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psnet.ahrq.gov/node/40198/psn-pdf
February 09, 2011 - Measures and measurement of high-performance work
systems in health care settings: propositions for
improvement.
February 9, 2011
Etchegaray J, St John C, Thomas EJ. Measures and measurement of high-performance work systems in
health care settings: Propositions for improvement. Health Care Manage Rev. 2011;36(1):3…
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psnet.ahrq.gov/node/37675/psn-pdf
April 09, 2008 - Hospital progress in reducing error: the impact of
external interventions.
April 9, 2008
Hosford SB. Hospital progress in reducing error: the impact of external interventions. Hosp Top.
2008;86(1):9-19. doi:10.3200/HTPS.86.1.9-20.
https://psnet.ahrq.gov/issue/hospital-progress-reducing-error-impact-external-interv…
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psnet.ahrq.gov/node/72685/psn-pdf
January 27, 2021 - Human Factors and Ergonomics in Healthcare.
January 27, 2021
Carayon P, Hignett S, Albolino S eds. Int J Qual Health Care. 2021;33(Supp1):1-71.
https://psnet.ahrq.gov/issue/human-factors-and-ergonomics-healthcare
Human factors approaches have been identified as one of the primary vehicles to create las…
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psnet.ahrq.gov/node/60565/psn-pdf
June 03, 2020 - The public has been forgiving. But hospitals got some
things wrong.
June 3, 2020
Ofri D. The public has been forgiving. But hospitals got some things wrong. New York Times. 2020; May
21.
https://psnet.ahrq.gov/issue/public-has-been-forgiving-hospitals-got-some-things-wrong
The complexity of the COVID-19 crisis cr…
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psnet.ahrq.gov/node/72652/psn-pdf
January 20, 2021 - Textbook of Patient Safety and Clinical Risk Management.
January 20, 2021
Donaldson L, Ricciardi W, Sheridan S, Tartaglia R, eds. Springer Nature: Cham Switzerland; 2021. ISBN
9783030594022.
https://psnet.ahrq.gov/issue/textbook-patient-safety-and-clinical-risk-management
Foundations and practical exp…
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psnet.ahrq.gov/node/854249/psn-pdf
January 01, 2014 - What is safety science?
August 19, 2013
Aven T. What is safety science? Safety Sci. 2014;67:15-20. doi:10.1016/j.ssci.2013.07.026.
https://psnet.ahrq.gov/issue/what-safety-science
Safety is seen as the absence of accidents and safety science research can be used to improve many
industries, including healthcare. Th…
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psnet.ahrq.gov/node/39547/psn-pdf
January 19, 2011 - The impact of a tele-ICU on provider attitudes about
teamwork and safety climate.
January 19, 2011
Chu-Weininger MYL, Wueste L, Lucke JF, et al. The impact of a tele-ICU on provider attitudes about
teamwork and safety climate. Qual Saf Health Care. 2010;19(6):e39. doi:10.1136/qshc.2007.024992.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/45777/psn-pdf
January 11, 2017 - Disclosure of adverse events in pediatrics.
January 11, 2017
McDonnell WM; Altman RL; Bondi SA et al for the Committee on Medical Liability and Risk Management;
Council on Quality Improvement and Patient Safety. Pediatrics. 2016;138(6);e20163215.
https://psnet.ahrq.gov/issue/disclosure-adverse-events-pediatrics
Op…
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psnet.ahrq.gov/node/46385/psn-pdf
October 23, 2018 - The key to reducing doctors' misdiagnoses.
October 23, 2018
Landro L. Wall Street Journal. September 12, 2017.
https://psnet.ahrq.gov/issue/key-reducing-doctors-misdiagnoses
Misdiagnosis has gained recognition as an important patient safety problem. This newspaper article reports
on several areas of research and i…
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psnet.ahrq.gov/node/47062/psn-pdf
October 13, 2018 - Latent risk assessment tool for health care leaders.
October 13, 2018
Paine LA, Holzmueller CG, Elliott R, et al. Latent risk assessment tool for health care leaders. J Healthc
Risk Manag. 2018;38(2):36-46. doi:10.1002/jhrm.21316.
https://psnet.ahrq.gov/issue/latent-risk-assessment-tool-health-care-leaders
Health …
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psnet.ahrq.gov/node/47983/psn-pdf
May 01, 2019 - Health systems and hospitals in pursuit of high reliability.
