ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

BY
23 ² 24 September 2010

Facilitator: Mr Gabriel Susayan
GABRIEL SUSAYAN

ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Ever end up frustrated after a conversation with someone because you didn¶t feel like you communicated as well as you would have liked? Ever walk away from a conversation asking yourself what just happened?

GABRIEL SUSAYAN

ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

The 4C's of Effective Communication
4C's of a diamond and how the Cut, Color, Clarity, and Carat Weight, will ultimately determine the fifth C cost. I believe there are also 4C's to Effective Communication.

CLEAR We must communicate clearly or what we say may be misunderstood. We must write legibly or our written communication may be misunderstood. The terms and phrases we use must be clear and understood by all, or our communication will not be effective.

GABRIEL SUSAYAN

We need to be concise in our communication to be effective.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS CONCISE Often in our communication. GABRIEL SUSAYAN . we ramble on and on and never really get around to what it is we want to say.

Then work is performed that cannot be charged for. incomplete repairs being done. Being complete means giving ALL of the pertinent information. or more work being done than the customer expected. Now. being complete and being concise is not contradictory. or it must be redone in the shop resulting in additional cost and expense to the store. or Repair. inaccurate instructions result in countless problems in the shop. Solder.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS COMPLETE Incomplete. GABRIEL SUSAYAN . Directions such as: Please Fix. Being concise means giving ONLY the pertinent information. often result in the wrong repair being done.

then another time write in small letters the abbreviation est. In addition. those instructions may be missed because they were communicated in an inconsistent manner. in the top corner of the envelope. If on one occasion we write the instruction ESTIMATE in big letters across the middle of the envelope.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS CONSISTENT We must communicate consistently from day to day in order for our communication to be effective. then on a third occasion check off a small box. our staff must communicate consistently. GABRIEL SUSAYAN .

.. It enables us to swap old behaviour patterns for a more positive approach to life. Assertive communication actually increases the appropriate use of this sort of behaviour. quite often when we feel vulnerable or unsure of ourselves we may resort to submissive. manipulative or aggressive behaviour.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Why use assertive communication? All of us use assertive behaviour at times. GABRIEL SUSAYAN .

Assertiveness can enhance the following: ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Improve interpersonal relationships Reduce conflicts/anxiety Enhance self esteem Retrain self respect Minimize stress Treats others respectfully Reduce feelings of helplessness/depression Gives a sense of control GABRIEL SUSAYAN .ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Assertiveness is a style of communication that greatly enhances our effectiveness with others and produces the most positive outcomes.

GABRIEL SUSAYAN . ‡ And it allows us to constructively confront and find a mutually satisfying solution where conflict exists. honest and direct way. ‡ It recognises our rights whilst still respecting the rights of others. ‡ It allows us to take responsibility for ourselves and our actions without judging or blaming other people.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS What IS assertive communication? ‡ Assertive communication is the ability to express positive and negative ideas and feelings in an open.

.. NOT an acceptable style of communication with everyone.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS What assertive communication is not. but at least it's NOT being aggressive. Assertive communication is definitely NOT a lifestyle! NOT a guarantee that you will get what you want. GABRIEL SUSAYAN .

and overbearing sarcastic. and apologetic direct. helpless. and guilt-inducing wailing. accepting. honest. arrogant. indecisive. ambiguous. moaning. deceiving. intolerant. responsible. passive. bulldozing.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Four behavioural choices direct aggression : bossy. manipulative. Submissive Assertive : : GABRIEL SUSAYAN . and spontaneous indirect aggression : insinuating. opinionated.

ASSERTIVE GABRIEL SUSAYAN . 1. PASSIVE-AGGRESSIVE 4. AGGRESSIVE 3.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS 4 STYLES OF COMMUNICATION. PASSIVE 2.

GABRIEL SUSAYAN .ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Passive ‡ ‡ ‡ It tends to avoid conflict at all costs. that if he speaks up. and a loss of a sense of control. This individual usually has a low sense of self-esteem. User beliefs ‡ ‡ that other peoples¶ needs are more important than their own. and results in feelings of victimization. It tends to result in a lose-win situation. and has a difficult time recognizing his/her own needs and knowing how to get them met more appropriately. It internalize discomfort rather than risk upsetting others. resentment. others will ignore or reject him.

This person operates from a real sense of inadequacy and may have a lack of empathy for others. This individual uses intimidation and control to get his/her needs met. and is disrespectful and hurtful to others in communications. User beliefs ‡ that power and control are the only way to get needs met. GABRIEL SUSAYAN .ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Aggressive ‡ ‡ It creates a win-lose situation.

ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Passive-Aggressive ‡ It incorporates elements of both of the previous styles. GABRIEL SUSAYAN . forgetfulness. and intentional inefficiency rather that being direct in his communications with others. He tends to use procrastination.

This individual operates from the belief that each of us is responsible for solving our own problems. This person takes responsibility for his own decisions and actions. as well as those of the other person. GABRIEL SUSAYAN . This style respects one¶s own rights and opinions. and neither party in communication has to justify themselves to each other.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Assertive ‡ ‡ Is directed with the goal of creating a win-win situation.

