Making Inroads with Congress
What follows is an interview with Randal Moseley, MD, Medical Director of Patient Safety and Risk at Confluence Health, representative of the Washington Patient Safety Coalition (WPSC), former WPSC Steering Committee chair, and member of the Washington State Hospital Association Patient Safety Committee.
Why is the issue of diagnostic error important to you?
“Confluence Health has two hospitals and 12 branch clinics throughout 12,000 square miles of rural North Central Washington, which creates unique practice challenges,” said Randal Moseley, MD. “I became more aware of diagnostic error a few years ago after a few events in our health system, which brought me to my first SIDM annual conference in 2017.”
The Society to Improve Diagnosis in Medicine’s (SIDM) annual conference became an inspiration for Dr. Moseley’s passion to improve diagnostic performance on a state level as well as within Confluence Health. Since then, the Washington State Hospital Association and the Washington Patient Safety Coalition have organized efforts around improving diagnosis, including holding educational webinars to raise awareness among providers, providing targeted messages at key meetings, and more. In fact, the hospital association has collaborated with the Oregon Association of Hospitals and Health Systems through the Northwest Safety and Quality Partnership to expand discussion of this issue to a regional level.
In a previous ACT Update, Randal Moseley, Steve Levy, and Emily Wittenhagen outlined some of the initiatives they’ve undertaken to improve the diagnostic process.
“We’ve seen excitement on the state level from the state medical officer organization and annual hospital trustees summit, and it’s since become an issue regionally,” said Dr. Moseley. “Now we’re bringing our concerns to a national level by attempting to impact research funding for diagnostic error.”
How have you engaged lawmakers on the issue of diagnostic error?
Dr. Moseley and Dr. Peter Rutherford, CEO of Confluence Health, wrote to Rep. Kim Schrier (WA-8) to describe how the issue of diagnostic error affects people in the state, and asking for her to support a dedicated funding commitment proportionate to its public health impact.
The letter included an ‘SBAR,’ a one-page “Situation, Background, Assessment, Recommendation” document commonly used in healthcare communications that outlined the importance of addressing diagnostic error.
“It was difficult to summarize the issue of diagnostic error in just a page, but we made it a point to show how this issue affects people in her district and describe efforts underway that could use her support. We kept the ask clear and came to her as concerned constituents,” said Dr. Moseley.
Rep. Schrier’s office replied quickly with an offer for a meeting to gain more information.
What success have you seen?
The Confluence Health team secured a meeting with Rep. Schrier, where they shared their concerns, discussed the scope and scale of the problem, and elevated her interest in the topic.
“We got her attention because this is a patient safety issue,” Dr. Moseley explained. “We were concerned on behalf of the public interest, and that helped our cause a lot.”
In response to their efforts Rep. Schrier sent a letter to the U.S. House of Representatives Appropriations Committee in support of dedicating funding for work specifically on diagnostic safety and quality at the Agency for Healthcare Research and Quality (AHRQ).
Looking to the future Dr. Moseley wants to keep communication with Rep. Schrier open.
“We sent a thank you note to show our deep appreciation of her response,” he said.
How did SIDM support you during this process?
“SIDM made this whole process easy,” said Dr. Moseley. He worked with Leslie Tucker, senior policy advisor at SIDM, to coordinate messaging, timing, and communication. Reflecting on the process Dr. Moseley said he found it helpful to learn more about the funding process and what effect the letter could have on the field of diagnostic safety and quality.
"Policymakers want to be helpful, but they have to know there's a problem in the first place and how it affects their constituency," said Leslie Tucker. "Elected officials are always interested in important work happening in their districts. One facet of our work at SIDM is making connections between leaders in Washington DC and diagnostic safety and quality champions back home."
What’s your advice to others interested in pursuing this strategy?
“Use what resources you have and keep your ask short,” said Dr. Moseley. “You should craft an effective message with reasonable brevity.”
The team at Confluence Health and SIDM know that people working on Capitol Hill, from lawmakers to their legislative staff, don’t have much time so they kept their communications short, made the ask clear, and illustrated the problem with de-identified examples of impacted constituents.
Dr. Moseley noted that inaccurate or delayed diagnoses are not issues that will resolve overnight, and that it will take consistent effort over time to move the needle. He encouraged people “to keep the energy up and keep plugging away.”
If you are interested in connecting with a lawmaker, please reach out to Leslie Tucker at Leslie.Tucker@ImproveDiagnosis.org. SIDM can provide support with facilitating introductions, providing background materials, and other support.