When NOT to Escalate — Understanding Proportionate Responses

So far in this course, we have focused heavily on when you SHOULD escalate concerns about patient safety. But the SJT also tests whether you understand proportionate responses — recognising when a situation does NOT require escalation, and when over-escalating would be inappropriate.

Getting this balance right is the difference between Band 1 and Band 2. Band 1 candidates consistently match their response to the severity of the situation.

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The Problem with Over-Escalation

Over-escalation means raising a concern to a level that is disproportionate to the situation. While under-escalation (failing to raise a genuine patient safety concern) is more dangerous, over-escalation creates its own problems:

Problem	Consequence
Alarm fatigue	If everything is escalated, seniors stop taking escalations seriously
Wasted clinical time	Senior clinicians are pulled away from genuinely urgent tasks
Damaged relationships	Colleagues feel you do not trust them or are trying to get them in trouble
Reduced autonomy	You appear unable to handle anything independently
System overload	Formal reporting systems become clogged with trivial issues