The Purple Flag Escalation Hierarchy Model
When responding to a Purple Flag alert, which indicates a time sensitive situation jeopardising learner and placement safety, immediate action is vital. However, addressing the issue in the moment is only the first step in ensuring long-term risk mitigation and effective governance.
While prompt reactions are crucial for containing immediate risks, they are insufficient on their own to prevent future occurrences of similar incidents.
Therefore, it's imperative to establish a structured process for escalating concerns and risks beyond the initial response stage. This process is formalised in what we call the Purple Flag Escalation Hierarchy (Girling 2023).
The Purple Flag Escalation Hierarchy outlines a defined protocol for handling emerging themes, recurring issues, repeated Purple Flags, and instances of non-compliance or poor engagement from placement areas.
By adhering to this hierarchy, we establish a systematic approach to address challenges proactively and prevent them from escalating into more severe problems.
Having such process is essential because it serves as the backbone of our practice as guardians of placement quality and the learner experience. It ensures that we are not only responsive in crisis moments but also proactive in identifying and addressing underlying issues that may compromise the safety and wellbeing of learners.
Ultimately, by integrating the Purple Flag Escalation Hierarchy into our operations, we demonstrate our commitment to maintaining the highest standards of quality and safety in placements while safeguarding the overall learning experience for our students.
How does the Hierarchy work?
No Issues
Single Purple Flag - Serious Incident
Single Purple Flag - Localised
The first tier of the model is where we aspire all placement areas to be. Placement feedback is reviewed regularly through standard processes and emerging themes are used to aid quality improvement during learning environment quality audits.
Single Purple Flag - Localised
Single Purple Flag - Serious Incident
Single Purple Flag - Localised
Respond - Resolve - Mitigate
The second tier of the hierarchy indicates action required following the raising of a single, or standalone Purple Flag.
In this situation, it is not part of an emerging theme of Purple Flags or increasing concerns surrounding the specific placement area.
The intended action is to promptly respond to the issue and resolve it on a local level with the learner and placement area directly. Tailored follow up and a supportive action plan is put in place to mitigate the current impact and prevent reoccurrence.
Single Purple Flag - Serious Incident
Single Purple Flag - Serious Incident
Single Purple Flag - Serious Incident
Respond - Resolve - Escalate - Investigate
Where a Purple Flag is raised that identifies a serious incident has occurred, there is a need to ensure that additional risk and governance actions are taken.
All of the actions from the tier below are completed, followed by enhanced plan of support for the learner and placement area.
Examples of a serious incident might include:
- Patient harm
- Learner harm
- Medication error
- Bullying or harassment
- Learner feeling unsafe
Appropriate follow up is essential to ensure that appropriate risk management is undertaken in accordance with local Trust policies, and to meet our contractual obligations as a placement provider (NHS England Education Contract)
Repeated Purple Flags
Repeated Purple Flags
Single Purple Flag - Serious Incident
Communicate - Audit - Action - Restore
Where there are more than three Purple Flags raised in a single placement area, this triggers a review under the Repeated Purple Flags tier.
Monitoring Purple Flags for emerging themes and repeated placement areas is an essential tool to aid the long-term maintenance of placement quality.
The first action in this is communication. This is key to ensuring placement area engagement. Discussions and open conversations with clinical leads, matrons/mangers where appropriate and education providers enables a path to restoring placement quality.
Undertaking a learning environment audit as per standard process can be a useful activity as it can highlight pinch points and begin to establish the root cause.
A bespoke action plan is created for the placement area in collaboration with all stakeholders, and is done with a culture of safety, inclusion and collaboration.
It typically includes addition supervision and assessment training, enhanced visibility from the Student Support Team, and can include a temporary reduction in learner capacity.
Poor Progress
Repeated Purple Flags
Poor Progress
Escalate - Investigate - Action - Audit - Restore
This uppermost tier is reserved for the rare situations where a bespoke action and development plan is ineffective. This can be due to more complex external factors, poor staff engagement, or wider non-compliance with the commitment to learner safety.
In this situation, it is necessary for senior personnel to be involved in discussions and for s more formalised risk and governance action plan.
Whilst this includes the placement area as a key stakeholder, it is led by the Student Support Team and supported by senior matron/management.
On possible outcome may be the pausing of placements in this area, withdrawal of learners, and in some cause formal investigations - thankfully this is a very rare occurrence.
Appropriate, professional and transparent communication is a fundamental element of this highest level of intervention.
The aim of this process is to ultimately restore placement quality and remove risk to learner and/or patient harm.