Medicine's Blind Spot: A Foundation Takes on Diagnostic Error



What are some the most intractable problems in healthcare? Rising costs? Lack of access? Incurable or deadly diseases? Yes, those are all serious threats to health, but at least government and philanthropy have marshalled forces to address many of them. What hasn’t really been tackled is the dangerous and often deadly issue of diagnostic error.

Diagnostic error is more widespread than you think. On the other hand, the odds are that you’ve experienced it, or will one day: According to the National Academy of Medicine, “Nearly every American will experience a diagnostic error in their lifetime, sometimes with devastating consequences.” Diagnostic errors are the most common cause of medical errors reported by patients, accounting for nearly 60 percent of all errors and an estimated 40,000 to 80,000 deaths per year.

One major funder has had enough.

The Gordon and Betty Moore Foundation is bringing its deep pockets and science-based problem-solving acumen to bear on diagnostic error. It will invest $85 million over the next six years to improve diagnostic performance through its Diagnostic Excellence Initiative. The initiative aims to “reduce harm from erroneous or delayed diagnoses, reduce costs and redundancy in the diagnostic process, improve health outcomes and save lives.”

It will be tight in focus, concentrating on the three clinical categories that are responsible for “a disproportionate share of serious harm and preventable death because of sub-optimal diagnosis” —cardiovascular events, infections and cancers

Why is diagnostic error so widespread? To start, it’s a complex, multifaceted problem. The National Academy of Medicine released a report in 2015 describing diagnostic error as a blind spot in healthcare. The report contained several recommendations to improve diagnosis, including promoting teamwork among healthcare teams, enhancing patient engagement, implementing large-scale error reporting systems, and improving health information technology. Simply put, there is no single solution to this problem, and the Moore Foundation recognizes this. So it is taking a stepwise approach to achieve diagnostic excellence.

Clinicians are frequently unaware of diagnostic errors that they have committed, particularly if they do not have an opportunity to see how their diagnoses turn out over time. Timely feedback to clinicians on their diagnostic performance is essential. Currently, U.S. healthcare systems are unable to systematically measure diagnostic performance in real time, relying on such things as postmortem examinations, medical record reviews and malpractice claims. This backward-looking approach limits the ability to quantify performance and guide improvements. So the initiative’s first area of focus is strengthening accountability by developing and validating new measures for diagnostic performance. 

In addition, the foundation will explore opportunities to support capacity building and leadership development in diagnostic excellence. And the foundation will use its experience in scientific and technological development to assess the potential for new technologies to improve diagnostic performance.

Research on systems and methods to improve diagnosis is the most under-recognized and underfunded opportunity to improve patient safety in healthcare, according to researchers. A 2017 study estimated that U.S. federal research spending on the issue of diagnostic error remains minimal, totaling just a few million dollars each year. So this is a great place for philanthropy to make a contribution.

The Moore Foundation has shown itself to be an effective agent of change in healthcare. Its Betty Irene Moore Nursing Initiative engaged bedside nurses to lead improvement efforts that successfully changed the way hospitals provide care throughout the San Francisco Bay Area and greater Sacramento.

The Diagnostic Excellence Initiative is the second initiative of the foundation’s Patient Care Program, and looks like the kind of commonsense approach that can yield real gains through improvements in systems and procedures, without waiting for breakthroughs in science or multi-year development and testing of new therapies.