Assertiveness in Pharmacy Practice

Assertiveness Overview

• Assertive pharmacists actively engage in patient care.
• They initiate communication with patients.
• They convey their views regarding patient drug therapy management.
• They resolve conflicts in a respectful way.

Defining Assertiveness and Comparing Response Styles

• Assertiveness is best understood by comparing it with passivity and aggression.

Passive Behavior

• Designed to avoid conflict at all costs.
• Individuals do not express their true thoughts for fear of disagreement.
• Individuals hide and wait for others to initiate conversation.
• The needs/wants of others are prioritized above their own.
• There is a high need for approval and worry about others' responses.
• Passive individuals often see themselves as victims open to manipulation.
• This view is damaging to self-esteem.

Aggressive Behavior

• Aggressive people seek to "win" conflict situations by dominating, or intimidating others.
• They promote their own views while indifferent or hostile to others' feelings and thoughts.
• They are easily angered and have a low tolerance for frustration.
• They may "win" in the short term, their behavior often leads to long-term negative consequences.
• Aggressive approaches do not build trusting relationships.

Assertive Behavior

• It requires respecting others as well as themselves.
• Communication goals should be defined in terms of what one will do.
• Take active steps to change responses to criticism rather than waiting for others to change.
• People respond passively or aggressively due to irrational beliefs.
• These beliefs involve fear of rejection, over-concern for others' needs, and perfectionist standards.

Assertiveness Techniques: Providing Feedback

• When conveying negative feedback, use techniques to make the communication less threatening.
• Focus on a person's behavior instead of their personality.
• Be specific rather than general - focus on recent behavior without bringing up the past.
• Focus on problem-solving to avoid a "win/lose" situation.
• Focus should be on attacking problems and issues, not people or personalities.
• Provide feedback in a private setting.
• Use "I" statements to voice concerns.

Assertiveness Techniques: Inviting Feedback from Others

• Invite feedback to improve interpersonal communication skills.
• Encourage others to provide feedback, even when negative.
• Be honest in communications.
• Pharmacists should routinely assess patient satisfaction.
• Welcome suggestions from employees on how to improve pharmacy operations.

Assertiveness Techniques: Setting Limits

• Difficulty saying "no" to requests leads to feeling overwhelmed and angry.
• Making a decision on how to spend personal time is acceptable.
• Being assertive in setting limits does not mean stopping helping others.

Assertiveness Techniques: Making Requests

• Trust that others will respond in an assertive manner, including saying "no."
• Do not overreact when someone turns down a request.

Assertiveness Techniques: Being Persistent

• When saying "no" to something, continue to repeat that decision calmly.
• This allows being assertive without becoming aggressive or giving in.

Assertiveness Techniques: Ignoring Provocations

• As a pharmacist, aggression may be received from patients who are angry, helpless, or from other unfairly critical pharmacists.
• Ignoring aggressive comments and focusing on underlying problems can keep conflict from escalating.

Assertiveness Techniques: Responding to Criticism

• Criticism can be devastating due to irrational beliefs.
• irrational beliefs include needing to be loved by everyone and needing to completely competent in everything.
• Focus on the fact that neither of these are realistic or achievable standards

Assertiveness and Patients

• Activities such as hiding behind the counter distinguish passive pharmacists.
• Passive pharmacists avoid interaction unless specifically asked questions to avoid potential conflicts.
• Assertive pharmacists introduce themselves, give information on medications, and assess medication use.
• Encouraging patients to be more assertive improves communication.
• Address patient criticism in a rational and assertive manner.
• Patient anger arises from frustrations/stresses related to being ill, not necessarily from you.
• Understand the patient's perspective and respond empathically.
• Get patients to turn criticism into useful feedback by finding out specifically what is the main issue.
• If a patient is aggressive, set limits while remaining calm.

Assertiveness and Other Health Care Professionals

• Consultation with physicians/nurses is required when patient medication therapy problems arise.
• Speaking directly to the prescribing physician will be most effective.
• Be persistent with receptionists and nurses in requests

Assertiveness and Employees

• Pharmacy managers are responsible for ensuring the staff treat patients well
• They must make clear to all employees what is expected in the way of patient care.
• Managers should use appropriate feedback techniques, and specify behavior with specific actions.
• Express what should be changed without attacking the pharmacist.
• Expectations should be repeated and not allow the pharmacist to make excuses
• Managers should not become angry or dismiss attacks

Assertiveness and Employers

• It is necessary to be assertive not only with your employees, but with supervisors too.
• Criticism should not be met with counterattacks, excessive apologies, or excuses.
• Agree with judgments while separating the mistake and your worth as a person.
• Be assertive when giving feedback

Getting Useful Feedback

• Determine and understand exactly what happened that led to the criticism.
• The service can't be improved unless specific feedback is received and steps are understood.

Agreeing with Criticism

• Acknowledge the mistake if the criticism is valid.
• Avoid "Yes, but..." responses that may lead to increased annoyance.
• Acknowledge mistakes and apologize to help prevent anger from prevailing
• Apologies will seem manipulative if the same mistakes continue to be made.

Disagreeing with Criticism

• State the disagreement and tell why the statement is inaccurate.
• Not speaking against injustice or untruth leads to loss of self-esteem.

Fogging

• An approach that acknowledges the truth while not accepting implied judgments.

Delaying a Response

• If surprised/confused by criticism, allow time to think before responding.
• If too surprised or upset, delay the response.

Assertiveness and Colleagues

• A pharmacist should consider any new requests and be honest/assertive

Summary of Responses

• Quadrant 1: I'm OK and You're OK: Assertive - People like and respect you because you accept them in spite of their faults; confidence and self-esteem are the high.
• Quadrant 2: I'm not OK and You're OK: Passive - The other person may benefit, but you are ignored, and people won't respect you, affecting your performance.
• Quadrant 3: I'm OK and You're not OK: Aggressive - There is a tendency to behave superior, dismissing and distrusting people; has an effect on others.