1601 lines
66 KiB
HTML
1601 lines
66 KiB
HTML
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<meta name="description" content="The Two-Challenge Rule is another tool used to facilitate team members' speaking up. It was developed to manage conflict when team members’ perception of a situation differs. Human factor experts developed the rule to help airline captains prevent disasters when otherwise excellent decision makers experience momentary lapses in judgment." />
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<title>Tool: Two-Challenge Rule | Agency for Healthcare Research and Quality</title>
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="//www.ahrq.gov/research/findings/nhqrdr/index.html">National Healthcare Quality and Disparities Report</a></h2>
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<ul>
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||
</ul>
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<p>Latest available findings on quality of and access to health care</p></div>
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/funding/fund-opps/index.html">Notice of Funding Opportunities</a></h2>
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<ul>
|
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<li><a href="/funding/policies/nofoguidance/index.html">Notice of Funding Opportunity Guidance</a></li>
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|
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<li><a href="/funding/policies/hhspolicy/index.html">HHS Grants Policy Statement</a></li>
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<div class="content">
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<ul>
|
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<li><a href="/funding/priorities-contacts/special-emphasis-notices/index.html">Special Emphasis Notices</a></li>
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<li><a href="/funding/priorities-contacts/contacts/index.html">Staff Contacts</a></li>
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<div class="content">
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<ul></ul></div>
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</section>
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/funding/process/index.html">Grant Application, Review & Award Process</a></h2>
|
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<ul>
|
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<li><a href="/funding/process/grant-app-basics/index.html">Grant Application Basics</a></li>
|
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|
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<li><a href="/funding/process/dates/index.html">Application Deadlines & Important Dates</a></li>
|
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<li><a href="/funding/process/grant-app-basics/apptips.html">AHRQ Tips for Grant Applicants</a></li>
|
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<li><a href="/funding/process/mechanisms/index.html">Grant Mechanisms & Descriptions</a></li>
|
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<li><a href="/funding/process/review/index.html">Application Receipt & Review</a></li>
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<li><a href="/funding/process/award-process/index.html">Award Process</a></li>
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/funding/grant-mgmt/index.html">Post-Award Grant Management</a></h2>
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<ul>
|
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<li><a href="/funding/grantee-profiles/index.html">AHRQ Grantee Profiles</a></li>
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<li><a href="/funding/grant-mgmt/recognition_ahrq-funded_study.html">Getting Recognition for Your AHRQ-Funded Study</a></li>
|
||
<li><a href="/funding/grant-mgmt/grants-by-state.html">Grants by State</a></li>
|
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<li><a href="/funding/grant-mgmt/nces.html">No-Cost Extensions (NCEs)</a></li>
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/funding/contracts/index.html">Contracts</a></h2>
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<ul></ul></div>
|
||
|
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</div>
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</section>
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</div>
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<div class="subnav-3-cols">
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<div class="content">
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|
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/funding/grant-mgmt/grants-by-state.html">AHRQ Grants by State</a></h2>
|
||
|
||
<ul>
|
||
</ul>
|
||
|
||
<p>Searchable database of AHRQ Grants</p></div>
|
||
|
||
</div>
|
||
</div>
|
||
<div class="mm-feature-block hide-on-mobile block block-block-content block-block-contentc6610af5-d53e-4c4c-8541-cbf02cc0fa2a" id="block-block-content-c6610af5-d53e-4c4c-8541-cbf02cc0fa2a">
|
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|
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<div class="content">
|
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|
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/pcor/index.html">PCOR</a></h2>
|
||
|
||
<ul>
|
||
</ul>
|
||
|
||
<p>AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund.</p></div>
|
||
|
||
</div>
|
||
</div>
|
||
|
||
</section>
|
||
|
||
</div>
|
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</div>
|
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|
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|
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/news/index.html">News</a></h2></div>
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|
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<div class="content">
