WHO World Patient Safety Day 2024: Improving Diagnosis for Patient Safety

In this blog I will provide a brief background to the WHO WPSD, discuss the theme for this year of Improving Diagnosis for Patient Safety, highlight what the RCSEd is doing to mark this important day and run through some of the College’s current patient safety initiatives.

Improving Diagnosis for Patient Safety

The Patient Safety Group (PSG) of the Royal College of Surgeons of Edinburgh (RCSEd) are delighted to lend our enthusiastic support to the sixth World Patient Safety Day (WPSD). This event, established by the World Health Organisation (WHO) in 2019, takes place on 17 September every year. It helps to raise global awareness amongst all stakeholders about key Patient Safety issues and foster collaboration between patients, health care workers, health care leaders and policy makers to improve patient safety. Each year a new theme is selected to highlight a priority patient safety area for action.

The theme set by the WHO for this year’s WPSD is “Improving diagnosis for patient safety”, recognising the vital importance of correct and timely diagnosis in ensuring patient safety and improving health outcomes.

Resolution WHA72.6 and the Global patient Safety Action Plan 2021-2030 highlight the need for ensuring diagnostic safety. The global action plan encourages countries to adopt strategies that reduce diagnostic errors.

A diagnosis identifies a patient’s health problem(s) and is key to accessing the care and treatment needed. Diagnostic error has been defined as the failure to (a) establish an accurate and timely explanation of a patient’s health problem(s) or (b) communicate that explanation to the patient. Failure in the diagnostic process, leads to diagnoses that are delayed, incorrect, or even missed altogether.

Diagnostic errors often arise from a combination of cognitive and symptom factors that impact on the recognition of a patient’s key symptoms and signs, and the interpretation and communication of investigation results.

Safe, accurate, efficient and timely diagnosis is the foundation on which all future decisions about treatment and prognosis are made and there is a significant impact if errors are made. If an error is made at this initial stage, then the ramifications extend through the entire patient journey.

Diagnostic error is one of the most important safety problems in health care today, and inflicts the most harm, dwarfing all other causes of harm from medical errors combined. It is estimated that one in three patients experience a diagnostic error at some point in their treatment. Diagnostic error accounts for 16% of preventable harm that arises in healthcare globally. Over 50% of patients involved in surgical error experience at least moderate harm, and this is fatal in 1 in 7.

Substantial work is needed to improve the safety of the diagnostic process.

Through the slogan “Get it right, make it safe!”, the WHO calls on all stakeholders to prioritize diagnostic safety and adopt a multifaceted approach rooted in systems science and human factors to strengthen systems, design safe diagnostic pathways, support clinical decision making and engage patients and their families throughout the entire diagnostic process.

The WHO have set four key objectives for this year’s WPSD:

• Raise global awareness of errors in diagnosis contributing to patient harm and emphasise the pivotal role of correct, timely and safe diagnosis in improving patient safety.
• Give prominence to diagnostic safety in patient safety policy and clinical practice at all levels of health care.
• Foster collaboration among policy-makers, healthcare leaders, health workers, patient organizations and other stakeholders in advancing correct, timely and safe diagnosis.
• Empower patients and families to actively engage with health workers and health care leaders to improve diagnostic processes.

The WHO highlight four key campaign messages for this year’s WPSD:

1. Correct and timely diagnosis is the first step to preventative interventions and effective treatment.

• Diagnostic errors account for 16% of preventable patient harm and are common in all health care settings
• Diagnostic errors can include missed, incorrect, delayed or miscommunicated diagnoses
• Diagnostic errors can worsen patient outcomes and at times lead to prolonged or severe illness disability, or even death, and increased health care costs

2. Understanding the diagnostic process is key to reducing errors.

• The diagnostic process involves many iterative steps
• Patient’s initial presentation; history and examination; diagnostic testing, discussion and communication of results; collaboration and coordination; final diagnosis and treatment plan; follow-up and re-evaluation
• Errors can occur at any stage

 3. A range of solutions are available to address diagnostic errors.

• Policy-makers and health care leaders should foster positive workplace environments and provide quality diagnostic tools
• Health workers should be encouraged to continuously develop their skills and address unconscious bias in judgement
• Patients should be supported to be actively engaged throughout their diagnostic journey

4. Diagnosis is a team effort.

• Correct and timely diagnosis requires collaboration among patients, families, caregivers, health workers, health care leaders and policy-makers

All stakeholders must be engaged in shaping the diagnostic process and empowered to voice any concerns.

