Ensuring Quality Patient Care by Minimizing Diagnostic Errors Through Effective Healthcare Planning & Implementation

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Ensuring Quality Patient Care By Minimizing Diagnostic Errors

Through Effective Healthcare Planning & Implementation

Diagnosis is one of the major steps in ensuring patient care and providing quality healthcare in an organization. Diagnostic error, which is an inappropriately delayed or missed or wrong diagnosis can lead to patient harm (H. (Physician) Singh et al., 2016) and leads to mistrust in the healthcare fraternity including the healthcare providers as well as the organization. Since patient diagnosis is the primary step in providing quality healthcare, diagnostic errors made in healthcare organizations can lead to compromise in providing quality patient care. However, diagnostic errors can be minimized if the right healthcare delivery plan is made and implemented through quality enhancement initiatives. According to Roberts (2013), the common diagnostic errors being made by organizations can be of the following nature, namely – no-fault errors, system errors, and cognitive errors. Whereas “no-fault” errors are attributed to limited knowledge, the other two errors, system errors and cognitive errors can be controlled by proper information management systems such as EHR and education and training, enhancing cognitive strategies and feedback respectively (Roberts, 2013). This paper looks into various aspects of the problem of Diagnostic errors in healthcare organizations. It will further provide evidence-based support for the problems of diagnostic errors leading to compromise in patient care and will further provide a performance improvement solution and its implementation plan. It will discuss how the performance improvement plan is made using Quality ensuring tools followed by its use in healthcare organizations. Further, it will look into the aspects of the Implementation strategy of the performance improvement initiative through the means of effective communication. The paper will discuss the role of Communication in ensuring quality patient outcomes. Lastly, it will look into Quality benchmarking and will provide success parameters for the performance improvement initiative on basis of financial implications, information management systems, and processes that can ensure quality patient care by minimizing diagnostic errors in healthcare organizations.

The Problem of Diagnostic Errors and Their Impact

The National Academy of Sciences (2015) defines Diagnostic Errors as the failure to make out an accurate and timely explanation of the patient’s condition or the failure to communicate that explanation to the patient. Diagnostic Error is a major public health concern with most people experiencing diagnostic error at least once in their lifetime (Hall et al., 2020). The outcome of diagnostic errors is thus derogatory and affects the quality of patient care. Quality of Care, as defined by the Institute of Medicine (1990) entails six parameters of healthcare, namely, Safe, Effective, Patient-centered, Timely, Efficient, and Equitable care. Any of these, if hampered affect the quality of care and is detrimental to patient safety and quality patient care. Therefore, Diagnostic errors which directly affect the safety of the patients are a matter of concern as far as the Quality of Healthcare parameters is concerned. 

Diagnostic errors are one of the significant causes of morbidity as well as mortality and are considered adverse medical events (Roberts & Ali, 2013). Not only are the adverse medical events costly, but also have a dramatic effect on the patients as well as their loved ones (Roberts & Ali, 2013). Additionally, organizations have to bear the brunt of diagnostic errors made by doctors and healthcare professionals. For instance, diagnostic errors lead to negative health outcomes, financial burdens, and psychological stress (National Academy of Sciences, 2015). Organizations face many problems related to physical, psychological, interdepartmental, or organizational conflicts along with cost bearing. Therefore, diagnostic errors are a hindrance to patient safety and meeting quality standards in healthcare.

Evidence-Based Support

Prevalence and Causes of Diagnostic Errors

A recent study indicated that 5% of US adult patients suffer or experience diagnostic errors in outpatient settings (H. Singh et al., 2017). Half of these patients included the possibility of being harmed. A study in Malaysia reported the prevalence of diagnostic errors to be 3.6% (H. Singh et al., 2017). Also, in medical malpractice, diagnostic errors are found to be the most common category (H. Singh et al., 2017). It is thus evident that diagnostic errors are the most common medical malpractice and are a significant public health concern even in developed countries. 

Causes and Patient-Safety Practices

Studies on diagnostic errors often reveal the root cause of the errors which may range from cognitive errors to system flaws owing to improper communication or coordination of care to insufficient access to doctors (H. (Physician) Singh et al., 2016). A recent study in a developed country revealed the causes of process breakdown leading to diagnostic errors involved 79% of the errors caused during clinical encounters between patients and practitioners (H. Singh et al., 2017). The other problems were found to be referral errors, patient-related factors, improper follow-up and tracking of diagnostic information, and improper performance as well as interpretation of diagnostic information (H. Singh et al., 2017). Studies have also found that there are two major factors contributing to all the major problems of diagnostic errors, namely -  cognitive-based factors along with communication and coordination (Hall et al., 2020).  Although diagnostic errors are costly and account for a significant proportion of medical litigations and morbidity, they can still be avoided (Roberts & Ali, 2013).

