Safety and Healthcare Workers’ Errors Prevention

Introduction

Today, millions of people die because of medical errors and poorly organized safety issues in hospitals and other medical facilities. The question of patient safety remains an urgent point for consideration among researchers from different parts of the world. In the United States, more than 250,000 people die annually; in Canada, approximately 24,000 citizens have the same reason for death, and approximately 850,000 British patients are the victims of medical errors (Graban, 2016). Despite various attitudes and approaches to understanding and promoting safety, one statement stays the same, proving that safety cannot be ignored, and the prevention of medical errors has to be maintained in clinical settings.

This paper aims to discuss the importance of safety issues in health care, investigate possible medical and care errors in order to determine their causes and prevention, evaluate the role of healthcare employees in patient safety, and research the strategies with the help of which the work of healthcare practitioners can be improved. Patient safety is maintained through the combination of multiple steps and decisions in terms of which healthcare workers have to exchange their experience and knowledge and define the most helpful practices. The investigation of recent studies dated between 2014 and 2018 will be used to explain the worth of such strategies as appropriate hire and retain procedures, education of healthcare workers, handover management, and cultural establishment. Safety of patients and prevention of medical errors in health care are the goals that have to be achieved, and without clear definitions, explanations, and examples, the success of these objectives is hard to observe.

Importance of Safety in Health Care

The peculiar feature of safety through the prism of health care is its variety and the inability to be always predicted. Despite multiple definitions, terms, and components of patient safety, there is one rule that cannot be ignored or misunderstood. The fields of medicine, healthcare, and nursing have already become more complex, promoting effectiveness through new technologies, behaviors, and approaches, and patient safety is the required minimum that allows reducing risks and unnecessary harm associated with all these improvements (Shojania & Panesar, 2014). In other words, if people accept the idea of technological improvement and professional growth, they should think about safety and its promotion to all employees, patients, and other stakeholders. The safety of patients is a priority of many healthcare facilities (Shojania & Panesar, 2014). Care providers need to take responsibility for patient-centered care and high-quality services. At the same time, certain standards and rules that have already been established cannot be ignored. Therefore, safety is also a possibility to combine past experiences and recently obtained knowledge.

However, it is wrong to neglect the fact that not only patients are interested in the safety of services. Clinicians, managers, and other employees also want to be confident that they work under safe conditions and offer safe services to their patients (Vincent, Burnett, & Carthey, 2014). Safety means the possibility to avoid unintended harm and prevent damage to human health (Shojania & Panesar, 2014). Hospitals are able to choose various methods to meet the goal and make sure that their services are safe. Sometimes, safety includes the necessity to improve knowledge and develop skills that are required to complete different tasks and help people. In some cases, safety means the ability to cooperate with different people. In the majority of cases, safety is the obligation to make fast and appropriate decisions. Still, in any situation, it remains a moving target due to constantly improved standards, needs, and expectations (Vincent & Amalberti, 2015). Each decade introduces new approaches and methods to prevent diseases, inform people, and develop skills.

There are many reasons why safety cannot be ignored by patients and workers in health care settings. For example, it is necessary to remember that safety is not developed by accident. A plan is usually required with a list of strategies being developed in it, depending on many organizational, individual, and environmental factors (Hall, Johnson, Watt, Tsipa, & O’Connor, 2016). Each intervention has to be planned in order to promote patient safety. In case safety issues are ignored, the vulnerability of the staff is possible, and some injuries cannot be avoided. As it has been already saying, safety means the avoidance or prevention of illnesses. Any disease has a negative impact on a person. Safety is when a patient gets guarantees to reduce the threats of getting sick (Graban, 2016). Simultaneously, when employees follow safety rules and precautions, they also minimize their chances of having health problems. All these improvements and preventions are necessary for the creation of a safe and healthy environment.