The WHO have also provide practical advice for all stakeholders on how to enhance diagnostic safety in healthcare, both at a personal clinician level in an individual’s own practice and also at an organisational level to help shape health care policy. 

The WHO also raise a Call to Action to all stakeholders to follow for this year’s WPSD: 

1. Patients, families and caregivers

• Be informed, involved, and proactive in your diagnosis
• Be actively engaged in the diagnostic process and with your health care team
• Share accurate and comprehensive information about your symptoms and medical history
• Make sure you understand the diagnostic process, your illness or symptoms expected progression, and next steps
• Check your information is up-to-date, keep track of your symptoms, medical visits, tests and treatments
• Share your questions and concerns
• Don’t be afraid to ask questions
• Speak up, ask about alternative options or seek a second opinion if you need to share your experiences and contribute to making diagnosis safer for others

 2. Health workers providing clinical care

• Make diagnostic excellence integral to your daily practice
• Keep focused on the person at the centre of the diagnosis
• Listen to your patient, ask them about their concerns and tailor the interventions to their needs
• Take a careful and thorough history and  physical examination of your patient
• Talk openly and empathetically with your patients and encourage them to ask questions
• Leverage available technology, tools, and tests to reach a diagnosis
• Be a good team player and contribute to a safe and collaborative professional environment, where information is shared in a timely manner
• Keep learning
• Participate in regular training and seek feedback from your peers and patients
• Contribute a culture of continuous improvement by sharing best practices, and information about errors and near misses with peers

  3. Health care facility leaders and managers

• Implement safer systems to improve diagnosis, support your clinical teams and empower patients
• Empower the health workforce through policy, culture and practice
• Ensure adequate staffing, resources and regular capacity development
• Make sure quality and well-maintained tests and technologies are available
• Implement and monitor the use of diagnostic safety guidelines, protocols and practices to ensure errors are minimised
• Promote a culture of continuous learning and safety, and take action to address problem areas
• Establish a conducive, collaborative and safe work environment free from distractions
• Continually seek feedback from patients/ families and reserve space for advocates on advisory bodies
• Celebrate diagnostic excellence within your teams

 4. Policy-makers and programme managers

• Champion diagnostic excellence in health policy
• Prioritise patient safety in policy, legislation and regulation
• Ensure that appropriate guidelines and protocols to support diagnostic processes exist at a national level and are implemented provide the necessary budget, staff, training and access to tools and technologies for national health systems
• Establish national collaboration mechanisms to sustainably engage stakeholders
• Promote accountability through monitoring and evaluation mechanisms, and ensure health leadership prioritise transparency
• Set up national knowledge-sharing systems and encourage continuous learning
• Invest in research into diagnostic errors, patient harm and the development of diagnostic tools and technologies

 5. Patient organisations and civil society

• Advocate for quality and safe diagnosis
• Champion diagnostic safety in health policy and practice
• Work with patients, policy-makers and health care leaders to build health systems that deliver correct and timely diagnosis
• Facilitate patient advocacy and support their role in promoting and improving diagnostic safety
• Work with policy-makers, academics, health care leaders, health workers and patients to help identify areas for improvement
• Contribute to the development of educational and training resources for health workers and patients

 6. Diagnostics and medical devices’ regulators, manufacturers, innovators and managers

• Innovate for smart solutions and diagnostic excellence
• Drive research and development for diagnostic tools and technologies
• Ensure diagnostic solutions meet the highest standards of safety, quality and reliability
• Create user-friendly products and instructions and provide regular training for health workers and patients
• Collaborate with patients, health workers and health care leaders to build products tailored to the needs of end-users

WPSD 2024 at the RCSEd

The Patient Safety Group of the College have drawn together a comprehensive, multi-layered campaign to highlight WPSD and champion the theme of Diagnostic Safety in surgery and dentistry. Many different resources have been developed including Surgeons News feature, Educational Vignettes, Blogs, Infographics, and webinar contribution.

