Rapport Patiëntveiligheid, de rol van de bestuurder - Veilige zorg ...

Noten bij hoofdstuk 41 | Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer HealthSystem. Washington, DC: National Academy Press; 2000.2 | Cooper JB, Gaba DM, Liang B, Woods D, Blum LN. National Patient Safety Foundationagenda for research and development in patient safety. MedGenMed. 2000;2(3):E38.3 | Spath PL. Patient Safety Improvement Guidebook. Forest Grove, OR: Brown-Spath &Associates; 2000.4 | Wagner C, van der Wal G. Voor een goed begrip. Bevordering patiëntveiligheid vraagtom heldere definities. Medisch Contact. 2005;60(47):1888-91.5 | Marx D. Whack-a-Mole: The Price We Pay For Expecting Perfection. Dallas: By Your SideStudio; 2009.6 | Vaughn D. The Challenger Launch Decision: Risky Technology, Culture, and Deviance atNASA. Chicago, IL: University of Chicago Press; 1996.7 | Blendon RJ, DesRoches CM, Brodie M, Benson JM, Rosen AB, Schneider E, et al. Viewsof practicing physicians and the public on medical errors. N Engl J Med.2002;347(24):1933-40.8 | Berwick DM. Errors today and errors tomorrow. N Engl J Med. 2003;348(25):2570-2.9 | Pierluissi E, Fischer MA, Campbell AR, Landefeld CS. Discussion of medical errors inmorbidity and mortality conferences. JAMA. 2003;290(21):2838-42.10 | Connor M, Duncombe D, Barclay E, Bartel S, Borden C, Gross E, et al. Creating a fairand just culture: one institution’s pat toward organizational change. Jt Comm J QualPatient Saf. 2007;33(10):617-24.11 | Berwick DM. Errors today and errors tomorrow. N Engl J Med. 2003;348(25):2570-2.12 | Onderzoeksraad voor Veiligheid. Een onvolledig bestuurlijk proces: hartchirurgie in UMCSt Radboud Onderzoek naar aanleiding van berichtgeving op 28 september 2005 over te hogemortaliteit. Den Haag:Onderzoeksraad; april 2008.13 | Berwick DM. Errors today and errors tomorrow. N Engl J Med. 2003;348(25):2570-2.14 | Pierluissi E, Fischer MA, Campbell AR, Landefeld CS. Discussion of medical errors inmorbidity and mortality conferences. JAMA. 2003;290(21):2838-42.15 | Nuland SB. The doctors’ plague: germs, childbed fever, and the strange story of IgnácSemmelweis. New York: W.W. Norton; 2003.16 | Brown C, Lilford R. Evaluating service delivery interventions to enhance patient safety.BMJ. 2009;338:159-63.17 | Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP,Weiler PC, Hiatt HH. Incidence of adverse events and negligence in hospitalizedpatients. Results of the Harvard Medical Practice Study I. N Engl J Med.1991;324(6):370-6.18 | Walshe K. Adverse events in health care: issues in measurement. Qual. Health Care2000;9:47-52.98Hoofdstuk 4 | Waarom leiding geven aan patiëntveiligheid ingewikkeld is