Throughout healthcare there has been a push to include all health care personnel as part of the diagnostic team, along with patients and their families. Team-based healthcare has shown to provide better outcomes for patients and better use of laboratory testing to facilitate that outcome. The National Academy of Science’s report Improving Diagnosis in Health Care delineates the role of the healthcare team members and training opportunities to improve the diagnostic process overall.1
Historically, the diagnostic process has been a solitary activity, completed by a single physician, in response to data available at the time. As healthcare increases in complexity, a single-minded answer is no longer appropriate. Technologies and testing continue to grow, science expands our understanding of disease processes, and as a result, a single person knowing all the details required for an appropriate diagnosis decreases. Clinicians need to collaborate efficiently with the experts around them in the healthcare setting, including patients and their families.
The Institute of Medicine has identified five principles for team-based healthcare that should drive the diagnostic process. These principles include shared goals, clear roles, mutual trust, effective communication, and measurable processes/outcomes. Being able to meet all five of these principles takes additional support from all members of the team and leadership.2
As with any team, some challenges may arise. Challenges can be identified as patient-related or related to the healthcare professional. Patient-related challenges that need consideration include access to healthcare, cultural/language barriers, and health literacy.
When a diagnostic team is being considered, the patient and their family should be the center of that team. The Institute for Patient and Family-Centered Care has compiled data that suggest, without patient and family interaction, the diagnostic process can never be fully a team endeavor.3 The rest of the team is comprised of healthcare professionals and diagnosticians that are experts in their field. The team make-up is not static, as each diagnosis can require a different set of experts and needs to be tailored to the patient individually. Diagnosticians on the team include a physician, physician assistants, advance practice nurses, and others that are licensed to provide diagnoses. This includes pathologists and radiologists. Other experts in their respective fields include nurses, radiology technologists, pharmacists, and laboratory scientists, among many others. A few examples of diagnostic team models include diagnostic management teams (DMTs) and integrated practice units (IPUs).4
To better the overall diagnostic process, improvements in knowledge and training are needed for both clinicians and patients. For patients who are unfamiliar with the diagnostic process, each step may cause fear or anxiety. Patients and their families know their health best and must understand that sharing details could mean the difference between a correct and incorrect diagnosis. For clinicians, relying simply on one’s own knowledge and information does not benefit the team. A learning environment that allows clinicians and other healthcare professionals to work through diagnostic scenarios can promote team-building, improve clinical reasoning and communication, and encourage appropriate use of testing, diagnostic tools, and health information technology. All of the skills mentioned are learned through practice and repetition; they are not always intuitive to healthcare professionals. It takes time and dedication to build the skills needed to function fully on a team.5
Working as a team to improve diagnosis in healthcare is a must, and that team needs to be interdisciplinary, fully engaged with patients and their families. Learning the skills required to work well with a team takes time, but it is time the healthcare system must devote.
References:
1National Academies of Sciences, Engineering, and Medicine. (2015) Improving diagnosis in health care. Washington, DC: The National Academies Press.
2Mitchell, P., M. Wynia, R. Golden, B. McNellis, S. Okun, C. E. Webb, V. Rohrbach, I. Von Kohorn. Core Principles & Values of Effective Team-Based Health Care, Discussion Paper. October 2012. Available at: https://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care/
3The Institute For Patient and Family-Centered Care. Resources available at: https://www.ipfcc.org/
4Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri, A., Al Saadi, M., Shaikh, F., & Al Zamil, F. (2014). Health care professional development: Working as a team to improve patient care. Sudanese journal of paediatrics, 14(2), 9–16.
5AHRQ, Practice Facilitation Handbook, Module 19: Implementing Care Teams. Available at: https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod19.html