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Showing results for "learned".

  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36377/psn-pdf
    October 28, 2010 - Healthcare: The Problems Are Organizational Not Clinical. October 28, 2010 J Org Behavior. 2006;27(7):809-1029. https://psnet.ahrq.gov/issue/healthcare-problems-are-organizational-not-clinical This special issue looks at the organizational challenges to high quality and safe health care such as how errors are hand…

  2. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/74275/psn-pdf
    December 06, 2023 - Spotlight Series December 6, 2023 Healthcare Excellence Canada. 2020-2024. https://psnet.ahrq.gov/issue/all-one-and-one-all-how-patient-safety-starts-healthcare-workers This quarterly webinar series focuses on a variety of topics that support patient safety and quality improvement such as learning from event revie…

  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/43314/psn-pdf
    August 15, 2018 - ISQua Fellowship Programme. August 15, 2018 International Society for Quality in Health Care. https://psnet.ahrq.gov/issue/isqua-fellowship-programme This announcement highlights a peer learning initiative that builds on existing programs and interdisciplinary networks to develop participants' understanding about …

  4. Artificial Intelligence: System-Level Considerations | PSNet

    psnet.ahrq.gov/curated-library/artificial-intelligence-system-level-considerations
    March 27, 2024 - Breadcrumb Home The PSNet Collection Curated Libraries Subscribed Artificial Intelligence: System-Level Considerations  Download  Share Facebook Twitter Linkedin Copy URL Subscribe Created By: Lorri Zipper…

  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40378/psn-pdf
    June 01, 2024 - Organisation Patient Safety Incident Reports. May 18, 2018 National Patient Safety Agency https://psnet.ahrq.gov/issue/organisation-patient-safety-incident-reports This Web site provides data on safety incidents from the United Kingdom in the form of workbooks sorted by either organization or region. In June 2024,…

  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38447/psn-pdf
    March 04, 2010 - Never Events--Framework 2010-11. March 4, 2010 National Patient Safety Agency. London, UK: National Reporting and Learning Service; 2010. https://psnet.ahrq.gov/issue/never-events-framework-200910 This report from the United Kingdom is intended to guide Primary Care Trusts in implementing never events policies for…

  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34579/psn-pdf
    August 20, 2012 - Edgeware: Insights from Complexity Science for Health Care Leaders. Second ed. August 20, 2012 Zimmerman B, Lindberg C, Plsek P. Irving, TX: VHA Incorporated; 2008. ISBN: 9780966782806 https://psnet.ahrq.gov/issue/edgeware-insights-complexity-science-health-care-leaders A workbook that presents a series of self-le…

  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38250/psn-pdf
    June 10, 2018 - Using external errors to signal a clear and present danger. June 10, 2018 ISMP Medication Safety Alert! Acute Care Edition. November 6, 2008;13:1-2. https://psnet.ahrq.gov/issue/using-external-errors-signal-clear-and-present-danger This article addresses the biases inherent when hearing reports of errors at other …

  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35474/psn-pdf
    September 21, 2009 - Is consent required for publication of medical errors? September 21, 2009 Weisbaum K, Hyland S, Bernstein M. Is consent required for publication of medical errors? Healthc Q. 2005;8(4):66-9. https://psnet.ahrq.gov/issue/consent-required-publication-medical-errors The authors argue that, under certain conditions, p…

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/40989/psn-pdf
    December 07, 2011 - The criminalization of mistakes in nursing. December 7, 2011 Philipsen NC. The Criminalization of Mistakes in Nursing. J Nurs Pract. 2011;7(9):719-726. doi:10.1016/j.nurpra.2011.07.004. https://psnet.ahrq.gov/issue/criminalization-mistakes-nursing This commentary describes how treating medical mistakes in a puniti…

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/35007/psn-pdf
    May 22, 2009 - Peripheral vision: expertise in real world contexts. May 22, 2009 Dreyfus HL, Dreyfus SE. Peripheral Vision. Organization Studies. 2005;26(5). doi:10.1177/0170840605053102. https://psnet.ahrq.gov/issue/peripheral-vision-expertise-real-world-contexts The authors describe a five-stage model of acquiring expertise an…

