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www.ahrq.gov/research/findings/final-reports/ptmgmt/design-table2.html
July 01, 2018 - Develop problem-solving skills and help with problem-solving.
Provide emotional support . … Provide followup regarding reassessment, goals, problem-solving, reinforcement, prompts, and reminders … Protocols for providing support (for motivating, building confidence, problem solving, setting goals
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www.ahrq.gov/hai/tools/mvp/modules/cusp/learn-from-defects-fac-guide.html
February 01, 2017 - Slide 6: Problem-Solving Hierarchy
Say:
First-order problem solving resolves an issue for one patient … Ask:
What method of problem solving should we employ? … Say:
Instead of relying on first-order problem solving, practice second-order problem solving. … Slide 7: Problem-Solving Goal
Say:
First-order problem solving addresses the immediate need but … Ask:
How can you make sure that everyone is aware of the problem?
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psnet.ahrq.gov/issue/reporting-and-second-order-problem-solving-can-turn-short-term-fixes-long-term-remedies
May 07, 2018 - Newspaper/Magazine Article
Reporting and second-order problem solving can turn short-term … Citation Text:
Reporting and second-order problem solving can turn short-term fixes into long-term … Cite
Citation
Citation Text:
Reporting and second-order problem
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psnet.ahrq.gov/issue/organizational-learning-experience-high-hazard-industries-problem-investigations-line
May 24, 2016 - Book/Report
Organizational Learning from Experience in High-Hazard Industries: Problem … Citation Text:
Organizational Learning from Experience in High-Hazard Industries: Problem Investigations … Citation
Citation Text:
Organizational Learning from Experience in High-Hazard Industries: Problem
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psnet.ahrq.gov/issue/hospitals-installed-more-sinks-stop-infections-sinks-can-make-problem-worse
October 05, 2016 - The sinks can make the problem worse. … The sinks can make the problem worse. Branswell H. STAT. October 25, 2016. … The sinks can make the problem worse. Branswell H. STAT. October 25, 2016.
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/ahcpsample.pdf
September 01, 2012 - Question or Problem with this Packet? … Call your Discharge Educator: (555) 555-2222
Serious health problem? Call Dr. … :
Noncardiac Chest
Pain
Noncardiac chest pain is pain that is not caused by a heart
problem. … See your doctor and ask questions.
11
My Medical Problem:
High Blood Pressure
High … AveryFor my appointment onWednesday, August 8th, at 11:30 am
My Medical Problem:
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/improvement-slides.pptx
November 01, 2019 - needed equipment
Solution is straightforward, usually requiring resources but not culture change
4
Problem … be hard to implement because they require consensus, teamwork, communication, change in habits
5
Problem … Discuss drivers of the problem (e.g., fear of offending colleagues, difficulty explaining change in … Solving
First-order problem solving
Solves one problem in one particular instance
Generally does not … help prevent future harm from occurring
Second-order problem solving
Uses adaptive interventions
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/training-tools/tool.html
June 01, 2017 - General capacity to improve on more than one outcome or process
Partnership itself
Problem … Problem solving: If key elements are lacking, has a strategy been developed to address this issue? … Problem solving: If positive incentives are inadequate or disincentives are identified, have strategies …
Can pick and choose among offered activities
Other
Problem … Problem solving: If change goals are not aligned and integrated with the strategic goals, performance
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/improvement-facilitator-guide.pdf
November 01, 2019 - Another example of a technical problem would be
failure to administer needed antibiotics to septic … When considering possible technical solutions to a
problem, it is important to assess their ease of … First-order problem
solving involves solving one problem at a time. … Second-order problem solving uses both technical and
adaptive interventions. … change than first-
order problem solving.
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www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-appendix-xiii-template-scoping-decision-problem-address-through-decision-modeling
July 01, 2017 - Template for Scoping the “Decision Problem” to Address Through Decision Modeling
Share to … Based on items 1 and 2, provide a clear written statement of the decision problem/objective and scope … Template for Scoping the “Decision Problem” to Address Through Decision Modeling . U.S.
