Process breakdowns in diagnosis

Hess, Dr. Donald dhess at SUSQUEHANNAHEALTH.ORG
Thu Dec 1 12:15:12 UTC 2016


Greetings Mark:

Thanks for your important reminder that diagnosis is a process. Even though we tend to think of it as a noun, one that reduces to an ICD number, it is essentially a verb.

The diagnostic process is deeply embedded into other organizational processes, e.g. patient throughput, standardized protocols, EHR documentation, etc. More importantly, it is also blended into the interpersonal information exchange amongst clinicians, patients & families. Perhaps this "hiddenness" explains why it has taken so long to recognize the importance of the diagnostic process relative to the quality of care.

Who owns the process? It is broadly distributed.

Who defends the integrity of the process? To the extent that ownership is broadly distributed, likewise the responsibility.

For example, when a quality improvement initiative is being planned, who will ask: "What are the potential adverse consequences to the diagnostic process"?

Regards, Don

Dr. Donald Hess

From: Mark Graber [mailto:graber.mark at GMAIL.COM]
Sent: Wednesday, November 30, 2016 2:22 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Process breakdowns in diagnosis

One of the major messages in the IOM report was that diagnosis is a PROCESS.  Quality improvement work then becomes possible by examining and addressing the process breakdowns that contribute to errors and harm.

The attached article from Saul Weingart & associates is a terrific illustration of how much can be learned from this approach.  With permission of the publisher, its our pleasure to forward this article, and an accompanying editorial by Hardeep Singh, in advance of their appearing online (soon !) in the Joint Commission Journal.   Both of these articles have important messages.



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