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psnet.ahrq.gov/node/47106/psn-pdf
August 15, 2018 - Imitating incidents: how simulation can improve safety
investigation and learning from adverse events … Imitating Incidents: How Simulation Can Improve Safety Investigation and Learning From
Adverse Events … https://psnet.ahrq.gov/issue/imitating-incidents-how-simulation-can-improve-safety-investigation-and-
learning-adverse … strategies to integrate simulation into care routines to optimize cross-functional organizational learning … https://psnet.ahrq.gov/issue/imitating-incidents-how-simulation-can-improve-safety-investigation-and-learning-adverse
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psnet.ahrq.gov/node/38000/psn-pdf
August 03, 2009 - The competitive imperative of learning.
August 3, 2009
Edmondson A. … The competitive imperative of learning. Harv Bus Rev. 2008;86(7-8):60-7, 160. … https://psnet.ahrq.gov/issue/competitive-imperative-learning
This article draws on experience analyzing … team behavior in hospitals to discuss how learning processes
can help organizations execute tasks effectively … https://psnet.ahrq.gov/issue/competitive-imperative-learning
https://psnet.ahrq.gov/issue/learning-mistakes-easier-said-done-group-and-organizational-influences-detection-and
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psnet.ahrq.gov/node/46467/psn-pdf
October 18, 2017 - The Role of Clinical Learning Environments in Preparing
New Clinicians to Engage in Patient Safety. … Disch J, Kilo CM, Passiment M, Wagner R, Weiss KB; National Collaborative for Improving the Clinical
Learning … https://psnet.ahrq.gov/issue/role-clinical-learning-environments-preparing-new-clinicians-engage-patient … -
safety
Incorporating patient safety in education and learning environments can augment physician … https://psnet.ahrq.gov/issue/role-clinical-learning-environments-preparing-new-clinicians-engage-patient-safety
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psnet.ahrq.gov/node/47479/psn-pdf
December 12, 2018 - "Closing the loop": a mixed-methods study about
resident learning from outcome feedback after patient … "Closing the loop": a mixed-methods study about resident learning
from outcome feedback after patient … https://psnet.ahrq.gov/issue/closing-loop-mixed-methods-study-about-resident-learning-outcome-feedback … after-patient
Seeking feedback on patient outcomes after a patient handoff takes place may provide useful learning … identified both a lack of time and inadequate systems for tracking patients as
significant barriers to learning
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psnet.ahrq.gov/node/44043/psn-pdf
September 20, 2017 - Incident learning in pursuit of high reliability:
implementing a comprehensive, low-threshold reporting … Incident learning in pursuit of high reliability: implementing a
comprehensive, low-threshold reporting … https://psnet.ahrq.gov/issue/incident-learning-pursuit-high-reliability-implementing-comprehensive-low … -
threshold-reporting
This study describes the experience of an incident learning program in a radiation … https://psnet.ahrq.gov/issue/radiation-oncology-incident-learning-system
https://psnet.ahrq.gov/issue
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psnet.ahrq.gov/node/46844/psn-pdf
March 07, 2018 - Learning collaboratives: insights and a new taxonomy
from AHRQ's two decades of experience. … Learning Collaboratives: Insights And A New Taxonomy From
AHRQ's Two Decades Of Experience. … https://psnet.ahrq.gov/issue/learning-collaboratives-insights-and-new-taxonomy-ahrqs-two-decades-
experience … Learning collaboratives are multimodal interventions that are often used to implement evidence-based … The authors suggest
that efforts to evaluate learning collaboratives or quality improvement interventions
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psnet.ahrq.gov/node/45627/psn-pdf
April 26, 2017 - Imperfect practice makes perfect: error management
training improves transfer of learning. … Imperfect practice makes perfect: error management training improves
transfer of learning. … psnet.ahrq.gov/issue/imperfect-practice-makes-perfect-error-management-training-improves-
transfer-learning … //psnet.ahrq.gov/issue/imperfect-practice-makes-perfect-error-management-training-improves-transfer-learning … //psnet.ahrq.gov/issue/imperfect-practice-makes-perfect-error-management-training-improves-transfer-learning
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.272_slideshow.ppt
July 01, 2012 - Simulation-based education with mastery learning improves residents' lumbar puncture skills. … Simulation-based education with mastery learning improves paracentesis skills. … Mastery Learning: Theory and Practice. New York, NY: Holt, Rinehart, and Winston; 1971. … (SBML) uses simulation with the mastery learning model
*
*
Simulation-Based Mastery Learning … Simulation-based education with mastery learning improves paracentesis skills.
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psnet.ahrq.gov/node/35934/psn-pdf
February 24, 2011 - Learning from mistakes: factors that influence how
students and residents learn from medical errors. … Learning from mistakes. … https://psnet.ahrq.gov/issue/learning-mistakes-factors-influence-how-students-and-residents-learn-medical … nearly 60 structured interviews with medical trainees and
categorized the factors that influenced their learning … The authors
discuss recommendations and specific educational methods that may promote improved learning
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psnet.ahrq.gov/node/37557/psn-pdf
February 27, 2008 - Learning from patient safety incidents: creating
participative risk regulation in healthcare. … Learning from patient safety incidents: Creating participative risk regulation in healthcare. … https://psnet.ahrq.gov/issue/learning-patient-safety-incidents-creating-participative-risk-regulation … commentary addresses the importance of involving front-line personnel in patient safety reporting and
learning … https://psnet.ahrq.gov/issue/learning-patient-safety-incidents-creating-participative-risk-regulation-healthcare
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psnet.ahrq.gov/node/43003/psn-pdf
March 05, 2014 - Learning from every death.
