A new perspective: blending ecological psychology and Safety II to learn from diagnostic excellence

OBJECTIVES: Traditional safety frameworks applied in isolation have been insufficient to address the problem of diagnostic error in healthcare. We created a novel blend of approaches - leveraging Safety II and ecological psychology - to investigate diagnostic good catch events where healthcare teams made timely and accurate diagnoses. METHODS: We performed a case series of qualitative interviews, grounded in ecological psychology, with individuals involved in diagnostic good catch events at our institution. From these interviews, we identified facilitators to the diagnostic process which were organized in a People Environments Tools and Technologies Scan. RESULTS: We conducted 3 semi-structured interviews with a total of 4 clinicians. We identified numerous strategies, activities and contextual features that contributed to an individual's and team's ability to make accurate and timely diagnoses. Examples included the use of a "trust but verify" practice when admitting new patients, a thorough physical exam enhanced by point of care ultrasound, and the utility of open spaces to encourage collaboration among providers. CONCLUSIONS: A novel framework, coupling Safety II principles and ecological psychology, offers a complement to lessons learned from Safety I event reviews and provides opportunities to develop robust and pragmatic interventions to mitigate diagnostic error.