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psnet.ahrq.gov/node/41771/psn-pdf
March 20, 2018 - Improving Patient Safety Systems for Patients With
Limited English Proficiency: A Guide For Hospitals.
March 20, 2018
Rockville, MD: Agency for Healthcare Research and Quality; September 2012. AHRQ Publication No. 12-
0041.
https://psnet.ahrq.gov/issue/improving-patient-safety-systems-patients-limited-english-prof…
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psnet.ahrq.gov/node/46963/psn-pdf
April 18, 2018 - A Just Culture Guide.
April 18, 2018
NHS Improvement. London, UK: National Health Service; March 15, 2018.
https://psnet.ahrq.gov/issue/just-culture-guide
Although focusing on system failure has been highlighted as key to improving patient safety, individual
behaviors must also be recognized as contributors to ris…
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psnet.ahrq.gov/node/39735/psn-pdf
January 03, 2017 - A practical guide to Failure Mode and Effects Analysis in
health care: making the most of the team and its
meetings.
January 3, 2017
Ashley L, Armitage G, Neary M, et al. A practical guide to Failure Mode and Effects Analysis in health care:
making the most of the team and its meetings. Jt Comm J Qual Patient Saf.…
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psnet.ahrq.gov/node/34747/psn-pdf
August 04, 2009 - The Improvement Guide: A Practical Approach to
Enhancing Organizational Performance. 2nd ed.
August 4, 2009
Langley GJ, Moen R, Nolan KM, et al. Hoboken, NJ: Jossey-Bass; 2009. ISBN: 9780470430880.
https://psnet.ahrq.gov/issue/improvement-guide-practical-approach-enhancing-organizational-performance-
2nd-ed
Effec…
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psnet.ahrq.gov/node/41402/psn-pdf
May 23, 2012 - Achieving meaningful use of health information
technology: a guide for physicians to the EHR Incentive
Programs.
May 23, 2012
Seidman J. Achieving meaningful use of health information technology: a guide for physicians to the EHR
Incentive Programs. Arch Intern Med. 2012;172(9):731-736. doi:10.1001/archinternmed.2…
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psnet.ahrq.gov/node/43178/psn-pdf
July 28, 2014 - Safety measurement and monitoring in healthcare: a
framework to guide clinical teams and healthcare
organisations in maintaining safety.
July 28, 2014
Vincent CA, Burnett S, Carthey J. Safety measurement and monitoring in healthcare: a framework to guide
clinical teams and healthcare organisations in maintaining s…
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psnet.ahrq.gov/issue/patient-and-family-engagement-primary-care-case-studies
November 01, 2016 - Book/Report
Patient and Family Engagement in Primary Care: Case Studies.
Citation Text:
Patient and Family Engagement in Primary Care: Case Studies. Rockville, MD: Agency for Healthcare Research and Quality; September 2016. AHRQ Publication No. 16-0035-2-EF.
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psnet.ahrq.gov/issue/healthcare-411-patient-perspective
October 23, 2019 - Government Resource
Healthcare 411.
Citation Text:
Healthcare 411. Rockville, MD: Agency for Healthcare Research and Quality. September 29, 2010.
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psnet.ahrq.gov/node/44723/psn-pdf
December 16, 2015 - Situation, background, assessment, and
recommendation–guided huddles improve
communication and teamwork in the emergency
department.
December 16, 2015
Martin HA, Ciurzynski SM. Situation, Background, Assessment, and Recommendation-Guided Huddles
Improve Communication and Teamwork in the Emergency Department. Jour…
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psnet.ahrq.gov/node/38330/psn-pdf
September 24, 2010 - Medication safety teams' guided implementation of
electronic medication administration records in five
nursing homes.
September 24, 2010
Scott-Cawiezell J, Madsen RW, Pepper GA, et al. Medication safety teams' guided implementation of
electronic medication administration records in five nursing homes. Jt Comm J Qu…
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psnet.ahrq.gov/node/45971/psn-pdf
April 21, 2018 - Guide to Improving Patient Safety in Primary Care
Settings by Engaging Patients and Families.
