After reading Chapter 4 of the IOM report (Keeping Patients Safe) as well as your other readings
for this module, reflect on this content in relation to your work setting and patient safety.
Compose an initial pose that highlights an assessment of patient safety issues in your work
setting in relationship to the 5 management practices described in the IOM report (Keeping
Patients Safe) using evidence-based research.
1. Select and describe the most pressing patient safety issues in your work setting that you think
2. Provide rationale using evidence-based research on your patient safety issue that speaks to how patient safety could be improved in your work setting. What are the best practices? How are
they being implemented? What could your work setting improve upon based on the best
practices presented in the literature?
3. Select one (1) out of the five (5) essential management practices that could best be utilized in
helping to implement the changes for improved patient safety based on the evidence-based
research you uncovered on your patient safety issue.
o * The five essential management practices are (IOM, 2003):
1. Balancing the tension between production efficiency and reliability (safety).
2. Creating and sustaining trust throughout the organization.
3. Actively managing the process of change.
4. Involving workers in decision making pertaining to work design and work flow.
5. Using knowledge management practices to establish the organization as a “learning
organization” (p. 3).
4. Given the readings you have competed thus far on leadership theory, in what ways do you
think transformational leadership would best support implementation of improved patient safety
practices in your work setting?
Institute of Medicine. (2003). Keeping patients safe: Transforming the work environments of
nurses. Retrieved from http://books.nap.edu/openbook.php?record_id=10851&page=3.
Institute of Medicine. (2004). Transformational leadership and evidenced- based management. In
Institute of Medicine. Keeping patients safe: Transforming the work environment of nurses.
Institute of Medicine Report (pp. 108-161). National Academies Press.
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