Medical error reporting in America: a changing landscape.

Abstract:

:Should the United States require mandatory reporting of medical errors within the health care system? Many barriers to medical error reporting currently exist and have made it difficult to establish a nationwide reporting system. As such, individual states have begun to address this issue one state at a time. This article reviews the barriers to nationwide reporting, provides a brief historical perspective on quality initiatives including medical error reporting, examines what the individual states have initiated, and considers these implications from a nursing perspective. Finally, the hands of "big money" stakeholders are presented and considered throughout the entire discussion.

journal_name

Qual Manag Health Care

authors

Karlsen KA,Hendrix TJ,O'Malley M

doi

10.1097/01.QMH.0000344594.48510.82

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

59-70

issue

1

eissn

1063-8628

issn

1550-5154

pii

00019514-200901000-00008

journal_volume

18

pub_type

杂志文章
  • Patient safety and the integration of graduate nurses into effective organizational clinical risk management systems and processes: an Australian study.

    abstract:OBJECTIVES:This article explores and describes key processes facilitating the integration of neophyte graduate nurses into safe and effective organizational systems and processes as part of a hospital's overall local clinical governance and clinical risk management (CRM) program. METHODS:This study was undertaken usin...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/01.QMH.0000316994.02039.80

    authors: Johnstone MJ,Kanitsaki O

    更新日期:2008-04-01 00:00:00

  • Opinions and use of advance directives by physicians at a tertiary care hospital.

    abstract::The physician-patient relationship is an essential part of end-of-life planning, including discussions of advance directives (AD). Physicians likely to encounter AD issues with their patients were identified and queried as to their knowledge, opinion, and experience with ADs. Though most physicians felt ADs were helpf...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200008030-00004

    authors: Langerman A,Angelos P,Johnston C

    更新日期:2000-04-01 00:00:00

  • Quality improvement and the need for IRB review.

    abstract::Improving health care quality is increasingly recognized as a national priority in the United States. As a result, more and more health care organizations can be expected to undertake quality improvement (QI) initiatives. A question being raised with increasing frequency is: "Which QI activities need review by an inst...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200307000-00006

    authors: Nerenz DR,Stoltz PK,Jordan J

    更新日期:2003-07-01 00:00:00

  • The importance of negative feedback and consequences of actions in the design of processes.

    abstract::Like many organizations, Continental Rehabilitation Hospital of San Diego designs and communicates templates and targets for desired changes in behaviors and tracks results. It recognizes and celebrates successes and struggles with its failures. A recent case example demonstrates the importance of generating immediate...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-199706010-00007

    authors: Chaplin E,Bailey M,Barger L,Bruce J,Guzman O,Galleisky G,Thompson-Henry S

    更新日期:1997-10-01 00:00:00

  • Surgical Assessment Units: The Key to More Efficient Emergency Surgical Provision and Admissions?

    abstract:BACKGROUND:Hospitals establish surgical assessment units to promote efficiency and improve patient experience. Surgical assessment units are believed to reduce unnecessary admissions. We evaluated a hospital's on-call surgery service without this facility to determine benefits of implementation. METHODS:All emergency ...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0000000000000236

    authors: Reeds MG,Andreani SM,Rohatgi A,Taylor FGM

    更新日期:2020-01-01 00:00:00

  • Managers' views and experiences of a large-scale county council improvement program: limitations and opportunities.

    abstract::The aim of this study was to explore and evaluate managers' views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swed...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0b013e31828bc276

    authors: Andersson AC

    更新日期:2013-04-01 00:00:00

  • Physicians as inclusive leaders: insights from a participatory quality improvement intervention.

    abstract::The patient-centered medical home model of primary care requires increased collaboration in care delivery. Recent studies suggest that such a collaborative model of care is aided by physician leaders who practice an inclusive approach to leadership; however, they do not empirically demonstrate what such strategies loo...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0b013e31825e876a

    authors: Howard J,Shaw EK,Felsen CB,Crabtree BF

    更新日期:2012-07-01 00:00:00

  • A multidisciplinary care pathway significantly increases the number of early morning discharges in a large academic medical center.

    abstract::In an environment where there is increased demand for hospital beds, it is important that inpatient flow from admission to treatment to discharge is optimized. Among the many drivers that impact efficient patient throughput is an effective and timely discharge process. Early morning discharge helps align inpatient cap...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0000000000000049

    authors: Durvasula R,Kayihan A,Del Bene S,Granich M,Parker G,Anawalt BD,Staiger T

    更新日期:2015-01-01 00:00:00

  • Medical organization structures that promote quality and efficiency: past research and future considerations.

    abstract::This article reviews studies of the effects of medical organization structure on quality and cost conducted over the past three decades. Topics of inquiry have proceeded from the organizational to the individual provider level and from the inpatient to the ambulatory level. The article presents the findings of these s...

