AHRQ Patient Safety Network

The Collection > Organizational Behaviorists

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Safety Target

•Device-related Complications (5)

•Diagnostic Errors (12)

•Identification Errors (7)

•Discontinuities, Gaps, and Hand-Off Problems (49)

•Fatigue and Sleep Deprivation (10)

•Medication Safety (77)

•Medical Complications (37)

•Nonsurgical Procedural Complications (6)

•Surgical Complications (77)

•Psychological and Social Complications (122)

Origin/Sponsor

•Africa (1)

•Asia (13)

•Australia and New Zealand (29)

Resource Types

•Journal Article (526)

•Legislation/Regulation (3)

•Meeting/Conference (8)

•Newspaper/Magazine Article (42)

•Press Release/Announcement (1)

•Special or Theme Issue (11)

•Tools/Toolkit (4)

•Web Resource (4)

Error Types

•Epidemiology of Errors and Adverse Events (57)

•Active Errors (59)

•Latent Errors (39)

•Near Miss (13)

Approach to Improving Safety

•Quality Improvement Strategies (148)

•Legal and Policy Approaches (55)

•Error Reporting and Analysis (170)

•Communication Improvement (210)

•Human Factors Engineering (65)

•Teamwork (170)

•Specialization of Care (29)

•Logistical Approaches (35)

•Culture of Safety (211)

•Technologic Approaches (52)

•Education and Training (161)

Clinical Areas

•Allied Health Services (2)

Target Audience
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Organizational Behaviorists

Setting of Care

•Hospitals (368)

•Psychiatric Facilities (1)

•Residential Facilities (5)

•Ambulatory Care (32)

•Outpatient Surgery (1)

•Patient Transport (6)

1 - 20 of 641

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STUDY

What’s past is prologue: organizational learning from a serious patient injury.

Tamuz M, Franchois KE, Thomas EJ. Safety Sci. 2011;49:75-82.

STUDY

Ambulance personnel perceptions of near misses and adverse events in pediatric patients.

Cushman JT, Fairbanks RJ, O'Gara KG, et al. Prehosp Emerg Care. 2010;14:477-484.

BOOK/REPORT classic

The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives.

Maxfield D, Grenny J, Lavandero R, Groah L. Provo, UT: VitalSmarts; 2011.

STUDY

A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life.

Holden RJ, Scanlon MC, Patel NR, et al. BMJ Qual Saf. 2011;20:15-24.

COMMENTARY

In Conversation with...Allan Frankel, MD

AHRQ WebM&M [serial online]. July 2006.

BOOK/REPORT

Talking with Patients and Families about Medical Error: A Guide for Education and Practice.

Truog RD, Browning DM, Johnson JA, Gallagher TH. Baltimore, MD: Johns Hopkins University Press; 2011. ISBN: 0801898048.

COMMENTARY

Ashamed to admit it: owning up to medical error.

Ofri D. Health Aff (Millwood). 2010;29:1549-1551.

COMMENTARY

Disclosing harmful medical errors to patients: tackling three tough cases.

Gallagher TH, Bell SK, Smith KM, Mello MM, McDonald TB. Chest. 2009;136:897-903.

COMMENTARY

What happens when things go wrong?

Brandom BW, Callahan P, Micalizzi DA. Paediatr Anaesth. 2011;21:730-736.

STUDY

Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting.

Makowsky MJ, Schindel TJ, Rosenthal M, Campbell K, Tsuyuki RT, Madill HM. J Interprof Care. 2009;23:169-84.

STUDY

More than words: patients' views on apology and disclosure when things go wrong in cancer care.

Mazor KM, Greene SM, Roblin D, et al. Patient Educ Couns. 2013;90:341-346.

STUDY

Disclosure of medical error to parents and paediatric patients: assessment of parents' attitudes and influencing factors.

Matlow AG, Moody L, Laxer R, Stevens P, Goia C, Friedman JN. Arch Dis Child. 2010;95:286-290.

NEWSPAPER/MAGAZINE ARTICLE

Debriefing for patient safety.

Turner SH, Kurtz WD. Patient Saf Qual Healthc. November/December 2008:5:42-44,46.

COMMENTARY classic

Fixing healthcare from the inside, today.

Spear SJ. Harv Bus Rev. September 2005;83:78-91.

MEETING/CONFERENCE PROCEEDINGS

A Hospital Accident: Lessons Learned – A Death, A Conviction, and A Healing.

Texas Medical Institute of Technology. June 16, 2011.

STUDY

Moral distress, compassion fatigue, and perceptions about medication errors in certified critical care nurses.

Maiden J, Georges JM, Connelly CD. Dimens Crit Care Nurs. 2011;30:339-345.

STUDY

A novel method for reproducibly measuring the effects of interventions to improve emotional climate, indices of team skills and communication, and threat to patient outcome in a high-volume thoracic surgery center.

Nurok M, Lipsitz S, Satwicz P, Kelly A, Frankel A. Arch Surg. 2010;145:489-495.

STUDY

Learning from different lenses: reports of medical errors in primary care by clinicians, staff, and patients: a project of the American Academy of Family Physicians National Research Network.

Phillips RL, Dovey SM, Graham D, Elder NC, Hickner JM. J Patient Saf. 2006;2:140-146.

NEWSPAPER/MAGAZINE ARTICLE

Too many abandon the "second victims" of medical errors.

ISMP Medication Safety Alert! Acute Care Edition. July 14, 2011;16:1-3.

COMMENTARY

Disclosing harmful pathology errors to patients.

Dintzis SM, Gallagher TH. Am J Clin Pathol. 2009;131:463-465.

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