Improving diagnosis: four things you can do right now
An accurate and timely diagnosis is foundational to high-quality healthcare. A diagnosis sets off a chain of events—a course of treatment, a change in habits or lifestyle, sometimes even a radical shift in outlook on life itself. Unfortunately, in some instances, the diagnosis is wrong, or it comes too late.
Errors in diagnosis are made more commonly than we would like to think. They affect an estimated 1 in 20 U.S. adults every year. They’re the single greatest source of medical malpractice claims, and they have accounted for the highest proportion of payments for malpractice. Their total cost is estimated to be at least $100 billion a year.
The human cost, of course, is incalculable. An inaccurate or delayed diagnosis can initiate a series of harmful actions, from necessary treatment that is not provided to toxic medications or invasive treatments that are administered unnecessarily. Twelve million people a year in the U.S. are affected by diagnostic errors, and one-third of these patients suffer serious harm because of missed, inaccurate or delayed diagnoses.
Efforts to better understand and improve diagnosis are at the frontier of patient safety. They comprise a critical field of study that holds great promise. It is the branch of patient safety research and improvement that focuses specifically on the process of diagnosis— when and how it occurs, and how we can make it more accurate and precise.
As with other patient safety concerns, improving diagnostic safety is also a leadership challenge. There are steps organizations can take to make the process of diagnosis safer, but they will require organizational commitment at the highest levels. Examining diagnosis with an eye toward safety requires committing time and resources, and potentially asking clinicians to reexamine some long-held beliefs and assumptions.
It’s not easy, we acknowledge. The process of diagnosis often is not a discrete event. Sometimes a patient presents with something that’s immediately apparent, but just as often, symptoms or test results develop or change slowly over time, and multiple encounters may be necessary to diagnose an issue that is not obvious the first time a patient seeks help.
Nevertheless, thanks to the innovative leaders who established this field, concrete steps are already identified that healthcare organizations can begin right now to improve their own diagnostic processes and cut down on the risk of error.
1. Commit to diagnostic excellence organizationally.
Like all patient safety solutions, collective actions make improving diagnosis possible. Improvement will require support for front-line team members as well as system-level changes including things such as investments in electronic clinical decision support and redesigning workflows and workspaces to reduce and avoid unnecessary interruptions and burdens on providers. Make diagnostic safety an agenda item at board and other leadership meetings. These conversations may require the CEO in tandem with the chief medical officer or chief nursing officer, as appropriate, to muster the organizational will to stay
focused on improvement. The message to carry forward: an accurate, timely and precise diagnosis is an important part of patient-centric care, and it’s impossible to put patients’ needs first without getting the diagnosis right. For more on understanding the leadership challenge, consult a recently published Agency for Healthcare Research and Quality (AHRQ) issue brief (bit.ly/ MH-calltoaction).
2. Start collecting information about system performance.
While rates of diagnostic errors are difficult to measure, organizations can still start gathering data. Another AHRQ issue brief (bit.ly/MH-stateofscience) published last year examines the state of the science and is an excellent place to learn about the kinds of data to collect and how to analyze them. Organizations already using the AHRQ Surveys on Patient Safety Culture might also explore the Diagnostic Survey Supplemental Items for the Medical Office Survey, to help medical offices assess the extent to which their organizations support the diagnostic process.
3. Engage patients around diagnostic safety.
Broadly speaking, research shows that when patients are engaged in their care, it can lead to measurable improvements in safety and quality. With research suggesting that as many as 4 in 5 process breakdowns associated with diagnostic errors involved the patient-clinician encounter, this is an excellent point on which to focus any improvement strategy. This summer, AHRQ published a toolkit (bit.ly/MH_toolkit) to help patients, families and health professionals work together as partners to improve diagnostic safety.
4. Collaborate.
As with so many challenges within healthcare, working together is essential. Develop a strategy with local partners to share data. Start or join a regional learning collaborative focused on diagnostic safety, and work with a Patient Safety Organization. Get involved with the Society for Improving Diagnosis in Medicine, an important professional society driving change.
None of these tactics alone will eliminate the risk of diagnostic error. But over time, they will foster learning and improvement, and build trust between clinician and patient, and among clinicians and organizations that support diagnostic excellence.
The science base around the process of diagnosis is evolving. While we are confident that the coming years and advancing capabilities of information technology will bring major improvements, patients can’t afford to wait—and waiting isn’t necessary. Organizations that commit today to understanding and improving their process of diagnosis with an eye toward safety and accuracy will be well positioned for the future. We are hopeful that more innovation will offer technology-driven solutions, but let’s not wait for them. The field is offering opportunities that are ready to go now. ■