A health care environment is safe when workers and patients are able to identify their needs and combine them in a proper way, avoiding sacrifices and mistakes. This kind of work requires numerous commitments, changes, and thoughtfully developed steps. Human resource development, leadership, cooperation, and participation are the crucial components of safety promotion in healthcare facilities (Graban, 2016). Safety of care is interrelated with the quality of services, as well as employees’ burnout, emotional control, and future prospects of health care (Salyers et al., 2017). Taking into consideration the needs of patients, employees, and the expectations of employers to improve the quality of their work, the importance of safety in health care cannot be ignored. It is not only a significant contributor to the development of professional skills and knowledge but also a good chance to introduce new standards and promote guarantees of a healthy future.

Many events that occur in hospital settings change human lives in different ways. A workplace injury or patient’s death is always a cause to worry, regret, and think that something could be done to stay away from such a result. Human loss and sufferings have to be avoided by any possible chance because a person can never be prepared for such changes. A safe environment is a step forward to minimize injuries and achieve a number of benefits (Allen, Braithwaite, Sandall, & Waring, 2016). In this paper, healthcare safety will be discussed in terms of safe working and treatment conditions. In other words, patient and employee safety has to be discussed. On the one hand, its importance is explained by the possibility to reduce costs connected with medical and organizational errors, cooperate with loyal and professional workers, and improve the quality of all services offered. On the other hand, patients will be glad to visit a hospital and ask for help when they are provided with guarantees and explanations why the chosen services are credible and safe.

Safety means a lot for healthcare workers and patients. It is not enough to use words and written guidelines in order to prove that all services and care are safe and appropriate. It is better to demonstrate real results, decreased cases of re-hospitalization, and zero deaths caused by medical errors. If the prevention of mistakes is possible, this chance should be used by any hospital in the United States.

Errors, Their Causes, and Prevention

Medical and healthcare errors are usually unintended and may be caused by stress, disappointments, and losses. Some patients lose time when they receive inappropriate services. Many people lose their patience when they expect one outcome but come to another result. Unfortunately, some mistakes lead to the loss of human life, and such an ending has to be avoided. It is estimated that medical errors introduce the third most common reason for death among the citizens of the United States (Makary & Daniel, 2016). However, the role of a medical mistake is a complex issue because of its causes, outcomes, aftermath decisions, and lessons. On the one hand, a healthcare worker can learn a lot from a medical error and be motivated not to repeat it in the future, do everything possible to avoid similar situations, and help other people recognize possible threats. On the other hand, a medical error that leads to a significant loss can de-motivate people, solve their contradictions in courts, or ask for revenge.

Any medical error has its causes and results. Makary and Daniel (2016) define it as an unintended act, an activity with an unachieved intended outcome, a failure, a deviation from a properly-organized plan, or the result of a wrong plan being developed. These errors may occur at the organizational or personal levels. Therefore, it is wrong to believe that all mistakes are equally harmful or equally helpful. Each situation has its own backgrounds, participants, and outcomes. Personal qualities also influence an understanding and acceptance of medical errors because some healthcare workers can be prepared for it or, at least, try to do something in response, and some people cannot move or even speak as soon as they understand that a mistake was made (Crisp, 2017). Every mistake plays its unique role in the development of health care and the promotion of safe and high-quality environments. Some of them will be discussed in this section.

Depending on the environment and the abilities of healthcare workers, medical errors may be intrinsic and caused by poor or not enough experience to achieve good results. The lack of experience is usually observed among young practitioners and those who have to make an urgent decision in new care settings. Some practitioners admit that their medical mistakes are based on a lack of knowledge (Bari, Khan, & Rathore, 2016). However, the authors of recent studies do not explain what kind of knowledge is missing. Therefore, it is hard to understand if such mistakes are based on the weak professionalism of teachers who have to teach future nurses, clinicians, and other medical staff or laziness or poor qualities of students. Still, the knowledge-based cause cannot be ignored in this discussion. Sometimes, nurses or doctors admit that their medical errors are based on the fact that they are not able to recognize all warming signs in time (Bari et al., 2016). They may be knowledgeable and experienced enough, but because of personal inattentiveness, they fail to admit a crucial sign that results in an error.

