Dealing with issues

Graded assertiveness

Teaching people to speak up and creating the dynamic where they will express their concerns is a key safety factor.12 Occasionally the team members may not agree with the leader’s management plan or the team leader may go silent and appear to be cognitively stuck. Members can use this as an opportunity to practice graded assertiveness. This is a communication technique that can allow anyone to challenge any action or behaviour that they think is inappropriate.
One way to remember it is to use the PACE mnemonic:

Probe: ‘Do you know that…?’
Alert: ‘Can we go back to the start and repeat the primary survey?’
Challenge: ‘Please stop what you are doing while we check …’
Emergency: ‘Stop what you are doing and put down the scalpel.’

No one team member should be afraid to point out a risk, a concern or an actual or potential error.

Five-step advocacy

An alternative approach is the advocacy approach:

1. Get attentionExcuse me, doctor!
2. Raise your concernThere is no end-tidal CO2 trace.
3. State the problem as you see itIm concerned that the intubation was unsuccessful.
4. Suggest a solutionWhy dont we remove the ETT and go back to bagging the patient?’
5. Obtain an agreement‘Does that sound like a safe thing to do?’

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