Pat Croskerry, MD, PhD, FRCP (Edin), Dalhousie University
Mark Graber, MD, Society to Improve Diagnosis in Medicine
Ashley Meyer, PhD, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
Gordon Schiff, MD, Brigham and Women's Center for Patient Safety Research
This session is recommended as an overview for the first-time attendee. Participants will gain an understanding of the problem of diagnostic error, including what it is and how it impacts patients and health systems. Internationally-recognized experts in the field will share their knowledge and answer questions.
8:00 a.m. - 12:00 p.m.
A Workshop on Reducing Diagnostic Error in Clinical Settings Read more...
Moderator:
Paul L. Epner, MBA, MEd, Society to Improve Diagnosis in Medicine
Michael Kanter, MD, The Permanente Federation & The Southern California Permanente Medical Group
Michael Laposata, MD, PhD, University of Texas Medical Branch - Galveston
Diana Rusz, BA in Psychology, MPH, Society to Improve Diagnosis in Medicine
Brent Smith, MD, Intermountain Healthcare
Health care systems are continually involved in quality improvement, but rarely are those efforts directed to the problem of diagnostic error. Unfortunately, we are still early in the development of effective interventions. However, such interventions do exist. In this workshop, we will share case studies of what works, hear the results of an environmental scan that sought to learn all interventions being attempted, and in a highly interactive environment, determine strategies for implementing diagnostic error quality improvement in your clinical setting now.
8:00 a.m. - 12:00 p.m.
Diagnostic Reasoning: Key Teaching Skills at the Bedside...and How to Fill Out the Evaluation Form Read more...
Moderators:
Gurpreet Dhaliwal, MD, University of California, San Francisco
Andrew P.J. Olson, MD, University of Minnesota
Speakers:
Denise Connor, MD, UCSF and San Francisco VA Medical Center
Lisa Sanders, MD, FACP, Yale University School of Medicine
Benji Mathews, MD, FACP, CLHM, HealthPartners and University of Minnesota Medical School
Paul Bergl, MD, Medical College of Wisconsin
This interactive session will help front-line educators highlight the diagnostic process on inpatient rounds or outpatient encounters. Sessions will focus on using the patient’s story to diagnose, using the physical exam to reduce diagnostic error and increase high value care, and how to fill out the evaluation form with something more meaningful than “really great differentials…continue to read more and see more."
8:00 a.m. - 12:00 p.m.
The Cognitive Psychology of Diagnostic Error Read more...
Speakers:
Sandra Montiero, PhD, McMaster University
Geoffrey Norman, PhD, McMaster University
Laura Zwaan, PhD, Institute of Medical Education Research, Rotterdam, Erasmus MC
This course will provide a broad overview of the cognitive psychology of diagnostic reasoning, aimed at physicians or researchers who want to learn more about the cognitive psychology of diagnostic decision making. We will discuss the main theories of diagnostic reasoning and decision making (e.g. dual process thinking, the use of heuristics, cognitive biases) and ways to reduce cognitive error. The latest developments and results of recent studies will be reviewed.
12:00 p.m. - 1:00 p.m.
Lunch on Own
Day One
1:00 p.m. - 1:30 p.m.
Opening Remarks
Speakers:
Dana Siegal, RN, CPHRM, CPPS, CRICO Strategies
Robert Trowbridge, MD, Tufts University School of Medicine and Maine Medical Center
1:30 p.m. - 2:30 p.m.
Diagnostic Error and Clinical Reasoning Case Conference Read more...
Case Discussant
Gurpreet Dhaliwal, MD, University of California, San Francisco
Case Commentators:
Andrew Olson, MD, University of Minnesota
Joe Rencic, MD, Tufts Medical Center
In this session, an expert clinician will review and discuss a case previously unknown to him as it is presented in the way it unfolded in the clinical setting. He will share his thought processes and how he approaches such cases. Two experts in clinical reasoning will contemporaneously comment on his thought processes, specifically concentrating on what others can learn from expert clinicians. An emphasis will be placed on common sources of error, potential means of avoiding error, and the interaction between systems factors and cognition.
2:30 p.m. - 3:00 p.m.
Panel Discussion: Teamwork and the Clinical Reasoning Case Conference Read more...