    journal_title:Quality management in health care

    pub_type: 杂志文章,评审

    doi:10.1097/00019514-199503040-00002

    authors: Burns LR

    更新日期:1995-07-01 00:00:00

  • Process improvement in hospitals: a case study in a radiology department.

    abstract::To improve processes in hospitals, a case study was conducted at a German university hospital, which consists of more than 30 clinics and institutes on a large campus. The case study focused on the analysis of the patient flow and of machine utilization in the radiology department. Radiological devices are spread over...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0b013e3181bee127

    authors: Nickel S,Schmidt UA

    更新日期:2009-10-01 00:00:00

  • A curriculum for training quality scholars to improve the health and health care of veterans and the community at large.

    abstract::In 1998, the Veterans Health Administration invested in the creation of the Veterans Administration National Quality Scholars Fellowship Program (VAQS) to train physicians in new ways to improve the quality of health care. We describe the curriculum for this program and the lessons learned from our experience to date....

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200210030-00006

    authors: Splaine ME,Aron DC,Dittus RS,Kiefe CI,Landefeld CS,Rosenthal GE,Weeks WB,Batalden PB

    更新日期:2002-04-01 00:00:00

  • Transactional versus transformational style of leadership--employee perception of leadership efficacy in public and private hospitals in Kuwait.

    abstract:OBJECTIVES:To determine whether employees working for a transformational leader perceive their leader as more effective than do those working for a transactional leader. To assess whether employees in private hospitals are more likely to perceive their leaders as transformational than are employees in public hospitals....

    journal_title:Quality management in health care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00019514-200410000-00009

    authors: Al-Mailam FF

    更新日期:2004-10-01 00:00:00

  • Proving the effectiveness of community programs in jeopardy: the role of formative evaluation.

    abstract::Today's health care programs are being scrutinized like never before and yet few clinicians and managers know how to show the value of programs without time-consuming outcomes research. This is especially true for new and innovative programs that are dependent on outside funding and may not have enough time to show an...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200109040-00005

    authors: Quinn DC

    更新日期:2001-07-01 00:00:00

  • Patient Involvement in Evaluation of Safety in Oral Antineoplastic Treatment: A Failure Mode and Effects Analysis in Patients and Health Care Professionals.

    abstract:OBJECTIVES:To identify risks associated with delivery of treatment with oral antineoplastic agents in an outpatient setting and to evaluate additional value and feasibility of engaging patients in a proactive risk analysis. METHODS:We conducted 2 separate but parallel failure mode and effects analyses (FMEAs) among pa...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0000000000000199

    authors: Mattsson TO,Lipczak H,Pottegård A

    更新日期:2019-01-01 00:00:00

  • Perioperative nurses' ability to think critically.

    abstract:AIMS:The purpose of this quantitative descriptive correlational study was to assess for presence and degree of critical thinking skills among perioperative (OR) nurses. BACKGROUND:Critical thinking has become a multidisciplinary "buzz phrase"; however, critical thinking, reflective thinking, or mental discipline was d...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0b013e3181dafec7

    authors: Fesler-Birch DM

    更新日期:2010-04-01 00:00:00

  • Assessing the evidence of Six Sigma and Lean in the health care industry.

    abstract:BACKGROUND:Popular quality improvement tools such as Six Sigma and Lean Systems (SS/L) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether these 2 quality improvement tools actually improve health care quality. ...

    journal_title:Quality management in health care

    pub_type: 杂志文章,评审

    doi:10.1097/QMH.0b013e3181eb140e

    authors: DelliFraine JL,Langabeer JR 2nd,Nembhard IM

    更新日期:2010-07-01 00:00:00

  • Pay for performance: an excellent idea that simply needs implementation.

    abstract::Pay for performance cannot consist of a one-size-fits-all approach. Variation in quality and cost of care is best measured using a single "value" (quality/cost) score that is decomposed into component cost and quality for every health care encounter type. Economic incentives must be enough to focus the provider's atte...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200501000-00004

    authors: Goldfield N,Burford R,Averill R,Boissonnault B,Kelly W,Kravis T,Smithline N

    更新日期:2005-01-01 00:00:00

  • Using control charts to analyze serial patient-related data.

    abstract::The authors collected data from the record of a patient who had recently undergone coronary bypass surgery and used these data to construct control charts. The control charts helped them to interpret the variation in several clinical parameters and to evaluate the clinical responses to this variation. ...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:

    authors: Laffel G,Luttman R,Zimmerman S

    更新日期:1994-10-01 00:00:00

  • Ambulatory care in the new millennium: the role of consumer information.

    abstract::The past decade has been marked by extensive change in the organization of health care delivery systems (the "supply side" of health care). There has been relatively less change in the nature of the health care consumer (the "demand side" of health care). The emergence of the Internet as a consumer health care technol...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200008020-00009

    authors: Sennett C

    更新日期:2000-01-01 00:00:00

  • Are doctors unhappy? A study of residents with an open interview form.

