The ARCC communication technique is a structured tool used in high-stakes clinical settings to promote a culture of safety and empower all healthcare personnel to voice concerns about patient well-being. ARCC provides a framework for staff members, regardless of their position or seniority, to assertively elevate a potential safety issue in a standardized, non-confrontational manner. The method helps to flatten the traditional healthcare hierarchy, known as the authority gradient, which can often discourage junior staff from speaking up to a physician or senior colleague. This systematic approach ensures that every team member has a clear, protected process for escalating a perceived risk until it is resolved, thereby making patient safety a shared responsibility among all caregivers.
Decoding the Acronym
The ARCC acronym is a mnemonic that stands for Ask a question, Request a change, voice a Concern, and utilize the Chain of Command. Each letter represents a distinct, sequential step in a graduated process of assertive communication designed to prevent medical errors. The first step, “Ask a question,” is the least aggressive and allows the initiating party to open a dialogue by expressing a doubt or seeking clarification about a plan or action.
Moving to the second step, “Request a change,” is necessary if the initial question does not lead to a resolution or if the behavior or plan remains unchanged. Here, the team member suggests a specific, alternative action, often by stating what they believe should be done differently. If the request is not acknowledged or the issue persists, the third step, “Concern,” provides a more direct and forceful expression of the potential harm. By explicitly using the word “concern,” the speaker clearly communicates their professional judgment that a safety risk exists, emphasizing the gravity of the situation to their colleague.
Assertive Communication in Practice
The first three steps of the ARCC model—Ask, Request, and Concern—are the core of its assertive communication strategy, guiding the speaker from a soft inquiry to a firm professional warning. An initial “Ask” might involve a nurse saying to a physician, “Are we sure about this dosage, or should we double-check the patient’s weight-based calculation?”. This phrasing maintains respect while prompting a pause and verification of clinical information.
If the physician dismisses the question or continues with the action, the nurse would then move to “Request a change,” saying, “I request that we pause the procedure for a moment so I can verify the order against the patient’s chart”. This progression is structured to overcome the reluctance to speak up, which often stems from a fear of being wrong or disrespecting a superior. The model forces the communication to become progressively more explicit, preventing safety concerns from being lost in vague language.
Should the request still not be honored, the team member proceeds to voice a “Concern,” using a clear safety phrase like, “I am concerned that proceeding before verifying the patient’s identity could lead to a wrong-patient error”. This third statement links the action directly to a potential patient harm event, which is a powerful trigger in a safety-focused environment. This deliberate escalation is designed to ensure that the seriousness of the situation is fully understood by the receiving party before involving management.
When to Engage the Chain of Command
The final step of the ARCC protocol, “Chain of Command,” is activated only when the prior assertive communication steps—Ask, Request, and Concern—have been exhausted without a resolution to the safety issue. This step is a critical last resort, signifying that a team member’s direct efforts to mitigate an immediate risk have failed. Engaging the Chain of Command means formally escalating the unresolved concern to the next level of management or administrative authority. The specific individuals involved may vary, but it often begins with a direct supervisor, charge nurse, or unit manager, and can proceed up to a department head or administrator if necessary.
Healthcare organizations protect this step as a necessary mechanism for preventing patient harm when consensus cannot be reached at the point of care. The Chain of Command ensures that the concern is addressed by someone with the authority to intervene, review the situation, and mandate a stop or change in the action. Utilizing this final step is a protected professional responsibility, not an act of insubordination. This formal escalation process acts as a safety net, guaranteeing that no serious, unaddressed risk is allowed to continue.