Perspectives on Safety
Our Perspectives on Safety section features expert viewpoints on current themes in patient safety, including interviews and written essays published monthly. Annual Perspectives highlight vital and emerging patient safety topics.
Narrow Results Clear All
Approach to Improving Safety
- Communication Improvement 26
- Culture of Safety 32
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Education and Training
28
- Students 1
- Error Reporting and Analysis 36
- Human Factors Engineering 20
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Legal and Policy Approaches
45
- Incentives 11
- Regulation 10
- Logistical Approaches 10
- Policies and Operations 1
- Quality Improvement Strategies 47
- Research Directions 1
- Specialization of Care 1
- Teamwork 15
- Technologic Approaches 27
- Transparency and Accountability 2
Safety Target
- Alert fatigue 1
- Device-related Complications 3
- Diagnostic Errors 7
- Discontinuities, Gaps, and Hand-Off Problems 6
- Fatigue and Sleep Deprivation 7
- Identification Errors 2
- Medical Complications 12
- Medication Safety 13
- Nonsurgical Procedural Complications 3
- Psychological and Social Complications 9
- Second victims 1
- Surgical Complications 4
Interview
In Conversation With… Timothy B. McDonald, MD, JD
- new
New Insights Into Apology and Disclosure Programs, April 2019
Dr. McDonald is President of the Center for Open and Honest Communication at the MedStar Institute for Quality and Safety, and Adjunct Professor of Law at Loyola University-Chicago School of Law and the Beazley Institute for Health Law and Policy. An internationally recognized patient safety expert, he served as a lead architect for the Communication and Optimal Resolution (CANDOR) toolkit, supported by AHRQ. We spoke with him about lessons learned over the years regarding event reporting and his insights about building and disseminating communication-and-resolution programs.
Interview
In Conversation With… … Jennifer Schulz Moore, LLB, MA, PhD
- new
New Insights Into Apology and Disclosure Programs, April 2019
Dr. Schulz Moore is the Director of Learning and Teaching at the University of New South Wales Faculty of Law and an Associate with the University of New South Wales School of Public Health and Community Medicine. Her research in health law draws from her unique training in public health, law, and health social sciences. We spoke with her about disclosure and apology in health care as well as the intersection between health and legal systems in Australia, New Zealand, and the United States.
Interview
In Conversation With… Susan Haas, MD, MSc
Health System Consolidation and Patient Safety, March 2019
Dr. Haas is an obstetrician–gynecologist and co-Principal Investigator for Ariadne Labs' work focused on health care system expansion. We spoke with her about the trend of health systems getting larger and more integrated, the risks to patient safety, and ways to mitigate these risks.
Annual Perspective
Maternal Safety
- new
with commentary by Audrey Lyndon, RN, PhD, 2018
This perspective examines the troubling decline in maternal health outcomes in the United States and summarizes recent national initiatives to improve safety in maternity care.
Annual Perspective
Update: Patient Engagement in Safety
- new
with commentary by Rachel J. Stern, MD, and Urmimala Sarkar, MD, 2018
Patient engagement is widely acknowledged as a cornerstone of patient safety. Research in 2018 demonstrates that patient engagement, when done correctly, can help health care systems identify safety hazards, regain trust after they occur, and codesign sustainable solutions.
Interview
In Conversation With… Matthew Weinger, MD
Update on Simulation, August 2018
Dr. Weinger is Director of the Center for Research and Innovation in Systems Safety and Professor of Anesthesiology, Biomedical Informatics, and Medical Education at Vanderbilt University. He holds the Norman Ty Smith Chair in Patient Safety and Medical Simulation. We spoke with him about the current state of simulation training in health care, barriers to progress, and potential innovations.
Perspective
How Does Health Care Simulation Affect Patient Care?
with commentary by Joseph O. Lopreiato, MD, MPH, Update on Simulation, August 2018
This piece explores health care simulation including the four main methods used and the evidence base for its impact on learning and patient care.
