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Reflection on Risk and Quality Management in Healthcare

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Please provide a brief description for each listed below and any knowledge that may impact your practice.

Human errors:
- Root Cause Analysis (RCA) and Failure Mode Effect Analysis (FMEA)
- Just/non-punitive culture
- Professional accountability
- Swiss Cheese model
- What contributes to medical errors

How can healthcare staff learn from medical errors such as: wrong surgery/procedure or wrong patient?

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Human errors- human errors are mistakes caused by the action of human intervention or lack thereof. They are typically categorized into mistakes, which are failures in identifying a goal or in the method(s) of carrying out the goal; whereas slips are errors in carrying out an intended action (Reason, 1990).
Root cause analysis- root cause analysis is a step by step method of determining the underlying cause of a problem or failure. In health care a adverse event. The analysis focuses on processes and procedures rather than on a single individual. Typically the root cause analysis is conducted by a neutral party or team not involved with the error in any way and trained in conducting the step by step process.
Failure mode effect analysis (FMEA)- failure mode effect analysis is an assessment of the potential for a failure or error to occur. Unlike root cause analysis, FMEA occurs before an error happens, rather than after. It is often used in product, manufacturing, aeronautics, and in sales/customer service environments. The process is thorough and should assess both major and minor failures of processes to produce desired outcomes (Sahoo, 2013). This type of analysis should prioritize possible failures by seriousness or level of potential damage.
Just/nonpunitive culture- this is typically a work culture that ...

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A reflection on risk and quality management in healthcare is examined.

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Reflection on Risk and Quality Managment in Healthcare

What are your strengths and weaknesses in your ability to incorporate the principles below? What other information might you need to increase your effectiveness? Please provide at least two paragraphs.

List at least three methods of event investigation and describe one investigation
Define root cause analysis
Identify at least four regulatory agencies that mandate reports of adverse events
Identify risks of reporting (or not reporting) adverse events to regulatory agencies.
Discuss the significance of organizational culture
Identify communication process within different management and leadership styles when
reporting a patient safety event
Define the concept of "Buy-in."
Identify the positive aspects of recruitment and retention strategies.
What are the emotional effects of medical error on patients, families, and providers.
Identify at least 3 programs that provide support services
Identify benefits and risks of using technology informatics to prevent errors.
Discuss decision support systems
Discuss the significance of disclosure and apology

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