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Informationen zum Autor Julianne M. Morath is the chief operating officer and vice president of care delivery of Children's Hospitals and Clinics in Minneapolis - St. Paul! Minnesota. She is a board member of the National Patient Safety Foundation in Chicago! Illinois. Joanne E. Turnbull ! RN! MS! is a well-known writer and speaker on the subject of patient safety. Until 2001 she was the executive director of the National Patient Safety Foundation. Klappentext With this important resource! health care leaders from the board room to the point-of-care can learn how to apply the science of safe and best practices from industry to healthcare by changing leadership practices! models of service delivery! and methods of communication. Zusammenfassung The release of an Institute of Medicine report in late 1999 changed the landscape of patient safety quickly and dramatically. The news that as many as 98!000 individuals die each year from preventable medical error captured the attention of both the lay and professional public! nationally and internationally. Inhaltsverzeichnis Foreword ix Lucian L. Leape Preface xv Acknowledgments xxiii The Authors xxvii Introduction 1 1 Declare Patient Safety Urgent and a Priority 12 2 Error and Harm in Health Care 23 3 Understanding the Basics of Patient Safety 44 4 Assume Executive Responsibility 71 5 Import New Knowledge and Skills 96 6 Install a Blameless Reporting System 120 7 Assign Accountability 148 8 Align External Controls and Reform Education 181 9 Accelerate Change For Improvement 204 10 The End of the Beginning 234 References 245 Glossary 255 Appendixes 1 Checklist for Assessing Institutional Resilience 279 2 Creating De-Identified Case Studies for Dissemination 283 3 Medical Accidents Policy: Reporting and Disclosure! Including Sentinel Events 285 4 Medication Safety Team Feedback Form 295 5 Patient Safety Workplan 297 6 Safety Learning Report 300 7 Stop-the-Line Policy: Authority to Intervene to Restore Patient Safety 303 8 Complexity Lens Reflection 308 9 A Brief Look at Gaps in the Continuity of Care 311 10 A Brief Look at the New Look in Complex System Failure! Error! and Safety 313 11 A Reminder on Every Chart 315 12 List of Serious Reportable Events in Health Care 316 13 Statement of Principle: Talking to Patients About Health Care Injury 321 14 VHA Patient Safety Organizational Assessment 322 Additional Readings 331 Resources 335 Index 345 ...
