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461. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34669/psn-pdf
     June 26, 2015 - Learning from mistakes is easier said than done: group and organizational influences on the detection … Learning from Mistakes is Easier Said Than Done: Group and Organizational Influences on the Detection … https://psnet.ahrq.gov/issue/learning-mistakes-easier-said-done-group-and-organizational-influences- … organization must design and nurture work environments that encourage error reporting and fostering learning … https://psnet.ahrq.gov/issue/learning-mistakes-easier-said-done-group-and-organizational-influences-detection-and

462. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39802/psn-pdf
     November 16, 2010 - "Water cooler" learning: knowledge sharing at the clinical "backstage" and its contribution to patient … "Water cooler" learning: knowledge sharing at the clinical "backstage" and its contribution to patient … https://psnet.ahrq.gov/issue/water-cooler-learning-knowledge-sharing-clinical-backstage-and-its- contribution-patient … the forefront, leaving many “water cooler” conversations as a lost opportunity for organizational learning … https://psnet.ahrq.gov/issue/water-cooler-learning-knowledge-sharing-clinical-backstage-and-its-contribution-patient

463. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/44889/psn-pdf
     April 13, 2017 - An organizational learning framework for patient safety. April 13, 2017 Edwards MT. … An Organizational Learning Framework for Patient Safety. … https://psnet.ahrq.gov/issue/organizational-learning-framework-patient-safety Organizations are encouraged … https://psnet.ahrq.gov/issue/organizational-learning-framework-patient-safety https://psnet.ahrq.gov/ … issue/strategies-learning-failure https://psnet.ahrq.gov/issue/quest-eliminate-intrathecal-vincristine-errors

464. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43431/psn-pdf
     August 27, 2014 - After Mid Staffordshire: from acknowledgement, through learning, to improvement. … After Mid Staffordshire: from acknowledgement, through learning, to improvement. … https://psnet.ahrq.gov/issue/after-mid-staffordshire-acknowledgement-through-learning-improvement This … https://psnet.ahrq.gov/issue/after-mid-staffordshire-acknowledgement-through-learning-improvement https … report-mid-staffordshire-nhs-foundation-trust-public-inquiry https://psnet.ahrq.gov/issue/early-warnings-weak-signals-and-learning-healthcare-disasters

465. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/39623/psn-pdf
     June 23, 2010 - Safety learning system development--incident reporting component for family practice. … Safety learning system development--incident reporting component for family practice. … https://psnet.ahrq.gov/issue/safety-learning-system-development-incident-reporting-component-family- … https://psnet.ahrq.gov/issue/safety-learning-system-development-incident-reporting-component-family-practice … https://psnet.ahrq.gov/issue/safety-learning-system-development-incident-reporting-component-family-practice

466. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/36229/psn-pdf
     October 19, 2010 - Learning from mistakes in New Zealand hospitals: what else do we need besides "no-fault"? … Learning from mistakes in New Zealand hospitals: what else do we need besides "no-fault"? … https://psnet.ahrq.gov/issue/learning-mistakes-new-zealand-hospitals-what-else-do-we-need-besides-no- … https://psnet.ahrq.gov/issue/learning-mistakes-new-zealand-hospitals-what-else-do-we-need-besides-no-fault … https://psnet.ahrq.gov/issue/learning-mistakes-new-zealand-hospitals-what-else-do-we-need-besides-no-fault

467. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43677/psn-pdf
     November 19, 2014 - Reporting and Learning Systems for Medication Errors: The Role of Pharmacovigilance Centres. … https://psnet.ahrq.gov/issue/reporting-and-learning-systems-medication-errors-role-pharmacovigilance- … medication errors, this report provides information about incident reporting of medication errors and learning … https://psnet.ahrq.gov/issue/reporting-and-learning-systems-medication-errors-role-pharmacovigilance-centres … https://psnet.ahrq.gov/issue/reporting-and-learning-systems-medication-errors-role-pharmacovigilance-centres

468. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/37996/psn-pdf
     August 20, 2008 - "Every error counts": a web-based incident reporting and learning system for general practice. … "Every error counts": a web-based incident reporting and learning system for general practice. … https://psnet.ahrq.gov/issue/every-error-counts-web-based-incident-reporting-and-learning-system-general … https://psnet.ahrq.gov/issue/every-error-counts-web-based-incident-reporting-and-learning-system-general-practice … https://psnet.ahrq.gov/issue/every-error-counts-web-based-incident-reporting-and-learning-system-general-practice

469. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34599/psn-pdf
     January 30, 2008 - Organizational Learning from Experience in High-Hazard Industries: Problem Investigations as Off-line … Working Paper 4359-02 https://psnet.ahrq.gov/issue/organizational-learning-experience-high-hazard-industries-problem … This paper confronts two central issues for organizational learning from the prism of the chemical and … https://psnet.ahrq.gov/issue/organizational-learning-experience-high-hazard-industries-problem-investigations-line … https://psnet.ahrq.gov/issue/organizational-learning-experience-high-hazard-industries-problem-investigations-line

470. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/34765/psn-pdf
     January 04, 2017 - The Fifth Discipline: The Art & Practice of The Learning Organization. Revised & Updated Edition. … https://psnet.ahrq.gov/issue/fifth-discipline-art-practice-learning-organization-revised-updated-edition … Senge’s seminal and oft-referenced book outlines five competencies that support a learning organization … : systems thinking, personal mastery, mental models, building shared vision, and team learning. … https://psnet.ahrq.gov/issue/fifth-discipline-art-practice-learning-organization-revised-updated-edition

471. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45560/psn-pdf
     October 19, 2016 - Learning from excellence in healthcare: a new approach to incident reporting. … Learning from excellence in healthcare: a new approach to incident reporting. … https://psnet.ahrq.gov/issue/learning-excellence-healthcare-new-approach-incident-reporting Learning … https://psnet.ahrq.gov/issue/learning-excellence-healthcare-new-approach-incident-reporting https://psnet.ahrq.gov

472. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45612/psn-pdf
     November 09, 2016 - Pharmacist work stress and learning from quality related events. … Pharmacist work stress and learning from quality related events. … https://psnet.ahrq.gov/issue/pharmacist-work-stress-and-learning-quality-related-events High-quality … This survey of community pharmacists found that a blame-free culture promotes learning from error investigation … https://psnet.ahrq.gov/issue/pharmacist-work-stress-and-learning-quality-related-events https://psnet.ahrq.gov

473. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41424/psn-pdf
     June 27, 2012 - Practice-based learning and improvement: a two-year experience with the reporting of morbidity and mortality … Practice-based learning and improvement: a two-year experience with the reporting of morbidity and mortality … https://psnet.ahrq.gov/issue/practice-based-learning-and-improvement-two-year-experience-reporting- … https://psnet.ahrq.gov/issue/practice-based-learning-and-improvement-two-year-experience-reporting-morbidity-and-mortality … https://psnet.ahrq.gov/issue/practice-based-learning-and-improvement-two-year-experience-reporting-morbidity-and-mortality

474. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/40608/psn-pdf
     November 27, 2012 - Developing a 'critical' approach to patient and public involvement in patient safety in the NHS: learning … Developing a 'critical' approach to patient and public involvement in patient safety in the NHS: learning … psnet.ahrq.gov/issue/developing-critical-approach-patient-and-public-involvement-patient-safety- nhs-learning … psnet.ahrq.gov/issue/developing-critical-approach-patient-and-public-involvement-patient-safety-nhs-learning … psnet.ahrq.gov/issue/developing-critical-approach-patient-and-public-involvement-patient-safety-nhs-learning

475. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/43750/psn-pdf
     June 21, 2015 - Using a quantitative risk register to promote learning from a patient safety reporting system. … Using a quantitative risk register to promote learning from a patient safety reporting system. … https://psnet.ahrq.gov/issue/using-quantitative-risk-register-promote-learning-patient-safety-reporting … https://psnet.ahrq.gov/issue/using-quantitative-risk-register-promote-learning-patient-safety-reporting-system … https://psnet.ahrq.gov/issue/using-quantitative-risk-register-promote-learning-patient-safety-reporting-system

476. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/45312/psn-pdf
     July 27, 2016 - Perioperative safety: learning, not taking, from aviation. … Perioperative Safety: Learning, Not Taking, from Aviation. … https://psnet.ahrq.gov/issue/perioperative-safety-learning-not-taking-aviation Although aviation safety … https://psnet.ahrq.gov/issue/perioperative-safety-learning-not-taking-aviation https://psnet.ahrq.gov … aviation-and-healthcare-comparative-review-implications-patient-safety https://psnet.ahrq.gov/primer/checklists https://psnet.ahrq.gov/primer/debriefing-clinical-learning

477. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41952/psn-pdf
     January 16, 2013 - Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning … Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning … psnet.ahrq.gov/issue/prevention-wrong-location-misadministration-through-use-intradepartmental- incident-learning … psnet.ahrq.gov/issue/prevention-wrong-location-misadministration-through-use-intradepartmental-incident-learning … psnet.ahrq.gov/issue/prevention-wrong-location-misadministration-through-use-intradepartmental-incident-learning

478. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/41699/psn-pdf
     July 08, 2016 - Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. … Committee on the Learning Health Care System in America, Institute of Medicine. … https://psnet.ahrq.gov/issue/best-care-lower-cost-path-continuously-learning-health-care-america This … It emphasizes the importance of continuous learning—not only from high performing health care systems … https://psnet.ahrq.gov/issue/best-care-lower-cost-path-continuously-learning-health-care-america

479. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46695/psn-pdf
     January 10, 2018 - Predicting the future—big data, machine learning, and clinical medicine. … Predicting the future—big data, machine learning, and clinical medicine. … https://psnet.ahrq.gov/issue/predicting-future-big-data-machine-learning-and-clinical-medicine Medicine … This commentary outlines how machine learning can enable better analysis and application of data and … https://psnet.ahrq.gov/issue/predicting-future-big-data-machine-learning-and-clinical-medicine https:

480. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/47165/psn-pdf
     June 13, 2018 - https://psnet.ahrq.gov/issue/changing-how-we-think-about-healthcare-improvement In learning organizations … , leadership behavior creates a supportive learning environment where concrete processes are in place … to facilitate learning and encourage creativity among employees. … psnet.ahrq.gov/issue/changing-how-we-think-about-healthcare-improvement https://psnet.ahrq.gov/issue/building-learning-organization … psnet.ahrq.gov/issue/quality-improvement-series https://psnet.ahrq.gov/issue/fifth-discipline-art-practice-learning-organization-revised-updated-edition