HRO Tool of the Month: Ask, Request, Concern, Chain of Command (ARCC)
The HRO Tool of the Month comes from the Reliability Skill: Speak Up For Safety. This month, we will explore ARCC: Ask, Request, Concern, Chain of Command.
As you know, the Michigan Medicine Safety Promise is:
Our promise to patients, families and employees: Your Safety is our most important priority.
We are open and transparent about errors, and will stand up for those who speak up. We are accountable for our actions. We learn from our errors without blame. We do not tolerate reckless or disrespectful behavior.
So, if anyone observes a situation that is believed to compromise the safety of a patient, resident, or employee, there is a responsibility for raising that concern. Speak Up for Safety using ARCC is a communication technique that can help assert a concern in a non-threatening way to avoid defensiveness or aggressiveness when a simple question will suffice. ARCC also helps escalate the concern if it is not addressed.
How to use ARCC
In the fundamentals of HRO, using cross-checking at all times means to keep an eye and ear out for issues and errors. Using cross-checking with an assist is to provide an on the spot opinion. This can be as simple as the polite, “stop — you are about to back into the wet floor sign” followed by the “thanks” reply from your coworker.
However, when dealing with a potentially harmful situation, do not use cross-check. Use ARCC.
Use the Speak-Up for Safety tool ARCC instead of cross-checking with an assist when you are uncomfortable speaking directly.
- Start with Asking a simple question. If the question (this is called hint and hope) doesn’t draw their attention to the problem then Request a change, quickly explain why, and hand the dialogue back to them by adding “what do you think?” If the request doesn’t change their thinking, use the safe word “Concern” using the phrase “I am concerned that…” Even then, you still have Chain of Command. Use your Chain of Command to check your thinking and help you advocate for safety.
A healthy safety culture
ARCC is a very important piece of creating and maintaining a culture of safety. It is known that the relationship between leaders and staff members (also known as power distance) can prevent the staff member from asking a question or raising a concern.
Part of safety culture is having the courage to speak-up for safety, even when there is a distance in workplace status. This can also work from the opposite side as leaders can use their influence to create a safe space for others to ask questions. Leaders can support a healthy safety culture by developing, maintaining and posting a Chain Of Command (COC) document for their department or unit. To develop or update a COC, leaders may want to review Unit 2 of the HRO training (SAFE-C90238) available in MLearning. This template and one page document may also be helpful.
Resources for all
Please check out these resources for more clarification on Universal Relationship Skills and Reliability Skills. There are downloadable and printable handouts that you can share with your team or hang in your areas.