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psnet.ahrq.gov/issue/association-between-hospital-safety-culture-and-surgical-outcomes-statewide-surgical-quality
February 14, 2017 - Study
Association between hospital safety culture and surgical outcomes in a statewide surgical quality improvement collaborative.
Citation Text:
Odell DD, Quinn CM, Matulewicz RS, et al. Association Between Hospital Safety Culture and Surgical Outcomes in a Statewide Surgical Quality Im…
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psnet.ahrq.gov/issue/developing-and-implementing-standardized-process-global-trigger-tool-application-across-large
July 18, 2017 - Study
Developing and implementing a standardized process for Global Trigger Tool application across a large health system.
Citation Text:
Garrett PR, Sammer C, Nelson A, et al. Developing and implementing a standardized process for global trigger tool application across a large health …
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psnet.ahrq.gov/issue/does-clinical-supervision-health-professionals-improve-patient-safety-systematic-review-and
August 04, 2021 - Review
Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis.
Citation Text:
Snowdon DA, Hau R, Leggat SG, et al. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int…
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psnet.ahrq.gov/issue/medical-error-third-leading-cause-death-us
September 16, 2020 - Commentary
Medical error—the third leading cause of death in the US.
Citation Text:
Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139. doi:10.1136/bmj.i2139.
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Format:
DOI Google Scholar PubMed BibTeX EndNote X3 X…
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psnet.ahrq.gov/issue/safety-culture-operating-room-variability-among-perioperative-healthcare-workers
November 17, 2021 - Study
Safety culture in the operating room: variability among perioperative healthcare workers.
Citation Text:
Pimentel MPT, Choi S, Fiumara K, et al. Safety culture in the operating room: variability among perioperative healthcare workers. J Patient Saf. 2021;17(6):412-416. doi:10.1097/…
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psnet.ahrq.gov/issue/improving-patient-safety-governance-and-systems-through-learning-successes-and-failures
May 08, 2017 - Study
Improving patient safety governance and systems through learning from successes and failures: qualitative surveys and interviews with international experts.
Citation Text:
Hibbert PD, Stewart S, Wiles LK, et al. Improving patient safety governance and systems through learning from …
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psnet.ahrq.gov/issue/surgical-errors-happen-are-learners-trained-recover-them-survey-north-american-surgical
July 28, 2021 - Study
Surgical errors happen, but are learners trained to recover from them? A survey of North American surgical residents and fellows.
Citation Text:
Gabrysz-Forget F, Young M, Zahabi S, et al. Surgical errors happen, but are learners trained to recover from them? A survey of North Amer…
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psnet.ahrq.gov/node/60864/psn-pdf
August 31, 2020 - Safety Across The Board
August 31, 2020
Fitall E, Hall KK, Gale B. Safety Across The Board . PSNet [internet]. 2020.
https://psnet.ahrq.gov/perspective/safety-across-board
Defining Safety Across the Board
Safety Across The Board (SAB) is a concept originating from the Centers for Medicare & Medicaid Services
(CMS…
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www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/job-aid-joy-in-work.pdf
June 02, 2025 - Job Aid: Joy in Work
Primary Care Practice Facilitator
Training Series
1
Job Aid: Joy in Work
Joy in work is one of three categories of common goals practices
have for improvement. Joy in work is central to good patient
care and in recognition of this, the national triple aim has been
expanded to…
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psnet.ahrq.gov/issue/comparison-quality-measures-us-hospitals-physician-vs-nonphysician-chief-executive-officers
July 13, 2022 - Study
Comparison of quality measures from US hospitals with physician vs nonphysician chief executive officers.
