Articles

Articles

Are the Eyes Better Than the Gas? Use of a Five-Point Respiratory Exam Daved van Stralen, MD

Presented at: Making the Desert Bloom: Creating Excellence in LTC Medicine, AMDA’s 27th Annual Symposium, March 4-7, 2004, Phoenix, Arizona

Build a Healthy Safety Culture Using Organizational Learning and High Reliability Organizing  David Christenson, MA

A paper presented at the Wildfire 2007 international conference of wild land firefighters in Seville, Spain, May 2007 and the Bridging the Gap Between Theory and Practice, European HRO Conference, April/May 2007. Deauville, Normandy, France

Changing a Pediatric Sub-Acute Facility to Increase Safety and Reliability

David W. van Stralen, Racquel M. Calderon, Jeff F, Lewis and Karlene H. Roberts

Patient Safety and Health Care Management, Vol. 7, 259-282, 2008

C Libuser's Dissertation
Part 1
Introduction & Literature Review
Part 2
Case Reports & Model
Part 3
Results
Part 4
Summary
Part 5
Methods & Material

Creating Resilience on a Fire Assignment JT Holt, 5/12/2009

Managers that lead crews and teams into high risk environments want to believe the group they are leading is skilled, capable, strong...resilient even. Do we know what we mean when we are talking about having resilience or behaving resiliently?

CRITICAL THINKING: PLUGGING (OR MOVING) A HOLE IN OUR SWISS CHEESE Michael A. Johns, Assistant U.S. Attorney, January, 2010

The purpose of this and previous papers is to 1) improve decision quality or avoid decision error consequences, 2) improve the judging of decision quality by those with outcome knowledge and 3) protect decision makers from inappropriate second-guessing by non-experts, in hindsight.

Differences in Safety Climate Between Hospital Personnel and Naval Aviators David Gaba, MD; Sara Singer, MBA; Anna Sinaiko, BA; Jennie Bowen, BS; Anthony Ciavarelli, Ed.D

Full-Spectrum Analysis: A New Way of Thinking for a New World Adrian Wolfberg, Military Review, July-August, 2006

Introduction: Design and Organizational Change Richard Buchanan

Design Issues: Vol. 24, Number 1, Winter 2008

Hanford Human Improvement Performance Lessons Learned 2007

This document provides the lessons learned and results of a pilot initiative to implement Human Performance Improvement (HPI) tools and techniques by U.S. Department of Energy (DOE) Office of River Protection (ORP), DOE Richland Operations Office (RL), and their respective Prime Contractors.

High-Reliability Organizations: Changing the Culture of Care in Two Medical Units Daved van Stralen, M.D.

Design Issues: Vol. 24, Number 1, Winter 2008


High Reliability Organizing to develop managers and organizational capabilities

Dr. Annette Gebauer, Beratung für Corporate Learning, Berlin

A presentation at the 2010 International HRO Conference in New Orleans, Download Abstract, and Paper in German

HRO  Daved van Stralen, MD

HRO Before We Knew It Was Called HRO David A. Christenson

HRO implementation in a jet fighter squadron's quick reaction alert force operations in 1980

HRO Hypotheses Karlene Roberts, Ph.D; Carolyn Libuser

Implementation. How I do it Daved van Stralen, MD, FAAP December 2011

Managing the Unexpected Karl Weick,Ph.D; Kathleen Sutcliffe, University of Michigan, Ross School of Business

Presented at: MTU in Wildland Prescribed Fire Workshop, February 28, 2005, Jacksonville, Florida

Managing The Unpredictable Robert Bea

 "What can we learn from the Seattle Symphony and hospital pediatric emergency wards? For starters, they can teach us how to handle a crisis." March 2008, Engineering Management Feature Article.

Mindfulness: Are We Managing Our Expectations? By the Wildland Fire Lessons Learned Center's Staff Writer Jonetta T. Holt

Mitigating risks, visible hands, inevitable disasters, and soft variables: Management research that matters to managers Eric Ford; W. Jack Duncan; Arthur Bedeian; Peter Ginter; Matthew Rousculp; Alice Adams

Morning Briefings Reinforce Deference to Expertise JT Holt, 9/14/2008

Briefing crew leaders about the potential hazards they face and actions to take when they become realities.

Organizational Factors in Accident Risk Assessment Anthony Ciavarelli, Ed.D; Jeffrey Crowson

Presented at: Safety Across High-Consequence Industries Conference, March 9 & 10, 2004, St. Louis, MO

Organizing for Mindfulness: Eastern Wisdom and Western Knowledge Karl E. Weick and Ted Putnam

JOURNAL OF MANAGEMENT INQUIRY, Vol. 15 No. 3, pp. 275-287, September 2006

Patient Safety is an Organizational Systems Issue: Lessons from a Variety of Industries
Karlene Roberts Ph.D; Daved van Stralen, MD; Kuo Yu, Prepared for B. Youngblood and M. Hatlie (Eds.)

Handbook on Patient Safety. Aspen Publications

Practical Applications of Reliability Theory Roger Resar, M.D., Senior Fellow, Institute for Health Care Improvement, Health Research and Educational Trust, DOI: 10.1111/j.1475-6773.2006.00571.x

Risk Center Releases Findings of Two-Year Study: “Managing Large-Scale Risks in a New Era of Catastrophes,”

Howard Kunreuther and Erwann Michel-Kerjan

Risk Management Review, Wharton Risk Center, University of Pennsylvania, Spring 2008

Safety Climate and Risk Culture: How Does Your Organization Measure Up? Anthony Ciavarelli, PhD

Copyright © 2007, Human Factors Associates, Inc. All rights reserved.

Shooting an Elephant George Orwell (1903-1950)

The Incident Command System Gregory Bigley, Ph.D; Karlene Roberts, Ph.D

The Origins of EMS in Military Medicine: How Combat Medicine Influenced the Advent of Today's EMS Model

Daved van Stralen, M.D.

War on Trauma, Journal of Emergency Medical Services


Tracking and Responding to Small Errors in High Risk Environments

JT Holt, 7/25/2008

Responding to small system failures before they become big problems, even deadly catastrophes, without being able to pinpoint the actual cause is confusing and often creates hesitation.

Transferring Wildland Fire Knowledge Using A National Lessons Learned Center

David Christenson, MA, U.S. Wildland Fire Lessons Learned Center

A paper presented at the Wildfire2007 international conference of wild land firefighters in Seville, Spain, May 2007

What Risk Managers Need to Know Karlene Roberts, Ph.D

Presented at: American Society for Healthcare Risk Management, October, 17-20, 2008, Orlando, Florida

Why Transformation Efforts Fail John P. Kotter

Leading Change, Harvard Business Review, The Tests of a Leader, January 2007

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