A person with an assertive communication style ‡ ‡ ‡ ‡ has a body language that conveys openness and receptiveness. movements are fluid and relaxed. Posture is upright. and is aware of personal space. tone of voice is clear and with inflection. An assertive person makes good eye contact. GABRIEL SUSAYAN .ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS WHAT DOES ASSERTIVE COMMUNICATION LOOK LIKE? Much of our communication is non-verbal.

ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS When giving opinions. but not argumentative or threatening. and also is open to hearing other¶s points of view. ‡ ‡ ‡ ‡ an assertive person is willing to express his opinion. He does not use sarcasm or gossip as a way to communicate. GABRIEL SUSAYAN . He does not silently sit back out of fear of not being liked. He is direct.

Many people have a hard time receiving feedback.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS When an assertive person receives feedback from others. even if it¶s positive. ‡ He/she is able to listen and accept what the other person has to say. denying. or feeling anxious or inadequate. or minimize it rather than hearing it and simply saying ³thanks´! No one likes to hear negative feedback GABRIEL SUSAYAN . even if he/ she doesn¶t agree. ‡ ‡ How many times has someone paid you a compliment and you simply dismiss it. She makes conscious choices about how to respond the criticism. An assertive person does not react to criticism by counter-attacking.

shows sincerity congruent body language will improve the significance of the message appropriate gestures help to add emphasis a level. and is not intimidating use your judgement to maximise receptivity and impact how. well modulated tone is more convincing and acceptable. Eye contact Body posture Gestures Voice Timing Content : : : : : : demonstrates interest.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Characteristics of assertive communication There are six main characteristics of assertive communication. where and when you choose to comment is probably more important than WHAT you say GABRIEL SUSAYAN .

and no need to 'hype yourself up' to deal with others. Repeated Assertion : this technique allows you to feel comfortable by ignoring manipulative verbal side traps. To most effectively use this technique use calm repetition. and say what you want and stay focused on the issue. GABRIEL SUSAYAN .ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Six assertive techniques Behaviour Rehearsal : which is literally practising how you want to look and sound. argumentative baiting and irrelevant logic while sticking to your point. It is a very useful technique when you first want to use "I" statements. You'll find that there is no need to rehearse this technique. as it helps dissipate any emotion associated with an experience and allows you to accurately identify the behaviour you wish to confront.

without getting anxious or defensive. but remain the judge of your choice of action. use the information if it will be helpful or ignore the information if it is manipulative.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Fogging : this technique allows you to receive criticism comfortably. To use if effectively you need to listen for critical comments. negative feelings to improve communication. Negative enquiry : this technique seeks out criticism about yourself in close relationships by prompting the expression of honest. clarify your understanding of those criticisms. To do this you need to acknowledge the criticism. "I agree that there are probably times when I don't give you answers to your questions. agree that there may be some truth to what they say. An example of this technique would be. "So you think/believe that I am not interested?" GABRIEL SUSAYAN . and without rewarding manipulative criticism. An example of this could be.

³ Workable compromise : when you feel that your self-respect is not in question. However. but not apologise. this also reduces your critics' hostility. Instead. "Yes. tentatively and sympathetically agree with hostile criticism of your negative qualities. An example would be. you're right. You can always bargain for your material goals unless the compromise affects your personal feelings of self-respect. "I understand that you have a need to talk and I need to finish what I'm doing. An example of this technique would be. THERE CAN BE NO COMPROMISE. I don't always listen closely to what you have to say. So what about meeting in half an hour?" GABRIEL SUSAYAN . You should accept your errors or faults.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Negative assertion : this technique lets you look more comfortably at negatives in your own behaviour or personality without feeling defensive or anxious. if the end goal involves a matter of your self-worth and self-respect. consider a workable compromise with the other person.

and don¶t try to convince others that yours is the ³right´ one. Also know that you don¶t have to apologize or make excuses.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS STRATEGIES FOR DEVELOPING ASSERTIVE COMMUNICATION ‡ ‡ ‡ ‡ ‡ ‡ Watch your body posture ± practice using an open. and in the way you want to convey it. Remember everyone is entitled to an opinion. Don¶t apologize if it¶s not warranted. assertive body language and voice. Take a few seconds to make sure you are conveying the right message. Think before you speak. GABRIEL SUSAYAN . Remember it is ok to say ³no´.

ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS The advantages of assertive communication ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ It helps us feel good about ourselves and others It leads to the development of mutual respect with others It increases our self-esteem It helps us achieve our goals It minimises hurting and alienating other people It reduces anxiety It protects us from being taken advantage of by others It enables us to make decisions and free choices in life It enables us to express. both verbally and non-verbally. both positive and negative GABRIEL SUSAYAN . a wide range of feelings and thoughts.

it involves the risk that others may not understand and therefore not accept this style of communication. as mentioned earlier.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Disadvantages of assertive communication Others may not approve of this style of communication. You may also find out that you were wrong about a viewpoint that you held. having a healthy regard for another person's rights means that you won't always get what YOU want. or may not approve of the views you express. GABRIEL SUSAYAN . But most importantly. Also.

