24575 University Hospitals, Cleveland Medical Center. Case Western Reserve University, Ohio, USA.
14661500 Johns Hopkins University, Baltimore, Maryland, USA.
Hum Factors. 2022 Feb;64(1):6-20. doi: 10.1177/0018720821996187. Epub 2021 Mar 3.
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.
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.
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.
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.
The HRO lens offers some important ideas for how the safety of the diagnostic process can be improved.
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.
我们将高可靠性组织（HRO）范式应用于诊断过程，概述在诊断中实施 HRO 原则所面临的挑战，并为诊断过程的利益相关者提供克服这些障碍的解决方案。
有证据表明，医疗保健行业开始通过采用各种 HRO 原则和实践来组织更高的可靠性。这些原则有望提高更安全的护理，但很少考虑临床医生和医疗保健系统在诊断过程中实施 HRO 原则所面临的挑战。为了有效地部署 HRO 视角，必须认真考虑这些障碍。
我们回顾了 HRO 范式的关键原则、通过实施这些原则可以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中面临的挑战，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。
我们的分析揭示了多个挑战，包括固有的诊断不确定性、缺乏以诊断为重点的绩效反馈、诊断通常是一项单独而非团队活动的事实、简化诊断过程的倾向以及专业和机构等级制度。但这些挑战并非不可逾越——有策略和解决方案可以克服它们。
HRO 视角为如何提高诊断过程的安全性提供了一些重要思路。
这里提出的想法可以由临床医生和医疗保健领导者共同实施；两者对于系统地提高诊断性能都很有必要。
