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1.
Unfallchirurg ; 123(1): 22-28, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31728555

RESUMO

An error-resistant safety culture can only be achieved through proactive clinical risk management. In April 2019 the Federal Joint Committee once again increased the pressure on hospitals by means of the Quality Promotion and Enforcement Directive (QFD Directive) to take measures within the framework of clinical risk management in order to reduce the error and harm rate and therefore to significantly improve patient safety. In the long term this can only be achieved by positively influencing the safety culture and thus the attitudes and motives of all employees. Clinical risk management should focus on the prevention of so-called sentinel events on the one hand and on the reduction of frequent and avoidable complications on the other hand. This not only improves patient safety but also protects employees from negative consequences. Effective clinical risk management always follows a systemic approach, the 10 fields of action of which are discussed in this article. Large meta-analyses have also confirmed the substantial economic benefit of a clinical risk management.


Assuntos
Cultura Organizacional , Segurança do Paciente , Gestão de Riscos , Gestão da Segurança , Humanos
2.
J Nurs Adm ; 50(1): 45-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31809456

RESUMO

OBJECTIVE: To examine if increasing the percentage of nurses with bachelor degrees (BSNs) and/or certified nurses leads to improved patient outcomes, specifically the number of reported falls. BACKGROUND: Research suggests a link between higher levels of education and expertise and positive patient outcomes, including falls. The Institute of Medicine recommends an increase in BSN nurses. METHODS: This was a retrospective cross-sectional cohort analysis using data from the National Database of Nursing Quality Indicators from 2010 to 2016 from multiple medical centers in Central and Southern Illinois. RESULTS: With every 1-unit increase in the percentage of BSN nurses or certified nurses, a reduction in total patient falls per 1000 patient-days can be expected in the amount of 0.02 to 0.04 and 0.01 to 0.03, respectively, all else held constant. CONCLUSIONS: Improvements to patient outcomes may be optimized with increased percentages of nurses with bachelor degrees and/or certifications.


Assuntos
Acidentes por Quedas , Certificação , Competência Clínica , Recursos Humanos de Enfermagem no Hospital , Estudos de Coortes , Estudos Transversais , Escolaridade , Humanos , Estudos Retrospectivos , Gestão da Segurança
3.
Accid Anal Prev ; 134: 105351, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31715548

RESUMO

INTRODUCTION: Mindful organizing (also known as collective mindfulness) is a team level construct that is said to underpin the principles of high-reliability organizations (HROs), as it has shown to lead to almost error-free performance. While mindful organizing research has proliferated in recent years, studies on how to measure mindful organizing are scarce. Vogus and Sutcliffe (2007) originally validated a nine-item "Mindful Organizing Scale" but few subsequent validation studies of this scale exist. The present study aimed to validate a Spanish version of the Mindful Organizing Scale. METHOD: The sample included 47 teams (comprising of a total of 573 workers with an average team size of 12.19) from a Spanish nuclear power plant. A confirmatory factor analysis (CFA), reliability analysis, and an analysis of aggregation indices were carried out. A correlation analysis and CFA were used to further validate the scale in terms of its distinctiveness from, and relationship with, other team-related variables such as safety culture, team safety climate, and team learning. Finally, evidence of criterion-related validity was collected by testing the incremental validity of the mindful organizing scale in the association with various workplace safety outcomes (safety compliance and safety participation). RESULTS: The results confirmed a unidimensional structure of the scale and indicated satisfactory internal consistency. Aggregation of the scores to the team level was justified while significant positive correlations between mindful organizing and other team-related variables (safety culture, team safety climate, team learning) were found. Moreover, mindful organizing showed distinctiveness from safety culture, team safety climate and team learning. Finally, incremental validity of the scale was supported, as it shows to be associated with safety compliance and safety participation above and beyond other related constructs. CONCLUSIONS: The Spanish version of the Mindful Organizing Scale has shown to be a valid and reliable scale that can be used to measure mindful organizing. CONTRIBUTIONS: The validation of the unidimensional Spanish version of Vogus and Sutcliffe's (2007) Mindful Organizing Scale provides researchers and practitioners with a reliable and valid tool to use in Spanish speaking organizations to measure mindful organizing, which has been shown to result in more reliable performance. Theoretically, this study offers four contributions. Firstly, it validates a scale that operationalizes the 'mindful organizing' construct in a traditional high-reliability organization (nuclear power plant) which has never been done before. Secondly, it offers evidence that a mindful organizing scale can be validated in a new cultural context and language (Spanish) to any of the previous studies done before it. Thirdly, it adds to our understanding of mindful organizing's nomological network by distinguishing it from other team and safety-related variables. Lastly, it builds on current research showing sound psychometric properties of a one-dimensional, quantitative measure of mindful organizing.


