Physician burnout is a persistent problem that can have serious effects on safe practice. This review discusses a model to prioritize interventions to address physician burnout. The approach suggests actions at five levels: physical and mental health; safety and security; respect; appreciation and connection; and the ability to fully contribute to care.

Surgical checklists have been shown to improve safety outcomes in randomized trials, but implementation studies have not uniformly demonstrated benefit. This study included a large, multicountry observational cohort of surgical outcomes before and after implementation of a checklist. Mortality declined after checklist implementation, but the rate of postoperative complications remained unchanged. Investigators also conducted a meta-analysis of surgical checklist studies (excluding those that paired the checklist with other interventions) on postoperative mortality and complications. This synthesis of published studies suggests that checklists improved mortality and complications overall. Lucian Leape and David Urbach discussed their perspectives on surgical safety checklists in past PSNet interviews.

Incorporating patient safety education for medical students in various practice environments can enhance health care safety. This commentary describes efforts to integrate patient safety concepts into medical education and highlights the importance of including such curricula in obstetrics and gynecology. A past PSNet Annual Perspective discussed safety and medical education.

Following implementation of the web-based Targeted Solutions Tool in a 12-hospital health system, hand hygiene rates improved from a baseline rate of 58% to about 95%. Over the same period, rates of central line–associated bloodstream infections and ventilator-associated pneumonia both declined by more than 40%.

Professionalism in medicine is considered an essential component of safety culture, but efforts to monitor and address disruptive behaviors among physicians have not produced the desired outcomes. This commentary discusses the need for more explicit emphasis on building physician skills and attitudes to support zero harm, process improvement, high reliability, and commitment to excellence in all areas of medical care.

Although appropriate handwashing has been identified as an essential factor in preventing health care–associated infections, hand hygiene rates remain unacceptably low at many hospitals. This quality improvement project aimed to achieve adherence to hand hygiene practices at eight hospitals using change management methods drawn from human factors engineering. Each hospital investigated and identified specific causes of noncompliance with handwashing and developed specific interventions to address these barriers. These individualized efforts yielded a significant improvement in handwashing behavior. The authors argue that allowing each site to tailor the intervention to the specific causes of noncompliance led to the sustained improvements. This study suggests that local improvement may be a fruitful method to enhance the proven but incompletely implemented practice of hand hygiene. A recent AHRQ WebM&M interview and perspective discuss ways to enhance hand hygiene adherence.

After implementation of a barcode medication administration system at a children's hospital, adherence to institutional medication safety protocols was high and the incidence of medication administration errors appeared to be low based on direct observation.

Electronic health records have had mixed effects on patient safety. This qualitative study of physicians and nurses revealed safety concerns about alert fatigue and propagation of incorrect information as well as perceived safety improvements through enhanced communication and legibility.

… This commentary, by patient safety expert Dr. Mark Chassin, recommends that health care shift its focus from … thus far by the patient safety movement. A prior AHRQ WebM&M interview with Dr. Chassin discussed the role of the Joint Commission in …

… high reliability. The article's lead author, Dr. Mark Chassin, was interviewed for AHRQ WebM&M in 2009. …

This commentary describes human factors, usability, and informatics recommendations for electronic health records in pediatrics to improve their usefulness and reduce the risk of errors.

Accreditation by The Joint Commission was associated with stronger performance on disease-specific measures of hospital quality of care. Accredited hospitals also appeared to achieve greater improvements in care over time compared to non-accredited hospitals.

Reviewing progress in quality improvement, this commentary offers a framework to guide health care organizations toward high reliability.

… adverse consequences . Under the leadership of Dr. Mark Chassin, The Joint Commission has taken an increasingly …