Summary
- Achieving diagnostic excellence relies on active patient engagement and collaboration. To ensure a timely and accurate diagnosis, the process must be patient centered.
Patient-centeredness in health care is not a new concept. Highlighted by the Institute of Medicine’s framework on the six domains of health care quality, patient-centeredness focuses on “[p]roviding care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” To provide quality care, then, is to be patient centered. And, in the pursuit of diagnostic excellence — the “optimal process to attain an accurate and precise explanation about a patient's condition” — the patient must not only be included but prioritized.
Historically, the provider or diagnostic team has overseen the diagnostic process. Yet the patient, along with their families and friends, is the expert on their own experience, needs, preferences, and values. Ignoring or minimizing this expertise is a mistake. The patient is the singular consistent person engaged in their care journey from symptom onset, to seeking care, to adhering to a treatment plan. Because of this, it is critical to actively and meaningfully integrate and engage the patient into the process of diagnosis.
Moving forward, it is necessary to engage in improvements to the diagnostic process that are in service with — or co-created by — patients, focused on what matters to them. To date, tools and initiatives to improve patient engagement in the diagnostic process have focused on point of care experiences, such as shared-decision making and patient education. To further strengthen patient-centeredness in the diagnostic process, we might invest in the role patients could play as partners at the point of diagnosis and as part of a system of diagnostic excellence.
Patient-Centeredness at the Point of Diagnosis
In part, diagnostic excellence aims to better engage and integrate patients and their families into the diagnostic process at the site of care. In direct care, integrating patients is largely the clinician’s or clinical team’s responsibility. To more fully engage in patient-centered care and diagnostic processes, clinicians should take actions to collaborate with patients and families. For example:
- Recognize the patient is an expert on their health: Patients are the only constant throughout the diagnostic process. Their knowledge and experiences must be valued as a form of expertise parallel to clinical expertise. The diagnostic process relies on both areas of expertise to ensure accurate and timely diagnoses, and cannot be successful with only one.
- Align the diagnostic process with patient’s needs, values, and preferences: Respectful and responsive diagnostic processes require the intentional integration of the patient’s needs, values, and preferences. Ensuring that clinical care processes and treatment plans are collaborative, effectively communicated, and personalized can enhance patient outcomes, patient satisfaction, and adherence to treatment plans.
- Teach patients and family about the diagnostic process and their role: Health care systems and clinicians can educate patients and family on how the process works and how they can best contribute. Providing patients and family with this information can improve the accuracy of communication and speed of diagnosis.
- Create space for patients and families to collaborate and engage in shared decision-making with diagnostic teams: Respecting the patient’s autonomy is a fundamental ethical principle in health care. If patients and their families are not provided the opportunity to actively and meaningfully engage in the diagnostic process and decision-making, the likelihood of miscommunication and misalignment increases.
- Follow up with patients to ensure correct diagnosis and effective treatment planning: Patient follow-up is essential to ensure the accuracy of diagnosis and the effectiveness of, and adherence to, treatment. Through ongoing follow-up, the team can make changes as needed to be sure the patient is doing well and satisfied with their care and outcomes.
Investing in a Patient-Centered System
While engaging in patient-centeredness at the point of care can improve the timeliness and accuracy of the diagnostic process, these efforts alone cannot advance the quality of diagnosis and care. Health care systems have a responsibility to participate in patient-centered changes to improve diagnostic excellence throughout their organization. System-wide efforts may include:
- Engaging with patients and families in diagnostic-focused governance and programming: Creating or actively engaging a Patient and Family Advisory Council (PFAC) can provide patient perspectives; promote patient- and family-centered care; inform and guide implementation of new or renewed programming, services, and policies; and provide feedback on policies and procedures.
- Involving patients and family volunteers in secondary diagnostic review: Patients and family members can provide unique insights and feedback in a secondary review process, which may uncover pain points, harm, and missed opportunities that may go unrecognized by other members of a secondary diagnostic review team.
- Partnering with patients in quality improvement: Patients and families can provide unique perspectives and insights on how improvements can be made in the diagnostic process. Co-designing and co-producing these projects ensures that improvements are made from a patient and family perspective.
- Disseminating tools to support patient engagement in diagnostic excellence: Patients and families can help co-develop patient-focused materials on how the diagnostic process works, their role and responsibilities, and next steps. Precisely implementing and widely disseminating tools for patient engagement can help strengthen patient-clinician communication and improve diagnostic accuracy and timeliness.
- Including expert patients in medical education and training: The meaningful and repeated inclusion of patients as experts in medical education and training can socialize the collaborative nature of diagnosis and clinical care as well as expose students to patient expertise on and experiences of the diagnostic process and care delivery.
Conclusion
Patient-centeredness is a key component of safe, high-quality health care delivery, and improvements to diagnostic processes rely on active patient engagement and collaboration. While there have been notable efforts to enhance patient-centered diagnostic excellence, there is still room for improvement. Steps must be taken both at the site of care and system wide. Health care systems and staff must recognize patients’ years of lived experiences and partner with them as experts, consultants, and advisors in their own care journey and at the system level to effect large-scale improvements.
Kate Feske-Kirby is an IHI Research Associate, Innovation.
Photo by Freepik
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