Graded Assertiveness.

Graded assertiveness is a learned skill.
It is a process of communicating, advocating and directing in stressful or crisis scenarios.

There are many factors that can block good communication during critical events including:

  • differences in seniority or experience
  • job position
  • personal power
  • personal agendas
  • fear of ‘loss of face’
  • and plain old pig-stubbornness.

One form of graded assertiveness that has been developed, can be remembered with the word PACE.

PACE consists of 4 stages or tiers of communication. Each one is a measured escalation that systematically (if the problem is not resolved) transfers power from other….to shared…and finally to self.

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Here is one example to give you some idea of PACE in action.

  1. Probe:
    “did you know that this patient has a serious allergy to Latex?”
  2. Alert:
    “I think there might be Latex in the gloves you are using. Lets just check on the box”.
  3. Challenge:
    “It is against our policy for you to do this procedure wearing Latex gloves if the patient has an allergy. You should not continue”.
  4. Emergency:
    “Step away from the patient. You will not continue with this. I am contacting my team leader immediately”.

By using the 4 stages as a guideline you have a structured momentum that empowers you to move forward despite perhaps feeling uncomfortable doing so.

In such ‘moments of crisis’ you become an advocate for your patient, your colleagues or yourself.

A template for raising concerns:

Another tool that will help during graded assertiveness is to develop a structured template ahead of time that you can mentally access when you need to communicate a plan for engaging with problems or issues.
Here is such an example:

  1.  Attention:  “Excuse me John….”
  2.  State your concern:  “I notice from your fluid balance chart that the man in bed 6 has not had any output from his IDC in the last 2 hours.
  3. State the problem as you see it: “I think this man is deteriorating, and we need to have him reviewed.”
  4. State a solution: “I will phone doctor Kumar to come and review him urgently”.
  5. Obtain an agreement:  “Does that sound OK to you?”

 


Reference:

  1. Communication in a Crisis [Internet]. Available from: http://lifeinthefastlane.com/education/ccc/communication-in-a-crisis/
  2. Patient safety and acute care medicine: lessons for the future, insights from the past [Internet]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887110/

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