April 21, 2018
Rockville, MD: Agency for Healthcare Research and Quality; April 2018.
https://psnet.ahrq.gov/issue/guide-improving-patient-safety-primary-care-settings-engaging-patients-and-
families
Patient engagement i…
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psnet.ahrq.gov/issue/clinicians-guide-surgical-fires-how-they-occur-how-prevent-them-how-put-them-out
March 12, 2025 - Commentary
A clinician's guide to surgical fires: how they occur, how to prevent them, how to put them out.
Citation Text:
A clinician's guide to surgical fires. How they occur, how to prevent them, how to put them out. Health Devices. 2003;32(1):5-24.
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psnet.ahrq.gov/issue/improving-your-office-testing-process-step-step-guide-rapid-cycle-patient-safety-and-quality
October 23, 2019 - Toolkit
Improving Your Office Testing Process: A Step by Step Guide for Rapid-Cycle Patient Safety and Quality Improvement.
Citation Text:
Improving Your Office Testing Process: A Step by Step Guide for Rapid-Cycle Patient Safety and Quality Improvement. Rockville, MD: Agency for Healthc…
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psnet.ahrq.gov/issue/field-test-world-health-organization-multi-professional-patient-safety-curriculum-guide
June 04, 2014 - Study
Field test of the World Health Organization Multi-professional Patient Safety Curriculum Guide.
Citation Text:
Farley DO, Zheng H, Rousi E, et al. Field Test of the World Health Organization Multi-Professional Patient Safety Curriculum Guide. PLoS One. 2015;10(9):e0138510. doi:10.1…
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psnet.ahrq.gov/node/43710/psn-pdf
October 06, 2016 - Improving medication administration safety: using naïve
observation to assess practice and guide improvements
in process and outcomes.
October 6, 2016
Donaldson N, Aydin C, Fridman M, et al. Improving medication administration safety: using naïve
observation to assess practice and guide improvements in process and…
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psnet.ahrq.gov/node/46506/psn-pdf
October 11, 2017 - Getting Ahead of Harm Before It Happens: A Guide About
Proactive Analysis for Improving Surgical Care Safety.
October 11, 2017
Wiley K, Davies JM. Edmonton, AB: Canadian Patient Safety Institute; 2017.
https://psnet.ahrq.gov/issue/getting-ahead-harm-it-happens-guide-about-proactive-analysis-improving-
surgical-car…
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psnet.ahrq.gov/node/847730/psn-pdf
February 26, 2018 - “Brave men” and “emotional women”: a theory-guided
literature review on gender bias in health care and
gendered norms towards patients with chronic pain.
February 26, 2018
Samulowitz A, Gremyr I, Eriksson E, et al. “Brave men” and “emotional women”: a theory-guided literature
review on gender bias in health care a…
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psnet.ahrq.gov/node/43496/psn-pdf
November 01, 2016 - Designing and Delivering Whole-Person Transitional
Care: Hospital Guide to Reducing Medicaid
Readmissions.
November 1, 2016
Boutwell A, Bourgoin A , Maxwell J, et al. Rockville, MD: Agency for Healthcare Research and Quality;
September 2016. AHRQ Publication No. 16-0047-EF.
https://psnet.ahrq.gov/issue/designing-…
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psnet.ahrq.gov/issue/patient-education-materials-assessment-tool-pemat-and-users-guide-instrument-assess
December 24, 2008 - Toolkit
The Patient Education Materials Assessment Tool (PEMAT) and User's Guide: An Instrument to Assess the Understandability and Actionability of Print and Audiovisual Patient Education Materials.
Citation Text:
The Patient Education Materials Assessment Tool (PEMAT) and User's Guid…
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psnet.ahrq.gov/issue/health-care-leaders-action-guide-hospital-strategies-reducing-preventable-mortality
May 06, 2015 - Book/Report
Health Care Leaders Action Guide: Hospital Strategies for Reducing Preventable Mortality.
Citation Text:
Health Care Leaders Action Guide: Hospital Strategies for Reducing Preventable Mortality. Chicago, IL: Health Research & Educational Trust; March 2011.
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