ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

ASSERTIVE
COMMUNICATION SKILLS
FOR
HEALTHCARE
PROFESSIONAL
BY

23 – 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
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

CONCISE

Often in our communication, we ramble on and on and never really get

around to what it is we want to say. We need to be concise in our
communication to be effective.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

COMPLETE

Incomplete, inaccurate instructions result in

countless problems in the shop. Directions such
as: Please Fix, Solder, or Repair, often result in
the wrong repair being done, incomplete repairs
being done, or more work being done than the
customer expected. Then work is performed that
cannot be charged for, or it must be redone in
the shop resulting in additional cost and
expense to the store.

Now, being complete and being concise is not

contradictory. Being concise means giving ONLY
the pertinent information. Being complete means
giving ALL of the pertinent information.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

CONSISTENT

We must communicate consistently from

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

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Why use assertive communication?

All of us use assertive behaviour at times... quite often when we

feel vulnerable or unsure of ourselves we may resort to submissive,
manipulative or aggressive behaviour.

Assertive communication actually increases the appropriate use of

this sort of behaviour.

It enables us to swap old behaviour patterns for a more positive

approach to life.

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.
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

What IS assertive communication?

• Assertive communication is the ability to express positive and

negative ideas and feelings in an open, 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.

• And it allows us to constructively confront and find a mutually

satisfying solution where conflict exists.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

What assertive communication is not...

Assertive communication is definitely

NOT a lifestyle!
NOT a guarantee that you will get what you want.
NOT an acceptable style of communication with
everyone,

but at least it's NOT being aggressive.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Four behavioural choices

direct aggression : bossy, arrogant, bulldozing, intolerant,

opinionated, and overbearing
indirect aggression : sarcastic, deceiving, ambiguous,
insinuating, manipulative, and guilt-inducing
Submissive : wailing, moaning, helpless, passive,
indecisive, and apologetic
Assertive : direct, honest, accepting, responsible, and
spontaneous

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

4 STYLES OF COMMUNICATION.

1. PASSIVE

2. AGGRESSIVE

3. PASSIVE-AGGRESSIVE

4. ASSERTIVE

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Passive

• It tends to avoid conflict at all costs.

• It internalize discomfort rather than risk upsetting others.
• It tends to result in a lose-win situation, and results in feelings of
victimization, resentment, and a loss of a sense of control.

User beliefs
• that other peoples’ needs are more important than their own,
• that if he speaks up, others will ignore or reject him.

This individual usually has a low sense of self-esteem, and has a difficult
time recognizing his/her own needs and knowing how to get them met more
appropriately.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Aggressive

• It creates a win-lose situation.

• 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.

This person operates from a real sense of inadequacy and may

have a lack of empathy for others.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Passive-Aggressive

• It incorporates elements of both of the previous styles.

He tends to use procrastination, forgetfulness, and

intentional inefficiency rather that being direct in
his communications with others.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Assertive

• Is directed with the goal of creating a win-win situation.

• This style respects one’s own rights and opinions, as well
as those of the other person.

This individual operates from the belief that each of us is responsible for
solving our own problems, and neither party in
communication has to justify themselves to each other. This person takes
responsibility for his own decisions and actions.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

WHAT DOES ASSERTIVE COMMUNICATION LOOK LIKE?

Much of our communication is non-verbal.

A person with an assertive communication style

• has a body language that conveys openness and receptiveness.
• Posture is upright, movements are fluid and relaxed,
• tone of voice is clear and with inflection.
• An assertive person makes good eye contact, and is aware of
personal space.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

When giving opinions,

• an assertive person is willing to express his opinion, and also is open
to hearing other’s points of view.
• He is direct, but not argumentative or threatening.
• He does not use sarcasm or gossip as a way to communicate.
• He does not silently sit back out of fear of not being liked.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

When an assertive person receives feedback from others,

• He/she is able to listen and accept what the other person has to
say, even if he/ she doesn’t agree.

• Many people have a hard time receiving feedback, even if it’s

positive.

• An assertive person does not react to criticism by counter-attacking,

denying, or feeling anxious or inadequate. She makes conscious
choices about how to respond the criticism.

How many times has someone paid you a compliment and

you simply dismiss it, or minimize it rather than hearing it and
simply saying “thanks”! No one likes to hear negative
feedback

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Characteristics of assertive communication

There are six main characteristics of assertive communication.

Eye contact : demonstrates interest, shows sincerity
Body posture : congruent body language will improve the significance
of the message
Gestures : appropriate gestures help to add emphasis
Voice : a level, well modulated tone is more convincing and
acceptable, and is not intimidating
Timing : use your judgement to maximise receptivity and impact
Content : how, where and when you choose to comment is
probably more important than WHAT you say

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Six assertive techniques

Behaviour Rehearsal : which is literally practising how you want to look

and sound. It is a very useful technique when you
first want to use "I" statements, as it helps
dissipate any emotion associated with an experience and
allows you to accurately identify the behaviour you wish to confront.

Repeated Assertion : this technique allows you to feel comfortable by

ignoring manipulative verbal side traps,
argumentative baiting and irrelevant logic while sticking to your point.
To most effectively use this technique use calm repetition, and say
what you want and stay focused on the issue. You'll find that
there is no need to rehearse this technique, and no
need to 'hype yourself up' to deal with others.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Fogging : this technique allows you to receive criticism

comfortably, without getting anxious or defensive,
and without rewarding manipulative criticism. To do
this you need to acknowledge the criticism, agree
that there may be some truth to what they say, but
remain the judge of your choice of action. An
example of this could be, "I agree that there are
probably times when I don't give you answers to your questions.