    abstract::Several recent reports show that many physicians feel discontented and unhappy with their work situation. This could in part be due to a decline in status, loss of influence on health care organization, reduced wages etc. It is important to find ways to better understand their experiences of working life to get more f...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200401000-00008

    authors: Bergin E,Johansson H,Bergin R

    更新日期:2004-01-01 00:00:00

  • Perceived organizational problems in health care: a pilot test of the structured problem and success inventory.

    abstract::Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational ...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0b013e31824d18ff

    authors: Nyström ME,Terris DD,Sparring V,Tolf S,Brown CR

    更新日期:2012-04-01 00:00:00

  • Application of attribute control charts to risk-adjusted data for monitoring and improving health care performance.

    abstract::This article proposes a new class of control charts that may be used for monitoring and improving the quality of care. Unlike conventional control charts that rely on observed performance data, these charts use risk-adjusted data in addition to the observed data. The resulting time-ordered charts are capable of reduci...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200301000-00004

    authors: Hart MK,Lee KY,Hart RF,Robertson JW

    更新日期:2003-01-01 00:00:00

  • The synergistic role TQM and reengineering could play in standardizing the European vaccination policy.

    abstract::For the implementation of the proposed European standardized vaccination, total quality management (TQM) and reengineering could be powerful tools with a potentially synergistic effect. In the case examined, nonexplicit TQM prepared the organization in several ways for reengineering: providing the human capital, makin...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200210020-00009

    authors: Dubois HF

    更新日期:2002-01-01 00:00:00

  • Through the eye of the beholder: multiple perspectives on quality in women's health care.

    abstract::Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of ca...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-200008040-00002

    authors: Stichler JF,Weiss ME

    更新日期:2000-07-01 00:00:00

  • An Assessment of Organizational Health Literacy Practices at an Academic Health Center.

    abstract:BACKGROUND:Organizational health literacy is the degree to which an organization considers and promotes the health literacy of patients. Addressing health literacy at an organizational level has the potential to have a greater impact on more health consumers in a health system than individual-level approaches. OBJECTI...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0000000000000162

    authors: Prince LY,Schmidtke C,Beck JK,Hadden KB

    更新日期:2018-04-01 00:00:00

  • Application of variables control charts to risk-adjusted time-ordered healthcare data.

    abstract::In a previous article (M. K. Hart, Qual Manag Health Care. 2003;12(1):5-19), the authors presented risk-adjusted control charts applicable for attributes data. The present article discusses a similar class of control charts applicable for variables data that are often skewed. The key feature of these charts is their a...

    journal_title:Quality management in health care

    pub_type: 评论,杂志文章

    doi:10.1097/00019514-200404000-00003

    authors: Hart MK,Robertson JW,Hart RF,Lee KY

    更新日期:2004-04-01 00:00:00

  • An exploratory analysis of the correlation of pain scores, patient satisfaction with relief from pain, and a new measure of pain control on the total dose of opioids in pain care.

    abstract:OBJECTIVE:We explored the associations between opioid dose and multiple measures of pain. STUDY DESIGN AND MEASURES:Thirty-two consecutive patients admitted solely for an acute exacerbation of cancer-related pain or for surgery were followed for their entire hospital stay (115 days of pain). For each hospital day, we ...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0000000000000009

    authors: Harting B,Johnson T,Abrams R,Odwazny R,Hasler S,McNutt R,Patient Safety Committee at Rush and the UIC Center for Research Translation.

    更新日期:2013-10-01 00:00:00

  • Extending the application of critical path methods.

    abstract::Most health care organizations are using critical pathways in an attempt to reduce the variation in patient care, improve quality, enhance communication, and reduce costs. Virtually all of the critical path efforts to date have developed tables of treatments, medications, and so forth by day and have displayed them in...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-199503020-00005

    authors: Coffey RJ,Othman JE,Walters JI

    更新日期:1995-01-01 00:00:00

  • A method to track surgical site infections.

    abstract::We present an approach to assessing the impact of surveillance for surgical site infections and providing feedback to surgeons on their progress, as part of continuous quality improvement. Adjusting for patient risk factors using the Standardized Mortality Ratio, there was a marked decrease over time in both SMR (1.3 ...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/00019514-199806030-00006

    authors: McCall JL,Macchiaroli S,Brown RB,Schulte MJ,Calderone S,Selbovitz LG,Corl AM,Reed WP,Friedmann P

    更新日期:1998-04-01 00:00:00

  • From Hospital to Home: A Resident-Driven Quality Improvement Project to Overcome Discharge Prescription Barriers.

    abstract:BACKGROUND AND OBJECTIVES:Inability to obtain timely medications is a patient safety concern that can lead to delayed or incomplete treatment of illness. While there are many patient and system factors contributing to postdischarge medication nonadherence, availability and insurance-related barriers are preventable. P...

    journal_title:Quality management in health care

    pub_type: 杂志文章

    doi:10.1097/QMH.0000000000000264

    authors: Patel PA,Dillon JR,Mazique DC,Lee JI

    更新日期:2020-10-01 00:00:00