1. Gould, Kathleen Ahern PhD, RN

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Institute of Medicine. Improving Diagnosis in Health Care. September 2015.


Quality Chasm Series

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Improving Diagnosis in Health Care is the most recent report, released September 22, 2015, from the Institute of Medicine. This report is a continuation of the landmark Institute of Medicine reports To Err Is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001).


The first 2 reports from the Institute of Medicine alerted the public and united medical professional to improve health care by eliminating errors and making health care safer. The current report illuminates a new threat, yet inspires action as it states, "Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative."


This report looks at diagnostic error from the patient's perspective. It defines diagnosis error as "the failure to (a) establish an accurate and timely explanation of the patient's health problem(s) or (b) communicate that explanation to the patient."


Often, this type of error results in delay of care, or unnecessary or harmful treatments or great distress for patients and families. Many adverse events are also associated with diagnostic error. The committee described 8 specific goals to reduce diagnostic error and improve diagnosis (see insert for the report's recommendations, anchored to each of the 8 goals):


1. Facilitate more effective teamwork in the diagnostic process among health care professionals, patients, and their families.


2. Enhance health care professional education and training in the diagnostic process.


3. Ensure that health information technologies support patients and health care professionals in the diagnostic process.


4. Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice.


5. Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance.


6. Develop a reporting environment and medical liability system that facilitates improved diagnosis through learning from diagnostic errors and near misses.


7. Design a payment and care delivery environment that supports the diagnostic process.


8. Provide dedicated funding for research on the diagnostic process and diagnostic errors.



Specific recommendations are anchored to each goal within the report.


Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The committee's recommendations contribute to the growing momentum for change in this crucial area of health care quality and safety.


Balogh E, Miller BY, Ball JR, eds; Committee on Diagnostic Error in Health Care. Improving Diagnosis in Healthcare. National Academies of Sciences, Engineering and Medicine 2015. Washington DC: National Academies Press. Accessed September 23, 2015.


Nash D, Reifsnyder J, Fabius R, Pracilio V. Population Health: Creating a Culture of Wellness. Sudbury, MA: Jones & Bartlett; 2011.


The term population health is not new, but is has been more clearly defined in this text-as the distribution of health outcomes across a population, the health determinants that influence distribution, and the policies and interventions that impact the determinants. This definition has helped to identify gaps in our health care delivery system and expanded our view of population health, as the intersection of acute and chronic health and the combination of healthy and unhealthy behaviors. The key components of the definition, health outcomes, health determinants, and policies, serve as the foundation for this text.

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A new mandate requires that we focus on disease prevention and health promotion while also caring for episodes of acute and chronic illness. The goal is a new culture and health care system with a focus on health and wellness. To clarify this, the authors focus on the 4 pillars of population health: chronic care management, quality and safety, public health, and health policy. Collectively, these elements provide a foundation for implementing change and improvement.


Population health education and management are an essential component of national health reform. As Dr. David Nash and colleagues explain; sixty percent of American deaths are attributable to behavioral factors, social circumstances and environmental exposures. We need a broader perspective if we truly want to improve the health of our community and nation.


This text includes the history and future goals of population health, offers case studies and discussion questions, and suggests alternative readings and Web sites for further study. Some sections are critical to understanding the complexities of health care. Chapter 10 explains population health in action by introducing readers to the "Triple Aim," a model launched in 2007 by the Institute of Healthcare Improvement.


Available on Google books and in hardcopy, this book is a fundamental tool for anyone working toward health care reform and quality improvement. This book is organized for graduate work in population health but may be used by many health care leaders.



(Movie and Original Soundtrack) CD

This informative and entertaining film reflects an important time in medical history. It will inform and entertain those new to medicine and many experienced health care providers. Although this film is not a documentary, it does provide some historical facts that will be of interest to most medical professionals.


Set in New York City in 1900, this new Cinemax drama series centers on the Knickerbocker Hospital and the groundbreaking surgeons, nurses, and staff who push the boundaries of medicine in a time of astonishingly high mortality rates and zero antibiotics.1


The Knickerbocker, the hospital from which The Knick derives its name, was a real hospital that operated from 1862 to 1979 in Harlem, New York. Originally opened as the Manhattan Dispensary, it served as a hospital for northern Civil War veterans. In 1895, the building had been renamed the J. Hood Wright Memorial Hospital, and in 1913, its name was finally changed to the Knickerbocker, a title that stuck until a few years before its closing, when it was renamed the Arthur C. Logan Memorial Hospital.2


The series reproduce rapid advances in surgery between 2 eras (season 1 and 2), explained through the work of Dr William Stewart Halsted. A formidable figure in the history of surgery, Halsted is the basis for The Knick's lead character, Dr John Thackery (played by actor Clive Owen), chief of surgery at Knickerbocker Hospital in New York City.


The story reflects Halsted's work in the 1800s, when he introduced various principles into surgery that we take for granted today. Because the evolution of surgery in that time period is a main focus of The Knick, the producers and writers wanted to retain historical accuracy of the medical practice. To do this, they recruited Dr Stanley Burns to ensure historically accuracy. As the onset surgical advisor, Dr Burns shares his expertise and his massive collection of historic medical photographs and information from the Burns Archives.3


The Burns Archive contains over 1 million historic photographs and is best known for providing photographic evidence of forgotten, unseen, and disquieting aspects of history. The cornerstone of The Burns Archive is its unparalleled collection of early medical photography, but it is also renowned for its iconic images depicting the darker side of life: death, disease, disaster, mayhem, crime, racism, revolution, and war.2




1. Warmflash D. As seen on television: the dawn of modern medicine. March 30, 2016. Accessed April 2, 2016. [Context Link]


2. Knickerbocker Hosptial: an inspiration for the Cinemax's The Knick. August 7, 2014. Bowery Boys. Accessed April 2, 2106. [Context Link]


3. The Burns Archive. New York.[Context Link]