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Volumn 12, Issue 3, 2009, Pages 218-232

A system-oriented analysis model to enhance patient safety in healthcare organizations

Author keywords

Patient safety; Safety control structure; System oriented event analysis

Indexed keywords

ANALYSIS MODELS; EVENT ANALYSIS; HEALTH CARE PROFESSIONALS; HEALTHCARE ORGANIZATIONS; MODEL IMPLEMENTATION; OUTPATIENT CLINIC; PATIENT IDENTIFICATION; PATIENT SAFETY; PHILOSOPHICAL APPROACHES; PILOT STUDIES; RISK MANAGEMENT MODELS; SAFETY CONTROL STRUCTURE; SAFETY CONTROLS; STEP SYSTEM; SYSTEM APPROACH; SYSTEM KNOWLEDGE; SYSTEM-ORIENTED EVENT ANALYSIS; TECHNICAL SYSTEMS; VULNERABLE SYSTEMS;

EID: 70350345230     PISSN: 10981241     EISSN: 15206858     Source Type: Journal    
DOI: 10.1002/sys.20120     Document Type: Article
Times cited : (4)

References (43)
  • 2
    • 33845777515 scopus 로고    scopus 로고
    • Quality and safety by design
    • J.B. Battles, Quality and safety by design, Qual Saf Health Care 15 (Suppl l) (2006), i1-i3.
    • (2006) Qual Saf Health Care , vol.15 , Issue.SUPPL. 1
    • Battles, J.B.1
  • 3
    • 0345215145 scopus 로고    scopus 로고
    • The attributes of medical event-reporting systems: Experience with a prototype medical event-reporting system for transfusion medicine
    • J.B. Battles, H.S. Kaplan, T.W. Van der Schaaf, and C.E. Shea, The attributes of medical event-reporting systems: Experience with a prototype medical event-reporting system for transfusion medicine, Arch Pathol Lab Med 122 (1998), 231-238.
    • (1998) Arch Pathol Lab Med , vol.122 , pp. 231-238
    • Battles, J.B.1    Kaplan, H.S.2    Van Der Schaaf, T.W.3    Shea, C.E.4
  • 5
    • 37549060925 scopus 로고    scopus 로고
    • Thinking about accidents and systems
    • K. Thompson and H. Manasse (Editors), ASHP, Bethesda, MD
    • R.I. Cook and M. O'Connor, "Thinking about accidents and systems," Medication safety: A guide to health care facilities, K. Thompson and H. Manasse (Editors), ASHP, Bethesda, MD, 2005, pp. 73-87.
    • (2005) Medication Safety: A Guide to Health Care Facilities , pp. 73-87
    • Cook, R.I.1    O'Connor, M.2
  • 6
    • 52649175909 scopus 로고    scopus 로고
    • Enabling system thinking to accelerated the development of senior systems engineers
    • H.L. Davidz and D.J. Nightingale, Enabling system thinking to accelerated the development of senior systems engineers, Syst Eng 11(1) (2008), 1-14.
    • (2008) Syst Eng , vol.11 , Issue.1 , pp. 1-14
    • Davidz, H.L.1    Nightingale, D.J.2
  • 8
    • 24744469613 scopus 로고    scopus 로고
    • A systems framework for safety and security: The holistic paradigm
    • A.G. Hessami, A systems framework for safety and security: The holistic paradigm, Syst Eng 7(2) (2004), 99-112.
    • (2004) Syst Eng , vol.7 , Issue.2 , pp. 99-112
    • Hessami, A.G.1
  • 10
    • 0347403555 scopus 로고    scopus 로고
    • Applying the lessons of high risk industries to health care
    • P. Hudson, Applying the lessons of high risk industries to health care, Qual Saf Health Care 12 (2003), 7-12.
    • (2003) Qual Saf Health Care , vol.12 , pp. 7-12
    • Hudson, P.1
  • 12
    • 84953263937 scopus 로고    scopus 로고
    • International Air Transport Association (IATA),2nd edition, IATA, Montreal
    • International Air Transport Association (IATA), Operational Safety Audit Program manual, 2nd edition, IATA, Montreal, 2004.
    • (2004) Operational Safety Audit Program manual
  • 13
    • 0003413171 scopus 로고    scopus 로고
    • Institute of Medicine (IOM). National Academies Press, Washington, DC
    • Institute of Medicine (IOM), To err is human: Building a safer health system, National Academies Press, Washington, DC, 1999.
    • (1999) To err is human: Building a safer health system
  • 15
    • 0003593932 scopus 로고    scopus 로고
