Diagnostic Safety Policy and Practice: Advocacy Drivers and Challenges-Key Recommendations from a Qualitative Interview Study with US and Australian Experts.

BACKGROUND: Diagnostic errors are a global patient safety threat, with emergency settings particularly vulnerable. It remains poorly understood how diagnostic safety is incorporated into policy and reflected in practice. This study compares policy trajectories in the United States and Australia to offer insights into embedding diagnostic safety as a core patient safety priority over the past 25 years.

METHODS: Data collection was guided by "information power," where sample size is determined by the relevance and richness of the information participants provide. Qualitative semistructured interviews (n = 29) were conducted with experts from the United States (n = 15) and Australia (n = 14) to capture system-level and frontline perspectives across diagnostic safety research and policy (n = 14), emergency medicine (n = 9), and health consumer advocacy (n = 6). Transcribed interviews were analyzed using thematic analysis.

RESULTS: Eight themes were identified: four advocacy cycle drivers progressing the evolution of diagnostic safety policy in the United States and four persistent challenges impeding progress in the United States and Australia. Diverging evolutionary pathways showed that the United States developed a pioneering and increasingly coordinated approach to diagnostic safety, although threatened by limited federal funding and policy reach, while in Australia diagnostic safety is kept at the policy margins due to fragmentation and underfunding.

CONCLUSION: Key recommendations are provided to address persistent challenges constraining diagnostic safety in policy and practice. Coordinated action is required to drive recognition and solutions for diagnostic safety as a health policy issue and wicked practice problem and to achieve measurable impact toward sustained diagnostic excellence.