|
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/news/newsroom/index.html">Newsroom</a></h2>
|
||
|
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<ul>
|
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<li><a href="/news/newsroom/press-releases/index.html">Press Releases</a></li>
|
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<li><a href="/news/newsroom/social-media/index.html">AHRQ Social Media</a></li>
|
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<li><a href="/news/newsroom/ahrq-stats.html">AHRQ Stats</a></li>
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<li><a href="/news/newsroom/case-studies/index.html">Impact Case Studies</a></li>
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/news/blog/index.html">Blog</a></h2>
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<ul>
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<li><a href="/news/blog/ahrqviews/index.html">AHRQ Views</a></li>
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|
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/news/newsletters/index.html">Newsletter</a></h2>
|
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<ul>
|
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<li><a href="/news/newsletters/e-newsletter/index.html">AHRQ News Now</a></li>
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</ul></div>
|
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|
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<div class="content">
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/news/events/index.html">Events</a></h2>
|
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<ul>
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<li><a href="/news/events/ahrq-research-summit-diagnostic-safety.html">AHRQ Research Summit on Diagnostic Safety</a></li>
|
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<li><a href="/news/events/ahrq-research-summit-learning-health-system.html">AHRQ Research Summit on Learning Health Systems</a></li>
|
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<li><a href="/news/events/nac/index.html">National Advisory Council Meetings</a></li>
|
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<li><a href="/news/events/conference/index.html">AHRQ Research Conferences</a></li>
|
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<div class="hide-on-desktop block block-block-content block-block-contentd829a035-55e4-4ec0-b50d-6007e7da6e21" id="block-block-content-d829a035-55e4-4ec0-b50d-6007e7da6e21">
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<div class="content">
|
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/cpi/index.html">About</a></h2></div>
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|
||
|
||
|
||
<div class="content">
|
||
|
||
<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/cpi/about/index.html">About AHRQ</a></h2><ul><li><a href="/cpi/about/do-you-know-ahrq-quiz.html">How Well Do You Know AHRQ? Quizzes</a></li><li><a href="/cpi/about/profile/index.html">Profile</a></li><li><a href="/cpi/about/mission/index.html">Mission and Budget</a></li><li><a href="/cpi/corecompetencies/index.html">AHRQ's Core Competencies</a></li><li><a href="/cpi/about/nac.html">National Advisory Council</a></li><li><a href="/cpi/about/careers/index.html">Careers at AHRQ</a></li><li><a href="/cpi/about/directions/index.html">Maps and Directions</a></li><li><a href="/cpi/about/otherwebsites/Index.html">Other AHRQ Web Sites</a></li><li><a href="/cpi/about/hhs-agencies/index.html">Other HHS Agencies</a></li><li><a href="/cpi/about/20timeline/testimonials.html">Testimonials</a></li></ul></div>
|
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</div>
|
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</div>
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</section>
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|
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<div class="content">
|
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<div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2><a href="/cpi/about/organization/index.html">Organization & Contacts</a></h2>
|
||
<ul>
|
||
<li><a href="/cpi/centers/index.html">Centers and Offices</a></li>
|
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<li><a href="/cpi/about/organization/orgchart/organizational-chart.html">Organization Chart</a></li>
|
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<li><a href="/cpi/about/organization/contacts/key-contacts.html">Key Contacts</a></li>
|
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</ul></div>
|
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|
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</div>
|
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</div>
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|
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</section>
|
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|
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</div>
|
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</div>
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|
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<div class="subnav-2-cols">
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</div>
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<div class="col-md-12 col-sm-12 utility-mobile">
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<ul class="clearfix">
|
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<li class="first">
|
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<a href="/cpi/about/careers/index.html">Careers</a>
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<li>
|
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<a href="/contact/index.html">Contact Us</a>
|
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<li>
|
