The Institute of Medicine’s Improving Diagnosis in Health Care report outlines the following eight goals for reducing diagnosis errors:
• Facilitate more effective teamwork in the diagnostic process among healthcare professionals, patients, and their families. The diagnostic process hinges on successful collaboration among healthcare professionals, patients, and their families. Patients and their families are critical partners in the diagnostic process. In addition, all healthcare professionals need to be well-prepared and supported to engage in diagnostic teamwork.
• Enhance healthcare profes-sional education and training in the diagnostic process. Getting the right diagnosis depends on all healthcare professionals involved in the diagnostic process receiving appropriate education and training. Improved emphasis on diagnostic competencies and feedback on diagnostic performance is needed.
• Ensure that health information technologies (IT) support patients and healthcare professionals in the diagnostic process. Although health IT has the potential to improve diagnosis and reduce diagnostic errors, many experts are concerned that it is not effectively facilitating the diagnostic process and might even be contributing to errors. Collaboration among health IT vendors, users, and the Office of the National Coordinator for Health Information Technology is needed to better align health IT with the diagnostic process.
• Develop and deploy approach-es to identify, learn from, and reduce diagnostic errors and near misses in clinical practice. Few healthcare organizations have processes in place to identify diagnostic errors and near misses in clinical practice. However, collecting this information, learning from these experiences, and implementing changes are critical for achieving progress. Healthcare professional societies also can be engaged to identify high-priority areas to improve diagnosis.
• Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance. The work system and culture of many healthcare organizations could better support the diagnostic process. For example, healthcare organizations should promote a non-punitive culture that values feedback on diagnostic performance, ensures effective communication in diagnostic testing, and designs a work system that supports team members involved in the diagnostic process, including integrating error recovery mechanisms.
• Develop a reporting environment and medical liability system that facilitates improved diagnosis through learning from diagnostic errors and near misses. There is a need for safe environments, without the threat of legal discovery or disciplinary action, in which diagnostic errors, near misses, and adverse events can be analyzed and learned from to improve diagnosis and prevent diagnostic errors. Voluntary reporting efforts should be encouraged and evaluated for their effectiveness. Reforms to the liability system are needed to make healthcare safer by encouraging transparency and disclosure of medical errors, including diagnostic errors.
• Design a payment and care delivery environment that supports the diagnostic process. Payment likely influences the diagnostic process and the occurrence of diagnostic errors. For example, fee-for-service payment lacks incentives to coordinate care, and distortions between procedure-oriented and cognitive-oriented care might be diverting attention from important tasks in the diagnostic process. A fundamental research need is an improved understanding of the impact of payment and care delivery models on diagnosis.
• Provide dedicated funding for research on the diagnostic process and diagnostic errors. Federal resources devoted to diagnostic research are overshadowed by those devoted to treatment. Dedicated, coordinated funding for research on diagnosis and diagnostic error is warranted. Public/private collaboration and coordination can help extend financial resources to address research areas of mutual interest.
