New Action Plan Aims To Guide Health Systems’ Efforts on Diagnostic Safety

A new action plan developed by AHRQ-funded researchers aims to jumpstart health systems’ efforts to improve diagnostic safety. Insufficient progress has occurred, the authors asserted, since a 2015 National Academies of Sciences, Engineering, and Medicine report highlighted the cost and quality implications of diagnostic errors. The authors of the new action plan proposed that health systems be identified as LEDE (learning and exploration of diagnostic excellence) organizations by following five steps to achieve diagnostic excellence: implementing a virtual hub to coordinate activities for improving diagnosis; participating in new scientific initiatives to generate and translate evidence; focusing on measurement for improvement, rather than for punishment or reward; engaging clinicians in improving diagnosis activities and framing missed opportunities; and developing a culture of engaging and learning from patients. Access the abstract of an article on the action plan published in Academic Medicine.

2019 Oct 29. doi: 10.1097/ACM.0000000000003062. [Epub ahead of print]

Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan.

Singh H1, Upadhyay DK, Torretti D.

Author information

1: H. Singh is chief, Health Policy, Quality, and Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and professor of medicine, Baylor College of Medicine, Houston, Texas. D.K. Upadhyay is researcher-in-residence and program manager, Division of Quality, Safety and Patient Experience, Geisinger, Danville, Pennsylvania. D. Torretti is associate chief medical officer, Geisinger Medical Center, and chairman emeritus, Division of Medicine, Geisinger, Danville, Pennsylvania.

Abstract

Reducing errors in diagnosis is the next big challenge for patient safety. Diagnostic safety improvement efforts should become a priority for health care organizations, payers, and accrediting bodies; however, external incentives, policies, and practical guidance to develop these efforts are largely absent. In this Perspective, the authors highlight ways in which health care organizations can pursue learning and exploration of diagnostic excellence (LEDE). Building on current evidence and their recent experiences in developing such a learning organization at Geisinger, the authors propose a 5-point action plan and corresponding policy levers to support development of LEDE organizations. These recommendations, which are applicable to many health care organizations, include (1) implementing a virtual hub to coordinate organizational activities for improving diagnosis, such as identifying risks among competing priorities, prioritizing interventions that cross intra-institutional silos, and promoting a culture of learning and safety; (2) participating in novel scientific initiatives to generate and translate evidence, given the rapidly evolving "basic science" of diagnostic excellence; (3) avoiding the "tyranny of metrics" by focusing on measurement for improvement rather than using measures to reward or punish; (4) engaging clinicians in activities for improving diagnosis and framing missed opportunities positively as learning opportunities rather than negatively as errors; and (5) developing an accountable culture of engaging and learning from patients, who are often underexplored sources of information. The authors also outline specific policy actions to support organizations in implementing these recommendations. They suggest this action plan can stimulate scientific, practice, and policy progress needed for achieving diagnostic excellence and reducing preventable patient harm.