Negative enquiry : this technique seeks out criticism about yourself in

close relationships by prompting the expression of
honest, negative feelings to improve
communication. To use if effectively you need to listen for critical
comments, clarify your understanding of those criticisms, use the
information if it will be helpful or ignore the
information if it is manipulative. An example of this
technique would be, "So you think/believe that I am
not interested?"

GABRIEL SUSAYAN
 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, this also reduces your critics'
hostility. You should accept your errors or faults, but not apologise.
Instead, tentatively and sympathetically agree with hostile
criticism of your negative qualities. An example
would be, "Yes, you're right. I don't always listen closely to what you
have to say.“

Workable compromise : when you feel that your self-respect is not in

question, consider a workable compromise with the
other person. You can always bargain for your
material goals unless the compromise affects your personal feelings of
self-respect. However, if the end goal involves a matter of your self-
worth and self-respect, THERE CAN BE NO COMPROMISE.
An example of this technique would be, "I
understand that you have a need to talk and I need
to finish what I'm doing. So what about meeting in
half an hour?"

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

STRATEGIES FOR DEVELOPING ASSERTIVE COMMUNICATION

• Watch your body posture – practice using an open, assertive

body language and voice.
• Think before you speak. Take a few seconds to make sure you
are conveying the
• right message, and in the way you want to convey it.
• Don’t apologize if it’s not warranted.
• Remember it is ok to say “no”.
• Remember everyone is entitled to an opinion, and don’t try to
convince others that yours is the “right” one. Also know that
you don’t have to apologize or make excuses.

GABRIEL SUSAYAN
 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, a wide range
of feelings and thoughts, both positive and negative

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Disadvantages of assertive communication

Others may not approve of this style of communication, or

may not approve of the views you express.

Also, having a healthy regard for another person's rights

means that you won't always get what YOU want.

You may also find out that you were wrong about a viewpoint
that you held.

But most importantly, as mentioned earlier, it involves the risk

that others may not understand and therefore not accept this
style of communication.

GABRIEL SUSAYAN
 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. 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.

Simple Courtesy

Knock before you enter. Excuse yourself if you have to take a

phone call. Always be polite. Always use the person’s last
name prefaced by Mr., Mrs., Dr. or Dato., or whatever his or
her official title is. Pay attention to this. Don’t call a Doctor or
Dato, Tan Sir..a “Mister”. The only exceptions to this rule are
a) if your patient is a child or at least less than 18, or b) if your
patient specifically requested or insisted you call him/her by
their first name or nickname.

GABRIEL SUSAYAN
 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. With computers in every room, there is a tendency
just to go in the room, right to the terminal, and barely glance at the
person whose life you have in your hands. Patients notice this.

Greeting

Say a word or two to the patient with a smile as a way of

recognizing his/her humanity. “Nice to see you.” Or, “How are you?”

Listen

Hear the patient out as much as you have time for. This is what
patients complain about most – that their doctors never listen to
them. The patient needs to feel that you understand what is going
on with them. If you’re not looking at the person when s/he is
talking to you, you will be perceived as not listening, even if you
have heard and digested every single word.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Respect 

Respect your patient's opinions, acknowledge his/her beliefs even

if you don't agree. NEVER be condescending. Remain open-
minded. Never be so entrenched in your own opinions that you
can't allow your self to see the other side.

Don't discuss your own problems with patients. 

Don’t discuss your problem with patients. They're not coming to

visit you to discuss your difficulties. They have enough of their
own. If you're having a bad day, don't let it show. It's the mark of
being a professional to surpass your own difficulties in order to
take care of theirs.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Dealing with difficult patients

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

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Ten Commandments for dealing with difficult patients

Commandment I

Do the right thing. "It's so much easier to do the right thing than think of a
legalistic way to handle the situation," he said. Physicians should always stop
and think about what they are doing, and approach the problem with compassion
and empathy. The physician and the patient need to find a mutually satisfying
solution.

Commandment II

Be sure that the patient has decision-making capacity. "Otherwise you'll be in

big trouble," Dr. Lubin said. "Allowing a patient to leave when he's a danger to
himself and others is not the right thing to do." If a patient is waiting for care and
suddenly wants to leave, the physician should find out why For example, 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.

GABRIEL SUSAYAN
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Commandment III

Do not discharge a patient from your care without the best possible treatment
you can give, and always follow up with the patient, "You can't abandon the
patient," Dr. Lubin said. If a physician explains why leaving is inadvisable but
the patient leaves anyway, the next commandment is especially vital.

Commandment IV

Meticulously document what happened. "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 said. He also suggested that
physicians get documentation from others about what happened.

Commandment V

Never lose your temper. If you feel the urge to vent, there's always the supply
closet, Dr. Lubin said. Losing your temper with colleagues and ancillary staff
also isn't allowed.

GABRIEL SUSAYAN
 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.

Commandment VII

Never be distressed by insistent patients.

Commandment VIII

When a patient has a lot of new nondescript complaints, be sure to explore the
possibility of depression.

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
 ASSERTIVE COMMUNICATION SKILLS FOR HEALTHCARE PROFESSIONALS

Assertiveness is a useful communication tool. It's application is

contextual and it's not appropriate to be assertive in all situations.
Remember, your sudden use of assertiveness may be perceived
as an act of aggression by others.
There's also no guarantee of success, even when you use
assertive communication styles appropriately.

"Nothing on earth can stop the individual with the right mental
attitude from achieving their goal; nothing on earth can help the
individual with the wrong mental attitude" W.W. Ziege

GABRIEL SUSAYAN