March 5, 2014
Huddleston JM, Diedrich DA, Kinsey GC, et al. … Learning from every death. J Patient Saf. 2014;10(1):6-12.
doi:10.1097/PTS.0000000000000053. … https://psnet.ahrq.gov/issue/learning-every-death
This commentary describes how design and implementation … The reporting program offers insights about how to promote and enhance
organizational learning. … https://psnet.ahrq.gov/issue/organizational-learning-health-care-leaders-need-design-structures-and-processes-enhance
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psnet.ahrq.gov/node/39444/psn-pdf
June 28, 2010 - The relationship between organizational leadership for
safety and learning from patient safety events … The relationship between organizational leadership for safety
and learning from patient safety events … https://psnet.ahrq.gov/issue/relationship-between-organizational-leadership-safety-and-learning-patient … This Canadian study sought to quantify the
relationship between leadership and organizational learning … https://psnet.ahrq.gov/issue/relationship-between-organizational-leadership-safety-and-learning-patient-safety-events
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psnet.ahrq.gov/node/40119/psn-pdf
January 05, 2011 - Effects of learning climate and registered nurse staffing
on medication errors. … Effects of Learning Climate and Registered Nurse Staffing on Medication Errors. … https://psnet.ahrq.gov/issue/effects-learning-climate-and-registered-nurse-staffing-medication-errors … The learning climate (a component of safety culture that
measures communication between providers) was … https://psnet.ahrq.gov/issue/effects-learning-climate-and-registered-nurse-staffing-medication-errors
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psnet.ahrq.gov/node/42535/psn-pdf
October 16, 2013 - Implementing an interprofessional patient safety learning
initiative: insights from participants, project … Implementing an interprofessional patient safety learning initiative:
insights from participants, project … https://psnet.ahrq.gov/issue/implementing-interprofessional-patient-safety-learning-initiative-insights … prominent
strategy was stakeholder ownership of a patient safety issue in a supportive interprofessional learning … https://psnet.ahrq.gov/issue/implementing-interprofessional-patient-safety-learning-initiative-insights-participants
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psnet.ahrq.gov/node/43218/psn-pdf
July 28, 2014 - Risk management—learning from the mistakes of others.
July 28, 2014
Meydan C. … Risk management--learning from the mistakes of others. J Eval Clin Pract. 2014;20(4):505-7. … https://psnet.ahrq.gov/issue/risk-management-learning-mistakes-others
This commentary introduces a structured … for case review to help medical students learn risk
management strategies and promote organizational learning … psnet.ahrq.gov/issue/principles-risk-management-and-patient-safety
https://psnet.ahrq.gov/issue/yours-learning-organization
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psnet.ahrq.gov/node/45058/psn-pdf
February 18, 2017 - Learning from incidents in healthcare: the journey, not
the arrival, matters. … Learning from incidents in healthcare: the journey, not the arrival,
matters. … https://psnet.ahrq.gov/issue/learning-incidents-healthcare-journey-not-arrival-matters
Experiences from … This
commentary describes the Dutch national reporting system effort to encourage individual hospital learning … https://psnet.ahrq.gov/issue/learning-incidents-healthcare-journey-not-arrival-matters
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/40177/psn-pdf
June 08, 2011 - Learning from disasters to improve patient safety:
applying the generic disaster pathway to health system … Learning from disasters to improve patient safety: applying the
generic disaster pathway to health system … https://psnet.ahrq.gov/issue/learning-disasters-improve-patient-safety-applying-generic-disaster-pathway … https://psnet.ahrq.gov/issue/learning-disasters-improve-patient-safety-applying-generic-disaster-pathway-health-system … https://psnet.ahrq.gov/issue/bad-stars-or-guiding-lights-learning-disasters-improve-patient-safety
https
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psnet.ahrq.gov/node/45502/psn-pdf
March 01, 2017 - Screening electronic health record–related patient safety
reports using machine learning. … Screening Electronic Health Record–Related Patient Safety Reports
Using Machine Learning. … psnet.ahrq.gov/issue/screening-electronic-health-record-related-patient-safety-reports-using-
machine-learning … This study described the development of a machine learning
algorithm to analyze free-text data in incident … psnet.ahrq.gov/issue/screening-electronic-health-record-related-patient-safety-reports-using-machine-learning
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psnet.ahrq.gov/node/44584/psn-pdf
March 15, 2016 - Barriers to implementing a reporting and learning patient
safety system: pediatric chiropractic perspective … Barriers to Implementing a Reporting and Learning Patient Safety
System: Pediatric Chiropractic Perspective … https://psnet.ahrq.gov/issue/barriers-implementing-reporting-and-learning-patient-safety-system-pediatric … about patients' responses
were the most common barriers to participating in voluntary reporting and learning … https://psnet.ahrq.gov/issue/barriers-implementing-reporting-and-learning-patient-safety-system-pediatric-chiropractic
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psnet.ahrq.gov/node/44738/psn-pdf
May 21, 2016 - Thinking About Learning for
Improvement in Health Care.
May 21, 2016
Lucas B, Nacer H. … https://psnet.ahrq.gov/issue/habits-improver-thinking-about-learning-improvement-health-care
Committed … lasting improvements in response to the Francis inquiry, this report
discusses a model that focuses on learning … https://psnet.ahrq.gov/issue/habits-improver-thinking-about-learning-improvement-health-care
https:// … https://psnet.ahrq.gov/issue/fifth-discipline-art-practice-learning-organization-revised-updated-edition