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Licensed Unlicensed Requires Authentication Published by De Gruyter June 5, 2017

Are health care provider organizations ready to tackle diagnostic error? A survey of Leapfrog-participating hospitals

  • David E. Newman-Toker EMAIL logo , J. Matthew Austin , Jordan Derk , Melissa Danforth and Mark L. Graber
From the journal Diagnosis



A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality.


This study is an anonymous online survey of safety professionals from US hospitals and health systems in July–August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188). The instrument was focused on knowledge, attitudes, and capability to address diagnostic errors at the institutional level.


Overall, 61 (32%) responded, including community hospitals (42%), integrated health networks (25%), and academic centers (21%). Awareness was high, but commitment and capability were low (31% of leaders understand the problem; 28% have sufficient safety resources; and 25% have made diagnosis a top institutional safety priority). Ongoing efforts to improve diagnostic safety were sparse and mostly included root cause analysis and peer review feedback around diagnostic errors. The top three barriers to addressing diagnostic error were lack of awareness of the problem, lack of measures of diagnostic accuracy and error, and lack of feedback on diagnostic performance. The top two tools viewed as critically important for locally tackling the problem were routine feedback on diagnostic performance and culture change to emphasize diagnostic safety.


Although hospitals and health systems appear to be aware of diagnostic errors as a major safety imperative, most organizations (even those that appear to be making a strong commitment to patient safety) are not yet doing much to improve diagnosis. Going forward, efforts to activate health care organizations will be essential to improving diagnostic safety.

Corresponding author: David E. Newman-Toker, MD, PhD, Professor of Neurology, Ophthalmology, Otolaryngology and Emergency Medicine; Director, Division of Neuro-Visual and Vestibular Disorders; and Director, Armstrong Institute Center for Diagnostic Excellence, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, CRB-II, 2M-03, 1550 Orleans Street, Baltimore, MD 21231, USA, Phone: +443-287-9593, Mobile: +443-801-1203, Fax: +410-502-7869


Dr. Newman-Toker’s effort was supported by the Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins University School of Medicine. Dr. Austin’s effort was partly supported through a contract with The Leapfrog Group around performance measurement in health care.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Supplemental Material:

The online version of this article (DOI: offers supplementary material, available to authorized users.

Received: 2016-12-23
Accepted: 2017-3-15
Published Online: 2017-6-5
Published in Print: 2017-6-27

©2017 Walter de Gruyter GmbH, Berlin/Boston

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