Patient Safety and the “Just Culture”

This presentation by David Marx defines just culture, the safety task, the just culture model, and
statewide initiatives in New York.

Call to Action: Safeguarding the Integrity of Healthcare Quality and Safety Systems

The National Association for Healthcare Quality Call to Action: Safeguarding the Integrity of
Healthcare Quality and Safety Systems provides best practices to enhance quality, improve
ongoing safety reporting and protect staff. It addresses accountability, protection of those who
report quality and safety concerns, and accurate reporting and response.

BLOG:

PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

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RESOURCES:

The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.