Assuntos
Atenção Plena , Gestão da Segurança/organização & administração , Inquéritos e Questionários/normas , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centrais Nucleares/organização & administração , Psicometria , Reprodutibilidade dos Testes , Traduções
4.
Accid Anal Prev ; 134: 105350, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31715549

RESUMO

Previous studies have acknowledged the impact of risk perception on safety behavior, but were largely controversial. This study aims to clarify this conflict and the mechanism through which risk perception can have an impact on safety behavior. From the perspective of the dual attribute of the job demand concept in job demands-resources theory, we posit that risk perception can be considered as a job hindrance or a job challenge depending on the context, thereby resulting in a negative or positive impact on safety behavior, respectively. The current research context is the construction industry and the hypotheses were tested using hierarchically nested data collected from 311 workers in 35 workgroups. Risk perception was demonstrated to be a job hindrance exerting a negative impact on safety behavior and safety motivation mediated this effect. In addition, two dimensions of group-level safety climate--supervisor's and coworkers'--were expected to alleviate or even reverse the detrimental effects of hindrance risk perception on safety motivation and on safety behavior via motivation. A moderation model and a first-stage moderated mediation model were established, respectively, for testing the moderating roles of safety climate in the relationship between risk perception and safety motivation, and in the indirect relationship of risk perception with safety behavior via motivation. Surprisingly, contrary to the hypotheses, when supervisor's safety climate changed from a low level to a high level, the impact of risk perception on safety motivation changed from positive to negative, and the negative effect of risk perception on safety behavior via safety motivation was not alleviated but worsened. As expected, for workers in a positive coworkers' safety climate, the negative effect of risk perception on motivation and the indirect negative effect of risk perception on behavior were both reversed to the positive. This indicates that coworkers' safety climate helped to change perceived risk from a job hindrance to a challenge. This research contributes to workplace risk perception and safety behavior research by theoretically viewing risk perception as a dual job hindrance-challenge concept and proposing two competing hypotheses concerning the impact of risk perception on safety behavior. The empirical investigation confirmed the hindrance attribute of risk perception in the construction context. It provides a theoretical framework and empirical evidence for future research to synthesize the conflict risk perception-safety behavior relationship. We also contribute to the literature by pointing out the potential negative role of certain supervisor safety activities such as paternalistic leadership in influencing employee safety.


Assuntos
Cultura Organizacional , Gestão da Segurança/organização & administração , Prevenção de Acidentes/métodos , Adulto , Indústria da Construção/organização & administração , Feminino , Humanos , Masculino , Motivação , Saúde do Trabalhador
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1376-1380, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838807

RESUMO

Objective: To establish the model of the self-confidence, motivation and authoritative advice factors influencing the use of child restraint and use structural equation model to test it to provide scientific basis for promoting the advocacy of use of child restraint. Methods: Using multi-stage cluster random sampling method, 9 112 parents from the family with one or more private cars and 0-6 years old children in Shanghai and Shenzhen were investigated about the use of child restraint. A theoretical model of the self-confidence, motivation and authoritative advice factors influencing the use of child restraint was constructed. The theoretical model was validated and quantitatively analyzed by structural equation model. Results: The overall model accords with the expected theoretical model, and the goodness of model fit was fine. The indicators had met the standard. RMSEA=0.03, CFI=0.97. The standardization coefficients of each route showed statistical significance (P<0.05). The standardization coefficients of the influence of authoritative suggestions and motives on self-confidence were 0.45 and 0.30 respectively, and the standardization coefficients of the influence of self-confidence on the use of child restraint was 0.40. The standardization coefficient of the influence of authoritative suggestions on motivation was 0.61. Conclusions: In the advocacy of the use of child restraint, we should attach importance to the use of recommendations from experts and organizations with professional authority, good credibility and public welfare. We should take the status of children's road traffic safety and the mechanism of the role of child restraint as one of the key points of propaganda.


