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psnet.ahrq.gov/node/41602/psn-pdf
August 15, 2012 - How Can Health Care Organizations Become More Health
Literate?: Workshop Summary. … https://psnet.ahrq.gov/issue/how-can-health-care-organizations-become-more-health-literate-workshop- … summary
This report details the results of a workshop on health literacy in health care organizations … https://psnet.ahrq.gov/issue/how-can-health-care-organizations-become-more-health-literate-workshop-summary … https://psnet.ahrq.gov/issue/how-can-health-care-organizations-become-more-health-literate-workshop-summary
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psnet.ahrq.gov/node/60969/psn-pdf
November 08, 2023 - patient safety event and near-miss information, voluntarily reported by AHRQ-listed Patient Safety
Organizations … //psnet.ahrq.gov/issue/network-patient-safety-databases
https://psnet.ahrq.gov/issue/patient-safety-organizations-hospital-participation-value-and-challenges … https://psnet.ahrq.gov/issue/patient-safety-organizations-hospital-participation-value-and-challenges
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psnet.ahrq.gov/node/42056/psn-pdf
January 01, 2014 - Antecedents of willingness to report medical treatment
errors in health care organizations: a multilevel … Antecedents of willingness to report medical treatment errors in health care
organizations: a multilevel … https://psnet.ahrq.gov/issue/antecedents-willingness-report-medical-treatment-errors-health-care-
organizations-multilevel … https://psnet.ahrq.gov/issue/antecedents-willingness-report-medical-treatment-errors-health-care-organizations-multilevel … https://psnet.ahrq.gov/issue/antecedents-willingness-report-medical-treatment-errors-health-care-organizations-multilevel
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psnet.ahrq.gov/node/855058/psn-pdf
October 31, 2023 - My work largely
focuses on the organization, delivery, and financing of care, and how the healthcare … When you’re working in an
organization where there are clear power differentials and stressful conditions … families, and clinicians to worry about their safety in the healthcare environment and erode trust in the
organization … within an organization is important. … It is one of those things that can tip people over in their decision to leave a
unit, leave an organization
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psnet.ahrq.gov/node/34951/psn-pdf
February 28, 2011 - psnet.ahrq.gov/issue/ambiguity-and-workarounds-contributors-medical-error
This commentary discusses the role organizations … The
authors contrast characteristics of error-prone organizations with high-performing ones and provide … specific
illustrations of how each type of organization designs and executes work, responds to problems … The authors suggest that health
care organizations should not strive to become factories of repetition
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psnet.ahrq.gov/node/37261/psn-pdf
December 19, 2011 - Creating complex health improvement programs as
mindful organizations: from theory to action. … Creating complex health improvement programs as mindful organizations: from
theory to action. … https://psnet.ahrq.gov/issue/creating-complex-health-improvement-programs-mindful-organizations-theory … https://psnet.ahrq.gov/issue/creating-complex-health-improvement-programs-mindful-organizations-theory-action … https://psnet.ahrq.gov/issue/creating-complex-health-improvement-programs-mindful-organizations-theory-action
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psnet.ahrq.gov/node/37406/psn-pdf
March 28, 2012 - Learning from preventable adverse events in health care
organizations: development of a multilevel model … Learning from preventable adverse events in health care
organizations: development of a multilevel model … https://psnet.ahrq.gov/issue/learning-preventable-adverse-events-health-care-organizations-development … https://psnet.ahrq.gov/issue/learning-preventable-adverse-events-health-care-organizations-development-multilevel-model … https://psnet.ahrq.gov/issue/learning-preventable-adverse-events-health-care-organizations-development-multilevel-model
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psnet.ahrq.gov/perspective/conversation-libby-hoy-and-stephen-hoy
March 10, 2021 - Kendall Hall : Please kick us off by introducing yourselves and your organization. … We help organizations to build patient and family advisory programs. … We listen to what the priorities are for that particular hospital or organization. … That first step is figuring out the strategic priorities that the organization is really focused on. … Quality Improvement Organizations. Accessed February 1, 2021.
