Healthcare professionals developed a game that can teach people how to improve their communication and interactions with colleagues and patients.

Called PEARLS and Ladder, it is loosely inspired by the children’s board game “Chutes and Ladders.” Still under development, the game uses two different communication tools: PEARLS and Ladder of Inference. (Read more about PEARLS at: For more details about Ladder of Inference, visit:

“We’ve tested PEARLS and Ladder for about a year in various settings, and it’s really helping people practice having conversations,” says Julie K. Johnson, MSPH, PhD, professor of surgery at Northwestern University.

The game helps people learn the best ways to respond during a difficult conversation. It includes a board with color cards that offer various interpersonal scenarios. Four to six people play the game, rolling dice and moving their pieces to spots that direct players to draw cards, Godfrey explains.

The players listen to each person’s communication scenario and strategize how to change it into a positive, productive relationship. In one scenario, an employee is working with a colleague on a project, and starts climbing the Ladder of Inference. On the first rung, the colleague does not respond to voicemail messages. “A couple more emails, and you think she’s avoiding you. Then you call, and she doesn’t return the calls,” Johnson says.

The employee concludes the colleague is avoiding her because of a past disagreement. A few rungs up the ladder, the employee makes assumptions, which lead to suspicions that the colleague is trying to sabotage her work. At the top of the ladder, the employee concludes she will seek revenge by not helping the colleague next time. The employee looks for other examples of when the colleague was trying to make her look bad.

In the board game, the employee decides to descend the ladder, taking steps that will lead to better communication and a healthier relationship. This de-escalation includes meeting with the colleague to find out why she did not return the messages. The employee might learn her colleague had not returned the messages because of a family crisis. “What you don’t know is she is dealing with her sick mother in the hospital,” Johnson says.

Employees need to learn the right skills to go down the ladder, realizing they have made the wrong assumptions or are thinking about things incorrectly, Johnson adds.