Medical error, incident investigation and the second victim: doing better but feeling worse?

AW Wu, RC Steckelberg - BMJ quality & safety, 2012 - qualitysafety.bmj.com
In the past decade, hospitals and healthcare workers have become more familiar with
medical errors and the harm they can cause. As a result, incident investigation has become …

Positive deviance: a different approach to achieving patient safety

R Lawton, N Taylor, R Clay-Williams… - BMJ quality & …, 2014 - qualitysafety.bmj.com
Patient safety management within healthcare systems globally can feel like a relentlessly
negative treadmill. Mortality reviews, incident reporting systems and audits all focus attention …

Barriers to incident reporting in a healthcare system

R Lawton, D Parker - BMJ Quality & Safety, 2002 - qualitysafety.bmj.com
Background: Learning from mistakes is key to maintaining and improving the quality of care
in the NHS. This study investigates the willingness of healthcare professionals to report the …

Creating a “no blame” culture: have we got the balance right?

M Walton - BMJ Quality & Safety, 2004 - qualitysafety.bmj.com
Medical errors make headline news. The headlines will always emphasise the human
suffering associated with medical error, but the prevention of such errors comes as the result …

Incident reporting and patient safety

C Vincent - BMJ, 2007 - bmj.com
Incident reporting should ideally communicate all information relevant to patient safety.
Local incident reporting systems in hospitals typically use an incident form that comprises …

Analysis of clinical incidents: a window on the system not a search for root causes

CA Vincent - BMJ Quality & Safety, 2004 - qualitysafety.bmj.com
Incident reporting lies at the heart of many initiatives to improve patient safety. The UK
National Patient Safety Agency (NPSA) 1 has recently launched a national reporting and …

Barriers to incident reporting

J Firth-Cozens - BMJ Quality & Safety, 2002 - qualitysafety.bmj.com
Resistance of physicians to clinical governance will continue until they can see how a real
programme works operationally and a measurable leap in quality is achieved. In the …

Patient safety incident reporting: a qualitative study of thoughts and perceptions of experts 15 years after 'To Err is Human'

I Mitchell, A Schuster, K Smith… - BMJ quality & …, 2016 - qualitysafety.bmj.com
One of the key recommendations of the Institute of Medicine's (IOM) report, To Err is Human,
15 years ago was for greater attention to incident reporting in healthcare, analogous to the …

The problem with incident reporting

C Macrae - BMJ quality & safety, 2016 - qualitysafety.bmj.com
Seminal reports that launched the modern field of patient safety highlighted the importance
of learning from critical incidents. 1 2 Since then, incident reporting systems have become …

Adverse events in health care: issues in measurement

K Walshe - BMJ Quality & Safety, 2000 - qualitysafety.bmj.com
Adverse events—“instances which indicate or may indicate that a patient has received poor
quality care” 1—are used widely in healthcare quality measurement and improvement …