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Total Results: 2,150 records

Showing results for "happen".

121. Scoring Different Kinds of Health Care Quality Measures | Agency for Healthcare Research and Quality
     www.ahrq.gov/talkingquality/translate/scores/scoring.html
     June 01, 2016 - Do you want to tell people how often this event happened or how often it did not happen? … Experience indicates that in this case, saying how often a patient safety event did happen will be

122. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/changing-system-slides.pptx
     June 01, 2021 - Why did it happen? What could you do to reduce the risk? How do you know that risk was reduced? … Imagine the world as they did when the event occurred. 13 Changing the System 13 Why Did It Happen

123. Identify Defects Through Sensemaking, Facilitator Notes | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/identify/notes.html
     December 01, 2012 - Why Did It Happen? Slide 24. What Will You Do To Reduce the Risk of Recurrence? Slide 25. … Why did it happen? What will you do to reduce risk? … Why did it happen? Step 1. Visualize the factors that led to the event. Step 2. … Return to Contents   Slide 23: Why Did It Happen? Do: Play the video. … Defects are clinical or operational events that you do not want to happen again.

124. Identify Defects Through Sensemaking | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/identify/index.html
     July 01, 2018 - Why Did It Happen? (34 sec.) What Will You Do to Reduce the Risk of Recurrence? (40 sec.)

125. Sensemakingnotes (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/identify/sensemakingnotes.docx
     August 08, 2012 - · Why did it happen? · What will you do to reduce risk? … categorized in three main types: skill-based, rule-based, and knowledge-based. · Skill-based failures happen … The consequent event is described in terms of the event's consequences: · Harm that did happen · Harm … that did not happen—No harm event · Event did not reach the patient—Near-miss event We then ask why … Why did it happen? · Step 1. Visualize the factors that led to the event. · Step 2.

126. Supplemental-Elicitation-Protocol-Cgcahps-Adult 2357-7A (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/item-sets/CG/supplemental-elicitation-protocol-cgcahps-adult_2357-7a.docx
     December 01, 2016 - CAHPS® Clinician & Group Survey 3.0 Supplemental Items: Narrative Comments Population Version: Adult Supplemental Items for the CAHPS® Clinician & Group Survey 3.0 Topic: Narrative Comments Population Version: Adult Languages: English This is the beta version of the CAHPS Patient Narrative Elicitation Pro…

127. Understand the Science of Safety for Perinatal Safety: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/perinatal-care/modules/teamwork/understand-sci-fac-guide.html
     May 01, 2017 - Slide 4: How Can These Errors Happen? … The first step in comprehending why they happen is accepting that people are not perfect. … Why did it happen? What will we do to reduce the recurrence? How will we know it worked? … Why did it happen? How will you reduce the risk of recurrence? How will you know it worked?

128. Nursing Home Survey on Patient Safety Culture: Background and Information for Translators (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/nursing-home/resources/infotransNHSOPS.pdf
     January 01, 2010 - expect supervisors to investigate all factors, including systems reasons, to determine why mistakes happen … Sometimes, Most of the time, Always, Does Not Apply or Don’t Know) How often do the following things happen … Sometimes, Most of the time, Always, Does Not Apply or Don’t Know) How often do the following things happen … Sometimes, Most of the time, Always, Does Not Apply or Don’t Know) How often do the following things happen … This nursing home lets the same mistakes happen again and again. (negatively worded) D4.

129. 129-Ss-Blank-Lfd (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/129-ss-blank-lfd.docx
     April 01, 2025 - A defect is any clinical or operational event or situation that you would not want to happen again. … Why Did It Happen? Below is a framework to help you review and evaluate your case.

130. Hospital Survey on Patient Safety Culture Version 2.0: Composites and Items (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospitalsurvey2-items.pdf
     August 01, 2019 - We are informed about errors that happen in this unit. C2. … When errors happen in this unit, we discuss ways to prevent them from happening again. C3.

131. 091-Decolonization-Implementation-Fg (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/091-decolonization-implementation-fg.docx
     April 01, 2025 - Slide 6 Where Does Decolonization Happen? … This tool asks four important questions: what happened, why did it happen, how to reduce the likelihood … The next question was to investigate is, why did it happen? … next step in the process is to develop an intervention to reduce the likelihood that this risk will happen

132. Mod5-Disclosure-Checklist (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/mod5-disclosure-checklist.pdf
     April 01, 2016 - Purpose: To provide guidance to individuals who are conducting initial or followup disclosure conversations, including key disclosure communication skills. Who should use this tool? Disclosure Lead and any staff who will be engaged in disclosure conversations. How to use this tool: Use Part I of the checklist to pre…

133. Disclosure Checklist | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/checklist5.html
     August 01, 2022 - Disclosure Checklist AHRQ Communication and Optimal Resolution Toolkit Purpose: To provide guidance to individuals who are conducting initial or followup disclosure conversations, including key disclosure communication skills. Who should use this tool? Disclosure Lead and any staff who will be engaged in …

134. 111-Ss-Cusp-Lfd-Worksheet-A3 (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/111-ss-cusp-lfd-worksheet-a3.docx
     April 01, 2025 - How Can We Reduce the Chance This Will Happen Again?

135. 111-Cusp-Learning-From-Defects-Worksheet (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-surgery/111-cusp-learning-from-defects-worksheet.docx
     April 01, 2025 - How Can We Reduce the Chance This Will Happen Again?

136. Supplemental-Elicitation-Protocol-Cgcahps-Child 2358-7A (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/item-sets/CG/supplemental-elicitation-protocol-cgcahps-child_2358-7a.docx
     December 01, 2016 - CAHPS® Clinician & Group Survey 3.0 Supplemental Items: Narrative Comments Population Version: Child Supplemental Items for the CAHPS® Clinician & Group Survey 3.0 Topic: Narrative Comments Population Version: Child Languages: English This is the beta version of the CAHPS Patient Narrative Elicitation Pro…

137. CUSP Videos | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/videos/index.html
     September 01, 2019 - Why Did It Happen?

138. Public Reporting of Patients' Comments with Quality Measures: How Can We Make It Work? (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20140603_QI/3_rachel_grob.pdf
     June 25, 2014 - past 12 months) Positive experiences: 1 Question with narrative guide (what happened, how did it happen … (past 12 months) Positive experiences: 1 Question with narrative guide (what happened, how did it happen

139. Understand-Facilitator-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/understand/understand-facilitator-guide.docx
     May 01, 2017 - The first step in comprehending why they happen is accepting that people are not perfect. … Why did it happen? What will we do to reduce the recurrence? How will we know it worked? … Why did it happen? How will you reduce the risk of recurrence? How will you know it worked?

140. Transcript: How To Address Attitudes and Beliefs Around Infection Prevention Strategies and Techniques (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/attitudes-beliefs-transcript.pdf
     April 01, 2022 - So, it can happen. And it does happen. And there's plenty in the literature. … that help us to get there, that improve teamwork, improve communication, that all show that this can happen … So, we know it can happen. … So, to share successes like that, yes, it does happen.