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psnet.ahrq.gov/node/867651/psn-pdf
February 26, 2025 - .4,5
Definition of Safety and Safety Management Principle
Safety I defies safety as having as few things … given the uncertainty,
intractability, and complexity of healthcare work, the surprise is not that things … how things occasionally go wrong. 4,5,19
https://psnet.ahrq.gov//#4
https://psnet.ahrq.gov//#19
https … gaps
between “work-as-imagined" and “work-as-done.”4,5,19
Safety II as an Investment
Maximizing things … A Safety II
approach may also require new methods and tools to understand how things work, depending
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psnet.ahrq.gov/primer/safety-i-safety-ii-and-new-views-safety
October 02, 2024 - “given the uncertainty, intractability, and complexity of healthcare work, the surprise is not that things … In this way, an investigation proposes to understand how things usually go right as a basis for explaining … how things occasionally go wrong. 4,5 , 19 Safety II suggests that systems are increasingly intractable … gaps between “work-as-imagined" and “work-as-done.” 4,5 , 19 Safety II as an Investment Maximizing things … A Safety II approach may also require new methods and tools to understand how things work, depending
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psnet.ahrq.gov/perspective/conversation-withpat-croskerry-md-phd
June 01, 2010 - Once I became aware of things that were going wrong, I began to look outside of medicine and to other … and distortions of their reasoning, especially in emergency medicine, which is a fertile ground for things … So when you add all those things up, you realize that to expect high-quality decision-making is somewhat … RW: Can you give us a couple of examples of things that you built into your emergency departments that … Some of them are still suffering from that secrecy and covering things up.
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psnet.ahrq.gov/node/855104/psn-pdf
November 08, 2023 - error-stress-and-teamwork-medicine-and-aviation-cross-sectional-surveys
https://psnet.ahrq.gov/issue/checklist-manifesto-how-get-things-right
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psnet.ahrq.gov/node/33820/psn-pdf
December 01, 2016 - meets once a
month or once a week, but it's very dependent on the personnel in the room and many other things … It sounds daunting, but when you do it, it makes things so easy. … RW: Any other things you wanted to talk about?
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psnet.ahrq.gov/node/33692/psn-pdf
February 01, 2010 - RW: It strikes me that one of the hardest things you have to do is balance the tension in training between … One of the
things that we'd like to get to at a national level, which would translate to the individual … RW: Some of the things you've articulated create some overlap with other organizations. … As you think back during your time as residency director,
what were the things about ACGME and the RRCs … I am very hopeful that two other things will
happen.
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psnet.ahrq.gov/node/60238/psn-pdf
April 15, 2020 - psnet.ahrq.gov/issue/addiction-disease-isolation-so-pandemic-puts-recovery-risk
https://psnet.ahrq.gov/issue/why-things-bite-back-technology-and-revenge-unintended-consequences
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psnet.ahrq.gov/node/33857/psn-pdf
July 01, 2012 - But they could be
attributable to lots of things. … RW: I'm going to call out things that did not exist 10 years ago and do now, and I'd love to hear your … thoughts on have they surprised you, have they changed things, or how you think they're going to change … things in the future. … RW: One of the most persuasive things I read in research in my book was Erik Brynjolfsson's work about
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psnet.ahrq.gov/perspective/conversation-connor-wesley-rn-bsn-patient-safety-concerns-and-lgbtq-population
February 01, 2023 - As many as 40% of homeless youth are LGBTQ+ . 5 We see a lot more homelessness, which leads to things … These things have so much power that I do not think people always realize. … Sarah Mossburg: Some of the key things that I hear you talking about in relation to the patient safety … no different than the things people do outside the LGBTQ+ community. … I am a million different things.
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psnet.ahrq.gov/perspective/patient-safety-concerns-and-lgbtq-population
February 01, 2023 - As many as 40% of homeless youth are LGBTQ+ . 5 We see a lot more homelessness, which leads to things … These things have so much power that I do not think people always realize. … Sarah Mossburg: Some of the key things that I hear you talking about in relation to the patient safety … no different than the things people do outside the LGBTQ+ community. … I am a million different things.
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psnet.ahrq.gov/perspective/conversation-withvineet-arora-md-ma
March 01, 2011 - Well, certainly admission, which includes things like transfer from EMS [emergency medical services] … What we say is to focus it on two things: (1) the tasks to be done and (2) the anticipatory guidance, … So you really sense that it's a very dynamic process, and things could go wrong at any step. … The challenge is that more things are being handed off now of course with duty hours. … an EKG, placing an arterial line, things that are very susceptible to sleep loss.
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psnet.ahrq.gov/node/859352/psn-pdf
December 20, 2023 - https://psnet.ahrq.gov/issue/transformational-effort-patient-safety
https://psnet.ahrq.gov/issue/when-things-go-wrong-responding-adverse-events
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psnet.ahrq.gov/node/836971/psn-pdf
April 20, 2022 - association-between-operative-autonomy-surgical-residents-and-patient-outcomes
https://psnet.ahrq.gov/issue/graded-autonomy-medical-education-managing-things-go-bump-night
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psnet.ahrq.gov/node/47739/psn-pdf
February 20, 2019 - bedside-computer-vision-moving-artificial-intelligence-driver-assistance-patient-safety
https://psnet.ahrq.gov/issue/why-things-bite-back-technology-and-revenge-unintended-consequences
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psnet.ahrq.gov/node/61053/psn-pdf
October 21, 2020 - All Things Considered. National Public Radio. October 5, 2020.
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psnet.ahrq.gov/node/33784/psn-pdf
April 01, 2015 - Part of it is driven by the idea
that if you don't use a checklist then things are disorganized, and … So the concept that—but for a checklist—things were like the Wild West in operating rooms, I don't think … Things could always be improved, but they weren't all that bad in North America. … One is there is no limit to things that are not
harmful and may be helpful. … There's probably an infinite number of things that you
could do that at least someone believes is a
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psnet.ahrq.gov/issue/many-faces-error-disclosure-common-set-elements-and-definition
December 16, 2009 - November 23, 2016
The Medical Apology: Making It Right When Things Go Wrong. … November 20, 2015
Should health care providers be forced to apologise after things go
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psnet.ahrq.gov/issue/trainees-perceptions-patient-safety-practices-recounting-failures-supervision
September 20, 2011 - May 17, 2023
Bad things can happen: are medical students aware of patient centered care … August 24, 2022
That’s the way we do things around here!
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psnet.ahrq.gov/perspective/conversation-amy-c-edmondson-phd-am
February 01, 2017 - One way to look at what's happening in that scenario is that the leader's mental model of how things … Today's leaders need to stop and challenge themselves when things go wrong. … And, it's great, because when things go wrong, they can say, "It's not my fault." … There was no apparent standardization, even around things that could be standardized. … How does that movement relate to the things we've been talking about?
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psnet.ahrq.gov/perspective/new-insights-about-team-training-decade-teamstepps
February 01, 2017 - One way to look at what's happening in that scenario is that the leader's mental model of how things … Today's leaders need to stop and challenge themselves when things go wrong. … And, it's great, because when things go wrong, they can say, "It's not my fault." … There was no apparent standardization, even around things that could be standardized. … How does that movement relate to the things we've been talking about?