From To Err Is Human to Improving Diagnosis in Health Care: The risk management perspective

Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management
Robert F Bunting, Daniel P Groszkruger

Abstract

The publication of To Err Is Human in 2000, followed by Crossing the Quality Chasm in 2001, marked a watershed in patient safety. The Institute of Medicine (IOM) reports intensified the focus on patient safety and demanded a redesign of the healthcare system to improve quality and safety. Since publication of these reports, the focus has been on improving processes--those methods of healthcare delivery prone to failure and errors. Recently, there has been a concerted and sustained drive to add cognitive (diagnostic) errors to the focus. The recent publication of the IOM's Improving Diagnosis in Health Care has expanded the focus on patient safety and quality improvement. A new focus on diagnostic errors augments rather than replaces the previous focus. In this article, the authors offer a brief review of To Err Is Human and Crossing the Quality Chasm to lay a historical foundation. They then discuss a transition into the focus on diagnostic errors and summarize the latest recommendations from Improving Diagnosis in Health Care. This collated synthesis of 3 powerful IOM reports should guide risk managers and other healthcare personnel as they strive to improve every aspect of healthcare delivery.

References

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Jan 22, 2013·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Michelle HoppesRobert F Bunting
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Citations

May 5, 2016·Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry·Robert J BolandChristopher K Varley
Apr 1, 2018·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Douglas P CropperNicolas W Shammas
Apr 10, 2018·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Lori A PaineSimon C Mathews
May 13, 2018·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Nancy LemoineHardeep Singh
Aug 24, 2018·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Sahar Ebrahim ZadehCraig D Barton
Apr 13, 2019·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Adam Novak
Oct 1, 2019·Annals of Internal Medicine·Valerie M VaughnMohamad G Fakih
Oct 4, 2017·Practical Neurology·David Joseph Nicholl
Oct 8, 2019·American Journal of Clinical Pathology·Steven H Kroft, Roger L Bertholf
Oct 11, 2019·Laboratory Medicine·Steven H Kroft, Roger L Bertholf
Jul 18, 2020·Proceedings·Jared W HenricksenConnie Madden
Aug 11, 2019·BMC Medical Informatics and Decision Making·Kate RadcliffeUrmimala Sarkar
Sep 8, 2017·Journal of Biomedical Semantics·Alexandr UciteliHeinrich Herre
Sep 25, 2021·International Journal of Qualitative Studies on Health and Well-being·Chunhong ShiYinhua Zhang
Oct 29, 2021·Journal of Healthcare Risk Management : the Journal of the American Society for Healthcare Risk Management·Sindhu KrishnanRichard D Urman

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