A multi-institutional rapid qualitative assessment of factors supporting diagnostic excellence in hospital medicine

Diagnostic errors among hospitalized adults are prevalent and costly. Traditional approaches that focus on identifying and fixing mistakes (Safety-I) may fall short in the dynamic and complex hospital environment. Instead, focusing on approaches that emphasize the understanding of how things go right and adapt to challenges (Safety-II) may offer better insights into what contributes to accurate and timely diagnoses.

We sought to characterize hospitalists' perceptions of diagnostic excellence and the factors and adaptations needed to achieve it.

Focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, researchers, and patient representatives about (1) recognition of diagnostic excellence, (2) what makes diagnostic journeys go well, and (3) factors that facilitate diagnosis in difficult situations. Rapid qualitative methods including templated summaries and matrix analysis were applied to analyze these focus groups.

We conducted five focus groups with 36 individuals from 23 unique institutions. Participants shared three factors that facilitate a successful diagnostic journey: clinical reasoning that is structured yet adaptive, collaborative diagnosis through teamwork, and systems-level support for diagnostic capacity. Participants readily recognized diagnostic excellence, though noted the challenge in systematically identifying these cases.

While diagnostic excellence case identification is seen as a challenge, providers do note people, process, and technology opportunities to support better diagnosis. Optimization of diagnosis in hospital medicine may benefit from a focus on team and communication redesign, adaptive technology development, and workload management.