Moderator:
Karen Cosby, MD, CPPS, Rush Medical College
Speakers:
Gurpreet Dhaliwal, MD, University of California, San Francisco
Penny Greenberg, MS, RN, CPPS, CRICO Strategies
Linda Kenney, ADME, MITSS Meically Induced Trauma Support Services, Inc.
The case presentation will be followed by a multi-disciplinary panel discussion centered on the role of teamwork in the diagnostic process. The case will be used to exemplify how multi-disciplinary collaboration and teamwork can make diagnosis more reliable, accurate and timely.
Robert El-Kareh, MD, MS, MPH, University of California, San Diego
Laura Zwaan, PhD, Institute of Medical Education Research, Rotterdam, Erasmus MC
The field of diagnostic error is in the early days of translating research into interventions shown to be effective in clinical settings. In this session practitioners, selected through peer review, present submitted abstracts. During the second part of this session, there will be an interactive discussion with the presenters and experts on strategies for making a difference for patients today.
5:00 p.m. - 7:00 p.m.
Poster Session and Networking Reception
Day Two
Day Two
Day Two
8:45 a.m. - 9:00 a.m.
Opening Remarks
9:00 a.m. - 10:00 a.m.
Keynote Presentation:Donald M. Berwick, MD, MPP, FRCP, Institute for Healthcare Improvement
The Role of Diagnostic Error in Patient Safety Read more...
Despite being the subject of increasing attention, diagnostic error remains a significant risk to patient safety. Factors underlying the unacceptable rates of diagnostic error are complex and stem from the intricacy and uncertainty inherent to the diagnostic process and the structure of health care system. Improvements in diagnostic reliability, however, are likely to lead to significant gains in all domains of the quadruple aim, including improved the patient experience, lower costs, better patient outcomes, and higher clinician satisfaction. A priority must be placed on improving diagnostic safety as a means of providing safe and patient-centered care.
10:00 a.m. - 10:30 a.m.
Keynote Panel: Discussion of The Role of Diagnostic Error in Patient Safety
Speakers:
Donald M. Berwick, MD, MPP, FRCP, Institute for Healthcare Improvement
Patricia Folcarelli
Timothy Mosher, MD, Penn State Health
10:45 a.m. - 12:15 p.m.
The Coalition in Action: Interventions, Advocacy and Driving Change Read more...
Speakers:
Paul L. Epner, MBA, MEd, Society to Improve Diagnosis in Medicine
David Newman-Toker, MD, PhD, Johns Hopkins University School of Medicine
Diana Rusz, BA in Psychology, MPH, Society to Improve Diagnosis in Medicine
Leslie Tucker, BA, L Tucker Consulting
The Coalition to Improve Diagnosis was formed just before the publication of the National Academy of Medicine’s (formerly IOM) landmark report on Improving Diagnosis in Health Care. With more than 30 leading healthcare organizations as members, the Coalition is intent on improving diagnosis through collective and individual actions. Collective actions are focused on inventorying quality improvement interventions, advocating for increased research funding, and developing a campaign to drive change among patient and healthcare professionals. In this session, we will provide updates on results-to-date which will include the results of the environmental scan of quality improvement interventions, the market research results on beliefs about diagnostic error.
12:15 p.m. - 1:00 p.m.
Lunch
1:00 p.m. - 1:45 p.m.
What Do We Know About Collaborative Diagnostic Decision Making? Read more...
Speaker:
Wolf Hautz, MD, MME, Inselspital University Hospital Berne
Modern healthcare is highly fragmented and many more than one person commonly contributes to a patient’s care. Still, diagnosing a patient’s condition is all too often conceptualized as a “lone wolf’s endeavor”. Consequently, much of what we know about diagnostic decision making may not be ecologically valid.
In this presentation, what is generally known about collaborative decision making will be introduced followed by a discussion of diagnostic decision making by more than one individual. A specific focus will be placed on when, if, and how diagnostic decision making benefits from this collaboration. Although many of the studies cited are experimental and thus commonly removed from real clinical settings, an attempt to be made to closely link their findings to the workplace and elaborate on their clinical implications, supported by real-world data wherever possible.
Because working in a team is different from simply working alongside one another, forms of collaboration in healthcare and their differences and implications will also be discussed. The presentation will end with a number of open questions on collaborative diagnostic decision making, providing a starting point for reflection and discussion.