Interview
In Conversation With… Andrew Gettinger, MD
Health Information Technology and Safety, September 2017
Dr. Gettinger is the Chief Medical Information Officer and the Executive Director of the Office of Clinical Quality and Safety for the Office of the National Coordinator (ONC). He led the development of an electronic health record (EHR) system at Dartmouth and was the senior physician leader during their transition to a vendor-based EHR. We spoke with him about safety and health information technology.
Perspective
Assessing the Safety of Electronic Health Records: What Have We Learned?
with commentary by Dean F. Sittig, PhD, and Hardeep Singh, MD, MPH, Health Information Technology and Safety, September 2017
This piece highlights four key lessons that the authors believe are useful for clinicians and health care organizations that seek to identify, prevent, and mitigate electronic health record–related safety issues.
Interview
In Conversation With… Amy C. Edmondson, PhD, AM
Update on Teamwork, February 2017
Dr. Edmondson is the Novartis Professor of Leadership and Management at Harvard Business School. She is an expert on leadership, teams, and organizational learning. We spoke with her about the role of teamwork in health care and why it is becoming increasingly important.
Interview
In Conversation With… Andrew Bindman, MD
New Leaders in Safety and Quality, November 2016
Dr. Bindman, an expert in health policy in underserved populations, was appointed as director of the Agency for Healthcare Research and Quality (AHRQ) in May 2016. We spoke with him about his new role at AHRQ.
Interview
In Conversation With… Richard Platt, MD, MSc
Big Data and Patient Safety, October 2016
Dr. Platt is Professor and Chair of the Harvard Medical School Department of Population Medicine. We spoke with him about big data and patient safety.
Perspective
Health Care Data Science for Quality Improvement and Patient Safety
with commentary by Alvin Rajkomar, MD, Big Data and Patient Safety, October 2016
This piece explores the role for a clinician data scientist in utilizing clinical datasets to improve health care quality and safety.
Interview
In Conversation With… Gregg S. Meyer, MD, MSc
Certification in Patient Safety, June 2016
Dr. Meyer is Chief Clinical Officer of Partners Healthcare System, the large Boston-based system that includes Massachusetts General and Brigham and Women's Hospitals. We spoke with him about training and certification in patient safety.
Interview
In Conversation With… Lorri Zipperer, MA
Ten years of AHRQ Patient Safety Network: A Window Into the Evolution of the Patient Safety Literature, November 2015
Ms. Zipperer was a founding staff member of the National Patient Safety Foundation as their information projects manager and has also been Cybrarian for AHRQ Patient Safety Network since its inception. We spoke with her about the role of librarians in patient safety.
Interview
In Conversation With… Vineet Arora, MD, MAPP
Electronic Tools for Patient Safety: Engaging Patients and Providers, September 2015
Dr. Arora is Director of GME Clinical Learning Environment Innovation and Assistant Dean for Scholarship and Discovery at the University of Chicago Pritzker School of Medicine. We spoke with her about the intersection of health information technology and patient safety.
Interview
In Conversation With… Eric J. Topol, MD
Electronic Tools for Patient Safety: Engaging Patients and Providers, September 2015
Dr. Topol is Director of Scripps Translational Science Institute and Editor-in-Chief of Medscape. We spoke with him about his book, The Patient Will See You Now: The Future of Medicine is in Your Hands.
Interview
In Conversation With… Robert M. Wachter, MD
New Insights on Safety and Health IT, July/August 2015
Dr. Wachter is Professor and the Interim Chairman of the Department of Medicine at UCSF. We talked with him about his new book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.
Perspective
New Insights on Safety and Health IT
with commentary by A. Zach Hettinger, MD, MS; Raj Ratwani, PhD; Rollin J. (Terry) Fairbanks, MD, MS, New Insights on Safety and Health IT, July/August 2015
This piece provides an overview of health IT usability design, including persisting challenges and progress in the field.
Perspective
Video to Improve Patient Safety: Clinical and Educational Uses
with commentary by Yan Xiao, PhD; Colin F. Mackenzie, MB, ChB; and F. Jacob Seagull, PhD, Using Video to Assess Quality and Safety, May 2015
This piece explores the advantages of using video in clinical practice and health care education to augment safety and quality.