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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50722/psn-pdf
    December 04, 2019 - 20 years later: to err is a leadership failure. December 4, 2019 Castellucci M, Meyer H. Modern Healthcare: November 11, 2019;49:18-22;28-30;32-34. https://psnet.ahrq.gov/issue/20-years-later-err-leadership-failure This special segment shares commentaries and online content that summarize growth and lack of progres…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47938/psn-pdf
    May 01, 2019 - Drug diversion and impaired health care workers. May 1, 2019 Quick Safety. April 15, 2019;(48):1-3. https://psnet.ahrq.gov/issue/drug-diversion-and-impaired-health-care-workers Fatigue, emotional stress, and illness can affect decision-making and lead to misuse of medications. This newsletter article describes the…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847547/psn-pdf
    March 12, 2025 - National Action Alliance to Advance Patient and Workforce Safety Webinar Series. March 12, 2025 US Department of Health and Human Services. 2023-2025.  https://psnet.ahrq.gov/issue/national-action-alliance-advance-patient-safety-webinar-series Work toward zero harm in health care is gaining national attention…

  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73989/psn-pdf
    October 20, 2021 - How is safety climate measured? A review and evaluation. October 20, 2021 Shea T, De Cieri H, Vu T, et al. How is safety climate measured? A review and evaluation. Safety Sci. 2021;143:105413. doi:10.1016/j.ssci.2021.105413. https://psnet.ahrq.gov/issue/how-safety-climate-measured-review-and-evaluation Assessing s…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36654/psn-pdf
    June 29, 2011 - The moderate success of quality of care improvement efforts: three observations on the situation. June 29, 2011 Katz-Navon T, Naveh E, Stern Z. The moderate success of quality of care improvement efforts: three observations on the situation. International Journal for Quality in Health Care. 2006;19(1). doi:10.1093…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45550/psn-pdf
    August 01, 2023 - Leape Ahead Award. August 1, 2023 American Association for Physician Leadership. https://psnet.ahrq.gov/issue/leape-ahead-award Efforts to incorporate respect and patient safety concepts into medical training have been inspired by the work and leadership of Dr. Lucian Leape, founding chairman of the Lucian Leape I…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/37196/psn-pdf
    June 06, 2018 - Fatal 1,000-fold overdoses can occur, particularly in neonates, by transposing mcg and mg. June 6, 2018 ISMP Medication Safety Alert! Acute Care Edition. September 6, 2007;12:1-4. https://psnet.ahrq.gov/issue/fatal-1000-fold-overdoses-can-occur-particularly-neonates-transposing-mcg- and-mg This article analyzes a…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/838258/psn-pdf
    October 05, 2022 - Solutions from Professional Regulation and Beyond. October 5, 2022 Safer Care for All. London, England:  Professional Standards Authority for Health and Social Care; 2022. https://psnet.ahrq.gov/issue/solutions-professional-regulation-and-beyond Dedicated leadership is an important component to examine and ad…

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43522/psn-pdf
    October 15, 2014 - A model of disruptive surgeon behavior in the perioperative environment. October 15, 2014 Cochran A, Elder WB. A model of disruptive surgeon behavior in the perioperative environment. J Am Coll Surg. 2014;219(3):390-8. doi:10.1016/j.jamcollsurg.2014.05.011. https://psnet.ahrq.gov/issue/model-disruptive-surgeon-beh…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44977/psn-pdf
    March 01, 2020 - Choosing a Patient Safety Organization March 1, 2020 Rockville, MD: Agency for Healthcare Research and Quality; March 2020. AHRQ Publication No. 20-0030. https://psnet.ahrq.gov/issue/choosing-patient-safety-organization Patient safety organizations (PSOs) collect and analyze protected incident data from across the …

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45006/psn-pdf
    April 06, 2016 - Quality and Patient Safety. April 6, 2016 Agency for Healthcare Research and Quality. https://psnet.ahrq.gov/issue/quality-and-patient-safety The Agency for Healthcare Research and Quality has provided access to patient safety research, information, and tools for nearly two decades. This website offers a wide rang…

  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60006/psn-pdf
    March 04, 2020 - National Patient Safety Syllabus 1.0 Training for all NHS Staff. March 4, 2020 London, UK: Academy of Medical Royal Colleges; 2020. https://psnet.ahrq.gov/issue/national-patient-safety-syllabus-10-training-all-nhs-staff A foundational understanding of safety is core to building reliable care processes and teams. T…

  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45606/psn-pdf
    October 27, 2016 - Unprofessional workplace conduct...defining and defusing it. October 27, 2016 MacLean L, Coombs C, Breda K. Unprofessional workplace conduct..defining and defusing it. Nurs Manage. 2016;47(9):30-34. doi:10.1097/01.NUMA.0000491126.68354.be. https://psnet.ahrq.gov/issue/unprofessional-workplace-conductdefining-and-d…

  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34636/psn-pdf
    June 14, 2011 - The wrong patient. June 14, 2011 Chassin MR, Becher EC. The wrong patient. Ann Intern Med. 2002;136(11):826-833. https://psnet.ahrq.gov/issue/wrong-patient This case study describes the events of a patient who underwent an unintended invasive cardiac electrophysiology study. While reviewing the details of the case…

  15. In Conversation With... John G. Reiling, PhD | PSNet

    psnet.ahrq.gov/perspective/conversation-john-g-reiling-phd
    June 01, 2014 - I think it's one of the most interesting cultural, process, and cognitive issues because we have such

  16. How Do IBH Practices & Functions Differ? | The Academy

    integrationacademy.ahrq.gov/products/ibh-lexicon/practice-differences
    July 01, 2024 - community resource connections Follow-up, outcome monitoring for timely adjustment of care and coordination Cultural

  17. Enhancing Hawaii Hospital Information Content: Data Acquisition.

    hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/hi25.jsp
    September 01, 2014 - Enhancing Hawaii Hospital Information Content: Data Acquisition. An official website of the Department of Health & Human Services Search All AHRQ Websites Careers Contact Us Espanol …

  18. Disposition of Comments for Screening of Methicillin-Resistant Staphylococcus Aureus (MRSA) (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/related_files/mrsa-screening-2010_disposition-comments.pdf
    January 01, 2010 - Disposition of Comments for Screening of Methicillin-Resistant Staphylococcus Aureus (MRSA) Comparative Effectiveness Research Review Disposition of Comments Report Research Review Title: Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) Draft review available for public comment from Marc…

  19. FRN 22: Future Research Needs for Strategies To Reduce Cesarean Birth in Low-Risk Women (pdf file)

    effectivehealthcare.ahrq.gov/sites/default/files/pdf/cesarean-birth_research.pdf
    January 01, 2020 - risen to almost one in three.6 Much of this increase occurred in the past decade.1 In the current cultural … risen to almost one in three.6 Much of this increase occurred in the past decade.1 In the current cultural … (4) To study how historical, social, and cultural forces seemingly unrelated to health and medicine … In essence, this social history will examine the historical, social, cultural, and medical factors that … As a historian of medicine, the P.I. will trace the social and cultural context of cesarean section

  20. Integrating Patient-Generated Health Data into Electronic Health Records in Ambulatory Care Settings: A Practical Guide (pdf file)

    digital.ahrq.gov/sites/default/files/docs/citation/pghd-practical-guide.pdf
    December 01, 2021 - Are there cultural barriers? … • Facilitate cultural acceptance/normalize change/leadership buy-in. • Create budget and projections … Understanding cultural values can be very helpful as well. … Scripting can also offer language that supports new cultural norms. … : Are there cultural barriers?
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