Summary
This reading guide gives an orientation to the field of diagnostic excellence with a short list of impactful materials. The references below link readers to free materials that cover challenges and approaches toward diagnostic excellence. This is not a comprehensive list of all content related to diagnostic excellence, but an open-access list of resources for those new to the field. The categories here are drawn from the CODEX Collection's Thematic Tags.
Foundations of Diagnostic Excellence
Broad overviews of diagnostic excellence, including overarching challenges, causes, and solutions that provide foundational content.
- Graber ML, Hoffer EP, Singh H, eds. 10 Years After “Improving Diagnosis in Health Care” Where have We Been and Where are We Going. Diagnosis (Berl). 2025:12(4):489-595.
- CDC. Core Elements of Hospital Diagnostic Excellence (DxEx). Centers for Disease Control and Prevention. 2025.
- Committee on Diagnostic Error in Health Care, National Academies of Science, Engineering, and Medicine. Improving Diagnosis in Health Care. National Academies Press; 2015.
- Schiff GD, Leape LL. How can we make diagnosis safer? Acad Med. 2012;87(2):135-138.
Big Three Conditions
Cancer, vascular events, and infections are the three conditions considered most vulnerable to misdiagnosis that contribute to substantial patient harm. This theme examines clinical and environmental factors contributing to errors in identifying disease in these three categories.
- Newman-Toker D, Schaffer A, Yu-Moe C, et al. Serious misdiagnosis-related harms in malpractice claims: the “Big Three”– vascular events, infections, and cancers. Diagnosis (Berl). 2019;6(3):227-240.
Epidemiology
Epidemiology of diagnostic error and diagnostic excellence, including how much, how many, how often error occurs, and the impact of diagnostic performance at the community, population, organizational, systemic, and global levels.
- Auerbach AD, Lee TM, Hubbard CC, et al for the UPSIDE Research Group. Diagnostic errors in hospitalized adults who died or were transferred to intensive care. JAMA Intern Med. 2024;184(2):164-173.
- Singh H, Meyer AN, Thomas EJ. (2014). The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf. 2014:23(9):727-731.
- Schiff GD, Hasan O, Kim S et al. Diagnostic error in medicine–analysis of 583 physician-reported errors. Arch Intern Med. 2009;169(20):1881-1887.
Overdiagnosis
Assignment of a disease or condition to a person that would never have caused harm if left undetected; although clinically unhelpful, it may cause physical, emotional, or financial harm.
- Schiff GD, Martin SA, Eidelman DH, et al. Ten principles for more conservative, care-full diagnosis. Ann Intern Med. 2018;169(9):643-645.
Tests, Screening, and Laboratory Processes
Clinical tools to determine diagnoses, including test-result interpretation, analysis, communication, screening methods, and laboratory systems and processes.
- Poon EG, Gandhi TK, Sequist TD, et al. I wish I had seen this test result earlier! Dissatisfaction with test result management in primary care. Arch Intern Med. 2004;164(20):2223-2228.
Patients and Families as Partners
Engagement of patients, families, and caregivers in the diagnostic process, emphasizing their roles as partners in diagnostic excellence by sharing experiences, reporting problems, and highlighting successes that contribute to their care and to organizational, community, and system-level improvement.
- Epstein HM, Haskell H, Hemmelgarn C, et al. The Patient’s Role in Diagnostic Safety and Excellence: From Passive Reception towards Co-Design. Agency for Healthcare Research and Quality; September 2024. AHRQ Publication No. 24-0010-8-EF.
Equity, Access, and Timeliness
Limits that degrade the availability of diagnostic services and result in delay, in general, but also with a distinct emphasis on interpersonal, institutional, socioeconomic, and structural oppression.
- Krishnan K, Commodore-Mensah Y, Gleason KT, et al. Roads diverge: mapping the journey towards diagnostic health equity. BMJ Open Qual. 2025;14:e003135.
Health Professional Education
Approaches to support health professional trainees, learners, and those continuing their education to implement diagnostic excellence in their practice.
- Branson CF, Williams M, Chan TM et al. Improving diagnostic performance through feedback: the diagnosis learning cycle. BMJ Qual Safe. 2021;30(12):1002-1009.
