Learning Objectives
· Differentiate between examples of passive, aggressive, and assertive behavior.
· Define what it means to be an assertive communicator and provide examples of assertive communication techniques.
· Apply assertive communication in techniques in scenarios involving patients, health care professionals, employees, employers, and colleagues.
· Reflect upon a scenario in your own life that could have been improved with assertive communication.
Aggressive behavior
· Place blame on others
· Seeks to win conflict situations by dominating or intimidating
· Promotes own self-interest
· Easily angered and low tolerance for frustration
· Negative long-term consequences “getting even”
· Patient’s that may not return to your pharmacy and spread information to family and friends
· Employee may sabotage goals of employer in indirect ways
Passive behavior
· Avoids conflict
· Approval seeking
· Fears disagreement
· Negative long-term consequences resentment, used, lack of willpower, anxiety in relationships
Theoretical Foundation of passive and aggressive behavior
· Fear of rejection or anger from others and need for approval
· Overconcern for the needs and rights of others
· Belief that problems with assertiveness are due to unalterable personality characteristics
· Perfectionist standards
Assertive behavior
· Direct, honest expression of ideas, opinions, and desires
· Conflicts are addressed immediately, and the solution is mutually understood
· One can stand up for oneself and solve interpersonal problems in ways that do not damage relationships
· Taking an active approach to make change and taking responsibility for our own behavior
Re-define goals
· Taking responsibility
Not blaming others for success/failure
· Making own decisions
Ownership of how and why we choose to live the way we do
· Set our own successes and failures
Eliminates the fear of rejection or failure
Assertive Techniques
· Provide feedback
· Focus feedback on a behavior rather than a personality
· Describe what was said/done rather than why it was done
· Focus on your own reaction rather than place blame
· Use I feel…
· Avoid overgeneralizing, focus on specific examples
· Intent of feedback is problem solving not venting
· Feedback should be in a private setting
· Inviting feedback from others
· Ability to hear criticism without defensiveness or anger
· Admission to mistakes
· Strengthens communication while also identifying areas of professional practice you can improve
· Setting limits
· Difficulty saying “no” to any requests
· Results in us feeling overwhelmed and angry at others for taking advantage of us
· Being assertive means:
· Take responsibility for decisions you make on how you spend your time or resources without feeling resentful toward others for making the request
· Do not feel like you must provide reasons for your decisions
· Making requests
· Asking what you want from others in a direct manner
· Asking for help
· Communicating expectations
· Cannot over-react when one turns down the request in an assertive way
· Being persistent
· Assure your rights are respected
· People may try to coax you into changing your mind
· Repeat decision calmly without becoming aggressive or giving in
· Broken record analogy- calmly repeat your response
· Can de-escalate situations
· Ignoring provocations
· People may try to “win” by attempting to humiliate or intimidate others
· “Aggressive response”
· Ignoring critical comments of others and focusing on solving problems to prevent escalation
· Your goal is to provide the best patient care
· Responding to criticism
· Why is receiving criticism so challenging for some of us?
· Approval seeking- “must be approved by everyone we know”
· Perfectionist standards- “must be competent at everything and never make mistakes”
· Poor response to criticism results in
· Aggressive behavior –> “getting even”
· Passive behavior –> “avoiding conflict”
· As assertive communicators, our goal is to challenge the underlying irrational beliefs that lead us to fear disapproval of others
Activity Portion
I will provide 5 scenarios that you could encounter as a pharmacist. I want you to provide a response in an assertive manner.
Scenario 1: Assertiveness and Patients
Jon Snow walks into your pharmacy with a new prescription for XYZ. Unfortunately, he has a high co-pay for this medication as it will cost the patient $75.00 out-of-pocket in addition to the other 6 maintenance medications the patient also picks up. When your technician tells the patient that insurance will cover some of it but that he will also owe an additional $75.00 out-of-pocket he become visibly upset. He becomes rude and deliberately insults your staff.
· As the pharmacist, how would you communicate with Jon Snow?
· What assertive techniques would you use?
Scenario 2: Assertiveness and Other Healthcare Professionals
Dr. Lee has a reputation for not respecting pharmacy staff members. He has said we are a useless profession and often asks why we keep “bothering” him. Other co-workers often say he is the worst to work with as he deliberately is difficult to get in contact with and tends to ignore pharmacy phone calls. You are an antimicrobial stewardship pharmacist who assesses antibiotic usage. Sansa Stark, a patient of yours has a Pseudomonal pneumonia. The patient is currently on ceftriaxone. You want to recommend escalating the antibiotics to cefepime.
· As the antimicrobial stewardship pharmacist, how would you approach Dr. Lee?
· What assertive techniques would you use?
Scenario 3: Assertiveness and Employees
Sansa Stark has been a technician at your pharmacy for 2 years. This past week, she has appeared more disheveled and has been arrived late to work for the 4 out of 5 days. You have also heard complaints from the other pharmacist that she has been rude to patients.
· As the pharmacy manager, how would you approach Sansa?
· What assertive techniques would you use?
Scenario 4: Assertiveness and Employers
You are a pharmacy manager at CVS. Your store fills approximately 300-400 scripts/day. Your supervisor is from corporate and has never worked in a pharmacy. A new store-specific initiative now mandates that flu shots must be given by pharmacists (cannot be given by interns) and the new goal is to achieve 100/month. Additionally, you just lost a full-time tech position.
· How would you approach your supervisor to ask for additional support or change in goals?
· What assertive techniques would you use?
Scenario 5: Assertiveness and Colleagues
You have been approached by a former colleague about an opening on a medication safety board in your local community. This responsibility would require over 10 hours of work per week. You already belong to several organizations both inside and outside of work. You are already overwhelmed with responsibility and are not interested in this position at this time.
· How would you respond to your colleague’s request?
· What assertive techniques would you use?
Self-Reflection
· Describe a time when you communicated passively or aggressively.
· Who were you communicating with?
· Why did you use that communication style?
· How could you have changed the situation and communicated assertively?
· What techniques will you use next time you are in a similar situation in order to communicate assertively?
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