Process breakdowns in diagnosis

Bob Swerlick rswerli at GMAIL.COM
Fri Dec 2 03:57:51 UTC 2016


It is hard (and perhaps impossible) to be in charge of quality of a process
which by all accounts defies measurement.

When diagnosis is flat out and spectacularly wrong, the process may be
easy. For example, when someone presents with profound anemia with renal
cell carcinoma and is misdiagnosed as having a non-existent stomach ulcer
or is accused of being crazy.

However, the diagnostic process involves being wrong at many points in the
process and as I see it the process itself is about getting less wrong over
time. Think of a differential and most of the things on the list are going
to turn out wrong diagnoses! When in the process does being wrong
constitute a misdiagnosis and when is that considered simply part of the
process?

Focus on process is useful when one has a method to improve the process.
You have to ultimately know if the process works and in order to do so, you
have to be able to measure whether whether such a process yields better
diagnostic results and provide feedback to those making diagnoses in a time
frame which allows them to change and improve. This may exist somewhere in
healthcare but I am not sure where that might be.

Bob Swerlick

On Thu, Dec 1, 2016 at 1:34 PM, Jason Maude <
jason.maude at isabelhealthcare.com> wrote:

> This is a really important question- who is responsible for the quality
> and standard of diagnosis quality in an institution? Shouldn’t the CMO be
> responsible for the overall standard of clinical care which includes
> diagnosis? If there isn’t this clarity, as implied below, then that’s where
> the problem starts. There has to be somebody who is responsible to drive
> the process forward.
>
> Regards
>
> Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886 <+44%201428%20644886>
> Tel: +1 703 879 1890 <(703)%20879-1890>
> www.isabelhealthcare.com
>
> From: "Hess, Dr. Donald" <dhess at SUSQUEHANNAHEALTH.ORG>
> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG>, "Hess, Dr. Donald" <dhess at SUSQUEHANNAHEALTH.ORG>
> Date: Thursday, 1 December 2016 12:15
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG>
> Subject: [IMPROVEDX] Process breakdowns in diagnosis
>
> 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 <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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>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/




-- 
Bob Swerlick






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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