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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/guide-appcusp.pdf
    December 01, 2017 - ........................................................................................ 5 Step 4: Learning … —Safety Team Leader Step 4: Learning From Defects Through Collective Sensemaking Once defects are … We recommend learning from at least one defect a quarter. … We went through the Learning From Defects Through Sensemaking process at our next monthly meeting. … You will find a real-time identification of defects and real-time system of learning.
  2. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/assemble/assemble-the-team.pptx
    May 01, 2017 - Team and Engage Leadership for Perinatal Safety AHRQ Publication No. 17-0003-2-EF May 2017 1 Learning … Pillars Balanced Scorecard American Organization of Nurse Executives Nurse Manager Leadership Partnership Learning … members feel that their environment supports the interpersonal risk involved in asking for help or learning … Invite input from all team members Encourage team members to contribute Promote active listening and learning … Managing the Risk of Learning: Psychological Safety in Work Teams. In West M, ed. 
  3. www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-massachusetts-state-snapshot.pdf
    January 01, 2018 - Through a learning collaborative, the State educated the practices on the medical home model and provided … Practices each received $1,150 per month to support their work in the learning collaborative. … are CHIPRA demonstration States ap- proaching practice-level quality measurement and what are they learning … • Evaluation Highlight No. 13: How did CHIPRA quality demonstration States employ learning collaboratives … of core measures for families and providers, findings from the patient experience survey, and the learning
  4. www.ahrq.gov/ncepcr/research-transform-primary-care/transform/final-impact/spread.html
    October 01, 2015 - New Mexico did not seek to replicate its own structure in the partner States, but instead created a learning … Shared learning from the New Mexico program continues to build, and additional States, including Michigan … The creation of the learning community emerged as a result of in-person meetings among all four States … individual and group technical assistance from North Carolina faculty and experts and peer-to-peer learning … Maryland Maryland built its program on the Maryland Learning Collaborative, which provided practice
  5. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module7/module7-resolution-facilitator.pptx
    August 24, 2015 - Creating a learning organization in which patient harm is reduced through ongoing learning from patient … Creating a learning organization is one of the most important outcomes in the CANDOR process. … Becoming a learning organization supports the goal of preventing similar harm to patients in the future … More information on supporting staff and creating a learning organization will be presented in the remaining … Resolution of an event presents an opportunity for organizational learning and sustainment of change,
  6. www.ahrq.gov/ncepcr/reports/grants-impact/spreading-model.html
    February 01, 2017 - New Mexico did not seek to replicate its own structure in the partner States, but instead created a learning … Shared learning from the New Mexico program continues to build, and additional States, including Michigan … The creation of the learning community emerged as a result of in-person meetings among all four States … individual and group technical assistance from North Carolina faculty and experts and peer-to-peer learning … Maryland Maryland built its program on the Maryland Learning Collaborative, which provided practice
  7. www.ahrq.gov/faqs/index.html?page=1
    June 12, 2025 - Frequently Asked Questions Check to find the answers to your questions about the Agency for Healthcare Research and Quality (AHRQ) programs and activities. You can search by category or key words. You can also send us your questions or website feedback here. We will respond to your requests based on the bes…
  8. www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-moving-forward-hays-slides.pdf
    October 01, 2017 - CAHPS® Moving Forward: Innovations in Tools and Research Webcast Advancing the Science of Patient Experience Assessment Ron Hays, Ph.D. University Of California – Los Angeles and RAND Health Program www.ahrq.gov/cahps CAHPS Family of Surveys Facility Surveys Hospital (HCAHPS) In-Center Hemodialysis Nursing Hom…
  9. www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/data-tools-webcast-2022-sangria.pdf
