A PMHNP at an inpatient psychiatric unit accidentally enters a lithium order for 900 mg twice daily instead of 300 mg twice daily for a newly admitted 62-year-old woman with bipolar I disorder and stage 3 chronic kidney disease. The nursing staff catches the error during medication reconciliation before the first dose is administered. The PMHNP reports the near-miss through the facility's incident reporting system. At the next interdisciplinary team meeting, the unit director presents the de-identified event as a case study and leads a discussion about EHR order entry safeguards, weight-based dosing alerts, and renal function flagging. Rather than disciplining the PMHNP, the director implements a new protocol requiring pharmacist co-verification of all lithium orders for patients with renal impairment. What framework does this organizational response best exemplify?