Hall et al. (2020) report that the Agency for Healthcare Research and Quality (AHRQ) reviewed the list of 23 patient-safety practices (PSPs) that can lead to diagnostic errors. The report presented by the committee suggested the PSPs selected to address the issue of diagnostic errors included four PSPs, namely – the use of clinical decision support (CDS), result notification system (RNS), peer review, and education and training (Hall et al., 2020). CDS provides support by addressing diagnostic errors through improved decision-making by involving multiple stakeholders in improving the knowledge base and through better communication. RNS also improves communication lapses in inpatient and ambulatory settings while education and training along with peer review also decrease biases and improve a practitioner’s clinical practice respectively (Hall et al., 2020). Thus, diagnostic errors can be decreased through the tools of proper knowledge, communication, and coordination.

Performance Improvement Initiative

The path to improving performance by reducing adverse events of diagnostic errors is the

right performance improvement plan addressing all the problems related to diagnostic errors. Since diagnostic errors are a multifaceted problem with complexities involved (Balogh et al., 2016), the performance improvement plan should be an inter-departmental and multidisciplinary one to address this complex public health concern.

Eight Goals for Improving Diagnostic Performance

 The performance improvement plan to decrease diagnostic errors as proposed by the committee of The National Academy of Sciences (2015) consists of eight overarching goals. The committee suggested that the first step to achieving the goal involves the facilitation of more effective teamwork in the diagnostic process that should involve the active participation of healthcare professionals, family, and the patients themselves (Balogh et al., 2016). The other steps include enhancing healthcare education and training healthcare professionals for better diagnostic processes, and the enhancement of health information technologies such as EHR and other IT management tools. A systematic EHR not only helps keep patient records confidential but also provides efficient health records that can be communicated among healthcare professionals. Additionally, healthcare practitioners must deploy approaches to identify, reduce and learn from diagnostic errors as well as near misses in their clinical practice. They must establish a work culture that is conducive to both the patients and the practitioners to enhance diagnostic performance. They should also develop a medical liability system and a reporting environment for diagnostic errors to help them learn from the errors made. Also, they must develop an environment for payment and care delivery system that supports the diagnostic process. Lastly, there should be sufficient funding for research on diagnostic errors and enhanced diagnostic processes (Balogh et al., 2016). 

Six Sigma and PDCA Quality Improvement Models

The above 8-step plan can be implemented and the data obtained can comply with the quality standards of the six-sigma quality improvement method (Frank & Chou, 2011). This Quality standard employs a five-phase methodology, namely – Define-Measure-Analyze-Improve-Control (DMAIC) (Frank & Chou, 2011). As evident, the problem of diagnostic errors should first be defined followed by measuring, and analyzing the errors for Improvement and finally for Quality control. Another way of improving Quality is the PDCA model of Deming (1986). The model defines meeting the Quality standards by the Plan-Do-Check-Act model. The above model can be implemented by first planning a way to decrease diagnostic errors followed by doing or implementing the plan followed by checking if the implemented plan is fine to be taken into practice and lastly Acting accordingly. 

Implementation Plan/Strategy

To make the Planned initiative successful, an implementation plan is a must. The implementation strategies to decrease diagnostic errors includes a good communication plan and audit processes (Abimanyi-Ochom et al., 2019). 

Communication Strategies

Since diagnostic processes involve making the right diagnosis and communicating the same to the patient, any error made at either of the steps can lead to an adverse medical event. So, communication is the key to improving the standards of patient care. Be it inter-departmental communication or patient-practitioner communication, efficient communication is the key to improving the outcomes of a well-devised plan. Proper communication within the departments through face-to-face, email, telephone, and documentation can be a good way to convey the right direction and reduce diagnostic errors (Abimanyi-Ochom et al., 2019). The right information conveyed about the right patient at the right time through the right source not only minimizes diagnostic error but it also contributes to a better cultural environment.

Audits and Computerized Decision Support

Additionally, audits and computerized decision support systems can further decrease the likelihood of making diagnostic errors in the future (Abimanyi-Ochom et al., 2019). The audits help the practitioners to analyze the errors made by the practitioners and help them to further evaluate and re-evaluate the gaps followed by unlearning and relearning from the errors made.