GABRIEL SUSAYAN . Mrs. or Dato.. Tan Sir. Dr. Pay attention to this. Excuse yourself if you have to take a phone call. The only exceptions to this rule are a) if your patient is a child or at least less than 18... Simple Courtesy Knock before you enter. Don¶t call a Doctor or Dato..a ³Mister´.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Importance of bedside manners Specific qualities of good bedside manner Prepare for the Visit Spend a few minutes reviewing the patient's history and medical problems before you even enter the room. Always use the person¶s last name prefaced by Mr. Patients are impressed if you know what's going on with them ahead of time without having to look up or ask for a lot of information about them while you're in the room with them. or b) if your patient specifically requested or insisted you call him/her by their first name or nickname. Always be polite. or whatever his or her official title is.

right to the terminal. there is a tendency just to go in the room. The patient needs to feel that you understand what is going on with them. ³How are you?´ Listen Hear the patient out as much as you have time for. Greeting Say a word or two to the patient with a smile as a way of recognizing his/her humanity. even if you have heard and digested every single word. and barely glance at the person whose life you have in your hands. With computers in every room. If you¶re not looking at the person when s/he is talking to you. ³Nice to see you.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Make eye contact Let the patient know that you are there for the sole purpose of seeing him/her.´ Or. you will be perceived as not listening. Patients notice this. GABRIEL SUSAYAN . This is what patients complain about most ± that their doctors never listen to them.

GABRIEL SUSAYAN . If you're having a bad day. acknowledge his/her beliefs even if you don't agree. They have enough of their own. Don¶t discuss your problem with patients. Remain openminded.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Respect Respect your patient's opinions. Don't discuss your own problems with patients. They're not coming to visit you to discuss your difficulties. don't let it show. NEVER be condescending. It's the mark of being a professional to surpass your own difficulties in order to take care of theirs. Never be so entrenched in your own opinions that you can't allow your self to see the other side.

" Dr. get it under control. Atlanta. Dr." he advised. Tell the patient someone is paging you. 3. "If you find yourself losing your temper. Lubin's 10 Commandments for dealing with difficult patients. Once calm. told participants at a session on managing difficult patients at the annual meeting of the American College of Physicians. a physician is better able to assess the situation. Michael F. Place folded sheets on a gurney. "You may never lose your temper. Go to a supply closet. 4. Lubin suggests that you try this four-step procedure: 1. GABRIEL SUSAYAN . Pound repeatedly. Lubin of Emory University. These actions will help you obey the fifth of Dr.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Dealing with difficult patients Before you lose your temper with a patient. 2.

and approach the problem with compassion and empathy. a patient with breast pain may want to leave because she has seen people die from the disease in recent months and is alarmed about the possible diagnosis. Lubin said. the physician should find out why For example. GABRIEL SUSAYAN ." If a patient is waiting for care and suddenly wants to leave. "Allowing a patient to leave when he's a danger to himself and others is not the right thing to do.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Ten Commandments for dealing with difficult patients Commandment I Do the right thing." he said. Physicians should always stop and think about what they are doing." Dr. "It's so much easier to do the right thing than think of a legalistic way to handle the situation. "Otherwise you'll be in big trouble. Commandment II Be sure that the patient has decision-making capacity. The physician and the patient need to find a mutually satisfying solution.

GABRIEL SUSAYAN . Lubin said. Lubin said." Dr. and always follow up with the patient. Commandment V Never lose your temper. If a physician explains why leaving is inadvisable but the patient leaves anyway. there's always the supply closet. Commandment IV Meticulously document what happened. "You can't abandon the patient." he said. Losing your temper with colleagues and ancillary staff also isn't allowed. Dr. "This includes what you told the patient about the consequences [of the patient's actions] and the treatment and follow-up that you have arranged. He also suggested that physicians get documentation from others about what happened. If you feel the urge to vent.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Commandment III Do not discharge a patient from your care without the best possible treatment you can give. the next commandment is especially vital.

Commandment VIII When a patient has a lot of new nondescript complaints. Commandment IX You have an obligation to care for your share of these difficult patients Commandment X Do not act as if your ego or your wellbeing is adversely affected by the patient's nonadherence GABRIEL SUSAYAN . Commandment VII Never be distressed by insistent patients.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Commandment VI Do not feel obligated to put yourself in danger of physical assault. Keeping tabs on your own temper doesn't mean that you should accept foul language or violent behavior from a patient. be sure to explore the possibility of depression.

W. nothing on earth can help the individual with the wrong mental attitude" W. Ziege GABRIEL SUSAYAN . It's application is contextual and it's not appropriate to be assertive in all situations.ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS Assertiveness is a useful communication tool. even when you use assertive communication styles appropriately. Remember. "Nothing on earth can stop the individual with the right mental attitude from achieving their goal. There's also no guarantee of success. your sudden use of assertiveness may be perceived as an act of aggression by others.