-
www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/05-sops-teamstepps-webcast-mazur.pdf
April 30, 2022 - Communication; 1 unit data only)
Communication about error 82 +15
We are informed about errors that happen … in this unit. 80 +15
When errors happen in this unit, we discuss ways to
prevent them from happening
-
www.ahrq.gov/cahps/surveys-guidance/item-sets/cg/suppl-narrative-items-cg-survey30-adult.html
August 01, 2021 - Supplemental Items for the CAHPS Clinician & Group Adult Survey 3.0/3.1: Narrative Comments
Population version: Adult
Learn about the CAHPS Patient Narrative Item Sets .
Placing the items in the survey:
Insert these supplemental items before the "About You" section of the survey.
Introducing the it…
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/2020_MOSOPS_Part_I-rev0921.pdf
January 01, 2020 - (F2)
Mistakes happen more than they should
in this office . … (E1R)
They overlook patient care mistakes that
happen over and over. … This office is good at changing office processes to make
sure the same problems don’t happen again. … Mistakes happen more than they should in this office. … They overlook patient care mistakes that happen over
and over.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/science-of-safety-slides.pptx
January 01, 2017 - Science of Safety ‹#›
AHRQ Safety Program for Mechanically Ventilated Patients
4
Errors Happen Because … individual doctors and nurses
Health care systems are rarely designed to catch mistakes before they happen
-
www.ahrq.gov/hai/cauti-tools/phys-championsgd/appa.html
October 01, 2015 - What do you want to happen by when?
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/community-pharmacy/pharmacy-survey-english.docx
June 02, 2025 - We look at staff actions and the way we do things to understand why mistakes happen in this pharmacy
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/pharmsops-composites.pdf
June 02, 2025 - We look at staff actions and the way we do things to understand why mistakes happen in this
pharmacy
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/coaching/coaching-slideset.pptx
May 01, 2017 - “Can you help me understand why that didn’t happen?
-
www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/training-tools/coaching-fac-notes.html
October 01, 2020 - Can you help me understand why that didn’t happen? … If something harmful to the patient can be avoided, the coach should say something and not let it happen
-
www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/nyp-webinar-servati-demo-project.pdf
June 02, 2025 - Implementing the New CAHPS® Protocol for Obtaining Patient Comments About Their Care
The NYP Patient Narrative
Demonstration Project
Tara Servati, M.P.H.
Patient Experience Specialist for the Ambulatory Care
Network, New York-Presbyterian
New York, NY
NYP Demonstration Project Overview
Overall Aim:
– Asses…
-
www.ahrq.gov/sites/default/files/wysiwyg/takeheart/assessing/takeheart-summary-presentation.pptx
April 26, 2023 - AHRQ Slide Template-Regular
TAKEheart:
AHRQ’s Initiative to Increase Patient Participation in Cardiac Rehabilitation
What We Planned, What Happened, and What We Learned
Michael Harrison and Dina Moss
April 26, 2023
(Edited 5-25-23)
Dina was COR and implementation lead; Michael was co-COR and evaluation/disseminati…
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/012-ss-decolonization-strategies.pptx
April 01, 2025 - Why did it happen?
How to reduce the likelihood of this defect from happening again? … Inconsistent use of mupirocin nasal decolonization
Inconsistent screening of patients for MRSA
Why did it happen
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hsops2-pt2_transition_apx.pdf
September 01, 2019 - and Communication About Error 68% 65% 3% Major wording
change
We are informed about errors that happen … (C1)
We are informed about errors that happen in this
unit. … ------------------------------------- My supervisor/manager overlooks patient safety
problems that happen … (C1)
We are informed about errors
that happen in this unit. … (C3) 66% 66% 0% +/- 3%
[-3% to 3%]
No
change
When errors happen in this unit, we
discuss ways
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/coaching/coaching-facnotes.docx
May 01, 2017 - Can you help me understand why that didn’t happen? … If something harmful to the patient can be avoided, the coach should say something and not let it happen
-
www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide70.html
October 01, 2014 - Concerns and benefits of quitting (e.g., "What might happen if you quit?").
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/cauti-tools/cauti-icu/preventing-cauti-icu-setting-module-3-slides.pptx
September 01, 2015 - ‹#›
AHRQ Safety Program for Reducing CAUTI in Hospitals
4
5
What Do You Think Will Happen
-
www.ahrq.gov/cahps/surveys-guidance/item-sets/cg/suppl-narrative-items-cg-survey30-child.html
August 01, 2021 - Supplemental Items for the CAHPS Clinician & Group Child Survey 3.0/3.1: Narrative Comments
Population version: Child
Learn about the CAHPS Patient Narrative Item Sets .
Placing the items in the survey:
Insert these supplemental items before the "About Your Child and You" section of the survey.
Int…
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/4es-early-mobility-facguide.docx
January 01, 2017 - How can execute our plan and make this happen? … early mobility at our hospital, change the culture, and provide the necessary resources to make it happen … A defect is anything you do not want to happen again. Ask, “What happened and why did it happen?”
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/asc-survey-english.pdf
June 02, 2025 - Staff are told about patient safety problems that
happen in this facility ......................... … We are good at changing processes to make sure
the same patient safety problems don’t happen again.
-
www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/patient-narratives-webinar-quality.pdf
June 02, 2025 - The Power of Patient Stories for Improving the Patient Experience webcast - Nembhard
Using Narratives for Quality Improvement
Ingrid Nembhard, PhD, MS
Fishman Family President’s Distinguished
Associate Professor of Health Care Management
Disclosures
This work was funded by the Agency for Healthcare
Research a…