Assuntos
Acidentes de Trânsito/prevenção & controle , Sistemas de Proteção para Crianças , Motivação , Pais/psicologia , Gestão da Segurança/métodos , Autoimagem , Automóveis , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Cintos de Segurança/estatística & dados numéricos
6.
Revista Espaço para a Saúde ; 20(2): [90-107], dez.2019. tab, ilus
Artigo em Português | LILACS | ID: biblio-1046436

RESUMO

Objetivo: Conhecer os principais riscos relacionados à segurança do paciente no transporte intra-hospitalar. Método: Trata-se de uma revisão integrativa, que utilizou os descritores: segurança do paciente, Cuidados críticos e transporte intra-hospitalar. Resultados: Analisaramse 12 artigos, todos na língua portuguesa, selecionados nas bases de dados BVS, CAPES e Google Acadêmico, delimitados ao período de 2010 a 2019. Conclusão: A alta incidência de eventos adversos em pacientes críticos durante o transporte intra-hospitalar torna imperativa a criação de protocolos institucionais para auxiliar e padronizar o transporte, minimizando erros e favorecendo uma prática segura.


Assuntos
Gestão da Segurança , Continuidade da Assistência ao Paciente , Prevenção de Acidentes , Instalações de Saúde
7.
Medicine (Baltimore) ; 98(50): e18352, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852137

RESUMO

Improvement in patient safety culture requires constant attention. This study aimed to identify hospital-level elements related to patient safety culture, such as patient safety management systems, activities and work environments.Two questionnaire surveys were administered to hospitals in Japan in 2015 and 2016. The first survey aimed to determine which hospitals would allow their staff to respond to a questionnaire survey. The second survey aimed to measure the patient safety culture in those hospitals. Patient safety culture was assessed using the Hospital Survey on Patient Safety Culture (HSOPS). The relationship of hospital-level patient safety culture with the aforementioned elements in each hospital was analyzed.The response rate to the first survey was 22% (721/3270), and 40 eligible hospitals were selected from the respondents. The second survey was administered to healthcare workers in those 40 hospitals, and the response rate was 94% (3768/4000). The proportion of respondents who had 7 or more days off each month was related to the scores of 7 composites and the Patient Safety Grade of HSOPS. Both the presence of a mission statement describing patient safety and the proportion of respondents who participated in in-house patient safety workshops at least twice annually were related to the scores of 5 composites and the Patient Safety Grade of HSOPS.Our study suggests that the number of days off each month, the presence of a hospital patient safety mission statement, and the participation rate in in-house patient safety workshops might be key factors in creating a good patient safety culture within each hospital.


Assuntos
Cultura Organizacional , Segurança do Paciente , Recursos Humanos em Hospital/psicologia , Gestão da Segurança , Local de Trabalho/psicologia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(11): 1260-1269, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31748451

RESUMO

We analyzed 197 fall incidents in the questionnaire survey about the incident that occurred in Department of Radiology. In the past paper about the patient safety, there is no report that evaluated incident data directly. The purpose of this paper is to analyze the factor of the medical incidents using statistical technique scientifically. In this paper, we do not suggest concrete precaution. At first, we found the number of patients (each gender, modality, generation) in the five facilities of the coworker of one week. We found an incident rate from this patient total number, and we normalized data. As a result, we were able to do each risk evaluation because a risk ratio and relative risk degree was found. And, we were able to identify modality and the generation with the significant difference using the testing for differences in population rate. By our analyses, we revealed the chapter which must strengthen safety management.


Assuntos
Acidentes por Quedas , Segurança do Paciente , Radiologia , Humanos , Gestão de Riscos , Gestão da Segurança
9.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(11): 1286-1296, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31748454

RESUMO

The work of radiological technologists is changing and more complicated because of the development of medical technology and implementation of information technology (IT). Although the cases of incident and accident have been reported, they have not been comprehensively analyzed in the workflow for radiotherapy. In this study, we visualized the workflow of radiological technologists in radiotherapy and revealed the causes of incidents and accidents. The work process was visualized by drawing workflow map. The structuring of problem was performed with interpretive structural modeling (ISM) method based on graph theory by analyzing of work categorized by safety management. Our results may be able to clarify the work of radiological technologists leads to the reduction of incidents and accidents in radiation therapy.