Organizational and Financial Outcomes of Implementation

If the above implementation strategy becomes successful, it would not only reduce the cost incurred due to diagnostic errors in patients but would also be beneficial in terms of improving quality care and building a sound reputation for doctors and healthcare organizations. Additionally, a better communication plan executed in an organization enhances a better culture of the organization which contributes to making a good plan implementable and the initiatives fruitful.

The success of the Performance Improvement Plan

Patient, Financial, and Organizational Outcomes

The success of any performance improvement initiative is measured by the outcomes of

Patient experience, quality of efficient patient care, decreased diagnostic errors by meeting the right diagnosis which is communicated to patients without delay, decreased readmissions of patients, and patient satisfaction. A successful implementation plan is marked by lesser costs incurred to patients and healthcare systems. The costs incurred by organizations can be in the forms of medical litigations, expenses borne by the organizations due to diagnostic errors, lawsuits, and compensations made to the patients in place of diagnostic errors made to the patients. Besides better financial outcomes, the other outcomes involve better patient experience in terms of lesser hospital readmissions, efficient treatment outcomes, sooner discharge, and patient satisfaction.

Quality Benchmarking

Benchmarking is one of the recognized methods to evaluate strengths and weaknesses at all healthcare levels (Willmington et al., 2022). It measures and compares the clinical outcomes across organizations and helps them to unlearn harmful practices and relearn the best healthcare practices (Willmington et al., 2022). Nowadays, benchmarking has been used to evaluate changes concerning better patient outcomes, better healthcare system management systems, and better interpersonal and inter-departmental relationships (Willmington et al., 2022).

Diagnostic Error Quality Benchmarks

Concerning diagnostic errors, quality benchmarking can help organizations to set standards for setting checklists for making diagnoses, setting patient satisfaction measures, and organizational standards. Since the quality of healthcare is majorly patient-centric, the quality standards should address patient problems at the levels of diagnosis, admission, hospitalization, discharge, and even during follow-ups. Diagnostic error minimization can help meet patient satisfaction levels by following minimum benchmark standards set at the regional, national, and international levels. 

Communication, Information Management, and Quality Outcomes

Besides patient outcomes owing to reduced diagnostic errors, there are better patient-practitioner relationships, better organizational processes in terms of better information management systems such as EHR utilization among different departments, patient confidentiality maintenance, meeting quality standards as per the set Quality benchmarks, and a good inter-departmental culture built by better communication systems. Communication is thus the key to enhancing organizational processes, bearing lesser financial costs, and enhancing information management systems which all contribute to decreasing diagnostic errors and meeting quality standards. Thus, minimizing diagnostic errors through the right communication by the right source using the right diagnostic system to the right patient at the right time for better financial, healthcare, and organizational outcomes is the essence of a quality healthcare delivery system.

Conclusion

Diagnostic errors are a great hindrance to meeting the quality of patient care, which is the most critical requirement for a successful healthcare delivery system. The rampant misdiagnosis missed diagnosis, and wrong and delayed diagnosis of patients can lead to physical, psychological, financial, and emotional stress among organizations and patients alike. Not only do diagnostic errors bring a bad name for the organization and mistrust in the medical fraternity but also lead to many challenges for the organizations. The main causes of diagnostic errors include cognitive errors, insufficient or improper information management systems, and systemic errors. Diagnostic errors are a major public health concern as they fail to meet the quality standards of patient safety, quality patient care, and patient satisfaction. However, diagnostic errors can be minimized with proper healthcare planning initiatives and implementation. In regards to minimizing diagnostic errors, patient-safety –practices (PSPs) like the use of clinical decision support (CDS), result notification system (RNS), peer review, and education and training can minimize diagnostic errors. To decrease diagnostic errors, an improvement plan has been made and an implementation plan devised. The improvement plan which was based on Edward Demming’s PDCA model, the six-sigma model for meeting quality standards was devised. The plan can be implemented through proper communication between healthcare professionals and patients. Not only does communication improve health standards by reducing organizational costs but also enhances patient satisfaction. The success of the improvement plan can be measured by looking into better financial outcomes, lesser patient readmissions, better organizational processes, information management systems, and better patient healthcare outcomes. Benchmarking is one of the best ways to measure healthcare outcomes by making diagnostic checklists, patient satisfaction measures, and setting standards for healthcare management systems. Thus minimizing diagnostic errors through efficient communication between patients and organizations can ensure the delivery of quality patient care. Summarizing, quality patient care can be ensured by reducing diagnostic errors through effective healthcare planning and implementation which when practiced can ensure success in the healthcare delivery in the organization. 

References

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