-
www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/learn-from-defects-fac-guide.html
July 01, 2023 - Latent conditions are sorted into two categories: technical failures and organizational failures. … In this model, 20 separate event cause types are given in four categories: technical, organizational, … Subcategories of organizational causes include—
Transfer of knowledge, such as a gap in new staff … OEX: Organizational, external.
OK: Organizational, knowledge transfer. … OM: Organizational, management.
HEX: Human, external.
HRV: Human, rule-based, verification.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/system/systemredesignsafetynet/systemredesign.pdf
June 01, 2015 - Transformational change in health care systems: an
organizational model. … Safety-Net Systems Redesign 20
Organizational Challenges
Organizational challenges facing safety-net … systems include:
Limited organizational resources. … guided by the study’s organizational model. … Team impressions of the broader organizational context, the
organizational culture, and informal aspects
-
www.ahrq.gov/research/findings/final-reports/leanprocess/leanprocess.html
May 01, 2018 - If so, the goal is to identify the organizational and contextual factors that may systematically contribute … We also briefly reviewed literature about quality improvement and organizational learning, innovation … These factors include contextual (organizational and environmental) variables, as well as variables associated … example, there was little rigorous reporting about external impetus for Lean/TPS (e.g., market factors), organizational … Internal pressures included the need or desire to improve a given error rate, untenable organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/c1_pdi_prioritizationworksheetinstructions.pdf
June 02, 2025 - The third section (purple) will
assist your organization in aligning each PDI with your organizational … This tool is designed to help guide your organization’s discussion
in determining the direction of organizational … Determine what your organizational comparator will be. … A 10 indicates that you completely agree that
the PDI aligns with organizational goals and priorities … , while a score of 0 indicates you
completely disagree that the PDI aligns with the organizational goals
-
www.ahrq.gov/hai/cusp/clabsi-hpwpreport/clabsi-hpwpap.html
August 01, 2015 - The four practices in this organizational engagement subsystem share a common theme of ensuring employees … Information sharing— Practices through which current information on organizational performance and other … development that is more than mandated/more than typical as another strategy to achieve greater relative organizational … Management training linked to organizational needs— Practices involving the alignment of leadership development
-
www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module6/mod6-facguide.html
March 01, 2017 - An improvement that has become part of the organizational culture and has been maintained regardless … Sustainability aims to maintain a process within an organizational culture, while spread aims to disseminate … This can include financial resources such as funding and supplies, external organizational support, and … Organizational Skepticism and Resistance
Resistance may be present within the organization itself. … If the barrier is related to lack of resources, then the facility could plan for gaps in organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/c1_combo_prioritizationworksheetinstructions.pdf
June 02, 2025 - The third section (purple) will assist your organization in aligning each QI with your
organizational … This tool is designed to help guide your organization’s discussion
in determining the direction of organizational … Determine what your organizational comparator will be. … A 10 indicates that you completely agree that
the PSI/IQI/PDI aligns with organizational goals and priorities … , while a score of 0 indicates
you completely disagree that the PSI/IQI/PDI aligns with the organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-creative-strategies-lee.pdf
June 02, 2025 - experience: CAHPS Clinician & Group surveys
► Staff idea creativity: Meeting transcripts
► Staff and organizational … implemented
by organizations
Barriers to implementation:
• Limited time due to workloads
• Stifling organizational … Successful patient experience improvement requires careful
attention to work, implementation, and organizational
-
www.ahrq.gov/sops/news/previous-announcements.html
March 01, 2025 - The new supplemental item set focuses on the extent to which nursing homes’ organizational culture supports … The supplemental items assess the extent to which the hospital’s organizational culture supports workplace … the survey item set as a supplement to the Medical Office Survey to assess the extent to which the organizational … The Workplace Safety Supplemental Items address hospital organizational culture supporting workplace … Goals of the Diagnostic Safety Supplemental Item Set Measuring the extent to which the organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Prologue_Battles_Vol2.pdf
June 02, 2025 - Within this broad theme are four categories of related
articles addressing (1) safety and organizational … individual clinical units and the organization as a whole can serve as a starting point to bring
about organizational … The articles in this volume represent an important group of case studies focused on issues of
organizational
-
www.ahrq.gov/funding/grant-mgmt/refstyle.html
September 01, 2015 - AHRQ Citation Style for Reference Lists
Modified Vancouver Style
The elements and organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/02-new_sops_diagnostic_safety-ginsberg.pdf
June 02, 2025 - • Surveys of providers and staff about the extent to which their
organizational culture supports patient … Assessed
Across SOPS Surveys
• Teamwork
• Communication Openness
• Communication About Error
• Organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/02-new-sops-workplace-safety-ginsberg.pdf
June 02, 2025 - • Surveys of providers and staff about the extent to which their
organizational culture supports patient … Assessed
Across SOPS Surveys
• Teamwork
• Communication Openness
• Communication About Error
• Organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/training-tools/training-tools-facnotes.docx
May 01, 2017 - This module is meant to augment the existing Spread module of the CUSP Toolkit while offering organizational … An improvement, such as implementing a safe surgery checklist, that has become part of the organizational … Slide 4
SAY:
Without sustainability, valuable time and resources spent investing in organizational … losing interest, or changes in organizational goals. … Organizational Skepticism and Resistance
Everyone responds to change differently, and some staff may
-
www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module6/mod6-slides.html
March 01, 2017 - beyond the life of the project, or the institutionalization or integration of programs into ongoing organizational … Slide 21: Potential Barriers to Sustainability
Lack of organizational infrastructure and resources … Organizational skepticism.
Individual resistance to change. … Staff turnover
Embed newly developed processes into new staff orientation and organizational policies … Fit within organizational mission.
Ongoing evaluation and transparency of measures.
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/leadership-1.html
June 01, 2021 - Public health advocates such as The Leapfrog Group and Hospital Compare are working on ways to represent organizational … Coalitions and researchers dedicated to improving diagnosis have created resources to address common organizational … safety requires transformational leadership rooted in a growth mindset—a belief that individual and organizational
-
www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/03-pt-narratives-support-px-strategy-grob.pdf
June 02, 2025 - addressed
Suggest solutions
Motivate staff to commit to
projects and take action
Improvement in
Organizational … processes
Organizational outcomes
Patient experience
Workforce experience
15
Patient Narrative
-
www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu6.html
October 01, 2014 - Tools and Resources
Those who have been involved in multiple organizational change … To achieve this goal, it is essential that the changes become integrated into existing organizational … What types of ongoing organizational support do we need from others to keep the new practices in place … The decision will be influenced by your organizational structure, improvement culture, and location of … Return to Contents
6.2 What types of ongoing organizational support do we need to keep the new practices
-
www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/pu6.html
October 01, 2014 - Tools and Resources
Those who have been involved in multiple organizational change … To achieve this goal, it is essential that the changes become integrated into existing organizational … What types of ongoing organizational support do we need from others to keep the new practices in place … The decision will be influenced by your organizational structure, improvement culture, and location of … Return to Contents
6.2 What types of ongoing organizational support do we need to keep the new practices
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-sustainability-centers-of-excellence5.html
April 01, 2025 - Steer CEs through organizational structures and processes. Guide overarching initiative directions. … Peer mentorship between clinical champions can build intentionality and organizational capacity to sustain … Formalized systems for organizational learning ensure that individual knowledge can be translated into