TY - JOUR
T1 - Crossing Academic Boundaries for Diagnostic Safety
T2 - 10 Complex Challenges and Potential Solutions From Clinical Perspectives and High-Reliability Organizing Principles
AU - Yousef, Elham A.
AU - Sutcliffe, Kathleen M.
AU - McDonald, Kathryn M.
AU - Newman-Toker, David E.
N1 - Funding Information:
Dr. Newman-Toker’s effort was supported by the Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins University School of Medicine. Dr. Newman-Toker conducts research related to diagnostic error, including serving as the principal investigator for grants on this topic. He serves as an unpaid member of the Board of Directors of the Society to Improve Diagnosis in Medicine and as its immediate past President. He serves as a medico-legal consultant for both plaintiff and defense in cases related to diagnostic error. There are no other conflicts of interest. None of the authors have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.
Publisher Copyright:
© Copyright 2021, Human Factors and Ergonomics Society.
PY - 2022/2
Y1 - 2022/2
N2 - Objective: We apply the high-reliability organization (HRO) paradigm to the diagnostic process, outlining challenges to enacting HRO principles in diagnosis and offering solutions for how diagnostic process stakeholders can overcome these barriers. Background: Evidence shows that healthcare is starting to organize for higher reliability by employing various principles and practices of HRO. These hold promise for enhancing safer care, but there has been little consideration of the challenges that clinicians and healthcare systems face while enacting HRO principles in the diagnostic process. To effectively deploy the HRO perspective, these barriers must be seriously considered. Method: We review key principles of the HRO paradigm, the diagnostic errors and harms that potentially can be prevented by its enactment, the challenges that clinicians and healthcare systems face in executing various principles and practices, and possible solutions that clinicians and organizational leaders can take to overcome these challenges and barriers. Results: Our analyses reveal multiple challenges including the inherent diagnostic uncertainty; the lack of diagnosis-focused performance feedback; the fact that diagnosis is often a solo, rather than team, activity; the tendency to simplify the diagnostic process; and professional and institutional status hierarchies. But these challenges are not insurmountable—there are strategies and solutions available to overcome them. Conclusion: The HRO lens offers some important ideas for how the safety of the diagnostic process can be improved. Application: The ideas proposed here can be enacted by both individual clinicians and healthcare leaders; both are necessary for making systematic progress in enhancing diagnostic performance.
AB - Objective: We apply the high-reliability organization (HRO) paradigm to the diagnostic process, outlining challenges to enacting HRO principles in diagnosis and offering solutions for how diagnostic process stakeholders can overcome these barriers. Background: Evidence shows that healthcare is starting to organize for higher reliability by employing various principles and practices of HRO. These hold promise for enhancing safer care, but there has been little consideration of the challenges that clinicians and healthcare systems face while enacting HRO principles in the diagnostic process. To effectively deploy the HRO perspective, these barriers must be seriously considered. Method: We review key principles of the HRO paradigm, the diagnostic errors and harms that potentially can be prevented by its enactment, the challenges that clinicians and healthcare systems face in executing various principles and practices, and possible solutions that clinicians and organizational leaders can take to overcome these challenges and barriers. Results: Our analyses reveal multiple challenges including the inherent diagnostic uncertainty; the lack of diagnosis-focused performance feedback; the fact that diagnosis is often a solo, rather than team, activity; the tendency to simplify the diagnostic process; and professional and institutional status hierarchies. But these challenges are not insurmountable—there are strategies and solutions available to overcome them. Conclusion: The HRO lens offers some important ideas for how the safety of the diagnostic process can be improved. Application: The ideas proposed here can be enacted by both individual clinicians and healthcare leaders; both are necessary for making systematic progress in enhancing diagnostic performance.
KW - communication and teamwork in healthcare
KW - organizational factors
KW - patient safety
KW - reliability issues
KW - safety culture and behavior change
KW - team situation awareness
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U2 - 10.1177/0018720821996187
DO - 10.1177/0018720821996187
M3 - Article
C2 - 33657891
AN - SCOPUS:85102126715
SN - 0018-7208
VL - 64
SP - 6
EP - 20
JO - Human Factors
JF - Human Factors
IS - 1
ER -