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psnet.ahrq.gov/issue/cost-quality-academic-health-centers-annual-costs-its-quality-and-patient-safety
October 14, 2020 - Health care organizations now invest heavily—in terms of both staff time and finances—in quality and … September 28, 2022
An asset-based quality improvement tool for health care organizations … : cultivating organization wide quality improvement and health care professional engagement. … for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations
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psnet.ahrq.gov/primer/disclosure-errors
September 15, 2024 - explanation as to why the error occurred How the error's effects will be minimized Steps the physician (and organization … This may also require changes in how organizations approach error disclosure. … Research and Quality has developed the Communication and Optimal Resolution (CANDOR) toolkit to help organizations … Current Context Disclosure of errors and adverse events is now endorsed by a broad array of organizations … It also calls for health care organizations to create an environment conducive to disclosure by integrating
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psnet.ahrq.gov/issue/quality-exponential-journey-100000-5-million-lives
August 22, 2007 - campaigns introduced by the Institute for Healthcare Improvement (IHI) and spotlights a pair of health care organizations … Learning from other organizations' safety errors. … November 12, 2008
AHRQ presses on: no rule yet, but agency taps 10 safety organizations
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psnet.ahrq.gov/issue/content-analysis-patient-safety-incident-reports-older-adult-patient-transfers-handovers-and
December 14, 2022 - safety incident reports for older adult patient transfers, handovers, and discharges: do they serve organizations … safety incident reports for older adult patient transfers, handovers, and discharges: do they serve organizations … safety incident reports for older adult patient transfers, handovers, and discharges: do they serve organizations … Quality
April 26, 2023
Learning from safety incidents in high reliability organizations
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psnet.ahrq.gov/issue/quality-improvement-patient-safety-project-level-versus-program-level-learning
April 01, 2010 - success of quality improvement programs and found that program-level learning (i.e., becoming a learning organization … : cultivating organization wide quality improvement and health care professional engagement. … All of us will fail and make mistakes, but how can they benefit us and our organizations? … Learning from other organizations' safety errors. … Health Care Executives and Administrators
General Internal Medicine
Hospital Medicine
Learning Organization
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psnet.ahrq.gov/node/47954/psn-pdf
August 07, 2019 - Special Issue on Resilience Engineering and High
Reliability Organizations. … https://psnet.ahrq.gov/issue/special-issue-resilience-engineering-and-high-reliability-organizations … https://psnet.ahrq.gov/issue/special-issue-resilience-engineering-and-high-reliability-organizations
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psnet.ahrq.gov/issue/patient-safety-and-quality-improvement-act-2005
March 29, 2023 - This bill amends the Public Health Service Act to encourage a culture of safety in health care organizations … law July 29, 2005, provides legal protection of information voluntarily reported to patient safety organizations … Patient Safety Databases Chartbook, 2019
February 5, 2020
How PSOs Help Health Care Organizations
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psnet.ahrq.gov/node/867655/psn-pdf
February 26, 2025 - According to the World Health Organization, the global rate of patient harm is about 1 in every 10
patients … Patient safety initiatives vary widely across healthcare organizations
despite common identifiable risk … Learning systems focus on fostering continuous learning across healthcare organizations and facilitating … Background
A learning health system is a health system (i.e., a group of one or more healthcare organizations … World Health Organization. September 11, 2023. [Available at]
2. ?
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psnet.ahrq.gov/node/46840/psn-pdf
June 20, 2018 - Interventions to improve employee health and well-being
within health care organizations: a systematic … Interventions to improve employee health and well-being within
health care organizations: A systematic … https://psnet.ahrq.gov/issue/interventions-improve-employee-health-and-well-being-within-health-care-
organizations … https://psnet.ahrq.gov/issue/interventions-improve-employee-health-and-well-being-within-health-care-organizations … https://psnet.ahrq.gov/issue/interventions-improve-employee-health-and-well-being-within-health-care-organizations
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psnet.ahrq.gov/node/35619/psn-pdf
June 24, 2010 - Studying patient safety in health care organizations:
accentuate the qualitative. … Studying patient safety in health care organizations: accentuate the qualitative. … https://psnet.ahrq.gov/issue/studying-patient-safety-health-care-organizations-accentuate-qualitative … Finally, a series of action steps are given for organizations to implement
qualitative methods into … https://psnet.ahrq.gov/issue/studying-patient-safety-health-care-organizations-accentuate-qualitative
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psnet.ahrq.gov/issue/building-cultures-high-reliability-lessons-high-reliability-organization-paradigm
September 05, 2018 - Review
Building cultures of high reliability: lessons from the high reliability organization … Building cultures of high reliability: lessons from the high reliability organization paradigm. … Achieving high reliability remains difficult for many organizations. … This article provides a brief history of the concept of high reliability organizations (HROs) and key … Building cultures of high reliability: lessons from the high reliability organization paradigm.
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psnet.ahrq.gov/issue/engineering-learning-healthcare-system-look-future-workshop-summary
June 15, 2011 - builds on earlier work discussing how process and systems engineering practices can help health care organizations … December 30, 2012
Seeing systems in health care organizations. … October 28, 2010
Patient Safety Organizations: a new paradigm in quality management and … Health Care Executives and Administrators
Educators
Human Factors Engineering
Learning Organization