Recent statistics show that hospitals aren’t always great at figuring out exactly what is going on with patients’ health. In fact, a recent study found that one in 20 patients are misdiagnosed each year. Studies also show that the estimated number of diagnostic errors that end in fatality is equivalent to the number of breast cancer deaths each year (40,500).
What can we do?
As hospital administrators, these statistics will certainly grab your attention, yet so often people look at data and think, “Okay. But what can I do to help?” If that is you, don’t panic! Keep reading to learn five ways hospital administrators can prevent misdiagnosis.
1. Encourage Questions and Communication Amongst Patients and Staff
As a hospital administrator, you want to provide the best care for your patients. Yet this is often not possible due to miscommunication. Miscommunication occurs in multiple ways (staff-to-staff, staff-to-patient, patient-to-staff), and is often the result of discomfort. Mistakes go unchecked when people feel uncomfortable speaking up or asking a question because they are afraid to step on toes or sound silly.
It wasn’t just alarm fatigue that contributed to a 16-year-old’s dramatic hospital poisoning. It was also a nurse who saw a number that didn’t add up, but because she was new to that rotation she didn’t want to ask questions or make a fuss.
As a hospital administrator, you can remedy the malady of unthinking obedience by encouraging questions and communication.
- If a nurse is concerned over a recent diagnosis, give her the time and authority to double check with colleagues.
- If a patient feels that their health problem extends beyond the doctor’s diagnosis, provide them the opportunity to ask questions and express their concerns.
- If a doctor is unsure about a recent change in policy, give them the space to challenge you!
2. Quality Evaluations For Both Patients & Staff
Staff and patient evaluations are great for preventing misdiagnosis and establishing a sense of accountability; yet often the evaluation process is deemed frivolous or “a waste of time.” Much of this stigma comes from past experiences with evaluations, the general consensus being that they are more of a “feel-good” tactic rather than a way to have one’s voice truly be heard.
This is where you, the hospital administrator, can come in and establish a proper evaluation climate. Both patients and staff should be encouraged and reminded that evaluations are a time to be heard and taken seriously.
One tip that could help: Ask patients about assistance, rather than asking them for critique. For example: “How could we improve your next doctors visit?”
3. Establish a Patient-First Community
It seems logical for a hospital to be a patient-first community; yet for some, hospital and doctor visits are viewed with a sense of stress or fear. If a patient doesn’t already have a great relationship with their doctor, odds are that they will likely stay relatively quiet, assuming that their doctor is super smart and that they don’t want to say anything dumb.
A good patient/doctor relationship is essential to effective healthcare. This was verified empirically when Canadian researchers audiotaped more than 300 office visits with 39 different primary-care doctors. Researchers asked patients to rate the visit in terms of the relationship with their doctors and then measured patient health over time.
When patients reported feeling that their doctors focused on their feelings and worries and listened to them carefully, they reportedly felt better. Not only was the qualitative data good, but the quantitative as well. The patients with good relationships with their doctors also showed fewer symptoms of disease.
Patients should be working with their doctors to help solve health issues – they shouldn’t be afraid of them! This is where hospital administrators can help by establishing a patient-first community. Patients need the confidence to speak comfortably, ask questions, and fully explain concerns without fear of being turned down.
When doctors listen better, patients talk more. Consider training your doctors to listen to patients.
Best practices include:
- Listen to understand.
- Recite what patients say in their heads instead of forming a response.
- Never interrupt. Let the patient finish speaking on their own.
- Recap and paraphrase to ensure doctors understand.
- Ask clarifying questions before moving on to new topics.
- Do comprehension checks. After instructing a patient a doctor should ask the patient to explain to the doctor what was explained to them in their own words.
4. Encourage Patients to Know their Own Health & Health History
Health history plays a huge role in diagnosis, yet some patients have a limited understanding of their health and history. In the past, this was fairly understandable because of the overwhelming amount of documents being sent to-and-from multiple hospitals (many times getting lost in the process).
But electronic health records (EHR) put patients’ health information is right at their fingertips. As a hospital administrator, you can establish your hospital as one that encourages patients not only to view these records, but also to refer to them in their life and while conversing with their doctor.
5. Implement New Technologies and Informatics Systems
Saving the most important for last: the implementation of new technologies and informatics systems. Technological advancements are allowing for easier diagnosis and smoother treatment; therefore, as a hospital administrator, advocating for new technologies is a crucial aspect of staying away from misdiagnosis.
For example, novel digital imaging technologies allow for a multi-detector computed tomography (MDCT), which is a form of computed tomography (CT) that utilizes both computers and x-rays, creating clear, 3D images that doctors can use to properly evaluate the entire area, rather than just a 2D image of it.
Many EHRs include computerized physician order entry (CPOE). This allows doctors to order prescription drugs and tests digitally, decreasing misdiagnosis stemming from illegible hand-written or fake prescriptions.
Hospital administrators can play a huge role in decreasing the incidence of misdiagnosis. Encouraging communication amongst both staff and patients is huge, and evaluations can certainly help. Also, encourage patients to speak up by training doctors to provide them patients with uninterrupted time to talk and ask questions. Encourage patients to know their own health and health history, so they can have more productive conversations with their physicians. And of course, always be aware of new technologies and informatics systems – these play a huge role in proper diagnosis and health care.
For more information on misdiagnosis, check out the following infographic, created by Adventist University’s Online Bachelor of Science in Radiologic Sciences, which highlights misdiagnosis in the US, and further details the latest technologies for preventing misdiagnosis.
Have you had any success battling misdiagnosis at your hospital? Add your experiences in the comments!