SPIES is the structure panels expect when they describe a problem with a colleague: the consultant who is underperforming, the junior who seems intoxicated, the registrar who is not answering bleeps, the nurse who reports a doctor's behaviour. It works at every level because the principles do not change; only the actions available do.
What the letters stand for
Seek information. Find out what is actually happening before you act. Talk to the colleague privately, talk to the people who raised it, look at the facts. Many concerns look different once you know the cause.
Patient safety. Throughout, ask whether a patient is at risk now. If one is, act on that first regardless of the relationship: review the patient, remove the colleague from clinical work if they are unsafe, cover the gap.
Initiative. What you can do yourself: a conversation, practical help, covering a shift, offering to meet regularly. Panels want to see that you would try to resolve it at the lowest level that is safe.
Escalate. When the problem is beyond you, is not resolving, or involves serious risk, involve the right person: your senior, the clinical director, the educational supervisor, the medical director, and know when a regulator must be told.
Support. The colleague is a person who may be unwell, overwhelmed or frightened. Keep them supported throughout, and support yourself and the team afterwards.
How to use it
Say the steps in order, in the first person, with the specifics of the scenario: who you would talk to, what you would say, what you would do if the colleague denied it or refused help. Panels always probe with "and if that did not work?" so have the next step ready at each stage.
At junior level
Seek information means a quiet word and listening. Patient safety means telling a senior if a colleague is unsafe to work, even if it feels disloyal. Initiative means practical help. Escalation means your registrar or consultant. Support means not leaving the colleague alone with it.
At consultant level
Seek information means a private, respectful conversation with a peer. Patient safety may mean removing a colleague from a list or a rota today. Initiative means mentoring, job plan changes, occupational health. Escalation means the clinical director and the medical director, and the regulator where impairment or conduct risks the public. Support means the colleague's wellbeing and the department's.
Impairment
For a colleague who appears intoxicated or impaired, the order compresses: patient safety first and immediately, then information, then escalation, with support throughout. Say that you would act kindly and that you would not keep it to yourself.
Common mistakes
Confronting rather than asking. Keeping a safety concern quiet to protect a relationship. Escalating without having spoken to the colleague where it was safe to. Forgetting support. And describing the colleague's faults at length and your own actions briefly.
Practising
Take the colleague scenarios for your level and talk each through aloud with SPIES, then have someone play the colleague who denies it, the senior who dismisses it, and the colleague who asks you to keep a secret.