Other intrinsic causes of medical errors include communication problems and burnout. Sometimes, nurses or other medical workers confess that one of the main shortages of their work is the inability to develop professional and informative communication (Bari et al., 2016). Such communication may be a part of a handover procedure. In many hospitals where the number of medical workers exceeds or employee turnover is high, not all employees know each other face to face. New nurses are not always ready to talk and ask questions. They hesitate and miss some important parts of a care process (Bari et al., 2016). Such inabilities to make fast decisions and get familiarized themselves with new working conditions can be a cause of a medical error with time. Finally, more than 20% of medical practitioners agree that a frequent reason for a mistake at the workplace is their fatigue. Medical and healthcare burnout influences the quality of patient care (Hall et al., 2016). Though all these intrinsic causes may be prevented, related mistakes occur and influence the quality of hospital work.

Nurses and medical workers disclose a number of extrinsic causes of medical errors as well. Many modern hospitals lack professional supervision and a high-quality presentation. The result of such shortages is the inability to exchange knowledge and information fast (Crisp, 2017). Employees are not prepared to deal with complex tasks and have nothing to ask for help (Bari et al., 2016). Procedural complications and wrong results of laboratory reports can also put patients’ lives under threat. However, sometimes, medical errors happen not because a medical worker does or does not do something but because a patient, his/her family member, or other stakeholders of a working and treatment process do. These activities may be poorly made decisions, a delayed address for professional help, the presentation of wrong information, cultural or religious beliefs, and even state/federal norms. The ability to neglect one rule in order to save human life and avoid an error is usually observed with time. Therefore, the more time a person works at the same place, the more chances to avoid serious health complications are.

Unfortunately, today, many people find it normal to change their working places, check new offers, and gain as much experience as possible. It is hard to make people change their minds and not to search for a new job even it is characterized by a list of positive characteristics. Healthcare is the field of multiple opportunities and options. One facility may hire people because of their high knowledge and professionalism. Some hospitals pay attention to the employees who like learning and can develop their skills all the time. In many clinics, communication and personal qualities deserve special attention. Still, despite a variety of requirements and working options, medical errors remain the same with a serious impact on human lives.

Medical errors can be of different types, depending on the outcomes and their perception by healthcare and medical workers, patients, their families, and other stakeholders. According to Bari et al. (2016), the majority of medical errors are minor by their nature. However, there are also serious mistakes and near misses that can influence the quality of care and determine the issue of safety. In some hospitals, healthcare workers believe that some mistakes can never be encountered because of their insignificant impact on patient’s treatment or the working environment. Such a variety of attitudes, causes, and types of mistakes prove that people are still able to change the quality of health care and prevent some errors in case they start paying attention to some details.

Prevention of medical errors is a topic of numerous discussions. Graban (2016) introduces visual management, group discussions, and the promotion of standardized work as the steps with the help of which some medical errors can be recognized, and the quality of care and treatment may be improved. Allen et al. (2016) explain that errors happen because risk and safety management is not as perfect as it can be in hospitals and other settings where a number of people can be at the same time. Salyers et al. (2017) investigate human factors to be used for the improvement of healthcare quality and the promotion of safety. The balance between the work system and the expectations of ordinary people is what determines the quality of health care. Therefore, one of the main steps that should be taken is the identification of the roles of healthcare workers in terms of patient safety and care quality.