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<a href="/informacion-en-espanol/index.html">Español</a>
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|
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|
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<a href="https://info.ahrq.gov/">FAQs</a>
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</ul>
|
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</div>
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|
||
<div id="breadcrumbs">
|
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<div class="row row-side-margins">
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<div class="col-12 .chrome">
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<div id="block-system-breadcrumb-block" class="block block-system block-system-breadcrumb-block">
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<div class="content">
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<nav role="navigation" aria-label="breadcrumb">
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<ol class="breadcrumb">
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<li class="breadcrumb-item">
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<a href="/">Home</a>
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</li>
|
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<li class="breadcrumb-item">
|
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<a href="/teamstepps-program/index.html">TeamSTEPPS Program</a>
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</li>
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<li class="breadcrumb-item">
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<a href="/teamstepps-program/curriculum/index.html">Curriculum Materials</a>
|
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</li>
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<li class="breadcrumb-item">
|
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<a href="/teamstepps-program/curriculum/mutual/index.html">Module 4: Mutual Support</a>
|
||
</li>
|
||
<li class="breadcrumb-item">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/index.html">Section 2: Explanation of Mutual Support Key Concepts and Tools</a>
|
||
</li>
|
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<li class="breadcrumb-item active">
|
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Tool: Two-Challenge Rule
|
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</li>
|
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</ol>
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<div class="container-fluid site-wrap">
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<div class="row">
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<div class="col-md-12 text-right addthis_toolbox">
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<div class="addtoany-toolbox">
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<h2 class="addtoany-header">SHARE:</h2>
|
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<div class="block block-addtoany block-addtoany-block">
|
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<div class="content">
|
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<span class="a2a_kit a2a_kit_size_16 addtoany_list" data-a2a-url="https://www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/rule.html" data-a2a-title="Tool: Two-Challenge Rule"><a class="a2a_button_facebook"><img src="/themes/custom/ahrq_bootstrap_barrio/pattern-lab/source/images/theme_core/share_icons/facebook-tiny.png" border="0" alt="Facebook"></a><a class="a2a_button_twitter"><img src="/themes/custom/ahrq_bootstrap_barrio/pattern-lab/source/images/theme_core/share_icons/x-tiny.png" border="0" alt="X"></a><a class="a2a_button_email"><img src="/themes/custom/ahrq_bootstrap_barrio/pattern-lab/source/images/theme_core/share_icons/envelope-tiny.png" border="0" alt="Email AHRQ"></a><a class="a2a_button_print"><img src="/themes/custom/ahrq_bootstrap_barrio/pattern-lab/source/images/theme_core/share_icons/print-tiny.png" border="0" alt="Print"></a><a class="a2a_dd addtoany_share" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ahrq.gov%2Fteamstepps-program%2Fcurriculum%2Fmutual%2Ftools%2Frule.html&title=Tool%3A%20Two-Challenge%20Rule"><img src="/themes/custom/ahrq_bootstrap_barrio/pattern-lab/source/images/theme_core/share_icons/plus-tiny.png" alt="Share"></a></span>
|
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|
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</div>
|
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</div>
|
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|
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|
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</div>
|
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</div>
|
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|
||
|
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<div>
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<div id="page-top"></div>
|
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<section class="row region region-page-top">
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<div data-drupal-messages-fallback class="hidden"></div>
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</section>
|
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|
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</div>
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|
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<div class="row side">
|
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<button class="btn sbf-btn hidden visible-xs" type="button" data-toggle="collapse"
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data-target=".navbar-collapse" aria-expanded="false" aria-controls="collapseExample">
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More topics in this section
