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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/nursinghome-resourcelist.pdf
April 01, 2023 - Just Culture
a. … provides links to ways to engage and teach about a Just Culture, execute a Just
Culture, and Evaluate … a Just Culture. … Nursing 2015 Just Culture Toolkit
https://nursing2015.wordpress.com/blue-team/blue-team-documents/just-culture-tool-kit … -
building/
This website provides a definition of Just Culture, presentations on Just Culture, a case
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www.ahrq.gov/hai/tools/clabsi-cauti-icu/overcome/mindsets.html
April 01, 2022 - Overcoming Mindsets
It can be difficult to address your staff’s underlying attitudes and beliefs … With time, effort, and shared understanding, your team can change those attitudes and beliefs to create … a stronger safety culture. … Engaging Physicians in Preventing CLABSI and CAUTI (PDF, 286.2 KB)
Making It Work – Overcoming the "Just … ; Transcript , PDF, 304.5 KB)
Audio interview with David Thompson – How To Address Attitudes and Beliefs
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes4.html
August 01, 2022 - A Just Culture supports disclosure and learning from errors and encourages viewing every event as an … This element supports the creation of just culture. … Improved culture of safety as a result of open, fair, and just management of individual and system issues … More information on Just Culture can be found in the Apply CUSP module of the AHRQ CUSP Toolkit. … to a systems approach to Event Investigation and Analysis supports a Just Culture.
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www.ahrq.gov/patient-safety/reports/liability/prologue.html
August 01, 2017 - Transparency between and among medical colleagues and a supportive just culture 1 are also central aspects … Introduction to the Just Culture. What is just culture? Outcome Engenuity Web site. … Available at https://www.outcome-eng.com/david-marx-introduces-just-culture/ . … See for example the Survey on Patient Safety Culture Database. … Available at
https://www.ahrq.gov/topics/topic-survey-on-patient-safety-culture-database.html .
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www.ahrq.gov/sops/news/previous-announcements.html
March 01, 2025 - Updated AHRQ Surveys on Patient Safety Culture Action Planning Tool AHRQ Surveys on Patient Safety Culture … Hospitals can administer the items at the end of the SOPS Hospital Survey 2.0, just before the background … Medical offices can administer the items at the end of the SOPS Medical Office Survey, just before the … Why Choose the AHRQ Surveys on Patient Safety Culture? … Shifting to a “Just Culture” framework to assess Response to Error.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module3/module-3-slides.pptx
March 01, 2017 - 2017
1
Objectives
Cite staff empowerment concepts
Discuss how staff empowerment contributes to a culture … Leader support and teams
Communication and information sharing
Positive reinforcement
Confidence
Just … | 25
PLAY VIDEO
Video 3.5: Just Culture and Open Communication - https://youtu.be/WdN-WdWKduU
Video … 3.5: Just Culture and Open Communication
25
Barriers to Staff Empowerment10
Lack of senior leader support … Just Culture, Healthcare Services Overview.
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module3/mod3-slides.html
March 01, 2017 - Just Culture. … Culture 8,9
Mission, values, and expectations. … Just Culture, Healthcare Services Overview . Outcome Engineering; 2012.
9. CUSP Toolkit . … Slide 25: A Just Culture
Image: Indicating a video on the slide
PLAY VIDEO
Video 3.5: Just Culture … Just Culture, Healthcare Services Overview . Outcome Engineering; 2012.
CUSP Toolkit .
