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psnet.ahrq.gov/issue/safety-quality-and-informatics-leadership-program
May 01, 2015 - 2018
Harvard Medical School, Boston, MA
The Institute of Medicine's learning health system concept
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psnet.ahrq.gov/node/41481/psn-pdf
September 26, 2012 - Impact of online education on intern behaviour around
Joint Commission national patient safety goals: a
randomised trial.
September 26, 2012
Shaw T, Pernar LI, Peyre S, et al. Impact of online education on intern behaviour around joint commission
national patient safety goals: a randomised trial. BMJ Qual Saf. 201…
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psnet.ahrq.gov/curated-library/organizational-learning
August 11, 2025 - Read More
Organisational learning in hospitals: a concept analysis. … This review defines the concept of organizational learning, characteristics of the activity, and the … Review
Organisational learning in hospitals: a concept analysis. … This review defines the concept of organizational learning, characteristics of the activity, and the
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psnet.ahrq.gov/node/47178/psn-pdf
July 10, 2018 - that are not clinically meaningful and may lead
to unnecessary testing and procedures, explaining the concept
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psnet.ahrq.gov/node/39581/psn-pdf
January 03, 2017 - argued that negative studies reflect
failed implementation of RRS, rather than failure of the RRS concept
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psnet.ahrq.gov/node/39123/psn-pdf
April 30, 2014 - This study used Veterans Administration data to analyze the
broader concept of "incorrect" surgical
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psnet.ahrq.gov/issue/normalization-deviance-healthcare-delivery
November 19, 2014 - This article explains the concept of normalization of deviance and discusses its application to patient
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psnet.ahrq.gov/issue/rising-frequency-it-blackouts-indicates-increasing-relevance-it-emergency-concepts-ensure
October 12, 2022 - Review
The rising frequency of IT blackouts indicates the increasing relevance of IT emergency concepts to ensure patient safety.
Citation Text:
Sax U, Lipprandt M, Röhrig R. The Rising Frequency of IT Blackouts Indicates the Increasing Relevance of IT Emergency Concepts to Ensure Patien…
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psnet.ahrq.gov/node/45554/psn-pdf
October 19, 2016 - Although diagnostic error has been an increasing focus of safety efforts, this study
broadens the concept
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psnet.ahrq.gov/node/44626/psn-pdf
November 04, 2015 - describes the
development of a new rapid approach to RCAs, colloquially called "SWARMing," based on the concept
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psnet.ahrq.gov/node/39338/psn-pdf
April 30, 2014 - A related
commentary [see link below] discusses this study's findings and the concept of health engineering
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psnet.ahrq.gov/node/46545/psn-pdf
March 27, 2018 - A recent PSNet interview with Mary Dixon-Woods discussed the evolving concept of
safety culture.
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psnet.ahrq.gov/issue/resilience-healthcare-and-clinical-handover
August 19, 2009 - This commentary introduces the concept of resilience and shares insights on how it can be applied in
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psnet.ahrq.gov/issue/building-cultures-high-reliability-lessons-high-reliability-organization-paradigm
September 05, 2018 - This article provides a brief history of the concept of high reliability organizations (HROs) and key
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psnet.ahrq.gov/primer/culture-safety
September 15, 2024 - The concept of safety culture originated outside health care, in studies of high reliability organizations … In an effort to balance the twin needs for no-blame and appropriate accountability, the concept of
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psnet.ahrq.gov/primer/patient-safety-101
January 16, 2025 - Background The History of the Patient Safety Movement The concept that patients could be harmed while … The concept of just culture , now widely used in health care, emphasizes that most errors result from
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psnet.ahrq.gov/issue/anticoagulant-safety-practices-call-pharmacist-supervision
May 08, 2024 - September 2, 2020
Nursing surveillance: a concept analysis
May 18, 2022
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psnet.ahrq.gov/node/33596/psn-pdf
June 01, 2025 - Background and Theory
The concept of failure-to-rescue (FTR) captures the idea that many complications … appropriate testing and
delayed treatment for an ultimately fatal complication, is consistent with the concept … aligned with Silber and colleagues’ original construct, may
refocus attention on the value of this concept
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psnet.ahrq.gov/perspective/conversation-paul-mcgann-md
July 10, 2024 - That concept of preventability changes over time, so we knew that was a moving target. … This issue of scaling is a really important concept that people who are interested in national improvement … : Bidirectionality, from the perspective of the federal government and agencies I worked at, is the concept … This is another example of that concept of bidirectionality that I was talking about. … PM : If there was one thought I could leave with your readers or listeners, it is that this concept of
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psnet.ahrq.gov/node/41280/psn-pdf
December 31, 2014 - integrated-displays-improve
The commonly used expression "missing the forest for the trees" is a shorthand summary of the concept