These will be released on social media over the seven days of the College’s WPSD campaign, starting on 16 September. Members and Fellows will have access to these through the College’s website following the campaign.

I hope that you find all of these interesting.

Surgeons News Feature

To help mark this year’s WPSD, the Patient Safety Group of the College have published a 10-page feature in the September edition of the College’s quarterly magazine Surgeons News. These articles include contributions from patients, College Members and Fellows, as well as Council members and College Surgical Specialty Boards. They cover a wide range of issues related to diagnostic safety and provide useful advice on how to improve diagnostic safety in daily practice.

Blogs

To mark this year’s WPSD, the College will be running a series of sixteen blogs on key surgical and dental topics in this area. These have been provided by patients, families and carers, alongside members of the College’s Patient Safety Group, College Council and the wider College fellowship. The College’s eleven Surgical Specialty Boards (SSBs) have been asked to provide blogs on key diagnostic pitfalls in their individual specialty that can result in harm.

The blogs will provide examples of how patients, clinical teams and health care organisations can work together to improve diagnostic safety. Two blogs will be released on each day of the College’s week-long WPSD campaign, starting on Monday 16 September.

1. Anna Paisley, Consultant Upper GI Surgeon, College Council Member and Chair of the College’s Patient Safety Group, provides a brief background to the WHO’s WPSD, discusses the theme for this year of Diagnostic Safety, highlights what the RCSEd is doing to mark this important day and runs through some of the College’s current patient safety initiatives.
2. Steve Yule, Director of the College’s Non-Technical Skills Faculty, Chair of Behavioral Sciences and Director of the Surgical Sabermetrics Laboratory at the University of Edinburgh, outlines how non-technical skills can enhance diagnostic safety in surgery.
3. Claire Morgan, Consultant in Restorative Dentistry, Dental Council Member and Deputy Chair of the College’s Patient Safety Group, highlights issues related to diagnostic safety in dentistry.
4. Sumita Barua, Senior Heart Transplant Clinical Fellow, and Majid Mukadam, Associate Specialist in Transplant Surgery and Chair of the College’s SASLED Committee, discuss the importance of patient education in protecting the precious gift of life after receiving a heart transplant.
5. Anna Paisley, Consultant Upper GI Surgeon, College Council Member and Chair of the College’s Patient Safety Group, discusses the critical importance of diagnostic safety in surgical care, highlighting the incidence, challenges, main causes and potential solutions, providing information on useful tools to help reduce diagnostic error.
6. Gareth Owens, Aortic Dissection Survivor, Chair of Aortic Dissection Awareness UK & Ireland, and Global THINK AORTA campaign Lead, provides an impactful patient perspective on emergency presentation of aortic dissection.
7. Ruwan Weerakkody, Consultant Vascular Surgeon, and Andrew Tambyraja, Consultant Vascular Surgeon and Chair of the College’s SSB in Vascular Surgery, discuss challenges faced in the diagnosis of the twin silent killers – abdominal aortic aneurysm and aortic dissection.
8. Andrew Martindale, Consultant Urologist, College Regional Surgical Advisor and Urology SSB Member, discusses the importance of teamwork for surgical diagnostic safety in the outpatient setting.
9. Alex Laird, Consultant Urologist and Chair of the College’s SSB in Urology, discusses how audit can be used to improve diagnostic outcomes for patients with upper tract urothelial cancers.
10. Prateek Arora, Senior Clinical Fellow in Colorectal Surgery, and Chelliah Selvasekar, Consultant Colorectal Surgeon and Chair of the College’s General Surgery SSB, highlight the importance of stool testing as part of the national Bowel Screening Programme to enhance the diagnostic precision of bowel cancer.
11. Martin Sinclair, Consultant General Surgeon and NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) Surgical Clinical Coordinator, shares the ways in which NCEPOD focuses on diagnostic safety to help improve health outcomes.
12. Nashreen Oozeer, Consultant Head and Neck Cancer Surgeon, Deputy Chair of the College’s SSB in Otolaryngology and lead for ENTUK patient information project, discusses how to enhance diagnostic safety in Head and Neck Surgery.
13. Afra Jiwa, PhD Student, Centre for Medical Informatics, Usher Institute, University of Edinburgh and Malcolm Cameron, Research Assistant, Centre for Medical Informatics, Usher Institute, University of Edinburgh illustrate how Artificial Intelligence can be harnessed to help reduce diagnostic errors.
14. Neil Ashwood, Consultant Trauma and Orthopaedic Surgeon, discusses ways to improve diagnostic safety in modern orthopaedic care.
15. Afra Jiwa, PhD Student, Centre for Medical Informatics, Usher Institute, University of Edinburgh and Malcolm Cameron, Research Assistant, Centre for Medical Informatics, Usher Institute, University of Edinburgh discuss the diagnostic impact of virtual consultations and diagnostics in modern healthcare.
16. Chris McEwan, Patient Safety Group Lay Representative, explores what World Patient Safety Day means to a broad sample of the population.
17. Angus Watson, Consultant Colorectal Surgeon, Council Member, Chair of the College’s Research Committee and Director of the Faculty of Remote, Rural and Humanitarian Health Care, explores diagnostic safety in colorectal diagnoses.
18. Likhith Alakandy, Consultant Neurosurgeon and Chair of the College’s SSB in Neurosurgery, highlights the importance of early diagnosis in cauda equina syndrome and brain tumours.
19. Craig Wales, Consultant Oral and Maxillofacial Surgeon and Chair of the College’s SSB in Oral and Maxillofacial Surgery, discusses the diagnostic challenges faced in necrotizing fasciitis.