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|
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<div class="block-sidebar-first block block-menu-block-forked block-menu-block-forkedteamstepps-program" id="block-menu-block-forked-teamstepps-program">
|
||
|
||
<span class="sbf-main"><a href="/teamstepps-program/index.html">TeamSTEPPS Program</a></span>
|
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|
||
|
||
<ul class="clearfix nav navbar-nav collapse dont-collapse-sm navbar-collapse">
|
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<li class="nav-item menu-item--collapsed sbf-level-one">
|
||
<a href="/teamstepps-program/updated/index.html" class="nav-link" data-drupal-link-system-path="node/240128">TeamSTEPPS Updates</a>
|
||
</li>
|
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|
||
<li class="nav-item menu-item--collapsed sbf-level-one">
|
||
<a href="/teamstepps-program/welcome-guides/index.html" class="nav-link" data-drupal-link-system-path="node/240129">Welcome Guides</a>
|
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</li>
|
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|
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<li class="nav-item menu-item--expanded active dropdown sbf-level-one">
|
||
<a href="/teamstepps-program/curriculum/index.html" class="nav-link active" aria-expanded="false" aria-haspopup="true" data-drupal-link-system-path="node/240152">Curriculum Materials</a>
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|
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<li class="dropdown-item menu-item--collapsed sbf-level-two">
|
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<a href="/teamstepps-program/curriculum/intro/index.html" data-drupal-link-system-path="node/240123">Introduction to Curriculum</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item menu-item--collapsed sbf-level-two">
|
||
<a href="/teamstepps-program/curriculum/communication/index.html" data-drupal-link-system-path="node/240147">Module 1: Communication</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item menu-item--collapsed sbf-level-two">
|
||
<a href="/teamstepps-program/curriculum/team/index.html" data-drupal-link-system-path="node/240148">Module 2: Team Leadership</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item menu-item--collapsed sbf-level-two">
|
||
<a href="/teamstepps-program/curriculum/situation/index.html" data-drupal-link-system-path="node/240149">Module 3: Situation Monitoring</a>
|
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|
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|
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<li class="dropdown-item menu-item--expanded active dropdown sbf-level-two">
|
||
<a href="/teamstepps-program/curriculum/mutual/index.html" class="active" aria-expanded="false" aria-haspopup="true" data-drupal-link-system-path="node/240150">Module 4: Mutual Support</a>
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|
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<a href="/teamstepps-program/curriculum/mutual/overview/index.html" data-drupal-link-system-path="node/240329">Section 1: Overview of Mutual Support Key Concepts and Tools</a>
|
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</li>
|
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|
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<li class="dropdown-item menu-item--expanded active dropdown sbf-level-three">
|
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<a href="/teamstepps-program/curriculum/mutual/tools/index.html" class="active" aria-expanded="false" aria-haspopup="true" data-drupal-link-system-path="node/240330">Section 2: Explanation of Mutual Support Key Concepts and Tools</a>
|
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<ul class="dropdown-menu menu-level-four">
|
||
|
||
<li class="dropdown-item sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/task.html" data-drupal-link-system-path="node/240331">Tool: Task Assistance</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/feedback.html" data-drupal-link-system-path="node/240332">Tool: Formative Feedback</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/advocacy.html" data-drupal-link-system-path="node/240333">Tool: Advocacy and Assertion</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/conflict.html" data-drupal-link-system-path="node/240334">Concept: Conflict in Teams</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item active sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/rule.html" class="active is-active" data-drupal-link-system-path="node/240335" aria-current="page">Tool: Two-Challenge Rule</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/cus.html" data-drupal-link-system-path="node/240336">Tool: CUS</a>
|
||
</li>
|
||
|
||
<li class="dropdown-item sbf-level-four">
|
||
<a href="/teamstepps-program/curriculum/mutual/tools/desc.html" data-drupal-link-system-path="node/240337">Tool: DESC</a>
|
||
</li>
|
||
</ul>
|
||
|
||
</li>
|
||
|
||
<li class="dropdown-item menu-item--collapsed sbf-level-three">
|
||
<a href="/teamstepps-program/curriculum/mutual/teach/index.html" data-drupal-link-system-path="node/240338">Section 3: Teaching Mutual Support Key Concepts and Tools </a>
|
||
</li>
|
||
</ul>
|
||
|
||
</li>
|
||
|
||
<li class="dropdown-item menu-item--collapsed sbf-level-two">
|
||
<a href="/teamstepps-program/curriculum/implement/index.html" data-drupal-link-system-path="node/240153">Implementation of TeamSTEPPS 3.0</a>
|
||
</li>
|
||
</ul>
|
||
|
||
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<h1 class="node__title">
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<span property="schema:name" class="field field--name-title field--type-string field--label-hidden">Tool: Two-Challenge Rule</span>
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</h1>