    • Joint Commission Resources (JCR), 2nd edition, Joint Commission Resources, Oakbrook Terrace, IL
    • Joint Commission Resources (JCR), Root cause analysis in health care: Tools and techniques, 2nd edition, Joint Commission Resources, Oakbrook Terrace, IL, 2003.
    • (2003) Root Cause Analysis in Health Care: Tools and Techniques
  • 16
    • 0036596101 scopus 로고    scopus 로고
    • The need for risk management to evolve to assure a culture of safety
    • A.M. Kuhn and B.J. Youngberg, The need for risk management to evolve to assure a culture of safety, Qual Saf Health Care 11(2002), 158-162.
    • (2002) Qual Saf Health Care , vol.11 , pp. 158-162
    • Kuhn, A.M.1    Youngberg, B.J.2
  • 17
    • 1342344540 scopus 로고    scopus 로고
    • A new accident model for engineering safer systems
    • N.G. Leveson, A new accident model for engineering safer systems, Safety Sci 42(4) (2004), 237-270.
    • (2004) Safety Sci , vol.42 , Issue.4 , pp. 237-270
    • Leveson, N.G.1
  • 19
    • 1642381128 scopus 로고    scopus 로고
    • Contract Research Report 325/ 2001 for Health & Safety Executive, Her Majesty's Stationery Office, Norwich NR3 1BQ, UK
    • A.D. Livingston, G. Jackson, and K. Priestley, Root causes analysis: Literature review, Contract Research Report 325/2001 for Health & Safety Executive, Her Majesty's Stationery Office, Norwich NR3 1BQ, UK, 2001.
    • (2001) Root Causes Analysis: Literature Review
    • Livingston, A.D.1    Jackson, G.2    Priestley, K.3
  • 20
    • 28944433025 scopus 로고    scopus 로고
    • The long road to patient safety. A status report on patient safety systems
    • D.R. Longo, J.E. Hewett, B. Ge, and S. Schubert, The long road to patient safety. A status report on patient safety systems, JAMA 294 (2005), 2858-2865.
    • (2005) JAMA , vol.294 , pp. 2858-2865
    • Longo, D.R.1    Hewett, J.E.2    Ge, B.3    Schubert, S.4
  • 23
    • 0030286892 scopus 로고    scopus 로고
    • Uncertainties in risk analysis: Six levels of treatment
    • M.E. Paté-Cornell, Uncertainties in risk analysis: Six levels of treatment, Reliab Eng Syst Safety 54 (1996), 95-111.
    • (1996) Reliab Eng Syst Safety , vol.54 , pp. 95-111
    • Paté-Cornell, M.E.1
  • 24
    • 0003783281 scopus 로고
    • 2nd edition, Basic Books, New York, Princeton University Press, Princeton, NJ
    • C. Perrow, Normal accidents: Living with high risk technologies, 2nd edition, Basic Books, New York, 1984, Princeton University Press, Princeton, NJ, 1999.
    • (1984) Normal Accidents: Living with High Risk Technologies , vol.1999
    • Perrow, C.1
  • 25
    • 0031279121 scopus 로고    scopus 로고
    • Risk management in a dynamic society: A modeling problem
    • J. Rasmussen, Risk management in a dynamic society: A modeling problem, Safety Sci 27 (1997), 183-213.
    • (1997) Safety Sci , vol.27 , pp. 183-213
    • Rasmussen, J.1
  • 27
    • 0004223940 scopus 로고
    • Cambridge University Press, New York
    • J. Reason, Human error, Cambridge University Press, New York, 1990.
    • (1990) Human Error
    • Reason, J.1
  • 28
    • 0034681819 scopus 로고    scopus 로고
    • Human error: Models and management
    • J. Reason. Human error: Models and management, British Medical Journal 320 (2000), 768-770.
    • (2000) British Medical Journal , vol.320 , pp. 768-770
    • Reason., J.1
  • 29
    • 54949103908 scopus 로고
    • Toward formal foundations of teleological systems science
    • W.M. Sachs, Toward formal foundations of teleological systems science, General Syst xxi (1976), 145-154.
    • (1976) General Syst , vol.21 , pp. 145-154
    • Sachs, W.M.1
  • 30
    • 70350336401 scopus 로고    scopus 로고
    • Advances in patient safety: From research to implementation, Agency for Healthcare Research and Quality. MD
    • P.M. Schyve, System thinking and patient safety. Advances in patient safety: From research to implementation, Volume 2. Agency for Healthcare Research and Quality, MD, 2007, ht tp://www.ahrq.gov/downloads/pub/advances/ vol2/Schyve.pdf.