Citation Text:
See H, Shreve L, Hartzell S, et al. Comparison of quality measures from US hospitals with physician vs nonphysician chief executive officers. JAMA Netw Open. 202…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-l.pdf
September 01, 2015 - AHRQ Safety Program for Reducing CAUTI in Hospitals - Appendix L. Intensive Care Unit Infographic Poster
AHRQ Safety Program for Reducing CAUTI in Hospitals
Appendix L. Intensive Care Unit Infographic Poster
…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Prologue_Henriksen_Vol1.pdf
June 02, 2025 - Prologue: Laying the Foundation
Prologue
Laying the Foundation
Kerm Henriksen, PhD
The volume starts with papers that look to the future and examine the past with respect to patient
safety; however, its overarching theme is assessment. An underlying premise to any volume that
focuses on assessment is tha…
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www.ahrq.gov/patient-safety/settings/hospital/fall-tips/index.html
February 01, 2021 - Fall TIPS: A Patient-Centered Fall Prevention Toolkit
This toolkit, developed through an AHRQ Patient Safety Learning Lab , consists of a formal risk assessment and tailored plan of care for each patient. The toolkit has reduced falls by 25 percent in acute care hospitals and is used in more than 100 hospitals…
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psnet.ahrq.gov/node/72720/psn-pdf
February 10, 2021 - Health system leaders' role in addressing racism: time to
prioritize eliminating health care disparities.
February 10, 2021
Austin JM, Weeks K, Pronovost PJ. Health System Leaders’ Role in Addressing Racism: Time to Prioritize
Eliminating Health Care Disparities. Jt Comm J Qual Patient Saf. 2020;47(4):265-267.
doi…
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psnet.ahrq.gov/node/73292/psn-pdf
May 19, 2021 - Redeployment of health care workers in the COVID-19
pandemic: a qualitative study of health system leaders'
strategies.
May 19, 2021
Panda N, Sinyard RD, Henrich N, et al. Redeployment of health care workers in the COVID-19 pandemic: a
qualitative study of health system leaders' strategies. J Patient Saf. 2021;17(…
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psnet.ahrq.gov/node/38425/psn-pdf
January 29, 2010 - Hospitalists as Emerging Leaders in Patient Safety:
lessons learned and future directions.
January 29, 2010
Flanders S, Kaufman SR, Saint S, et al. Hospitalists as emerging leaders in patient safety: lessons learned
and future directions. J Patient Saf. 2009;5(1):3-8. doi:10.1097/PTS.0b013e31819751f2.
https://psne…
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psnet.ahrq.gov/node/44604/psn-pdf
August 02, 2016 - Influencing the Quality, Risk and Safety Movement in
Healthcare: In Conversation with International Leaders.
August 2, 2016
Sears K, Stockley D, Broderick B, eds. Aldershot, UK: Ashgate Publishing; 2015. ISBN: 9781472449276.
https://psnet.ahrq.gov/issue/influencing-quality-risk-and-safety-movement-healthcare-conver…
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psnet.ahrq.gov/node/42007/psn-pdf
May 23, 2013 - Leaders' and followers' individual experiences during the
early phase of simulation-based team training: an
exploratory study.
May 23, 2013
Meurling L, Hedman L, Felländer-Tsai L, et al. Leaders' and followers' individual experiences during the
early phase of simulation-based team training: an exploratory study. B…
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psnet.ahrq.gov/node/40754/psn-pdf
September 07, 2011 - The partnership with patients: a call to action for leaders.
September 7, 2011
Denham CR. The partnership with patients: a call to action for leaders. J Patient Saf. 2011;7(3):113-121.
doi:10.1097/PTS.0b013e31822d6f2a.
https://psnet.ahrq.gov/issue/partnership-patients-call-action-leaders
This commentary discusses …
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psnet.ahrq.gov/node/38252/psn-pdf
November 26, 2008 - Hospital ethical climate and teamwork in acute care: the
moderating role of leaders.
November 26, 2008
Rathert C, Fleming DA. Hospital ethical climate and teamwork in acute care: the moderating role of
leaders. Health Care Manag Rev. 2008;33(4):323-331. doi:10.1097/01.HCM.0000318769.75018.8d.
https://psnet.ahrq.go…