Tool: DESC
The DESC script is a constructive approach to managing and resolving conflict. While used to address both informational and interpersonal conflict, it is most effective with the latter. It is especially appropriate for major conflicts such as hostile or harassing behaviors that are putting the well-being of patients or other team members or staff at risk of physical or emotional harm.
DESC involves a four-step process:
DESC will be most effective in a culture committed to safety for both patients and staff. It will be most helpful if used strategically:
- Time the discussion. As a form of feedback, DESC benefits from all the recommendations on how to effectively share feedback that were described earlier.
- Work on win-win—Despite your interpersonal conflict with the other party, team unity and quality of care depend on coming to a solution that all parties can live with.
- Frame problems in terms of personal experience and lessons learned.
- Choose the location—A private location that is not in front of the patient or other team members will allow both parties to focus on resolving the conflict rather than on saving face.
- Use "I" statements rather than blaming statements.
- Remember that critique is not criticism.
- Focus on what is right, not who is right.
DESC's use is illustrated in the conflict scenario below:
A nurse feels that a patient has abdominal distension and pain secondary to a distended bladder and needs a Foley catheter. The nurse receives the order from the resident on call. When the attending later realizes that the order was given without his consent, he raises his voice to the resident in front of staff and the patient.
As you think about this scenario, DESC is an appropriate tool to use in the following way:
D: "I (resident) am sensing that you (attending) are upset with me for ordering the Foley catheter for your patient."
E: "When you question my judgment in front of others, it embarrasses me and makes me very uncomfortable. It also undermines my credibility with the patient."
S: "If you are concerned or have a question regarding my performance, I would appreciate it if you would speak to me in private."
C: "A private conversation would be more beneficial to me because I would feel less embarrassed and would be able to ask questions and supply information. Can we agree to follow such a procedure if this happens again?"
The TeamSTEPPS curriculum now includes a set of video-based simulation training activities that teach key concepts related to task assistance. You may want to use parts of or all of that resource to teach these concepts. Select to view videos for Module 4: Mutual Support, which use the DESC tool.