Role of Healthcare Workers in Patient Safety

The role of healthcare workers cannot be ignored when it is necessary to maintain patient safety and offer high-quality services. The perceptions of ordinary people who are involved in caregiving and receiving determine the essence of health care. If a person lacks knowledge or has biased attitudes, certain deviations from standards can be orders, and the results of such deviations are hard to predict. However, it is necessary to admit that the list of healthcare workers is long and varies depending on the state, the type of facility, and even the number of patients that have to be treated. In some hospitals, there are many departments where not only nurses, pharmacists, physicians, and surgeons have to work (Graban, 2016). There is also a place for social workers, clinical officers, paramedics, and other specialists in certain spheres.

Each job has its own responsibilities and limitations that have to be followed. For example, hospital organizations find it normal to create general clinical guidelines and standards and make all employees follow them to provide all patients with the same amount of services, attention, and help. However, such healthcare workers as surgeons or therapists should admit that each patient is unique with a number of personal characteristics, demands, and expectations (Graban, 2016). It is wrong to offer similar services to all regardless of personal uniqueness. At the same time, being closely attached to patients and their families, many nurses admit the necessity to follow the standards in order not to be confused and follow high-quality standards. Vincent et al. (2014) underline that safety is the possibility to follow one common system and recognize failures in a short period of time in order to create a good response and eliminate all possible threats. Therefore, the role of healthcare workers is not to follow or break the rules but prove that the chosen approach to work makes sense.

Investigating the safety and quality of healthcare services, the role of management is usually prioritized in comparison to the necessity to diagnose and investigate a disease. Healthcare management undergoes numerous changes, and the knowledge about a disease that was available several decades ago cannot be as effective as the organizational skills obtained recently (Vincent & Amalberti, 2015). The role of healthcare workers is to be ready to cooperate with people but not with diseases. A kind look, a single touch, or even an unnoticeable nod can change the way of how the treatment is perceived by a patient. A nurse may know a lot about flu but has nothing to say to support a child or his/her family. Therefore, communication and the development of trustful relationships between healthcare workers and patients is the duty of the medical staff that determines the quality of care and the possibility to prevent medical errors.

Finally, healthcare workers should understand that they can serve as support and motivation for each other. Sometimes, it is not enough for a nurse to get permission and try a new approach to care or for a surgeon to investigate a new aspect of an operation. Professional support and enthusiasm can be the main sources of inspiration for employees in their intentions to improve care quality and learn the essence of medical errors. The information taken from books or memorized during lectures has its effect on healthcare quality. However, its worth can be increased as soon as it is discussed and evaluated with another person who has a similar level of knowledge.

Strategies for Healthcare Workers

Medical errors, as well as any other types of errors, are made by humans. Therefore, people have enough power to do something in order to prevent such mistakes, using their knowledge, experience, and qualities. Healthcare workers, including physicians, nurses, administrators, and leaders, have to recognize their weaknesses against medical errors in order to take a step and start developing new strategies. Their education, communication, and inevitability to work with people who usually know less than they are the main sources of inspiration and motivation. It is not enough to promote some changes without certain preparation and evaluation. Therefore, every organizational or personal change is a result of enhanced supervision, self-assessment, and the analysis of actions. Patient safety is possible when errors are prevented. Such a statement can become a good reason for developing strategies.

Among a variety of options and approaches, healthcare workers cannot use any methods and believe that they can work effectively. In this paper, four improvements will be discussed. First, healthcare leaders should promote effective hire and retain procedures in order to stay confident in the professionalism of the staff and their abilities to offer and develop safe services. Then, the role of education must be mentioned as quality is a changing concept, and the more healthcare workers learn about it, the better they are prepared for changes. Nurses can be the main contributors to medical error prevention through the establishment of handover procedures. Finally, safe and error-free healthcare culture must be properly recognized and maintained.