    January 01, 2022 - Useful Online Tools for CAHPS Survey Users - FISHER-SANGRIA AHRQ Data Tools & CAHPS Data Reporting Sylvia Fisher & Daniel Sangria AHRQ & Westat CAHPS User Network Explore the AHRQ Data Tools Medical Coverage and Expenditures The Medical Expenditure Panel Survey (MEPS) helps researchers and the public exp lo…
  10. www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/observation-comp-kit.html
    June 01, 2017 - Standard Work Observation Component Kit Contents 1. Why Standard Work Observation?          Connections to Other Components 2. Tips 3. Plan-Do-Study-Act Sequence: Observe Checklist Use Regularly 4. Example          Using the Observations 1. Why Standard Work Observation? As you’ve adapted a surgi…
  11. www.ahrq.gov/news/newsletters/e-newsletter/948.html
    March 01, 2025 - Use of Copper-Infused Surfaces Reduces Clostridioides difficile Spores Issue Number 948 AHRQ News Now is a weekly newsletter that highlights agency research and program activities. March 4, 2025 AHRQ Stats: Insurance Types Associated With Transportation Issues In 2021, 7.9 percent of adults on Medicare …
  12. www.ahrq.gov/sdoh/data-analytics.html
    July 01, 2022 - SDOH Data and Analytics Datasets and analytic tools that can power understanding of SDOH Datasets | Analytic Tools AHRQ Datasets AHRQ has extensive data resources that can be used today by researchers to study the relationships between health, SDOH, and healthcare. Social Determinants of Health Data…
  13. www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/57-senior-executives-facilitator.docx
    June 01, 2023 - AHRQ Safety Program for Improving Surgical Care and Recovery Facilitator Guide for Engaging Senior Executives Presentation Template Slide Title and Commentary Slide Number and Slide Engaging the Senior Executive Presentation Template Title slide for the tool – delete this slide from the presentation to your seni…
  14. 2-Overview-Guide (doc file)

    www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/2-overview-guide.docx
    June 01, 2023 - Program Overview This guide provides a high-level overview of the entire Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Surgical Care and Recovery (ISCR) and toolkit. In addition to this guide, consider reviewing the ISCR overview presentation and facilitator guide to learn about ISCR…
  15. www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/item-sets/CG/health-literacy-cg-cahps-adult-spanish-2357-3b.pdf
    June 02, 2025 - Supplemental Health Literacy Items for the CAHPS Clinician & Group Survey 12/1/2017 Page 1 Document No. 2357-3b www.ahrq.gov/cahps Supplemental Items for the CAHPS® Clinician & Group Survey 3.0 Topic: Health Literacy Population Version: Adult Language: Spanish Users of the CAHPS® Clinician & G…
  16. www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/cg/adult-eng-cg40-3351a.pdf
    October 30, 2020 - CAHPS Clinician & Group Adult Visit Survey 4.0 (beta) CAHPS Clinician & Group Survey Version: Adult Visit Survey 4.0 (beta) Language: English Notes • Purpose of Visit Survey 4.0 (beta): This new version of the Clinician & Group Survey asks patients about their experiences with care at their most recent visit…
  17. www.ahrq.gov/hai/tools/cauti-hospitals/toolkit-impl.html
    October 01, 2020 - Implementation Toolkit for Reducing CAUTI in Hospitals The Implementation module of the Toolkit for Reducing CAUTI in Hospitals discusses the importance of a comprehensive, unit-based approach to safety and its impact on improving patient care. It takes users step by step through execution of clinical and cul…
  18. www.ahrq.gov/ncepcr/reports/2024-annual-report/recent-grants-public-health.html
    May 01, 2024 - Investments in Primary Care Research for 2021 and 2022 Public Health and Community Integration Previous Page Next Page Table of Contents Investments in Primary Care Research for 2021 and 2022 Acknowledgments and Authors Message from the Acting Director of AHRQ's National Center for Excellence in…
  19. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/physician-checklist.docx
    January 01, 2017 - Foster organizational learning and actively participate in the process of learning from defects 17
  20. www.ahrq.gov/hai/cauti-tools/archived-webinars/cauti-sustainability-slides.html
    December 01, 2017 - Slide 2 Learning Objectives Describe how to use data to change culture and sustain goals. … Slide 13   Lessons Learned = Sustaining the Gain Treat a “CAUTI with respect – Learning from … Slide 22 The PDSA Cycle for Learning and Improvement Image: The PDSA Cycle. … It is the result of preparation, hard work, and learning from failure.” General Colin L. … One is titled "Mindfully Learning from Defects" and the other "Learning from Defects Fast Facts".

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