Infographics

Alongside the blogs the College will also be releasing a series of infographics summarising broad aspects of diagnostic safety, including:

• the scale of the problem
• causes of diagnostic error
• solutions to help improve diagnostic error
• how RCSEd can help you to improve diagnostic safety in your practice

Educational Vignettes

A series of Educational Vignettes have also been produced by the NOTSS Team (Non Technical Skills for Surgeons) to provide training in the non-technical skills of Situation Awareness, Decision Making, Communication & Teamwork, and Leadership. Good practice in all these areas is vital to ensure safety in the diagnostic setting. One of these will be released on the first four days of the campaign.

Webinar

The General Surgery SSB of the College is hosting a webinar on the evening of WPSD on the subject of Healthcare Safety and Quality in the US: Perspective from Time Leading a National Organisation.

Haytham Kaafarani, Professor of Surgery, Harvard Medical School, Hospital Director of Patient Safety and Quality, Massachusetts General Hospital, Medical Director, Trauma Center, Massachusetts General Hospital will be the main presenter. Patient Safety Group Chair, Anna Paisley, will be one of the panellists at this webinar and contribute to the discussion.

This webinar will give an overview of the safety & quality scene in the US with a focus on accreditation and regulation of healthcare organisations and will help participants

• Understand the regulatory and accreditation world of healthcare in the US
• Have a glimpse at the patient safety challenges faced in the US
• Understand diagnostic errors and bias in health care

RCSEd Commitment to Patient Safety

Upholding patient safety and ensuring the highest possible standards of patient care have been at the heart of the College’s activity since it was founded over 500 years ago. The Patient Safety Group supports and coordinates all the College’s Patient Safety initiatives. We have a multidisciplinary membership drawn from all the faculties of the College and including representation from both the wider surgical team and patients themselves.

Over the years, the College has worked hard to develop numerous resources to help improve patient safety. These have taken many forms and include:

Patient, Carer Support: The Patient Safety Group has worked hard over the last few years to develop high quality, innovative and accessible resources to support surgical and dental patients and their carers. It is hoped that these resources will help patients to better navigate surgical care and empower them to be advocates for their own health. 

Training Courses: These include the highly successful NOTSS Programme, PINTS Course and DeNTS Course, which aim to educate the whole peri-operative team in the non-technical skills which underpin safe operative surgery and dentistry, and the innovative ICONS workshop which was developed with patients to provide training in sharing the complex decisions involved in informed consent.

