Assertion is a specific skill that can be used effectively by any team member to avoid mistakes, focus issues and resolve differences. Every staff member has a right and responsibility to ensure a safe and efficient outcome, not just the team leader.
The climate needed to promote effective inquiry and advocacy is open, professional and devoid of the fear of reprisal. There are many documented cases where an error or death would have been avoided if someone with a critical piece of information had brought it forward. Training in this area uses a model for assertion that is direct and uncomplicated. The assertion model is illustrated below:
Examples of Assertion include:
Express openness to feedback;
Effectively avoid mishaps;
State the problem and propose action.
Assertiveness can be achieved if all people know they have “rights” and act accordingly. These rights are:
The right to have and express your own ideas and feelings;
The right to be listened to and taken seriously;
The right to be treated with respect;
The right to ask for information from others;
The right to make mistakes.
New Assertiveness Training Tool Now Available.
This 12-page educational training tool is the perfect way to train staff members about assertive behavior and set expectations for speaking up in the interest of patient safety. E-mail us to request a free copy and we will mail it directly to you:
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Assertive people recognize boundaries between their ideas and those of others. People responding assertively are aware of their feelings. Tensions are kept in a normal, constructive, and situationally appropriate range. Actions that indicate assertive behavior include:
Asking task-related questions;
Suggesting alternative solutions and courses of action;
Stating opinions of decisions and procedures that have been suggested;
Avoiding rank differences threaten mission safety or performance (refusing an unreasonable request);
Maintaining a position when challenged, until convinced by facts;
Confronting ambiguities and conflicts;
Asking for assistance when overloaded or having difficulty with a task.
Teaching people how to speak up and creating a dynamic environment where they will express their concerns is a key factor in patient safety. Below is an illustration of the Safer Healthcare "See It. Say It. Fix It." model for speaking up for patient safety.
Frequently, the lack of a common mental model or hierarchy gets in the way. People need to state the problem politely and persistently until they get an answer; the common practice of speaking indirectly (the “hint and hope” model) is fraught with risk. Focusing on the problem and avoiding the issue of who is “right” and “wrong” is quite important and critical.
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