Hire and Retain Procedures

Though it is wrong to believe that smart people can avoid mistakes, and those people who do not have solid background knowledge can make frequent mistakes, healthcare leaders should pay much attention to the procedure of choosing and hiring employees. The healthcare industry undergoes considerable changes because of increased demand for high-quality services. Therefore, the medical and healthcare staff is usually obliged to complete multiple tasks in a short period of time, cooperate with numerous people, and discuss various topics. People are not usually ready for huge amounts of work and make mistakes, questioning patient safety (Graban, 2016). Unfortunately, the salaries of medical workers are not as hired as some people expect. Some healthcare facilities admit poor or inappropriate working conditions, including the necessity to work long shifts and the inability to take days off as per personal request. As a result, such issues as nursing turnover and healthcare workers’ demand bother many organizations. Effective hire and retain procedures turn out to be a solution to multiple medical errors.

Professional employee shortage is one of the causes of medical errors and questionable patient safety in hospitals. For example, each year, the nursing shortage rises up to 8%, and the pharmacist shortage rises up to 30% in the United States (Graban, 2016). The medical error increase is observed and leads to a turnover. Hire procedures to have to be properly organized and maintained to make sure potential workers can deal with challenges, become holistic thinkers, and develop strong leadership qualities with time. It is necessary for current leaders to hire people who can stay in the organization for a long period of time. Such retaining promotes knowledge and experiences. Healthcare workers can learn as much as possible about the places of their work. One of the causes of medical errors is the lack of knowledge and the inability of new people to ask for help (Bari et al., 2016). Therefore, the improvement of hiring and retaining procedures can decrease the number of new people in the setting and develop their professional qualities.

When the time to hire a new person comes, a leader should prepare a list of questions to be answered. It is better to pay attention to such qualities as stress resistance, agility, critical thinking, and enthusiasm. Healthcare workers should not only follow the standards but to investigate the rules and find out new solutions and methods of work with the help of which care quality and patient safety may be improved.

Retaining among employees is characterized by a number of benefits. Employees know each other’s abilities and understand what they can expect from cooperation. They recognize available resources and inform patients. Nurses identify the needs of doctors and surgeons, and administrators learn the habits of regular workers. All these abilities can save time and lead to productive results with a fewer number of medical errors and increased patient safety.

Education Importance

When people are hired and provided with appropriate working conditions, some of them start thinking about the possibility of staying at the chosen place for a long period. The same goal is set by a leader. However, to be a part of the same team should not mean the necessity to follow the same rule and use the same methods of work all the time. Long-lasting cooperation should not be the reason for professional stagnation but become a chance to work together and discover new uncommon approaches. Life-long learning is one of the main concepts in the healthcare industry (Crisp, 2017). The enhancement of education turns out to be a significant contribution to patient safety. Though employees have already received a portion of knowledge in colleges or universities, it does not mean that they should stop their learning. Medical errors and negative emotions are associated with a lack of knowledge (Bari et al., 2016). Hence, the task is to identify the practices which can help to reduce such knowledge gaps.

There are several important rules in terms of which it is possible to promote education and support healthcare workers in their intentions to develop their skills. First, leaders should hire a counselor who can identify the problematic areas of employees and recognize which aspects should be improved. Thus, it is necessary not to scare workers and explain that the presence of this person can never lead to firing or wage decrease. Some employees understand that the improvement of the quality is possible only when all knowledge gaps are removed. Therefore, they are ready to study, exchange their experiences, and discover new sources of information. At the same time, leaders have to remember that not all workers are ready to admit their weaknesses, believing that their professionalism is enough to make contributions (Allen et al., 2016). In such a situation, additional motivation and explanations may be required to prove the importance of education as a chance to prevent errors and promote patient safety.

Patient safety is also closely connected to the level of knowledge among patients. Some patients wish to contribute knowledge they can gain and report concerns and threats in a proper way (Allen et al., 2016). They should also be educated but not by specially hired counselors and teachers. As a rule, it is expected to involve nurses in this learning process. Patient-nurse communication is a good method to gather as much information as possible. Poor communication, along with unprofessional staff, the lack of knowledge, and no critical-thinking skills, create the conditions under which medical errors and harm are made (Crisp, 2017). Education is a chance to learn about mistakes and their reasons and prevent negative outcomes in hospitals that may result in human death.