1:45 p.m. - 2:30 p.m.
Keynote Presentation: David Mayer, MD Leading a Culture of Teamwork
2:30 p.m. - 3:00 p.m.
Keynote Panel: Discussion of Collaborative Decision Making and a Culture of Teamwork
Speakers:
Wolf Hautz, MD, MME, Inselspital University Hospital Berne
David Mayer, MD, MedStar Health
Liz Mort
Ruth Ryan, RN, BSN ,MSW, CPHRM, RiskWriter LLC
3:00 p.m. - 3:15 p.m.
Break
3:15 p.m. - 4:30 p.m. and 4:45 p.m. - 6:00 p.m.*
Interactive Workshops
Engaging Nursing in Reducing Diagnostic Error: A Practical Workshop Read more...
Speakers:
Kelly Gleason, RN, BSN, Johns Hopkins University School of Nursing
Kathleen Rea, DNP, RN, ACNS-BC, PCCN, CNL, UVA Health System
Historically, diagnosis is considered solely a physician responsibility, and teamwork in diagnosis generally refers to physicians working together across medical specialties. There is a pressing need to adjust this view and for nurses to take part in efforts addressing diagnostic errors. While there are logistical, regulatory, and sociocultural barriers to nurses participating as full members of the diagnostic team that must be addressed, the potential benefits of their participation are immense. In this workshop, we address how to formalize and expand nurses’ engagement in the diagnostic process and how to maximize effectiveness of interprofessional teamwork and communication.
Engaging Your Institution in Reducing Diagnostic Error: A Practical Workshop Read more...
Speakers:
Harry Hoar III, MD, Baystate Medical Center
Doug Salvador, MD, MPH, Baystate Medical Center
Although there has been increasing focus on diagnostic error, many healthcare organizations may still be unsure of how to implement effective methods of reducing diagnostic error. This workshop will discuss barriers to engaging local decision makers and propose means of overcoming them. Participants will leave the workshop with an action plan to reduce diagnostic error in their own institution.
Engaging Patients in Research: A Practical Workshop Read more...
Speakers:
Traber Davis Giardina, PhD, MSW, Michael E. DeBakey Veterans Affairs Medical Center
Regina Greer-Smith, Master of Public Health - Fellow, American College of Healthcare Executives, Healthcare Research Associates, LLC
Despite the growing recognition of the prevalence and consequences of diagnostic errors, patient perspectives are seldom taken into consideration when researching diagnostic error causes or solutions. In this workshop, we will present data on patients’ perspectives of diagnostic error and why these perspectives are important for improving health outcomes. Additionally, we will present methods for engaging patients in research from beginning to end, providing researchers with the tools to successfully engage patients in research.
Balancing Diagnostic Errors with Conservative Diagnosis: Developing a New Paradigm for More Appropriate Diagnosis Read more...
Speakers:
Stephen Martin, MD, EdM, Barre Family Health Center | University of Massachusetts Medical School
Gordon Schiff, MD, Brigham and Women's Hospital Center for Patient Safety Research
There is a need for a more nuanced understanding of diagnosis that goes beyond merely “balancing tradeoffs” between under-diagnosis (diagnosis errors and delays) and over-diagnosis and wasteful over-testing. We must instead treat these problems as two sides of the same coin, with the unifying concept being more appropriate and careful diagnosis. Some diagnoses are pursued and treated that have little impact on patients’ health and well-being, with diagnostic interventions causing harm that outweigh any benefits; yet other diagnoses that would help relieve suffering are being missed entirely. To reframe and better approach this core challenge in diagnosis science, we have developed a new diagnosis paradigm built around 10 Key Principles of Conservative Diagnosis.
4:30 p.m. - 4:45 p.m.
Break
6:30 p.m.
Meet the Experts Dinner
Day Three
8:10 a.m. - 9:00 a.m.
Keynote Presentation: Amy C. Edmondson, PhD
The End of the Team as We Know It Read more...
As healthcare changes at an ever faster rate, we find ourselves moving from stable, bounded, clearly defined teams to a form of dynamic “teaming” across siloes, requiring a set of organizational and interpersonal skills that can be learned. Teaming means quickly building trust with others who are not always like you via self-disclosure and systematic inquiry. It involves coordinating care with other providers and disciplines across varied settings in an environment of uncertainty and unfamiliarity, and doing so without a script.
