Diagnostic safety is vital to learning health systems committed to eliminating preventable harm. There is an ethical, business, and community case for addressing diagnostic safety.
Ethical case: One in three patients has firsthand experience with a diagnostic error. One-third of malpractice cases that result in death or permanent disability stem from an inaccurate or delayed diagnosis, making it the number one cause of serious harm among medical errors.26 Diagnostic safety is a patient safety issue that affects millions of patients in the United States each year, and the time to act is now. Good patient outcomes hinge on having an accurate and timely diagnosis. Therefore, building capacity for diagnostic excellence is critical to more fully realizing the ethical imperative for healthcare organizations to do no harm.
Business case: Improving diagnosis can reduce costs. It is estimated that at least $200 billion is wasted annually on excessive testing and treatment.27 This overutilization contributes to harm, with aggressive testing mistakes and injuries believed to cause 30,000 deaths each year.27 Even more specifically, data from autopsies indicate that approximately 10 percent of patients had missed or incorrect diagnoses.2 Getting accurate diagnoses in a timely fashion is a crucial component of healthcare. It provides an explanation of a patient鈥檚 health problem and informs every subsequent healthcare decision. It is essential that every healthcare encounter is safe and free from harm.
Community case: Implications of an unhealthy population are increasingly recognized, and the complexity of addressing health challenges requires that healthcare leaders collaborate with other public and private community-oriented groups to improve health. Promotion of community health is an important strategy in combating preventable harm of all types, including diagnostic errors.
Building health-literate healthcare organizations, that is, healthcare organizations that make it easier for people to navigate, understand, and use information and services to take care of their health28 serves as a means to more meaningfully engage patients in diagnostic processes, as well as enabling broader patient activation in health. The community case for diagnostic safety is represented in the interdependent recommendations from the National Action Plan to Advance Patient Safety (NAP).9 The NAP highlights the need for a total system approach across the entire healthcare continuum that promotes robust collaboration among all stakeholders to prevent harm.9
An integral part of delivering high-quality healthcare is understanding the social determinants of health of patients and communities in which healthcare is provided.29 Historically in the United States, health outcomes have not been equal for all patients. Disparities in diagnosis occur by race, color, ethnicity, disability, sex, gender expression, gender identity, and sexual orientation. Disparities are a safety issue that should be owned by a health system鈥檚 leadership and a focus of its safety efforts.30
Leaders that consider the ethical, business, and community cases as part of their diagnostic safety efforts are better positioned to advance the well-being of their communities and staff and improve patient outcomes.31