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psnet.ahrq.gov/issue/tell-truth-whole-truth-may-do-patients-harm-problem-nocebo-effect-informed-consent
October 03, 2018 - Commentary
To tell the truth, the whole truth, may do patients harm: the problem … To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed … To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/learn-from-defects-facguide.docx
January 01, 2017 - Slide 5
Problem-Solving Hierarchy
SAY:
First-order problem solving resolves an issue for one patient … ASK:
What method of problem solving should we employ? … SAY:
Instead of relying on first-order problem solving, practice second-order problem solving. … Slide 6
Problem-Solving Goal
SAY:
First-order problem solving addresses the immediate need but does … ASK:
How can you make sure that everyone is aware of the problem?
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psnet.ahrq.gov/issue/problem-engaging-hospital-doctors-promoting-safety-and-quality-clinical-care
August 18, 2017 - Review
The problem of engaging hospital doctors in promoting safety and quality in … The problem of engaging hospital doctors in promoting safety and quality in clinical care. … The problem of engaging hospital doctors in promoting safety and quality in clinical care.
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www.ahrq.gov/hai/tools/ambulatory-surgery/sections/implementation/implementation-guide/app-k-blank-temp.html
May 01, 2017 - Improvement Study Template
Ambulatory Surgery Center
Slide 2: Problem … Statement
problem statement here>
Slide 3: Improvement Team
Project Leader(s … Observed performance:
Current performance: Below Goal by X or Goal Achieved
Slide 10: Cause of the Problem … problem>
Slide 11: Corrective Actions/Interventions
Intervention
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/postdisphone.docx
June 02, 2025 - Using your own words, can you explain to me what your main problem or diagnosis is? … CALLER: Do you have any questions for me about your main problem [diagnosis]? … CALLER: Since you left the hospital, do you feel your main problem, [diagnosis], has improved, worsened … What To Do If a Problem Arises
CALLER: Before we hang up, I want to make sure that if a medical problem … CALLER: And what about if you [give example of urgent but not emergent problem] in the evening?
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Mohr.pdf
February 01, 2004 - Problem types used for coding error reports
Problem Type Definition
Problematic
communication and … (Problem type: Decision)
Diagnostic “Patient with E.coli oh 157. … (Problem type: Other)
Equipment “Dictation was not completed due to a new technical problem not
encountered … (Problem type: Execution)
Problem Type
Categories Example error report
Problematic
communication … Problem types used for coding error reports
Table 3.
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www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/postdischarge-phone.html
March 01, 2025 - Using your own words, can you explain to me what your main problem or diagnosis is? … CALLER: Do you have any questions for me about your main problem [diagnosis]? … CALLER: Since you left the hospital, do you feel your main problem, [diagnosis], has improved, worsened … What To Do If a Problem Arises CALLER: Before we hang up, I want to make sure that if a medical problem … CALLER: And what about if you [give example of urgent but not emergent problem] in the evening?
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www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/postdischarge-phone.html
March 01, 2025 - Using your own words, can you explain to me what your main problem or diagnosis is? … CALLER: Do you have any questions for me about your main problem [diagnosis]? … CALLER: Since you left the hospital, do you feel your main problem, [diagnosis], has improved, worsened … What To Do If a Problem Arises CALLER: Before we hang up, I want to make sure that if a medical problem … CALLER: And what about if you [give example of urgent but not emergent problem] in the evening?
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www.ahrq.gov/hai/tools/mvp/modules/cusp/learn-from-defects-slides.html
February 01, 2017 - Use the Learning from Defects (LFD) tool to perform second-order problem solving. … Slide 6: Problem-Solving Hierarchy
First-Order Problem Solving
Recovers for one patient, but … Slide 7: Problem-Solving Goal
First-order problem solving addresses immediate need, but does not … Second-order problem solving addresses future needs and improves overall patient safety culture. … Image: Counterbalanced arrows illustrate first-order problem solving versus second-order problem solving
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psnet.ahrq.gov/web-mm/managing-complexity-diagnosis-life-threatening-complications-after-gastric-bypass-surgery
September 25, 2019 - to be solved at one point in time, rather than a recurring and evolving problem that is influenced by … From a psychological standpoint, problem representation can be conceived in two ways. 11 First, and … The second way to conceive of problem representation is as an individual’s mental representation of a … The importance of early problem representation during case presentations. … Reasoning on rounds: summary statement or problem representation?