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psnet.ahrq.gov/node/866358/psn-pdf
July 24, 2024 - To improve health care, focus on fixing systems — not
people.
July 24, 2024
Mate KS, Clark J, Salvon-Harman J. To improve health care, focus on fixing systems — not people.
Harvard Business Review. July 12, 2024;
https://psnet.ahrq.gov/issue/improve-health-care-focus-fixing-systems-not-people
While a focus on the…
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psnet.ahrq.gov/node/36106/psn-pdf
May 27, 2011 - Evidence-based red cell transfusion in the critically ill:
quality improvement using computerized physician order
entry.
May 27, 2011
Rana R, Afessa B, Keegan MT, et al. Evidence-based red cell transfusion in the critically ill: quality
improvement using computerized physician order entry. Crit Care Med. 2006;34(7…
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psnet.ahrq.gov/node/42380/psn-pdf
December 29, 2014 - Missed medication doses in hospitalised patients: a
descriptive account of quality improvement measures and
time series analysis.
December 29, 2014
Coleman JJ, Hodson J, Brooks HL, et al. Missed medication doses in hospitalised patients: a descriptive
account of quality improvement measures and time series analysi…
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psnet.ahrq.gov/node/35809/psn-pdf
February 25, 2015 - Stories from the sharp end: case studies in safety
improvement.
February 25, 2015
McCarthy D; Blumenthal D. Milbank Q. 2006;84(1):165-200
https://psnet.ahrq.gov/issue/stories-sharp-end-case-studies-safety-improvement
This study shares the efforts of six different health care organizations in implementing intervent…
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psnet.ahrq.gov/node/37621/psn-pdf
March 19, 2008 - An effort to improve electronic health record medication
list accuracy between visits: patients' and physicians'
response.
March 19, 2008
Staroselsky M, Volk LA, Tsurikova R, et al. An effort to improve electronic health record medication list
accuracy between visits: patients' and physicians' response. Int J Med …
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psnet.ahrq.gov/node/44574/psn-pdf
October 21, 2015 - Patient safety and quality improvement: reducing risk of
harm.
October 21, 2015
Leonard M. Patient Safety and Quality Improvement: Reducing Risk of Harm. Pediatr Rev.
2015;36(10):448-56; quiz 457-8. doi:10.1542/pir.36-10-448.
https://psnet.ahrq.gov/issue/patient-safety-and-quality-improvement-reducing-risk-harm
T…
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psnet.ahrq.gov/node/43952/psn-pdf
March 04, 2015 - Improving resident morning sign-out by use of daily
events reports.
March 4, 2015
Nabors C, Patel D, Khera S, et al. Improving resident morning sign-out by use of daily events reports. J
Patient Saf. 2015;11(1):36-41. doi:10.1097/PTS.0b013e31829e4f56.
https://psnet.ahrq.gov/issue/improving-resident-morning-sign-ou…
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psnet.ahrq.gov/node/41873/psn-pdf
November 28, 2012 - A new tool to give hospitalists feedback to improve
interprofessional teamwork and advance patient care.
November 28, 2012
Chesluk BJ, Bernabeo E, Hess B, et al. A new tool to give hospitalists feedback to improve
interprofessional teamwork and advance patient care. Health Aff (Millwood). 2012;31(11):2485-2492.
do…
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psnet.ahrq.gov/node/60800/psn-pdf
January 01, 2021 - Changing hospital organisational culture for improved
patient outcomes: developing and implementing the
Leadership Saves Lives intervention.
August 12, 2020
Linnander EL, McNatt Z, Boehmer K, et al. Changing hospital organisational culture for improved patient
outcomes: developing and implementing the leadership s…
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psnet.ahrq.gov/node/46336/psn-pdf
August 23, 2017 - Improving the Working Environment for Safe Surgical
Care.
August 23, 2017
Short-Life Working Group on Hospital Reports. Edinburgh, Scotland: Royal College of Surgeons of
Edinburgh; July 31, 2017.
https://psnet.ahrq.gov/issue/improving-working-environment-safe-surgical-care
Surgical training is demanding and can r…
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psnet.ahrq.gov/node/46458/psn-pdf
May 30, 2018 - Development of the Huddle Observation Tool for
structured case management discussions to improve
situation awareness on inpatient clinical wards.
May 30, 2018
Edbrooke-Childs J, Hayes J, Sharples E, et al. Development of the Huddle Observation Tool for structured
case management discussions to improve situation aw…
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psnet.ahrq.gov/node/41420/psn-pdf
September 26, 2012 - Improving healthcare quality through organisational peer-
to-peer assessment: lessons from the nuclear power
industry.
September 26, 2012
Pronovost P, Hudson DW. Improving healthcare quality through organisational peer-to-peer assessment:
lessons from the nuclear power industry. BMJ Qual Saf. 2012;21(10):872-5.
h…
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psnet.ahrq.gov/node/839824/psn-pdf
November 09, 2022 - Improving diagnostic decision support through deliberate
reflection: a proposal.
November 9, 2022
Schmidt HG, Mamede S. Improving diagnostic decision support through deliberate reflection: a proposal.
Diagnosis (Berl). 2023;10(1):38-42. doi:10.1515/dx-2022-0062.
https://psnet.ahrq.gov/issue/improving-diagnostic-de…
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psnet.ahrq.gov/node/44464/psn-pdf
January 01, 2020 - Who applies an intervention to influence cultural
attributes in a quality improvement collaborative?
September 16, 2015
Hsu Y-J, Marsteller JA. Who Applies an Intervention to Influence Cultural Attributes in a Quality
Improvement Collaborative? J Patient Saf. 2020;16(1):1-6.
https://psnet.ahrq.gov/issue/who-applie…
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psnet.ahrq.gov/node/41720/psn-pdf
January 18, 2013 - Standardized patient identification and specimen labeling:
a retrospective analysis on improving patient safety.
January 18, 2013
Kim JK, Dotson B, Thomas S, et al. Standardized patient identification and specimen labeling: a
retrospective analysis on improving patient safety. J Am Acad Dermatol. 2013;68(1):53-6.
…
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psnet.ahrq.gov/node/37259/psn-pdf
March 23, 2011 - Using a survey of incident reporting and learning
practices to improve organisational learning at a cancer
care centre.
March 23, 2011
Cooke DL, Dunscombe PB, Lee R. Using a survey of incident reporting and learning practices to improve
organisational learning at a cancer care centre. Qual Saf Health Care. 2007;16…
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psnet.ahrq.gov/node/47324/psn-pdf
November 07, 2018 - Engaging patients to improve quality of care: a
systematic review.
November 7, 2018
Bombard Y, Baker R, Orlando E, et al. Engaging patients to improve quality of care: a systematic review.
Implement Sci. 2018;13(1):98. doi:10.1186/s13012-018-0784-z.
https://psnet.ahrq.gov/issue/engaging-patients-improve-quality-ca…
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psnet.ahrq.gov/node/41336/psn-pdf
May 02, 2012 - Human factors–focused reporting system for improving
care quality and safety in hospital wards.
May 2, 2012
Morag I, Gopher D, Spillinger A, et al. Human Factors–Focused Reporting System for Improving Care
Quality and Safety in Hospital Wards. Hum Factors. 2012;54(2):195-213. doi:10.1177/0018720811434767.
https://…
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psnet.ahrq.gov/node/46208/psn-pdf
July 12, 2017 - Improving patient safety by practicing in a just culture.
July 12, 2017
Duffy W. Improving Patient Safety by Practicing in a Just Culture. AORN J. 2017;106(1):66-68.
doi:10.1016/j.aorn.2017.05.005.
https://psnet.ahrq.gov/issue/improving-patient-safety-practicing-just-culture
The importance of just culture is widel…
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psnet.ahrq.gov/node/38737/psn-pdf
July 13, 2009 - Reengineering hospital discharge: a protocol to improve
patient safety, reduce costs, and boost patient
satisfaction.
July 13, 2009
Clancy CM. Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and
boost patient satisfaction. Am J Med Qual. 2009;24(4):344-6. doi:10.1177/106286060…