May 1, 2019
Cheney C. HealthLeaders Media. April 17, 2019.
https://psnet.ahrq.gov/issue/health-systems-and-hospitals-pursuit-high-reliability
This news article describes how a 19-hospital health system successfully applied high reliability principles
to …
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psnet.ahrq.gov/node/41946/psn-pdf
January 09, 2013 - Thirty-day outcomes support implementation of a surgical
safety checklist.
January 9, 2013
Bliss LA, Ross-Richardson CB, Sanzari LJ, et al. Thirty-day outcomes support implementation of a surgical
safety checklist. J Am Coll Surg. 2012;215(6):766-76. doi:10.1016/j.jamcollsurg.2012.07.015.
https://psnet.ahrq.gov/is…
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psnet.ahrq.gov/node/836717/psn-pdf
March 09, 2022 - The problem with…using stories as a source of evidence
and learning.
March 9, 2022
Iedema R. The problem with … using stories as a source of evidence and learning. BMJ Qual Saf.
2022;31(3):234-237. doi:10.1136/bmjqs-2021-014221.
https://psnet.ahrq.gov/issue/problem-withusing-stories-source-evidence-and-learning
P…
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psnet.ahrq.gov/node/50572/psn-pdf
October 23, 2019 - Five reasons for optimism on World Patient Safety Day.
October 23, 2019
Fontana G, Flott K, Dhingra-Kumar N, et al. Five reasons for optimism on World Patient Safety Day.
Lancet. 2019;394(10203):993-995. doi:10.1016/S0140-6736(19)32134-8.
https://psnet.ahrq.gov/issue/five-reasons-optimism-world-patient-safety-day
…
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psnet.ahrq.gov/node/48179/psn-pdf
August 21, 2019 - Is WHO's surgical safety checklist being hyped?
August 21, 2019
Urbach DR, Dimick JB, Haynes AB, et al. Is WHO's surgical safety checklist being hyped? BMJ.
2019;366:l4700. doi:10.1136/bmj.l4700.
https://psnet.ahrq.gov/issue/whos-surgical-safety-checklist-being-hyped
Checklists are a popular yet controversial stra…
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psnet.ahrq.gov/node/40030/psn-pdf
January 04, 2011 - Beam me up Scotty! Impact of personal wireless
communication devices in the emergency department.
January 4, 2011
Richards JD, Harris T. Beam me up Scotty! Impact of personal wireless communication devices in the
emergency department. Emerg Med J. 2011;28(1):29-32. doi:10.1136/emj.2009.082370.
https://psnet.ahrq.g…
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psnet.ahrq.gov/node/73898/psn-pdf
September 29, 2021 - A Thematic Analysis of HSIB's First 22 Investigations.
September 29, 2021
Farnborough, UK: Healthcare Safety Investigation Branch; September 9, 2021.
https://psnet.ahrq.gov/issue/thematic-analysis-hsibs-first-22-investigations
In-depth failure investigations provide improvement insights for individuals and or…
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psnet.ahrq.gov/node/40274/psn-pdf
December 29, 2014 - Predictors of the perceived impact of a patient safety
collaborative: an exploratory study.
December 29, 2014
Pinto A, Benn J, Burnett S, et al. Predictors of the perceived impact of a patient safety collaborative: an
exploratory study. Int J Qual Health Care. 2011;23(2):173-81. doi:10.1093/intqhc/mzq089.
https://…
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psnet.ahrq.gov/node/42631/psn-pdf
November 08, 2013 - "That was a close call": endorsing a broad definition of
near misses in health care.
November 8, 2013
Marks CM, Kasda E, Paine LA, et al. "That was a close call": endorsing a broad definition of near misses in
health care. Jt Comm J Qual Patient Saf. 2013;39(10):475-479.
https://psnet.ahrq.gov/issue/was-close-call…
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psnet.ahrq.gov/node/46673/psn-pdf
March 21, 2018 - Human factors and simulation in emergency medicine.
March 21, 2018
Hayden EM, Wong AH, Ackerman J, et al. Human Factors and Simulation in Emergency Medicine. Acad
Emerg Med. 2018;25(2):221-229. doi:10.1111/acem.13315.
https://psnet.ahrq.gov/issue/human-factors-and-simulation-emergency-medicine
Human factors engine…