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<div property="schema:text" class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The Two-Challenge Rule is another tool used to facilitate team members' speaking up. It was developed to manage conflict when team members’ perception of a situation differs. Human factor experts developed the rule to help airline captains prevent disasters when otherwise excellent decision makers experience momentary lapses in judgment.</p>
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<p>In the clinical environment, team members should challenge colleagues if they have requested clarification but the response or confirmation does not ease the concern about potential harm to a patient. The Two-Challenge Rule can help team members frame communications about thoughts and reasoning about plans and decisions related to patient care. The goal is to create a teamwork culture where team members respectfully challenge one another when the plan is unclear or of concern.</p>
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<p>Limiting the use of the Two-Challenge Rule to situations where the patient or another team member may be at high risk of harm is best. In teams where it is understood and supported, it can enable any team member to raise concerns about harms using a process others recognize and understand. When used appropriately, the Two-Challenge Rule can give all team members, including the patient or family, a vocabulary and process to best advocate for the patient’s needs.</p>
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<p>The Two-Challenge Rule requires actions by both the person making the challenge and the person with whom they are raising the challenge.</p>
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<p>If your initial assertion is ignored:</p>
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<ul>
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<li>It is your <strong>responsibility </strong>as the challenger to assertively voice your concern at least<strong> two times </strong>to ensure that it has been heard.</li>
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<li>If the outcome is still not acceptable:</li>
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<li>The challenger must take a stronger course of action.</li>
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</ul>
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<p>The challenger should turn to the supervisor and move up the chain of command if necessary. This approach is intended to overcome our natural tendency to believe the team leader must always know what they are doing, even when the actions taken depart from established guidelines. When invoking this rule and moving up the chain, it is essential to communicate to the entire medical team that additional input has been solicited.</p>
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<p>If you receive a challenge from another team member, it is your responsibility to acknowledge the concerns instead of ignoring the person. Any team member should be empowered to “stop the line” if they sense or discover an essential safety breach. This action should never be taken lightly but requires immediate cessation of the process to resolve the safety issue.</p>
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<p>Both the Two-Challenge Rule and CUS (the following tool) are two-way interactions. It is equally important to behave appropriately if you are making or responding to the challenge. This interaction can set the tone for future interactions that might affect patient safety.</p>
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<p>To further your understanding of the Two-Challenge Rule, consider the situation described below:</p>
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<p><em>Mrs. Peters returned from the dentist after having a molar extracted. The nurse let Mrs. Peters’ aide, Judy, know that she should receive soft foods for a few days so as not to disturb the clot. Judy takes Mrs. Peters to dinner and watches the dietary aide deliver a regular meal. Judy stops the dietary aide, Matt, and tells him that Mrs. Peters needs a soft meal. Matt replies that Judy is wrong, as Mrs. Peters’ menu card says “regular diet.” Judy explains to Matt that, “No, Mrs. Peters just returned from the dentist, and the nurse said she needs soft foods.” Matt takes the tray back to talk to his supervisor.</em></p>
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<ul>
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<li>Was this an appropriate use of the Two-Challenge Rule?</li>
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<li>How should the dietary aide have responded?</li>
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</ul>
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<p>As you reflect on the teams you are part of, try to recall whether you have ever used or observed the use of the Two-Challenge Rule. Can you think of times when using this rule could have prevented harm to a patient? How can you encourage greater use of this tool in the teams you are part of?</p>
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<div id="page-reviewed" class="body-copy-italic">Page last reviewed May 2023 </div>
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<div id="page-created" class="body-copy-italic">Page originally created May 2023</div>
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<span class="citation-hdr">Internet Citation:</span> Tool: Two-Challenge Rule. Content last reviewed May 2023. Agency for Healthcare Research and Quality, Rockville, MD.<br>
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<span class="citation-url">https://www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/rule.html</span>
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