On the latest episode of the MGMA Insights Podcast, host Daniel Williams speaks with Susan Montminy, Director of Risk Management and Analytics for Coverys. Montminy discusses the complexities of diagnostic error and highlights key findings from Coverys’s recent white paper, Hidden in Plain Sight: Exposing the Drivers of Diagnostic Error, offering practical insights on reducing diagnostic errors through effective communication, leadership and culture.
Understanding Diagnostic Errors and Biases
The National Academy of Medicine defines diagnostic error as “the failure to establish an accurate and timely explanation of the patient’s health problem or the failure to communicate that explanation to the patient.” Montminy explains how these errors often go "hidden in plain sight" within healthcare systems, particularly in fast-paced environments like emergency departments (EDs) where diagnostic errors are more common. According to the white paper, 28% of diagnostic errors occur in the ED. “It is just this controlled chaos,” says Montminy, describing the ED environment as a buzzing beehive where “minute by minute, second by second” the team is responding to new, complex situations.
Montminy points out the high-stakes nature of diagnosing in emergency settings, where communication breakdowns and documentation issues can quickly arise. To address these concerns, she encourages healthcare leaders to prioritize team-based problem-solving. “Healthcare is a team sport, isn’t it?” Montminy says, emphasizing that every team member must operate at their peak for effective patient care.
Anchoring and Confirmation Bias in Diagnostic Errors
Two key contributors to diagnostic errors are anchoring and confirmation biases, both of which can be exacerbated by the high-intensity atmosphere in EDs. Anchoring bias occurs when clinicians fixate on certain findings early in the diagnostic process. "It's the tendency to lock on to certain findings in that patient’s initial presentation too early,” explains Montminy. Confirmation bias follows, where clinicians may unconsciously focus only on information that reinforces their initial diagnosis. “I’ve made my initial diagnosis, and now these pieces of information are confirming… I knew that’s what it was,” she notes, describing how the process can unknowingly limit diagnostic possibilities.
Both biases highlight the need for healthcare systems to build mechanisms that prompt clinicians to reassess their conclusions periodically. “It's about the ability to question somebody if… they’ve anchored,” Montminy adds, advocating for a culture where providers can respectfully challenge each other’s assumptions to ensure thorough, accurate diagnoses.
Introducing Diagnostic Timeouts
One effective solution discussed is the implementation of diagnostic timeouts. Much like the pause taken in surgical procedures to confirm all steps before an incision, a diagnostic timeout offers a structured pause in the diagnostic process. “It’s just calling in a couple of colleagues to say, ‘Alright, what am I missing?’” Montminy explains. This practice enables healthcare providers to openly examine their diagnostic assumptions, allowing for adjustments in real-time to avoid bias-driven errors.
Diagnostic timeouts also serve as a team-building exercise, fostering a culture of open communication. Leaders are encouraged to view these timeouts as an investment in patient safety and team cohesion. "We echo various [methods] as I mentioned, our team has all worked in this environment… so we’re not sitting here in our offices saying, ‘you need to do this or that,’” Montminy emphasizes, underscoring that timeouts should be adaptable to the specific needs of each clinical team.
Controlled Chaos in Emergency Departments
The chaotic nature of the ED demands a balance between rapid response and precise documentation. Montminy notes that one of the most critical aspects of managing this "controlled chaos" is strong leadership and organizational support. “You don’t see the look of stress on individuals,” she says, describing well-managed EDs where clinicians communicate constantly, and equipment and procedures are organized for easy access. Leaders play an essential role in taking the pulse of their team and offering support, whether that means increasing staffing during peak times or providing emotional support after challenging cases.
The Role of Technology and AI in Reducing Diagnostic Errors
Montminy sees potential in technology—specifically, artificial intelligence (AI)—to reduce diagnostic errors, though she warns against overwhelming clinicians with excessive information. “AI definitely has a role to help figure out how to pull in those key pieces of information,” she says, highlighting how AI could compile data to assist providers in forming accurate diagnoses. However, she stresses the importance of balance to ensure AI-driven data aggregation remains manageable and does not detract from the clinician’s focus.
Building a Culture of Patient Safety
Montminy emphasizes the necessity of building a patient safety culture where every team member feels empowered to voice concerns. She explains that effective diagnostic processes extend beyond the clinicians themselves, relying on the collective support of IT, risk, quality and leadership teams. “Walk a mile in my shoes,” she advises leaders, urging them to observe clinicians in real scenarios to identify and redesign systems that support seamless communication.
Resources Mentioned:
