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Total Results: 759 records

Showing results for "mistakes".

221. Facilitator Guide: Learning From Defects Through Sensemaking (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_learn_from_defects_facnotes.docx
     December 01, 2017 - Education can make people aware of the problem, but it alone will not eliminate mistakes. … Implement constraints that prevent mistakes. These are the strongest types of interventions.

222. Just Culture Webcast Presentation (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-2-presentation.pdf
     May 01, 2007 - My supervisor emphasizes learning rather than blame when staff make mistakes. 2.

223. AHRQ Toolkit Helped NorthShore Health Track Data to Keep Infection Rates Low | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/case-studies/201809.html
     January 01, 2019 - By identifying specific personnel, along with any mistakes that increase the risk of CAUTI, Shah can

224. Designing the Built Environment for A Culture and System of Patient Safety – A Conceptual, New Design Process (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Dickerman_84.pdf
     June 04, 2008 - The Scope of the Problem Medical mistakes, or errors, in which the design of the physical environment … issues of design for health care services, let alone the problems associated with medical error and mistakes … safety, no regulations or codes are devoted to patient safety—i.e., freedom from medical errors and mistakes … has paid little attention to exploring potential liability for designs that contribute to medical mistakes … The best way to avoid these and many other mistakes is to have a project team composed of individuals

225. CUSP: A Framework for Success (Transcript) | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/toolkit/content-calls/framework.html
     April 01, 2013 - We want to know whether we are learning from mistakes and whether our culture has improved. … It allows you to learn from mistakes and improve culture, which ultimately allows you to embrace technical … The fourth step for CUSP, then, is how are we going to learn from our mistakes? … Learning from mistakes, learning from defects has very effective tools, but just like the CUSP process … You’ve committed to learn from the mistakes that occur.

226. 149-Cusp-Tip-Sheet-Assembling-Team (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/149-cusp-tip-sheet-assembling-team.docx
     October 01, 2024 - A culture of teamwork and learning from mistakes helps improve patient safety.

227. AHRQ Safety Program for MRSA Prevention
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/107-cusp-psychological-safety.pptx
     October 01, 2024 - belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes

228. PowerPoint Presentation
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/106-cusp-psychological-safety.pptx
     April 01, 2025 - belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes

229. What Are The 4 Es? | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mrsa-prevention/toolkit/what-are-4e.html
     December 01, 2024 - execution involves identifying and addressing barriers, adjusting your approach, and learning from mistakes

230. Practice Member Survey (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/staff-survey-post-intervention-va.pdf
     February 23, 2018 - Mistakes have led to positive changes here B. I have many opportunities to grow in my work C. … This practice learns from its mistakes K.

231. H3 Staff Survey (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/results/research/staff-survey-mw.pdf
     January 01, 2014 - Mistakes have led to positive changes here 1 2 3 4 5 4. … This practice learns from its mistakes 1 2 3 4 5 13.

232. Testing the Design of a Quality Report By Getting User Feedback | Agency for Healthcare Research and Quality
     www.ahrq.gov/talkingquality/resources/design/testing.html
     September 01, 2019 - showed that college-educated people with strong quantitative and analytical experience made numerous mistakes

233. Physician Engagement (Slide Presentation) | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/toolkit/content-calls/phys-engagement/slides.html
     June 01, 2013 -   Preventable harm is not acceptable  Tell your own Josie story  Competent Learn from mistakes

234. Project Report - Lean Sigma (ppt file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/contentcalls/twomorees-slides/Two-More-Es-and-How-to-Spread-Dec-13-2011-508.ppt
     January 01, 2011 - ( Listen to resisters Standardize and learn from mistakes) Evaluate: how do I know we make a difference

235. Reducing Unecessary Urinary catheter Use in the Emergency Department: How to Implement the Process (ppt file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/integrating-teamwork-tools-cusp-efforts.ppt
     June 02, 2025 - assessing what is going on around you and with you Cross Monitoring Watching each other’s backs Ensuring mistakes

236. New AHRQ SOPS™ Health Information Technology Patient Safety Supplemental Items for Hospitals - (Yount) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospital/healthitwebinar/sops-hit-webcast4-yount.pdf
     June 02, 2025 - we have to double document information such as vitals, pain intake and output, that could lead to mistakes

237. On World Patient Safety Day, AHRQ Highlights the Urgent Need to Address Diagnostic Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/blog/ahrqviews/world-patient-safety-day-2024.html
     September 01, 2024 - Safety —provide clinical teams and patients with resources to recognize risks, avoid errors, learn from mistakes

238. 141-Cusp-Tip-Sheet-Assembling-Team (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/141-cusp-tip-sheet-assembling-team.docx
     April 01, 2025 - A culture of teamwork and learning from mistakes helps improve patient safety.

239. Patient Experience, Patient Safety, and Provider Well-Being: Associations and Paths (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/2023-virtual-research-meeting-summary-patient-experience.pdf
     January 01, 2023 - Mistakes were defined as complex errors involving diagnosis. … Problems were defined as mishaps not related to diagnosis (e.g., short delays) or mistakes that were … Analyses showed that when experiences of problems, mistakes, and a combination of problems and mistakes … Moreover, respondents reported that experiencing both problems and mistakes increased the likelihood

240. Facilitator-Notes (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module2/facilitator-notes.docx
     March 01, 2017 - be prevented in the future Senior leaders welcome opportunities to learn from setbacks, events or mistakes … based on the principles of safe system design: Simplify the system, create redundancy, and learn from mistakes