    • (2007) System Thinking and Patient Safety , vol.2
    • Schyve, P.M.1
  • 33
    • 70350347901 scopus 로고    scopus 로고
    • System Safety Society, New Mexico Chapter, 2nd edition, R.A. Stephens and W.W. Talso (Editors), System Safety Society, Albuquerque, NM
    • System Safety Society, New Mexico Chapter, System safety analysis handbook, 2nd edition, R.A. Stephens and W.W. Talso (Editors), System Safety Society, Albuquerque, NM, 1997.
    • (1997) System Safety Analysis Handbook
  • 35
    • 0036752138 scopus 로고    scopus 로고
    • Medical applications of industrial safety science
    • T.W. Van der Schaaf, Medical applications of industrial safety science, Qual Saf Health Care 11(2002), 205-206.
    • (2002) Qual Saf Health Care , vol.11 , pp. 205-206
    • Van Der Schaaf, T.W.1
  • 36
    • 4043154175 scopus 로고    scopus 로고
    • Analysis of clinical incidents: A window on the system not a search for root causes
    • C.A. Vincent, Analysis of clinical incidents: A window on the system not a search for root causes, Qual Saf Health Care 13(4) (2004), 242-243.
    • (2004) Qual Saf Health Care , vol.13 , Issue.4 , pp. 242-243
    • Vincent, C.A.1
  • 37
    • 16244381980 scopus 로고    scopus 로고
    • The end of the beginning: Patient safety five years after, To err is human
    • Millwood); Suppl Web Exclusives, W4
    • R.M. Wachter, The end of the beginning: Patient safety five years after "To err is human," Health Aff (Millwood); Suppl Web Exclusives, W4 (2004), 534-545.
    • (2004) Health Aff , pp. 534-545
    • Wachter, R.M.1
  • 38
    • 33845865785 scopus 로고    scopus 로고
    • From root causes to safer systems: International comparisons of nationally sponsored healthcare staff training programs
    • L.M. Wallace, From root causes to safer systems: International comparisons of nationally sponsored healthcare staff training programs, Qual Saf Health Care 15 (2006), 393-399.
    • (2006) Qual Saf Health Care , vol.15 , pp. 393-399
    • Wallace, L.M.1
  • 39
    • 33745081489 scopus 로고    scopus 로고
    • Safety and complexity: Inter-departmental relationships as a threat to patient safety in the operating department
    • J. Waring, R. McDonald, and S. Harrison, Safety and complexity: inter-departmental relationships as a threat to patient safety in the operating department, J Health Org Management 20(2-3) (2006), 227-242.
    • (2006) J Health Org Management , vol.20 , Issue.2-3 , pp. 227-242
    • Waring, J.1    McDonald, R.2    Harrison, S.3
  • 41
    • 47749086111 scopus 로고    scopus 로고
    • Resilience engineering: Redefining the culture of safety and risk management
    • D.D. Woods, Resilience engineering: Redefining the culture of safety and risk management, Hum Factors Ergonom Soc Bull 49 (2006), 1-3.
    • (2006) Hum Factors Ergonom Soc Bull , vol.49 , pp. 1-3
    • Woods, D.D.1
  • 42
    • 0013666946 scopus 로고    scopus 로고
    • Perspectives on human error: Hindsight biases and local rationality
    • F.T. Durso, R.S. Nickerson, J.D. Schvaneveldt (Editors), New York: Wiley
    • D.D. Woods and R. Cook, "Perspectives on human error: Hindsight biases and local rationality," Handbook of applied cognition, F.T. Durso, R.S. Nickerson, J.D. Schvaneveldt (Editors), New York: Wiley, 1999, pp.141-171.
    • (1999) Handbook of Applied Cognition , pp. 141-171
    • Woods, D.D.1    Cook, R.2
  • 43
    • 0346325828 scopus 로고    scopus 로고
    • Administrative data-based patient safety research: A critical review
    • C. Zhan and M. Miller, Administrative data-based patient safety research: A critical review, Qual Saf Health Care 12(Suppl 2) (2003), 58-63.
    • (2003) Qual Saf Health Care , vol.12 , Issue.SUPPL. 2 , pp. 58-63
    • Zhan, C.1    Miller, M.2


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.