Team Based Quality Review for Surgical Practice (TBQR) Workshop seeks to embed evidence-based structure into significant event review processes through the provision of training, educational resources, tools and frameworks underpinned by Human Factors and Systems Thinking sciences. Support is provided into how to follow a system-based approach, capture multiple perspectives from the wider healthcare team as well as patients, maximise learning, and, very importantly, ensure a non-threatening atmosphere and blame-free culture.

Making Sense of Mistakes Workshop explores the impact of mistakes on all those involved; looking at how best to support and prepare each other; and how we might appropriately respond to patients and their families in the aftermath. Making and living with mistakes is a core part of what it means to be a surgeon, yet it is seldom discussed. Many trainees feel ill-prepared to cope with the burden this can bring; many senior surgeons are still troubled by the legacy of past mistakes in their practice.

Addressing Conflict in Surgical Teams Workshop explores the causes and impact of conflict within the surgical workplace and discusses different strategies to address this, including how to have difficult conversations, the art of negotiation and how to approach challenging situations. These skills will help foster closer working relationships leading to more productive teamwork.

Web-based Resources: These include the Surgical Ward Round Toolkit which aims to reduce errors and improve safety on surgical ward rounds.

Patient Safety Webinars: This very popular 10-part series featured contributions from renowned world experts in the patient safety arena drawn from a wide range of disciplines.

Let’s Talk Surgery Patient Safety Podcasts: These experts have also contributed to the College’s podcast series allowing more in-depth personal discussion on key Patient Safety topics. All sessions were recorded and remain available to College members and fellows on the Education section of our website.

Surgeons News Articles: The Patient Safety Group has published a large number of articles in Surgeons News covering a broad range of patient safety topics.

RCSEd Annual Quality Improvement and Audit Symposium: This popular event provides opportunity for surgical and dental trainees to present and receive feedback on their audit and quality improvement projects. There is a dedicated patient safety session, incorporating a keynote lecture from an expert in the patient safety field, along with the presentation of a patient safety medal to the trainee delivering the best patient safety presentation.

MSc in Patient Safety and Clinical Human Factors: We have also worked with the University of Edinburgh as part of the Edinburgh Surgery On-Line Programme to develop an MSc in Patient Safety and Clinical Human Factors. This 3-year part-time programme supports any graduate health care professional in using evidence-based tools to improve the safety of everyday health care systems.

National Campaigns: These include the very successful Lets Remove It campaign, running since 2017, to reduce bullying and undermining, and its resultant detrimental effect on patient safety, in the surgical and dental workplace. A large range of resources have been developed to help in this area and the College were instrumental in forming the anti-bullying alliance with other national bodies.

National Guidelines: The College have also developed several national guidelines to influence healthcare policy and improve the working environment, such as Improving the Working Environment for Safe Surgical Care, Improving Safety Out of Hours and Raising Concerns, Whistleblowing and Speaking Up.

Staff Resilience and Wellbeing: We also recognise that staff resilience and wellbeing is a major factor in helping to ensure safe patient care. Improving surgical team wellbeing and mental health has been a major focus for the College over the last year. The College Trainees’ Committee has taken the lead in this and the Patient Safety Group have been proud to support them in this endeavour.

The Committee have run very successful wellbeing weeks over the last four years. These raised the awareness of the importance of wellbeing amongst all members of the surgical team and included various activities such as daily webinars, virtual workshops and sessions on cooking, mindfulness, yoga, art and how to make work fun. CPD points for the webinars in the series were provided, underlining the importance that the College places on this subject.

The College’s 'Moon and Back’ campaign, launched in 2021, encourages all members of the surgical team to take time out of their busy schedules to focus on their mental health.

We are also proud to be able to endorse the Royal Australasian College of Surgeons Wellbeing Charter for Doctors which describes the principles that guide the wellbeing of doctors and the shared responsibilities for wellbeing of the medical profession.

Please visit the College’s website and social media channels for more information on all these patient safety resources. It is great to be able to share these with you and to help raise awareness of the importance of patient safety in our everyday surgical and dental practice.

Written by Anna Paisley, Consultant General Surgeon, RCSEd Council Member and Patient Safety Group Chair