In the high-stakes environment of inpatient psychiatric care, safety isn't just a protocol—it's a culture. And in a culture that strives for High Reliability, we must challenge the assumption that authority alone dictates insight. True safety, as every frontline worker knows, emerges not from top-down policies but from the lived realities of those closest to risk.
One policy in particular—cell phone access for psychiatric inpatients— on a unit became a flashpoint for patient agitation, yet the voices most attuned to the issue had gone unheard for too long. This blog post makes the case for change, not from the top, but from the ground up.
The Policy Gap: Disconnected from Reality
The policy allowed patients to access their personal cell phones only with a provider’s order, and even then, only to retrieve phone numbers for use on hospital landlines. Social media and direct phone use were strictly prohibited. While this may seem cautious, the reality was more complex—and more dangerous.
Patients reported feeling cut off from their support networks, unable to manage essential life tasks like banking or medical appointments. In response, the facility observed a notable spike in safety incidents, including agitation, verbal aggression, and even attempted elopements.
Who raised the alarm? Not administrators. Not policymakers. But the public safety staff—those who walk the halls, respond to calls, and de-escalate crises daily.
Deference to Expertise: Trust the People Closest to the Work
The public safety team, composed of security officers and behavioral health technicians, consistently flagged one common thread in patient unrest: frustration over restricted phone access. Approximately 50% of daily safety incidents were linked to phone-related frustrations. Patients reported feeling isolated, especially those with family abroad who relied on WhatsApp or other encrypted messaging platforms. One officer recounted an incident where a patient denied access to WhatsApp attempted to elope, citing isolation as the primary trigger.
These observations were not anecdotal noise—they were critical data. In an HRO environment, data from the front lines is gold.
A Smarter, Safer Approach: Technology with Supervision
Informed by frontline insights, the quality team proposed a new model to inform a policy change —balancing safety with dignity and patient agency. First, they proposed supervised digital access. This allowed access to key apps (e.g., WhatsApp, banking, appointment scheduling) under staff supervision in a designated area. In addition, they proposed the use of device management software to restrict usage to only approved apps, blocking access to public social media or unsafe content.
Next, they advocated for task-specific access. This permitted staff-supervised use of phones for essential functions: paying bills, scheduling appointments, or managing subscriptions.
This was followed by patient education and communication planning. The facility implemented a clear, written policy discussed at admission. They also collaborated with patients to create individualized communication plans, managing expectations and reducing resentment.
Implementation with Accountability
This was not a free-for-all. It was a structured pilot, with checks and balances: notably a 3-month trial in a controlled environment, public safety staff trained in device supervision and software protocols, monthly feedback loop with public safety voices at the table and metrics tracked on incident reports, patient satisfaction, and staff feedback.
Results – Deference to Expertise
The new policy resulted in a 25–40% reduction in safety incidents linked to phone access, and improved patient-staff relationships, built on empathy and shared goals. A collaborative safety culture ensued due to the HRO principle of Deference to Expertise. The facility listened to those who experience patient behavior by honoring their expertise.