- Dhaliwal G, Olson APJ, Singhal G, eds. Health Professions Education. [special issue]. Diagnosis (Berl). 2019;6(2):75-185.
Cognition and Decision Making
Human characteristics that can affect the safety and reliability of decision making; including individual reasoning, how diagnostic conclusions are made, cognitive biases, and uncertainty.
- Staal J, Hooftman J, Gunput ST, et al. Effect on diagnostic accuracy of cognitive reasoning tools for the workplace setting: systematic review and meta-analysis. BMJ Qual Saf. 2022;31(12):899-910
- Dhaliwal G. Premature closure? Not so fast. BMJ Qual Saf. 2017;26(2):87-89.
- Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002;9(9):1184-1204.
AI and Diagnosis
Technologies that use algorithms and data to reason, problem solve, and learn from those actions, independent of human interaction, to impact diagnosis and diagnostic processes.
- Goh E, Gallo R, Hom J, et al. Large language model influence on diagnostic reasoning: a randomized clinical trial. JAMA Netw Open. 2024;7(10):e2440969.
Culture, Work System, and Implementation
Organizational, regulatory, policy, legal, cultural, environmental, operational, and physical-space factors that contribute to excellence or detract from safe, effective diagnosis.
- Leapfrog Group. Recognizing Excellence in Diagnosis: Recommended Practices for Hospitals. Leapfrog Group. 2024 update. Leapfrog Group: 2024.
Teamwork
Multidisciplinary contributions to diagnostic improvement through enhancing communication, disclosure, and learning.
- Graber ML, Rusz D, Jones ML, et al. The new diagnostic team. Diagnosis (Berl). 2017;4(4):225-238.
Business Case for Excellence
Financial and resource-focused explorations into economic, diagnostic stewardship, efficiency, effectiveness, efficacy, overuse, value, and waste in healthcare.
- Slawomirski L. et al. The Economics of Diagnostic Safety. OECD Health Working Papers, No. 176, OECD Publishing; 2025.
Lorri Zipperer, MA
Cybrarian and Content Strategist, UCSF CODEX
Lorri was a founding staff member of the National Patient Safety Foundation (NPSF). She has been monitoring the published output of the patient safety movement since 1997, most notably as the content curator for the AHRQ Patient Safety Network for 20 years. Her editorial work has produced books and articles on topics including diagnostic improvement, patient safety, resilience engineering, and systems thinking. Lorri is an American Hospital Association/NPSF Patient Safety Leadership Fellowship alumnus and an Institute for Safe Medication Practices (ISMP) Cheers award winner.
Anjana Sharma, MD
Learning Hub Faculty Lead, UCSF CODEX
Associate Professor, UCSF Department of Family and Community Medicine
Anjana brings a wealth of experience in patient safety, quality improvement, patient engagement, medical education, and health equity. As a primary care physician and researcher, she has spent numerous years studying patient safety in primary and ambulatory care, researched strategies to prevent diagnostic and medication errors, and developed interventions to improve patient engagement in medical care. She also teaches evidence-based medicine and patient involvement in practice improvement to the UCSF Family and Community Medicine Residency Program at ZSFG.
Learn more about Anjana here.
Benjamin Rosner, MD, PhD, FAMIA
Action Incubator Faculty Lead, UCSF CODEX
Clinical Professor, UCSF Division of Clinical Informatics and Digital Transformation (DoC-IT)
Ben is a nationally recognized researcher and entrepreneur in digital health who combines industry experience with pragmatic study design. His research focuses on feedback to physicians and health systems about their performance including performance on optimal use of the electronic health record, diagnostic performance (see GoodDx.org), and performance related to the implementation of digital health tools.
Learn more about Ben here.
Sumant Ranji, MD
Director, UCSF CODEX
Professor of Clinical Medicine, Division of Hospital Medicine at the Zuckerberg San Francisco General Hospital (ZSFG)
Sumant is a renowned leader in patient safety, quality improvement, and medical education. He first joined UCSF as a fellow in hospital medicine and clinical research, then went on to become a faculty member in the Division of Hospital Medicine at UCSF Health, where he held multiple leadership positions. As director of CODEX, he leads the center’s strategic planning and the execution of its work to champion diagnostic excellence research and build awareness of and engagement within the field.
Learn more about Sumant here.