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/onboarding/onboarding_overview_impmodel_facnotes.docx
December 01, 2017 - Adaptive work addresses the attitudes, beliefs, and values of clinicians that drive behaviors, norms, … This ensures we address the local values, attitudes, and beliefs that drive our actions. … Just finding the time to meet can be difficult. … Notice that “right” is in quotation marks, because a just or “right” culture sends the signal that safety … Alternatively, in cultures where the “right” thing to do is to get people in and out of beds as fast
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www.ahrq.gov/hai/tools/surgery/modules/on-boarding/overview-fac-notes.html
December 01, 2017 - Adaptive work addresses the attitudes, beliefs, and values of clinicians that drive behaviors, norms, … This ensures we address the local values, attitudes, and beliefs that drive our actions. … Just finding the time to meet can be difficult. … Notice that “right” is in quotation marks, because a just or “right” culture sends the signal that safety … Alternatively, in cultures where the “right” thing to do is to get people in and out of beds as fast
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module3/guide.html
March 01, 2017 - Discuss how staff empowerment contributes to a culture of resident safety, leading to improved outcomes … Video 3.3: Positive Reinforcement
Video 3.4: Collaborative Trust and Confidence
Video 3.5: Just … Culture and Open Communication
Barriers to Staff Empowerment
Slide 26
Key Concepts … Teamwork and Support, Open Communication, Positive Reinforcement, Collaborative Trust and Confidence, A Just … , Open Communication video, Positive Reinforcement video, Collaborative Trust and Confidence video, Just
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module3/guide.docx
March 01, 2017 - Learning Objectives:
· Cite staff empowerment concepts
· Discuss how staff empowerment contributes to a culture … Communication
· Video 3.3: Positive Reinforcement
· Video 3.4: Collaborative Trust and Confidence
· Video 3.5: Just … Culture and Open Communication
Barriers to Staff Empowerment
· Slide 26
Key Concepts Review
· Slide … Teamwork and Support, Open Communication, Positive Reinforcement, Collaborative Trust and Confidence, A Just … , Open Communication video, Positive Reinforcement video, Collaborative Trust and Confidence video, Just
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www.ahrq.gov/hai/cauti-tools/archived-webinars/preventing-cauti-specialized-populations-icu.html
December 01, 2017 - to the urinary catheter culture. … And it's really a set of values and beliefs that guide actions and decisions. … What are the values and the beliefs of your unit about urinary catheters and how does that guide actions … what are the values and beliefs about the indications, about insertion and maintenance, and about removal … And again, that way we can change the values and beliefs about urinary catheters that guides our actions
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/preventing-cauti-icu-transcript.doc
May 13, 2014 - to the urinary catheter culture. … And it’s really a set of values and beliefs that guide actions and decisions. … What are the values and the beliefs of your unit about urinary catheters and how does that guide actions … what are the values and beliefs about the indications, about insertion and maintenance, and about removal … And again, that way we can change the values and beliefs about urinary catheters that guides our actions
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/learn/faclearncusp.docx
January 01, 2009 - Introduce Just Culture principles,
2. Learn how Just Culture principles can augment CUSP, and
3. … A Just Culture learning environment allows the review of both system design and the employee’s choice … David Marx developed the Just Culture framework based on risk management concepts from high-reliability … Shared responsibility is the norm in a Just Culture, and a commitment to eliminating the possibility … of error is widespread within a Just Culture.
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/action-planning-webcast-transcript.pdf
June 01, 2019 - Just briefly mention relative to our conversation today about
patient safety culture that topic has … Just a little bit more detail, I mentioned that the Steering Committee is
focused on culture and along … with culture, leadership, so it relates to the last question that Naomi just answered
about leadership … I think the committee has recognized culture and leaderships' responsibility for setting
the right culture … Again, one is leadership and culture. The second is also represented within culture.
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www.ahrq.gov/hai/cusp/modules/apply/index.html
July 01, 2018 - Apply CUSP
The Apply CUSP module of the CUSP Toolkit introduces Just Culture principles, which … Accessible Version )
Team Check-up Tool [ - 227.5 KB] ( Accessible Version )
Video
Understand Just … Culture (YouTube video, 5 min., 32 sec.)
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www.ahrq.gov/patient-safety/settings/hospital/candor/grand-rounds.html
August 01, 2022 - Culture. … Just Culture principles are a crucial accompaniment to the CANDOR process framework and will spark the … If a Just Culture is so important to an organization’s culture, why do we still focus on blame? … In a Just Culture, not only is shared responsibility the norm, but a commitment to eliminating harm resulting … from error is widespread within the culture.
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/medoffice-resourcelist.pdf
April 01, 2023 - Just Culture
a. … provides links to ways to engage and teach a Just Culture, execute a Just
Culture, and evaluate a Just … Nursing 2015 Just Culture Toolkit
https://nursing2015.wordpress.com/blue-team/blue-team-documents/just-culture-tool-kit … -
building/
This website provides a definition of Just Culture, presentations on Just Culture, a … Just Culture
5. Living a Culture of Patient Safety Policy and Brochure
6.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/learn/learncusp.pptx
April 01, 2011 - Culture, and others to provide complete tools to support units in improving culture
11
11
Toolkit … care
Ambiguous orders or directions
Change in team members
Work load
26
26
Apply CUSP
Introduce Just … Culture principles
Learn how Just Culture principles can augment CUSP
Review key steps of the CUSP Toolkit … A Just Culture system6
Holds itself accountable
Holds staff members accountable
Has staff members that … Just Culture. Plano, TX: Outcome Engineering; 2011.
Pronovost P, Goeschel C, Colantuoni E, et al.
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www.ahrq.gov/sites/default/files/2024-04/etchegaray-report.pdf
January 01, 2024 - but many smaller leader/professional driven cultures. … the negatively worded questions is shifting the focus of the
nonpunitive response to error over to a just … • Complex adaptive systems: We need to consider that measures do not just function
as measures; they … data, how to get it back to the
community, and how to follow up on it with the goal being to avoid
just … o Qualitative methods can yield more than just the surveys in terms of
feedback and can be an intervention