In recent years, advocacy groups, researchers, healthcare providers, and others have raised awareness and understanding about diagnostic errors, drawing attention to the profound effect that these mistakes have on patients, families, and clinicians.

The efforts to shed light on delayed, wrong, and missed diagnoses have drawn clear attention to the scope and impact of these medical errors. What isn’t as clear is how to address these issues and develop effective and viable solutions. A number of potential strategies have been proposed, including implementing techniques to improve teamwork, adopting evolving technologies (such as artificial intelligence and clinical decision support systems), adjusting processes and workflows, using diagnostic pathways, and exploring cognitive debiasing techniques.

The National Academies of Sciences, Engineering, and Medicine’s (NASEM’s) influential report Improving Diagnosis in Health Care places significant emphasis on facilitating better teamwork to strengthen the diagnostic process. This recommendation includes supporting an environment that is conducive to collaboration, providing technology that assists with communication, establishing measurable processes and feedback mechanisms, and engaging patients and their families in the diagnostic process.²

When Improving Diagnosis in Health Care was published in 2015, the focus on teamwork as part of the diagnostic process represented a major conceptual shift because it advocated for distributing diagnostic responsibility across multiple providers rather than placing responsibility solely on the treating clinician — a model that had been the standard for hundreds of years. To this end, NASEM noted that the diagnostic team must have the knowledge, skills, resources, and competency to support the diagnostic process, which healthcare organizations should facilitate through interprofessional and intraprofessional teamwork and collaboration.⁴

Since the publication of Improving Diagnosis in Health Care, numerous other experts and researchers in the medical community have supported a team-based approach to diagnosis. For example the National Quality Forum’s 2020 report Improving Diagnostic Quality and Safety/Reducing Diagnostic Error: Measurement Considerations recommends strengthening teamwork and improving team communication as potential solutions for numerous issues associated with diagnostic errors.⁵ Similarly, the 2022 Safer Dx Checklist emphasizes collaboration, clear communication, and systems/processes that support the diagnostic team.⁶

Although the concept of the diagnostic team is seemingly straightforward, its execution in various care settings is much more complex. In an effort to help healthcare providers and organizations bring the concept of the diagnostic team to fruition, various best practices and recommendations have been suggested. At a high level, these recommendations include:

• Incorporating education and training related to team paradigms and effective collaboration into undergraduate and postgraduate medical and health-related curricula.
• Adapting to an evolving workforce in which nonphysician providers — such as nurse practitioners and physician assistants — are increasingly involved in and leading the diagnostic process. Providers and staff members within organizations should understand the scope of each clinician’s practice and be aware of various team members’ roles and responsibilities.
• Integrating allied healthcare professionals — such as pharmacists, medical technologists, physical and occupational therapists, etc. — into the diagnostic team in appropriate circumstances.
• Creating mechanisms to expand access to clinicians with specialized experience (e.g., increased consultations, telemedicine, and hotlines).
• Creating a psychologically safe culture that fosters collaboration and encourages members of the diagnostic team to participate and provide feedback. For example, team members should feel comfortable asking questions, making suggestions, and offering alternative hypotheses.
• Determining best practices and setting expectations for various types of communication, such as documentation in electronic health records, handoff procedures, and referrals/consultations. Including team members in the process of establishing these protocols can help facilitate awareness and support.
• Creating internal and external feedback loops and mechanisms that allow members of diagnostic teams to follow up on patients’ subsequent diagnostic and treatment-related outcomes (e.g., between the emergency department and inpatient units/wards).
• Using collaborative care rounds, staff huddles, and timeouts to facilitate communication among clinical disciplines and to review patient assessments, working diagnoses, differential diagnoses, and care plans.
• Promoting continuing education that enhances leadership skills, soft skills (e.g., communication, active listening, and emotional intelligence), and multidisciplinary teamwork.
• Seeking internal and external feedback on performance, including constructive criticism from members of the diagnostic team, others within the healthcare organization, patients, and other providers who are involved in patients’ care.
• Communicating verbally, rather than electronically, with clinicians and professionals in diagnostic support services, such as laboratory and radiology professionals.
• Consulting directly with pathologists about test selection and results interpretation, and seeking/providing feedback regarding testing and errors.
• Including patients/families as part of the diagnostic team through various engagement strategies that help educate and empower them. To learn more, see MedPro’s Risk Tips: Engaging Patients to Improve Diagnosis.⁷

Using a team approach to improve quality and safety in healthcare is not a new concept, but using this model to guide the diagnostic process diverges from the centuries-old norm of the treating provider as the solo diagnostician. Yet, in recent years, teamwork has been identified as a vital strategy for improving diagnostic quality and accuracy. To adopt a diagnostic team model, healthcare organizations can implement a range of strategies to enhance organizational safety culture, collaboration, communication, awareness, education, and patient engagement. To learn more about improving diagnosis, and to access tools for clinicians and patients, visit the Society to Improve Diagnosis in Medicine.

Endnotes

¹ The Society to Improve Diagnosis in Medicine. (n.d.). Frequently asked questions. Retrieved from www.improvediagnosis.org/page/Facts; The Society to Improve Diagnosis in Medicine. (n.d.). What is diagnostic error? Retrieved from https://www.improvediagnosis.org/what-is-diagnostic-error/; MedPro Group. (2021). Claims data snapshot: A 10-year overview of medical cases. Retrieved from www.medpro.com/documents/10502/5086245/Claims+Data+Snapshot_Ten+Year+Overview_2010-2019_Data+Analysis.pdf

² National Academies of Sciences, Engineering, and Medicine. (2015). Improving diagnosis in health care. Washington, DC: The National Academies Press.

³ Graber, M., Rusz, D., Jones, M., Farm-Franks, D., Jones, B., Cyr Gluck, J., Thomas, D. B., . . . Eichbaum, Q. (2017). The new diagnostic team. Diagnosis, 4(4), 225-238.

⁴ National Academies of Sciences, Engineering, and Medicine, Improving diagnosis in health care.

⁵ National Quality Forum. (2020). Improving diagnostic quality and safety/reducing diagnostic error: Measurement considerations. Retrieved from www.qualityforum.org/Publications/2020/10/Reducing_Diagnostic_Error__Measurement_Considerations_-_Final_Report.aspx

⁶ Center for Innovation in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, & Baylor College of Medicine. (2022). Improving Dx checklist: 10 high-priority practices for diagnostic excellence. Retrieved from www.ihi.org/resources/Pages/Tools/safer-diagnostic-checklist.aspx

⁷ Graber, et al., The new diagnostic team; Center for Innovation in Quality, Effectiveness, and Safety (IQuESt), et al., Improving Dx checklist: 10 high-priority practices for diagnostic excellence; Health Research & Educational Trust. (2018). Improving diagnosis in medicine change package. Retrieved from www.improvediagnosis.org/improving-diagnosis-in-medicine-change-package/; Olson, A., Rencic, J., Cosby, K., Rusz, D., Papa, F., Croskerry, P., Zierler, B., . . . Graber, M. L. (2019). Competencies for improving diagnosis: An interprofessional framework for education and training in health care. Diagnosis, 6(4), 335-341. doi: https://doi.org/10.1515/dx-2018-0107; Olson, A., Durning, S. J., Fernandez Branson, C., Sick, B., Lane, K. P., & Rencic, J. J. (2020). Teamwork in clinical reasoning – cooperative or parallel play? Diagnosis, 7(3), 307-312. doi: https://doi.org/10.1515/dx-2020-0020

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