Handover Procedures

Among the existing variety of strategies to promote safe and high-quality health care, much attention is paid to the process known as a clinical handover. It is a situation when a nurse or another medical worker transfers professional responsibility and care for patients to another person (Graban, 2016). Handovers cannot be ignored in clinical settings as it may be the only chance to share important information about patients, their conditions, or even family involvement. At the same time, nurses or other stakeholders involved in this process have to remember that the exchange of information should have its limits because of the number of patients, the peculiarities of their health, and the conditions under which they are delivered to hospitals.

Any handover process is based on communication. Linguistic techniques may determine the quality of this process, as well as the quality of care. Communication breakdowns provoke people to make mistakes (Makary & Daniel, 2016). Therefore, it is better to have a plan on how to organize a handover process. Healthcare workers should focus on the current status of patient’s health, prescribed medications, possible allergies, and an approved treatment plan. Allen et al. (2016) suggest the SBAR approach for handovers which means the description of the Situation, its Background, Assessment, and possible Recommendations. The quality of handovers may be improved, time can be saved, and employees are not confused by the amount of information.

Handovers are used to share new information and identify the changes that may happen to a patient. This strategy can become even more effective if it is combined with hiring and retaining procedures. When caregivers cooperate for a certain period of time, they can develop special signs and terms to introduce information. They are able to report fast and underline the main points. Time and details are the factors that can prevent medical errors and create the conditions under which patient safety is guaranteed.

Culture Establishment

Taking into account human needs, abilities, and standards, patient safety can be achieved through the establishment of necessary procedures, knowledge, and cooperation. In order not to memorize each idea separately, it is possible to unite all of them and introduce one common concept of safety culture (Vincent et al., 2014). Safety culture may have different facets, and leaders should support their employees in distinguishing them, asking appropriate questions, and considering the evidence. According to Vincent et al. (2014), the establishment of a culture where safety can be measured and monitored is based on five main postulates: past hard, the reliability of systems, operation sensitivity, staff preparedness and anticipation, and learning. The balance between these aspects has to be maintained. To be effective, a culture of safety should be deprived of hierarchies and open to free discussions. All mistakes should be reported because their identification can help to avoid similar errors in the future. Teamwork and collaboration must be appreciated because of the existing knowledge gaps.

Through teamwork and mutual discussions are a part of safety culture establishment, it is important to remember that any culture should have its author. The opinions of different people can be taken into consideration while developing the drafts. However, the final version of a document with cultural norms and standards has to be presented by a leader with the skills to assess and offer improvements (Graban, 2016). The goals of a safety culture and the objectives of healthcare workers may vary, and the task of a leader is to find compromise and continue the progress of care and safety. Cultures may be changed with time, and each team member should be ready to try something new. Safe and error-free environments are possible when changes are developed in accordance with specially approved models and plans. A properly established safety culture in a clinical setting is a result of the work of all its members. Still, as well as safety and quality, culture has to be a moving target to stay effective.

Expected Outcomes of Improvements

Any change, innovation, or progress can have an outcome that is not always easy to predict or explain. Therefore, much attention should be paid to the evaluation of potential results. The first rule is not to expect that all attempts and steps lead to positive results only. In many cases, leaders and their employees observe failures or additional challenges. Improvements may have their price, and healthcare workers should be ready to pay it. For example, the search for people to be hired or the process of education can take much time. The establishment of a safety culture and handovers may require special qualities and experience. In other words, additional attention and a portion of skepticism may help to achieve better results.

