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441. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40508/psn-pdf
     June 08, 2011 - Hassle in the dispensary: pilot study of a proactive risk monitoring tool for organisational learning … Hassle in the dispensary: pilot study of a proactive risk monitoring tool for organisational learning … /psnet.ahrq.gov/issue/hassle-dispensary-pilot-study-proactive-risk-monitoring-tool-organisational- learning-based … ://psnet.ahrq.gov/issue/hassle-dispensary-pilot-study-proactive-risk-monitoring-tool-organisational-learning-based … ://psnet.ahrq.gov/issue/hassle-dispensary-pilot-study-proactive-risk-monitoring-tool-organisational-learning-based

442. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47397/psn-pdf
     January 09, 2019 - Using patient safety reporting systems to understand the clinical learning environment: a content analysis … Using Patient Safety Reporting Systems to Understand the Clinical Learning Environment: A Content Analysis … https://psnet.ahrq.gov/issue/using-patient-safety-reporting-systems-understand-clinical-learning- environment-content … https://psnet.ahrq.gov/issue/using-patient-safety-reporting-systems-understand-clinical-learning-environment-content … https://psnet.ahrq.gov/issue/using-patient-safety-reporting-systems-understand-clinical-learning-environment-content

443. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43962/psn-pdf
     December 04, 2015 - Undergraduate baccalaureate nursing students' self- reported confidence in learning about patient safety … Undergraduate baccalaureate nursing students' self-reported confidence in learning about patient safety … https://psnet.ahrq.gov/issue/undergraduate-baccalaureate-nursing-students-self-reported-confidence- learning-about-patient … https://psnet.ahrq.gov/issue/undergraduate-baccalaureate-nursing-students-self-reported-confidence-learning-about-patient … https://psnet.ahrq.gov/issue/undergraduate-baccalaureate-nursing-students-self-reported-confidence-learning-about-patient

444. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46393/psn-pdf
     September 06, 2017 - The role of South--North partnerships in promoting shared learning and knowledge transfer. … The role of South-North partnerships in promoting shared learning and knowledge transfer. … https://psnet.ahrq.gov/issue/role-south-north-partnerships-promoting-shared-learning-and-knowledge- … https://psnet.ahrq.gov/issue/role-south-north-partnerships-promoting-shared-learning-and-knowledge-transfer … https://psnet.ahrq.gov/issue/role-south-north-partnerships-promoting-shared-learning-and-knowledge-transfer

445. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45645/psn-pdf
     November 16, 2016 - Simulated settings; powerful arenas for learning patient safety practices and facilitating transference … Simulated settings; powerful arenas for learning patient safety practices and facilitating transference … https://psnet.ahrq.gov/issue/simulated-settings-powerful-arenas-learning-patient-safety-practices-and … https://psnet.ahrq.gov/issue/simulated-settings-powerful-arenas-learning-patient-safety-practices-and-facilitating … https://psnet.ahrq.gov/issue/simulated-settings-powerful-arenas-learning-patient-safety-practices-and-facilitating

446. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44864/psn-pdf
     March 23, 2016 - Caught in the middle: a resident perspective on influences from the learning environment that perpetuate … Caught in the Middle: A Resident Perspective on Influences From the Learning Environment That Perpetuate … https://psnet.ahrq.gov/issue/caught-middle-resident-perspective-influences-learning-environment- perpetuate-mistreatment … https://psnet.ahrq.gov/issue/caught-middle-resident-perspective-influences-learning-environment-perpetuate-mistreatment … https://psnet.ahrq.gov/issue/caught-middle-resident-perspective-influences-learning-environment-perpetuate-mistreatment

447. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45850/psn-pdf
     July 02, 2017 - Learning from the design, development and implementation of the Medication Safety Thermometer. … Learning from the design, development and implementation of the Medication Safety Thermometer. … https://psnet.ahrq.gov/issue/learning-design-development-and-implementation-medication-safety- thermometer … https://psnet.ahrq.gov/issue/learning-design-development-and-implementation-medication-safety-thermometer … https://psnet.ahrq.gov/issue/learning-design-development-and-implementation-medication-safety-thermometer

448. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47380/psn-pdf
     September 05, 2018 - Operating management system for high reliability: leadership, accountability, learning and innovation … Operating management system for high reliability: Leadership, accountability, learning and innovation … https://psnet.ahrq.gov/issue/operating-management-system-high-reliability-leadership-accountability- learning-and … https://psnet.ahrq.gov/issue/operating-management-system-high-reliability-leadership-accountability-learning-and … https://psnet.ahrq.gov/issue/operating-management-system-high-reliability-leadership-accountability-learning-and

449. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47421/psn-pdf
     October 17, 2018 - The relationship between the learning and patient safety climates of clinical departments and residents … The Relationship Between the Learning and Patient Safety Climates of Clinical Departments and Residents … https://psnet.ahrq.gov/issue/relationship-between-learning-and-patient-safety-climates-clinical- departments-and-residents … https://psnet.ahrq.gov/issue/relationship-between-learning-and-patient-safety-climates-clinical-departments-and-residents … https://psnet.ahrq.gov/issue/relationship-between-learning-and-patient-safety-climates-clinical-departments-and-residents

450. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47636/psn-pdf
     December 12, 2018 - Learning from tragedy: the Julia Berg story. December 12, 2018 Graber ML, Berg D, Jerde W, et al. … Learning from tragedy: the Julia Berg story. … https://psnet.ahrq.gov/issue/learning-tragedy-julia-berg-story This commentary provides a clinical review … https://psnet.ahrq.gov/issue/learning-tragedy-julia-berg-story https://psnet.ahrq.gov/issue/clinical-diagnoses-and-autopsy-findings-discrepancies-critically-ill-patients … bias-eye-beholder-vignette-study-assess-recognition-cognitive-biases-clinical-case-workups https://psnet.ahrq.gov/issue/learning-patients-experiences-related-diagnostic-errors-essential-progress-patient-safety

451. (Mis)understanding safety culture and its relationship to safety management. | PSNet
     psnet.ahrq.gov/issue/misunderstanding-safety-culture-and-its-relationship-safety-management
     May 10, 2014 - A review of the safety literature to define learning from incidents, accidents and disasters. … April 21, 2021 Enabling a learning healthcare system with automated computer protocols … February 8, 2023 Positive approaches to safety: learning from what we do well. … February 18, 2017 Learning from failure: the need for independent safety investigation … October 7, 2015 A collaborative learning network approach to improvement: the CUSP learning

452. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/35242/psn-pdf
     February 24, 2011 - Learning from patient-reported incidents. … Learning from patient-reported incidents. J Gen Intern Med. 2005;20(9):830-6. … https://psnet.ahrq.gov/issue/what-can-hospitalized-patients-tell-us-about-adverse-events-learning-patient … https://psnet.ahrq.gov/issue/what-can-hospitalized-patients-tell-us-about-adverse-events-learning-patient-reported … https://psnet.ahrq.gov/issue/what-can-hospitalized-patients-tell-us-about-adverse-events-learning-patient-reported

453. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47143/psn-pdf
     January 30, 2019 - E-learning on risk management. … E-learning on risk management. … https://psnet.ahrq.gov/issue/e-learning-risk-management-opportunity-sharing-knowledge-and-experiences … https://psnet.ahrq.gov/issue/e-learning-risk-management-opportunity-sharing-knowledge-and-experiences-patient-safety … https://psnet.ahrq.gov/issue/e-learning-risk-management-opportunity-sharing-knowledge-and-experiences-patient-safety

454. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44761/psn-pdf
     January 06, 2016 - Two fatal cases of accidental intrathecal vincristine administration: learning from death events. … Two fatal cases of accidental intrathecal vincristine administration: learning from death event. … https://psnet.ahrq.gov/issue/two-fatal-cases-accidental-intrathecal-vincristine-administration-learning-death … https://psnet.ahrq.gov/issue/two-fatal-cases-accidental-intrathecal-vincristine-administration-learning-death-events … https://psnet.ahrq.gov/issue/two-fatal-cases-accidental-intrathecal-vincristine-administration-learning-death-events

455. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44089/psn-pdf
     April 22, 2015 - Learning from mistakes and near mistakes: using root cause analysis as a risk management tool. … Learning From Mistakes and Near Mistakes: Using Root Cause Analysis as a Risk Management Tool. … https://psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk- management-tool … https://psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk-management-tool … https://psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk-management-tool

456. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47537/psn-pdf
     November 14, 2018 - Developing a learning health system: insights from a qualitative process evaluation of a pharmacist-led … Developing a learning health system: Insights from a qualitative process evaluation of a pharmacist-led … https://psnet.ahrq.gov/issue/developing-learning-health-system-insights-qualitative-process-evaluation … https://psnet.ahrq.gov/issue/developing-learning-health-system-insights-qualitative-process-evaluation-pharmacist-led … https://psnet.ahrq.gov/issue/developing-learning-health-system-insights-qualitative-process-evaluation-pharmacist-led

457. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45576/psn-pdf
     July 02, 2017 - Peer feedback, learning, and improvement: answering the call of the Institute of Medicine report on … Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report on … https://psnet.ahrq.gov/issue/peer-feedback-learning-and-improvement-answering-call-institute-medicine … https://psnet.ahrq.gov/issue/peer-feedback-learning-and-improvement-answering-call-institute-medicine-report-diagnostic … https://psnet.ahrq.gov/issue/peer-feedback-learning-and-improvement-answering-call-institute-medicine-report-diagnostic

458. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44483/psn-pdf
     September 09, 2015 - Learning Not Blaming. September 9, 2015 Department of Health and Social Care. … https://psnet.ahrq.gov/issue/learning-not-blaming The National Health Service (NHS) has a history of … recommendations in the three reports included the need to support open discussions about what went wrong, learning … https://psnet.ahrq.gov/issue/learning-not-blaming https://psnet.ahrq.gov/issue/organisation-memory-report-expert-group-learning-adverse-events-nhs-chaired-chief-medical

459. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39590/psn-pdf
     June 09, 2010 - Learning from the best. June 9, 2010 Grantham D. Learning from the best. … https://psnet.ahrq.gov/issue/learning-best This news article highlights an award-winning addiction treatment … https://psnet.ahrq.gov/issue/learning-best

460. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44616/psn-pdf
     November 04, 2015 - Development of "SWARM" as a model for high reliability, rapid problem solving, and institutional learning … Development of "SWARM" as a Model for High Reliability, Rapid Problem Solving, and Institutional Learning … psnet.ahrq.gov/issue/development-swarm-model-high-reliability-rapid-problem-solving-and- institutional-learning … psnet.ahrq.gov/issue/development-swarm-model-high-reliability-rapid-problem-solving-and-institutional-learning … psnet.ahrq.gov/issue/development-swarm-model-high-reliability-rapid-problem-solving-and-institutional-learning