It reliably improves staff knowledge and confidence, but a Cochrane review rated the evidence that training alone reduces aggressive incidents as low to very low certainty (Geoffrion et al. 2020). That is the case for a ward-level model with champions, practice and follow-up, rather than a one-off course.
The standards don’t wait for more trials. NSQHS actions 5.34 to 5.36 require accredited hospitals to prevent aggression, use de-escalation and minimise restrictive practices, and the guidance for 5.36 asks how the organisation knows its workforce is competent in de-escalation (ACSQHC). The question for your service is how to meet them, not whether.
What about the ROI?
No study has measured a return on investment for Safewards or de-escalation training on their own. Don’t claim one. What you can show is a chain of evidence, with each link rated honestly:
- 1 Strong
Safewards reduces conflict and containment
UK randomised trial: 15% less conflict and about a quarter less containment (Bowers et al. 2015). Victorian trial wards: 36% less seclusion at 12 months (Fletcher et al. 2017).
- 2 Promising
Less conflict means fewer violent incidents
About 30% lower odds of a code grey in a Victorian ED pilot (Safer Care Victoria, 2021). Not shown on general wards (SCV, 2023).
- 3 Moderate
Less restraint means fewer staff injuries
Restraint was the most common activity when serious staff injuries happened in UK mental health trusts: 27% (Renwick et al. 2016).
- 4 One study
Fewer injuries means lower cost
One US unit cut restraint by 91%; workers’ compensation payments fell 98% (LeBel and Goldstein 2005).
The last link rests on one US study, so present it as an example of what is possible, not a forecast. The cost side is better evidenced: see what violence already costs.
How do you answer it?
Then turn “no evidence” into “let’s find out”. Offer a baseline, 90-day and 12-month measures from data you already collect, and a named owner. Part 2, Step 5 sets out the measurement plan, and Part 4 covers running a pilot.
Other objections you might hear
All six on one page: answering objections to violence prevention training. To build the case from the start, begin with Part 1, the values case, or go straight to Part 2, the financial case.
Frequently asked questions
Is there evidence that Safewards works?
Yes, in mental health inpatient units. A UK randomised trial of 31 wards found 15% less conflict and about a quarter less containment, and Victorian trial wards saw 36% less seclusion at 12 months. Results in emergency departments are promising; a Victorian pilot on general and aged wards found no significant difference.
What is the ROI of de-escalation training?
No study has measured a return on investment for de-escalation training or Safewards on their own. The closest evidence is that restraint is where many staff injuries happen, and one US service that cut restraint sharply saw large falls in workers’ compensation costs. Build your own measure into the business case.
Does de-escalation training reduce violence?
Training reliably improves staff knowledge and confidence. A Cochrane review rated the evidence that training alone reduces aggressive incidents as low to very low certainty, which is why training works best inside a ward-level model with follow-up and measurement.
Sources
- Bowers et al. 2015, Safewards cluster randomised controlled trial, International Journal of Nursing Studies
- Fletcher et al. 2017, Victorian Safewards trial (via the Victorian Department of Health evaluation page)
- Dickens et al. 2020, Safewards in NSW adult acute mental health wards, International Journal of Mental Health Nursing
- Safer Care Victoria, Safewards in three emergency departments (2021)
- Safer Care Victoria, Safewards in acute care (2023)
- Geoffrion et al. 2020, Education and training for preventing and minimising workplace aggression directed toward healthcare workers, Cochrane review
- Renwick et al. 2016, staff injury in UK NHS mental health trusts
- LeBel and Goldstein 2005, The economic cost of using restraint
- Australian Commission on Safety and Quality in Health Care, NSQHS actions 5.34 and 5.36