Assuntos
Bases de Dados Factuais , Fluxo de Trabalho , Acidentes , Gestão da Segurança
10.
Br J Nurs ; 28(19): 1266-1267, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680570

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses several recent reports on patient safety and argues that we may be in danger of over-engineering the patient safety debate.


Assuntos
Segurança do Paciente , Medicina Estatal/organização & administração , Humanos , Publicações , Gestão da Segurança/organização & administração , Reino Unido
11.
J Nurs Adm ; 49(11): 525-530, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31651611

RESUMO

Healthcare workplace violence is a growing concern among nurses; however, nurse administrators and managers may not be fully aware of the level, frequency, or extent of the trauma that staff nurses experience. This information gap is influenced by nurses' failure to report violent incidents, their belief that they are expected to care for violent/assaultive patients, time required for extensive documentation about these incidents, and perceptions that minimal follow-up to mitigate future episodes will occur. This article describes the evidence-based structures, processes, and practices supported to minimize organizational risk and protect nurses and other staff from being physically or emotionally injured and/or traumatized in the workplace.


Assuntos
Guias como Assunto , Recursos Humanos de Enfermagem no Hospital/psicologia , Gestão da Segurança/métodos , Gestão da Segurança/normas , Violência no Trabalho/prevenção & controle , Violência no Trabalho/psicologia , Local de Trabalho/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
12.
J Nurs Adm ; 49(11): 531-537, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31651612

RESUMO

OBJECTIVE: This study explored the relationships between nurse-sensitive structures, processes (work engagement [WE], frequency of fall risk discussion during report, and frequency of purposeful rounds), and patient falls. BACKGROUND: Strong WE is associated with better nurse-assessed quality of care, but previous research is limited by self-reported outcome measures. METHODS: We used a descriptive, cross-sectional, survey design with 41 nursing units from 7 hospitals. Nurses completed a survey including the Utrecht Work Engagement Scale. National Database of Nursing Quality Indicators reports provided falls data. RESULTS: WE was not related to patient falls, even after controlling for RN staffing and skill mix. The nursing units that had more nurses performing frequent purposeful rounds experienced greater falls with injury. Highly engaged nurses participated more in purposeful rounding and discussion of fall risk during bedside report than less engaged nurses. CONCLUSIONS: Further research is needed to understand the impact of WE on patient outcomes.


Assuntos
Acidentes por Quedas/prevenção & controle , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital/psicologia , Guias de Prática Clínica como Assunto , Gestão da Segurança/normas , Local de Trabalho/normas , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade
14.
Accid Anal Prev ; 133: 105290, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31585230

RESUMO

Highway operations are marred with inherent risks of injury or death, making risk management critical for ensuring the adequate safety of the people involved. This paper investigates the interaction between various highway safety risk factors and effective risk mitigation strategies related to such interaction. The Covariate-Balanced Determinant Detector (CBDD) technique is used to estimate the quantity of both individual and combined risks, and their effect on highway operations safety. Through this technique, the most dangerous risk combinations have been identified and corresponding risk mitigation scenarios have been developed. The results illustrate that the most dangerous scenarios probably result from the interactive effect of risk factors rather than individual factors, and the effect of mitigation strategies should be evaluated in response to a risk scenario before it is implemented.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Ocupacionais/prevenção & controle , Gestão da Segurança/métodos , Acidentes de Trânsito/prevenção & controle , Ambiente Construído/normas , Humanos , Traumatismos Ocupacionais/epidemiologia , Medição de Risco/métodos , Fatores de Risco
15.
Accid Anal Prev ; 133: 105295, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31590093

RESUMO

This formative study investigates the utility of the social norms approach (SNA) and self-determination theory (SDT) in framing safe bicycling messages with the goal of increasing intention to use bicycle lanes on a university campus. In Study 1, observational data showed that the majority of campus bicyclists did not use designated bike lanes while cycling; thus, intention to use bicycle lanes was chosen as the dependent variable for Study 2. Survey data (n = 168) collected from college students measured SNA and SDT constructs related to intention to use bicycle lanes, including descriptive norms, injunctive norms, autonomy, competence, and relatedness. Results indicate that different aspects of both the SNA and SDT are viable approaches for developing bicycle safety campaign messages, as competence, relatedness, and injunctive norms were significant predictors of intention to use bicycle lanes. Implications for the development of campaign messages are discussed, and information is presented to assist other groups so they can use the same process to develop relevant campaign messages.


