I felt like a good theme for the day was balance. The two concepts I thought about balancing were: using systems based on human-centered design to prevent errors and relying on humans themselves to catch errors. I really liked Tim’s discussion on creating devices and systems that are intuitive and make committing errors impossible. On the other hand, John mentioned how poorly-designed EMRs make healthcare workers more likely to commit errors, thinking the system is foolproof and that dangerous medication orders couldn’t possibly come through. These two topics really reinforced for me the importance of remaining forever vigilant and internalizing John Nance’s 50/50 mentality about healthcare errors.
Peter Kehr 06/14/17 Reflection
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