Objective

We apply the high-reliability organization (HRO) paradigm to the diagnostic process, outlining challenges to enacting HRO principles in diagnosis and offering solutions for how diagnostic process stakeholders can overcome these barriers.

Background

Evidence shows that healthcare is starting to organize for higher reliability by employing various principles and practices of HRO. These hold promise for enhancing safer care, but there has been little consideration of the challenges that clinicians and healthcare systems face while enacting HRO principles in the diagnostic process. To effectively deploy the HRO perspective, these barriers must be seriously considered.

Method

We review key principles of the HRO paradigm, the diagnostic errors and harms that potentially can be prevented by its enactment, the challenges that clinicians and healthcare systems face in executing various principles and practices, and possible solutions that clinicians and organizational leaders can take to overcome these challenges and barriers.

Results

Our analyses reveal multiple challenges including the inherent diagnostic uncertainty; the lack of diagnosis-focused performance feedback; the fact that diagnosis is often a solo, rather than team, activity; the tendency to simplify the diagnostic process; and professional and institutional status hierarchies. But these challenges are not insurmountable—there are strategies and solutions available to overcome them.

Conclusion

The HRO lens offers some important ideas for how the safety of the diagnostic process can be improved.

Application

The ideas proposed here can be enacted by both individual clinicians and healthcare leaders; both are necessary for making systematic progress in enhancing diagnostic performance.

中文翻译：

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跨越学术界限的诊断安全性：从临床角度和高可靠性组织原则的 10 个复杂挑战和潜在解决方案

客观的

我们将高可靠性组织 (HRO) 范式应用于诊断过程，概述了在诊断中实施 HRO 原则的挑战，并为诊断过程利益相关者如何克服这些障碍提供解决方案。

背景

有证据表明，医疗保健开始通过采用 HRO 的各种原则和实践来组织更高的可靠性。这些有望加强更安全的护理，但很少考虑临床医生和医疗保健系统在诊断过程中制定 HRO 原则时面临的挑战。为了有效地部署 HRO 视角，必须认真考虑这些障碍。

方法

我们回顾了 HRO 范式的关键原则、可能通过其制定预防的诊断错误和危害、临床医生和医疗保健系统在执行各种原则和实践时面临的挑战，以及临床医生和组织领导者可以采取的可能解决方案来克服这些挑战和障碍。

结果

我们的分析揭示了多重挑战，包括固有的诊断不确定性；缺乏以诊断为中心的绩效反馈；诊断通常是一个单独的活动，而不是团队活动；简化诊断过程的趋势；以及专业和机构地位等级。但这些挑战并非不可克服——有一些策略和解决方案可以克服它们。

结论

HRO 镜头为如何提高诊断过程的安全性提供了一些重要的想法。

应用

这里提出的想法可以由个别临床医生和医疗保健领导者实施；两者对于在提高诊断性能方面取得系统性进展都是必要的。