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psnet.ahrq.gov/node/33769/psn-pdf
June 01, 2014 - Patient Advocacy in Patient Safety: Have Things
Changed?
June 1, 2014
Haskell H. Patient Advocacy in Patient Safety: Have Things Changed? PSNet [internet]. 2014.
https://psnet.ahrq.gov/perspective/patient-advocacy-patient-safety-have-things-changed
Perspective
In 1981, a cancer patient named Paula Carroll founded…
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psnet.ahrq.gov/node/33767/psn-pdf
May 01, 2014 - Innovations in Promoting Hand Hygiene Compliance
May 1, 2014
Marra AR, Edmond MB. Innovations in Promoting Hand Hygiene Compliance. PSNet [internet]. 2014.
https://psnet.ahrq.gov/perspective/innovations-promoting-hand-hygiene-compliance
Perspective
One hundred sixty-five years after the publication of Ignaz Semmel…
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psnet.ahrq.gov/node/33822/psn-pdf
January 01, 2017 - In Conversation With… Paul H. O'Neill, MPA
January 1, 2017
In Conversation With… Paul H. O'Neill, MPA. PSNet [internet]. 2017.
https://psnet.ahrq.gov/perspective/conversation-paul-h-oneill-mpa
Editor's note: Mr. O'Neill served as the United States Secretary of the Treasury under President George
W. Bush and, prio…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.464_slideshow.ppt
January 01, 2019 - Spotlight
Spotlight
Mistaken Attribution, Diagnostic Misstep
*
Source and Credits
This presentation is based on the January 2019 AHRQ WebM&M Spotlight Case
See the full article at https://psnet.ahrq.gov/webmm
CME credit is available
Commentary by: Timothy R. Kreider, MD, PhD, and John Q. Young, MD, MPP, PhD
…
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psnet.ahrq.gov/node/33865/psn-pdf
September 01, 2018 - In Conversation With… Rebecca Lawton, PhD
September 1, 2018
In Conversation With… Rebecca Lawton, PhD. PSNet [internet]. 2018.
https://psnet.ahrq.gov/perspective/conversation-rebecca-lawton-phd
Editor's note: Rebecca Lawton, a Professor in the Psychology of Healthcare at the University of Leeds, is
a health psycho…
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psnet.ahrq.gov/node/49584/psn-pdf
April 01, 2009 - EMR Entry Error: Not So Benign
April 1, 2009
Koppel R. EMR Entry Error: Not So Benign. PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/emr-entry-error-not-so-benign
The Case
A 47-year-old man with advanced AIDS was admitted to an academic medical center with a chief complaint
of shortness of breath. He was …
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psnet.ahrq.gov/perspective/zero-harm-striving-reduce-preventable-harms-point-counterpoint-and-areas-agreement
September 24, 2024 - harm is thought to arise from linear, repeated processes that can be reliably improved, can result in focusing … Instead, with “Safety II,” risk reduction can motivate improvements in patient safety by focusing on … They become good by focusing on improvement and getting better. … is these small things that you focus on daily that create excellence and improvement over time, not focusing
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psnet.ahrq.gov/node/33616/psn-pdf
August 01, 2005 - A strong evidence base suggests that focusing on nursing would improve patient safety.
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.37_slideshow.ppt
November 01, 2003 - CRM training programs for health care providers
Focusing on information sharing, inquiry, and assertion
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psnet.ahrq.gov/perspective/conversation-ellen-deutsch-md-ms-facs-faap-fssh-cpps
December 14, 2022 - By focusing on developing capacities that enable care teams to respond to emergent problems, resilient … Instead of focusing on adherence to protocols and individual failures, resilient healthcare sees healthcare … Safety-II perspective should begin by looking for what goes right, and the greatest benefit may arise from focusing
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psnet.ahrq.gov/perspective/resilient-healthcare-and-safety-i-and-safety-ii-frameworks
December 14, 2022 - By focusing on developing capacities that enable care teams to respond to emergent problems, resilient … Instead of focusing on adherence to protocols and individual failures, resilient healthcare sees healthcare … Safety-II perspective should begin by looking for what goes right, and the greatest benefit may arise from focusing
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psnet.ahrq.gov/issue/focus-patient-safety
January 23, 2008 - Book/Report
Focus on Patient Safety.
Citation Text:
Focus on Patient Safety. Annu Rev Nurs Res. 2006;24:1-331.
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psnet.ahrq.gov/node/33809/psn-pdf
June 01, 2016 - Working on culture without focusing on burnout and joy and meaning will not give us the results we need … Just focusing on joy and meaning without really looking at culture and leadership is also going to be
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psnet.ahrq.gov/web-mm/double-never-event-wrong-patient-and-wrong-side
August 20, 2018 - The second skill is team leadership, focusing on maximizing every team member's potential, which is particularly … TeamSTEPPS provides a helpful framework for creating effective teams focusing on communication, leadership
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psnet.ahrq.gov/node/33668/psn-pdf
May 01, 2008 - RW: So, if you were trying to accelerate this pace, would you be focusing on creating a business case … RW: When David Brailer became the IT czar, I think he surprised some outsiders by focusing so strongly
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psnet.ahrq.gov/node/33696/psn-pdf
June 01, 2010 - RW: You ended up focusing on cognitive errors and diagnostic errors. … So we turned our M&M rounds
around, focusing on cognitive errors, affective errors, biases, distortions
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psnet.ahrq.gov/Information/Panel
January 01, 2012 - She has directed projects with multiple stakeholders focusing on Medicare Part D Medication Therapy Management … the Director of Medical Education Research and Innovation in the Medical Education Outcomes Center, focusing
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psnet.ahrq.gov/node/33671/psn-pdf
July 01, 2008 - Although caregiver collaboration is improving and organizations are focusing less on individual blame
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psnet.ahrq.gov/node/33647/psn-pdf
March 01, 2007 - For example, the physician-patient mentioned above tried to engage senior
leadership in focusing the
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psnet.ahrq.gov/perspective/conversation-richard-kronick-phd
February 01, 2014 - working on accelerating patient safety improvement in nursing homes and in ambulatory care—particularly focusing … Our research is focusing on how health IT can be designed and used to improve care, particularly looking … We are constantly focusing on how to make sure that what we do changes policy and practice.