  12. High Reliability Organization (HRO) Principles and Patient Safety | PSNet

    psnet.ahrq.gov/perspective/high-reliability-organization-hro-principles-and-patient-safety
    February 26, 2025 - We have learned that there might be underexplored sources of reliability. … I recently learned of a nursing unit that has embedded sensitivity to operations in an interesting way

  13. In Conversation with Timothy Vogus about High Reliability Organization (HRO) Principles and Patient Safety | PSNet

    psnet.ahrq.gov/perspective/conversation-timothy-vogus-about-high-reliability-organization-hro-principles-and
    February 26, 2025 - We have learned that there might be underexplored sources of reliability. … I recently learned of a nursing unit that has embedded sensitivity to operations in an interesting way

  14. Safety I, Safety II, and the New Views of Safety | PSNet

    psnet.ahrq.gov/primer/safety-i-safety-ii-and-new-views-safety
    October 02, 2024 - Safety I, Safety II, and the New Views of Safety Citation Text: Scanlon M, Jacobson N. Safety I, Safety II, and the New Views of Safety. PSNet [internet]. Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2025. Copy Citation Format: Google Scholar BibTeX E…

  15. The application of system dynamics modelling to system safety improvement: present use and future potential. | PSNet

    psnet.ahrq.gov/issue/application-system-dynamics-modelling-system-safety-improvement-present-use-and-future
    October 27, 2021 - Review Emerging Classic The application of system dynamics modelling to system safety improvement: present use and future potential. Citation Text: The application of system dynamics modelling to system safety improvement: present use and future potential. Ibrah…

  16. Investigating for improvement? Five strategies to ensure national patient safety investigations improve patient safety. | PSNet

    psnet.ahrq.gov/issue/investigating-improvement-five-strategies-ensure-national-patient-safety-investigations
    February 28, 2024 - Commentary Investigating for improvement? Five strategies to ensure national patient safety investigations improve patient safety. Citation Text: Macrae C. Investigating for improvement? Five strategies to ensure national patient safety investigations improve patient safety. J R Soc Med.…

  17. Retractions in the medical literature: how many patients are put at risk by flawed research? | PSNet

    psnet.ahrq.gov/issue/retractions-medical-literature-how-many-patients-are-put-risk-flawed-research
    August 31, 2011 - Study Retractions in the medical literature: how many patients are put at risk by flawed research? Citation Text: Steen G. Retractions in the medical literature: how many patients are put at risk by flawed research? J Med Ethics. 2011;37(11):688-92. doi:10.1136/jme.2011.043133. Copy …

  18. Evaluation of an interprofessional team training program to improve the use of patient safety strategies among healthcare professions students. | PSNet

    psnet.ahrq.gov/issue/evaluation-interprofessional-team-training-program-improve-use-patient-safety-strategies
    May 18, 2022 - Study Evaluation of an interprofessional team training program to improve the use of patient safety strategies among healthcare professions students. Citation Text: Evaluation of an interprofessional team training program to improve the use of patient safety strategies among healthcare p…

  19. Nursing accreditation system and patient safety. | PSNet

    psnet.ahrq.gov/issue/nursing-accreditation-system-and-patient-safety
    September 23, 2009 - Study Nursing accreditation system and patient safety. Citation Text: Teng C-I, Shyu Y-IL, Dai Y-T, et al. Nursing accreditation system and patient safety. J Nurs Manag. 2012;20(3):311-8. doi:10.1111/j.1365-2834.2011.01287.x. Copy Citation Format: DOI Google Scholar PubMe…

  20. How can the principles of complexity science be applied to improve the coordination of care for complex pediatric patients? | PSNet

    psnet.ahrq.gov/issue/how-can-principles-complexity-science-be-applied-improve-coordination-care-complex-pediatric
    October 19, 2022 - Commentary How can the principles of complexity science be applied to improve the coordination of care for complex pediatric patients? Citation Text: Matlow AG, Wright JG, Zimmerman B, et al. How can the principles of complexity science be applied to improve the coordination of care fo…
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