DESC Script
Whatt is
Wh
i it?
A structured, assertive, communication approach for managing
and resolving conflict.
D
Describ
ibe th
the specific
ifi sit
ituation
ti
E
Express your concerns about the action
S
Suggest other alternatives
C
Consequences should be stated
When to use it?
Whenever you have a personal conflict with another health team
member that threatens your ability to perform your job well.
Key Points
Have timely discussion
Use “I” statements Avoid blaming statements
Focus on what is right, not who is right
If you don’t know what to say under for C-consequences,
Don’t let that stop you !! You would still have made a good
assertive statement if you used D,E,S
DES.
JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
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How to use DESC ?
Case scenariio: As a fi
first year resiident you are asked by
an attending physician to prepare to admit a patient with
a stage 3 decubitus ulcer with possible sepsis. You find
that the patient is being admitted to the geriatric floor
and you go meet the patient and complete the work-up.
The att
Th
ttendi
ding greetts you with,
ith “I wanted
t d hi
him ad
dmitt
itted
d tto
the surgical ward, not the senior center,” in front of
coworkers at the nursing station. “You never think about
what will make our job easier.” This is not the first time
the attending has been verbally abusive.
DESC script
i t example:
l You
Y ddecide
id to
t use the
th DESC
script to respond to the attending as follows:
D
I know you’re busy but you did not indicate that you wanted the patient on
the surgical ward. Admitting decides where to place the patient not me, based
upon your instructions.
i t ti
It iis nott ffair
i tto yell
ll att me when
h you ddon’t
’t lik
like what
h t is
i
happening.
E
When you yell at me you make me uncomfortable and I feel diminish my
authority and possibly the respect I will receive from the staff because you
appear to be blaming me for a situation that I am not responsible for.
S
It would be more effective for you to discuss with admitting where you
want your patients or give me a full briefing on what you want done for the
patient and where you want them admitted.
p
C If you continue to treat me with disrespect when you only give me
partial information I will file a complaint with the Chief medical officer. I
will also post an adverse event into our reporting system.
JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
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DESC
DESC:
A case scenario for role play
ƒ You are the charge nurse for a 34 bed obstetrical unit. It’s busy in labor and
deliveryy and you just noticed that one of the fetal monitors is revealing a sustained low heart rate. You confront the nurse who tells you the resident said to “monitor the
situation,,” but you feel the patient should be prepped for a c-section. You find the obstetrical resident and he tells you that
you’re interfering and he has everything
under control. Meanwhile the fetal monitor shows evidence of fetal distress. The attending comes in and says to prep the patient for c-section. The resident says “that is just what I was about to do!
is
do!”
ƒ What would you do ?
ƒ Use the DESC script to share any concerns
with the resident. JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
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ALEEN
What is it? A conflict resolution approach to reduce
the tension in a confrontation, clarify the problem, and
reach a solution.
p
A Anticipate
Pause, think of problem, then approach
pp
person
L Listen
Listen without interrupting
E Empathize
Summarize and show empathy
E Explain
Explain your behavior or action
N Negotiate
Reach a mutually agreeable solution
When to use it? In conflict situations where a patient, family
member, or colleague is upset and approaches you with a
complaint or concern that you can address.
Key Points
- Listening to full story of other person without interruption is
importtantt to
t red
duce escalati
l ting tensi
t ion andd hel
h lp the
th ‘upset’
t’
person realize that they are being ‘heard’ .
- Show genuine empathy
- Reaching a mutually agreeable plan would require some
flexibilityy from your end on matters that are within your
control.
JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
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Using ALEEN
Case scenario: Mr.
Mr Doe is an 80
80-year-old
year old gentleman with Diabetes type 2
who is under your care in the ICU recovering from a splenectomy . His
surgery was complicated by bleeding requiring a reoperation. Patient is
stable in ICU and insulin is being used to control his blood glucose per a
standard ICU protocol. His home medications include oral hypoglycemic
agents but no insulin. One morning you hear the patient’s daughter yelling at
the nurses
n rses. She is extremel
e tremely upset
pset that her father is being given
gi en insulin
ins lin for
high blood glucose. She is concerned because her dad only needs ‘pills’ to
treat diabetes. She does not want him to receive insulin ‘for rest of his life’.
Could using ALEEN format help you handle this situation?
A You overhear daug
ghter yellingg at the nurses and instead of rushing
g to exp
plain and
defend your treatment plan you pause for a few moments to consider the situation then
approach her saying: “ It seems like you are upset, can you help me understand why? ”
L You listen without interrupting to daughter's concerns about her father being treated with insulin not the ‘pill’. She tells you that she does not think insulin is good for him and she does not want her dad to be on ‘insulin for rest of his life’. E You show empathy by saying : “ I can understand why that would be upsetting to
you. Certainly we would not want to give him medicine that would cause risk to him
or make the problem worse.
E You ask for permission to explain. “ Is it ok if I explained why we are giving your
father insulin?”. Then you explain why controlling blood glucose after surgery is
important to prevent surgical site infections and why insulin is a better treatment
option for him in the ICU given that he is not eating yet. You also explain that giving
him insulin now does not mean that he will need insulin ‘for rest of his life’.
N You assure the daughter that you will closely monitor her father’s blood sugar
aiming to keep it below 180 to prevent risk of infection and will plan to take him off
the insulin as soon as possible as he recovers from the surgery. You finish by asking if
that was a plan that the two of you could agree on. She approves and conversation ends
on a friendly
f i dl note.
JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
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ALEEN
ALEEN:
A case scenario for role play
ƒ
You are called to the surgery prep area by one of the nurses
to calm down an upset patient and family. The patient is a
78-year-old woman from out of state on her second trip with
her 3 children back to Hoppkins for a Whipp
pple procedure. She
was sent home the first time because of a fever and was again
canceled by the surgeon today. They were frustrated most
because this is the second time they are cancelled with “no
real answers and delaying surgery further when their mother
may have cancer.” You review the case and find out that
the pati
th
tientt has
h 103 ddegree fever whi
hich
h makkes it unsaffe to
undergo surgery and anesthesia due to increased risk of
developing infection, septic shock, and death. You plan to
go over, talk to the patient and family, and conduct a fever
work up for this patient.
ƒ What would you do ?
ƒ Use th
the ALEEN framework
f
k to
t resollve th
the
conflict with patient and family member.
JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
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The ‘Two Attempt Rule’
What is it? A communication process that seeks to ensure patient
safety by empowering providers to bring any safety concerns that go
‘unheard’ or aren’t addressed satisfactorily up the chain of command till
consensus is achieved .
Escalate if
Need be
Rechallenge
Get Attention
“NAMES First”
Make eye contact
Verbalize your
Feelings ( CUS)
Agree on
Course of Action
Clear &
Concise
State the issue
Propose
Action
When to use it?
Wh
i a patient
i safety
f concern that
h goes ‘unheard’
‘ h d’ or is
i not
Whenever
you voice
been addressed satisfactorily by other team members.
Key Points
p rule’ directs team members to attempt
p to ‘make
- The ‘two attempt
themselves heard’ twice . If that is unsuccessful this rule directs them to
escalate or go ‘up the chain of command’ till their concern is addressed.
- Using an assertive communication style , as in above diagram, will help
other team members ‘listen’ to you more.
-Using the CUS words ( I’m concerned ; I’m uncomfortable; this is a
safety
f t issue
i
) can be
b helpful
h l f l in
i communicating
i ti your feelings/
f li / view
i off the
th
situation and can help get the other person’s attention.
JHM Teamwork & Communication Program: Leadership Guidance Multidisciplinary Education
Program Evaluation