I just wanted to comment briefly on a great learning moment I had yesterday. During the domino game, I was assigned the administrator role for the third and final round in which the doctor and nurse are allowed to communicate directly. By a slight miscommunication, our group misplaced one domino which later lead to misplacing yet another. While my group did a great job accurately placing the remaining dominos, I noticed that even after making the first mistake, using more effective communication with rechecks and feedback with the second misplaced domino would have actually helped us recognize the first mistake. I found it interesting how a standard way of communicating that’s understandable and learned how to execute properly by both parties (much like in aviation), makes the world of difference not only in a simple game of dominos but in patient safety.
by Katie Thelen - The Academy for Emerging Leaders in Patient Safety
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