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.
Table of Contents
Foreword (Lucian L. Leape)
Preface
Acknowledgments
The Authors
Introduction
- Declare Patient Safety Urgent and a Priority
- Error and Harm in Health Care
- Understanding the Basics of Patient Safety
- Assume Executive Responsibility
- Import New Knowledge and Skills
- Install a Blameless Reporting System
- Assign Accountability
- Align External Controls and Reform Education
- Accelerate Change For Improvement
- The End of the Beginning
References
Glossary
Appendixes
- Checklist for Assessing Institutional Resilience
- Creating De-Identified Case Studies for Dissemination
- Medical Accidents Policy: Reporting and Disclosure, Including Sentinel Events
- Medication Safety Team Feedback Form
- Patient Safety Workplan
- Safety Learning Report
- Stop-the-Line Policy: Authority to Intervene to Restore Patient Safety
- Complexity Lens Reflection
- A Brief Look at Gaps in the Continuity of Care
- A Brief Look at the New Look in Complex System Failure, Error, and Safety
- A Reminder on Every Chart
- List of Serious Reportable Events in Health Care
- Statement of Principle: Talking to Patients About Health Care Injury
- VHA Patient Safety Organizational Assessment
Additional Readings
Resources
Index
Author Information
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.