When a leader is able to hire a professional nurse or a manager, the chances to organize healthcare services can be increased. Many hospitals are challenged by pressures upon budgets and services (Hall et al., 2016). Therefore, employers make a decision to hire people and sign contracts in order not to raise salaries and oblige them to work till the established deadlines. The outcome of such a decision is burnout and poor quality of services (Salyers et al., 2017). To achieve positive results, the hiring and retaining procedures have to be based on free will and desire to cooperate. As soon as employees observe that their leaders respect their rights, listen to their ideas, and ready to cooperate, they can offer fresh ideas, improve the current working conditions, and contribute to patient safety. Medical errors can be avoided because workers focus on their tasks and patients but not on the solution to their personal or workplace problems.

Another significant expectation of strategic improvements is the possibility to organize the work in hospitals and consider the needs of employees and patients. Life-long learning is a unique opportunity for people to discover their skills, identify their interests, and gain new knowledge. Sometimes, such activities are enough for people to stay motivated and willing to work. The quality of services and safety become the main responsibility of the personnel who is ready to do their best and meet the expectations. Team integration, self-respect, and personal dignity are the qualities that improve a working process and inspire new or old employees not to stop developing their skills.

Finally, it is obligatory to remember that any intention to redesign the already established system is a significant challenge as for an organization, as well as for its staff. People should be able to understand the necessity of change and their own contributions to improvements. As soon as these tasks are complete, the level of personal responsibility can be increased. The result of such improvements can be observed in the work of leaders who should find out new sources of motivation and among healthcare workers who should learn how to plan their steps and take care of people. The reports on medical errors will be used to identify possible threats and choose another direction. The elimination or, at least, a considerable decrease of mistakes can result in more lives being saved and more people being satisfied with the offered services. In general, the strategies and improvements among healthcare workers lead to the promotion of safety among employees, patients, their families, and other stakeholders of care processes.

Conclusion

In general, this research paper proves the relationship between safety and medical errors. The healthcare industry experiences numerous changes all the time. Sometimes, caregivers have to accept organizational changes and improve the quality of services. From time to time, it is necessary to report on mistakes and admit that everything is not as perfect in the setting as it can be expected. Finally, personal intentions and self-improvement can guide healthcare workers. Medical errors may take human lives, and even being aware of the threats, negative results cannot always be prevented. The worth of this paper is not the demonstration of the way how to stop making mistakes. Training, supervision, and monitoring should promote quality improvements in clinical settings. This work helps to recognize that people should not be afraid to be wrong because to err means to be a human.

References

Allen, D., Braithwaite, J., Sandall, J., & Waring, J. (2016). Towards a sociology of healthcare safety and quality. Sociology of Health & Illness, 38(2), 181-197.

Bari, A., Khan, R. A., & Rathore, A. W. (2016). Medical errors: Causes, consequences, emotional response and resulting behavioral change. Pakistan Journal of Medical Sciences, 32(3), 523-528.

Crisp, D. H. (2017). The anatomy of medical errors: The patient in room 2: A nurse’s story of surviving preventable medical errors and discovering the truth. Indianapolis, IN: Sigma Theta Tau International.

Graban, M. (2016). Lean hospitals: Improving quality, patient safety, and employee engagement (3rd ed.). Boca Raton, FL: CRC Press.

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One, 11(7). Web.

Makary, M. A., & Daniel, M. (2016). Medical error – The third leading cause of death in the US. BMJ: British Medical Journal, 353. Web.

Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine, 32(4), 475-482.

Shojania, K. G., & Panesar, S. S. (2014). Basics of patient safety. In S. S. Panesar, A. Carson-Stevens, S. A. Salvilla, & A. Sheikh (Eds.), Patient safety and healthcare improvement at a glance (pp. 2-4). Malden, MA: John Wiley & Sons.

Vincent, C., & Amalberti, R. (2015). Safety in healthcare is a moving target. BMJ Quality & Safety, 24, 539-540.

Vincent, C., Burnett, S., & Carthey, J. (2014). Safety measurement and monitoring in healthcare: A framework to guide clinical teams and healthcare organizations in maintaining safety. BMJ Quality & Safety, 23(8), 670-677.