9:00 a.m. - 9:30 a.m.
Keynote Panel: Discussion of The End of the Team as We Know It
Speakers:
Amy C. Edmondson, PhD
William Strull
9:30 a.m. - 9:45 a.m.
Break
9:45 a.m. - 12:30 p.m.
Concurrent Sessions
Oral Abstracts of Current Research and Educational Innovations Read more...
Moderators:
Andrew P.J Olson, MD, University of Minnesota
Laura Zwaan, PhD, Institute of Medical Education Research, Rotterdam, Erasmus MC
Expert Discussants:
Robert El-Kareh, MD, MS, MPH, University of California, San Diego
David Newman-Toker, MD, PhD, Johns Hopkins University School of Medicine
During the first part of the session, the outcomes of the research summit (held prior to the conference) will be summarized. During the second part of this session, authors selected through peer review will present submitted abstracts of research and educational innovations, followed by an interactive discussion with the presenters and experts.
Oral Abstracts of Current Practice Improvement Strategies Read more...
Speaker:
Michael Kanter, MD,The Permanente Federation and The Southern California Permanente Medical Group
The field of diagnostic error is in the early days of translating research into interventions shown to be effective in clinical settings. In this session practitioners, selected through peer review, present submitted abstracts. During the second part of this session, there will be an interactive discussion with the presenters and experts on strategies for making a difference for patients today.
Building and Sustaining Healthy Teams: Improving Communication, Reducing Burnout Read more...
Speakers:
Laurie C. Drill-Mellum, MD, MPH, Constellation
Susan Mann, MD, Beth Israel Deaconess Medical Center, QualBridge Institute
Dana Siegal, RN, CPHRM, CPPS, CRICO Strategies
Risk management, patient safety leaders and clinicians have long since understood the value of teamwork in acute care / task-oriented settings such as ED, OB and the OR. But building teams across multiple clinical specialties and locations, and over longer timelines is a newer concept of “teaming”. Using success stories from real clinical settings, this session will explore how we build, support and sustain successful team for diagnostic safety including coordination of roles and responsibilities, the critical role of communication in diagnostic teamwork, and the ever growing concern of provider burnout and its impact on successful teaming.
12:30 p.m. - 1:30 p.m.
Lunch
1:30 p.m. - 2:30 p.m.
"Remember When" ... Envisioning the Future of Diagnostic Safety Read more...
Speaker:
Dana Siegal, RN, CPHRM, CPPS, CRICO Strategies
This is a dramatized look-back to the hospitals of the past, from the 1970’s with our crisp white uniforms, hand-written notes and smoking in the nurses' station, to today's colorful scrubs, electronics everywhere, and entire non-smoking campuses. We will visit other significant social and healthcare changes as well, highlighting how dedication and persistence has made for great strides in pateint safety and patient-centeredness. We conclude by asking audience members, what will your story be 20 years from now, i.e., "can you believe that in 2017 we actually didn’t share medical records with patients, did surgery without a timeout, did not include the patient as a partner in healthcare, made needless diagnostic errors?"
Arabella Simpkin, MA (Oxon), BMBCh, MRCPCH, MMSc, Massachusetts General Hospital
Although physicians are rationally aware when uncertainty exists, the culture of medicine evinces a deep-rooted unwillingness to acknowledge and embrace it. This session will explore the presence of uncertainty in medicine, identifying the impact it has on learners, clinicians, educators, and patients and how this effects the diagnostic process. It will discuss key implications for the future of medical education, and identify ways to embrace and find strength in uncertainty.
3:30 p.m. - 3:45 p.m.
Break
3:45 p.m. - 4:45 p.m.
An Interactive Discussion of Pressing Questions in Diagnostic Error Read more...
Speakers:
Mark Graber, MD, Society to Improve Diagnosis in Medicine
Linda Kenney, ADME, MITSS Medically Induced Trauma Support Services, Inc.
Gordon Schiff, MD, Brigham and Women's Hospital and Harvard Medical School
Dana Siegal, RN, CPHRM, CPPS, CRICO Strategies
Using audience participation technology, the audience will be polled on important questions regarding diagnostic error that have arisen over the course of the conference. A moderated discussion will follow with a multi-disciplinary panel of experts weighing in on the audience’s answers and providing their own opinions.