Assuntos
Ciclismo/psicologia , Gestão da Segurança/métodos , Ciclismo/estatística & dados numéricos , Feminino , Humanos , Intenção , Masculino , Autonomia Pessoal , Normas Sociais , Estudantes/psicologia , Inquéritos e Questionários , Universidades , Adulto Jovem
16.
Br J Nurs ; 28(19): 1166-1167, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647742

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses several recent reports on patient safety and argues that we may be in danger of over-engineering the patient safety debate.


Assuntos
Segurança do Paciente , Medicina Estatal/organização & administração , Humanos , Publicações , Gestão da Segurança/organização & administração , Reino Unido
18.
Environ Pollut ; 255(Pt 1): 113217, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541818

RESUMO

Urban stormwater reuse is becoming increasingly prevalent to overcome the serious urban water scarcity being experienced around the world. Therefore, the adoption of reliable approaches to minimise the human health risk posed by pollutants commonly present in urban stormwater such as heavy metals and polycyclic aromatic hydrocarbons (PAHs) is critical for safe stormwater reuse. This study collected a total of 40 pollutant build-up samples and analysed the concentrations of nine heavy metals and 15 PAH species. Based on pollutant build-up data, pollutant concentrations in stormwater were estimated through modelling. Risk assessment was conducted using an existing model developed by previous studies. The study outcomes confirmed that simply evaluating the individual pollutant concentrations based on guideline threshold values cannot comprehensively estimate the overall human health risk posed by these pollutants. Accordingly, it is recommended that the assessment of the overall human health risk should be based on the pollutant mix present as provided by the models discussed in this paper. The study also demonstrated the practical application of a robust risk assessment model to derive the hierarchy of hazard control to provide a reliable underpinning to urban stormwater risk management. The outcomes suggest that decentralised hazard control methods such as the provision of custom designed Water Sensitive Urban Design (WSUD) measures can be implemented in priority areas with high risk from stormwater pollution based on the risk assessment undertaken. Distributed hazard control methods can be applied to reduce the generation of primary toxic pollutants, especially chromium (Cr) and heavy PAHs, through elimination and substitution measures. The percentage reduction in traffic volume required to mitigate the human health risk can be quantified through the risk models presented. The study outcomes will contribute to the development of efficient, targeted and reliable stormwater management strategies and to identify viable opportunities for stormwater reuse.


Assuntos
Eliminação de Resíduos Líquidos/métodos , Monitoramento Ambiental/métodos , Poluentes Ambientais/análise , Poluição Ambiental/análise , Humanos , Metais Pesados/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Chuva , Medição de Risco , Gestão da Segurança , Água/análise , Poluentes Químicos da Água/análise
19.
J Athl Train ; 54(8): 843-851, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31536387

RESUMO

The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.


Assuntos
Traumatismos em Atletas , Gestão da Segurança , Medicina Esportiva , Universidades/normas , Traumatismos em Atletas/classificação , Traumatismos em Atletas/prevenção & controle , Consenso , Humanos , Gestão da Segurança/métodos , Gestão da Segurança/organização & administração , Medicina Esportiva/métodos , Medicina Esportiva/normas , Estudantes , Estados Unidos
20.
Pflege ; 32(5): 259-266, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31538876

RESUMO

Safety Walk Rounds - Clinical unit visits with a focus on patient safety Abstract. Background: Safety Walk Rounds are a promising strategy to promote the safety culture and optimising patient safety. The purpose of this study was to explore patient safety attributes in various clinical areas including recommendations for improvement and leadership support. Methods: Safety Walk Rounds were conducted by the chief patient safety officer based on a structured questions format to open patient safety dialogues with clinicians at the ward level. Field notes were utilized for thematic analyses and topic categorization. Results: A total of 187 clinicians (64 % nursing staff, 19 % physicians, 17 % other health care professionals) participated on the Safety Walk Rounds. The discussion findings are presented in five categories: Events & circumstances (potentially) harmful for patients; safety culture; need for local action, as well as the need for leadership support to provide safe care. Conclusion and outlook: Safety Walk Rounds across the hospitals' clinical areas delivered insight into patient safety issues and safety culture with its caregiver's engagement to provide safe care as well as action points for future improvement including leadership support.


Assuntos
Unidades Hospitalares/organização & administração , Segurança do Paciente , Gestão da Segurança/organização & administração , Humanos , Liderança
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