The global progress for improving diagnosis: what we've learned, what comes next.

Abstract

Since the 2015 National Academies of Sciences, Engineering, and Medicine report on Improving Diagnosis in Health Care, global awareness of diagnostic safety has grown substantially. Progress has been most visible in high-income countries, with emerging international research networks, conferences, and educational programs. Australia and New Zealand have advanced incident reporting systems, specialty-specific diagnostic safety tools, and educational resources. European initiatives have expanded research on clinical reasoning, bias, and safety-netting, developed competency-based curricula, and investigated digital innovations including decision support systems. Japan has built on a strong tradition of clinical reasoning mastery, advancing theoretical frameworks, cultural analysis, and AI-based diagnostic support, and hosting major regional conferences. Despite these gains, engagement remains uneven, with limited data from low- and middle-income countries (LMICs). Barriers include resource constraints, underdeveloped infrastructure, and differing disease burdens that challenge the transferability of AI and other innovations. Future progress requires clear, measurable objectives across five domains: research, education, practice improvement, patient engagement, and policy. Recommendations include establishing national diagnostic error databases, promoting multicenter research in underrepresented settings, expanding standardized curricula, implementing structured audit-and-feedback systems, integrating patient perspectives, and embedding diagnostic safety indicators in policy and reimbursement frameworks. International collaboration, context-sensitive methodologies, and robust governance for emerging technologies are critical to ensure equitable improvements. By leveraging shared learning, strengthening capacity in LMICs, and aligning efforts with global policy frameworks, the diagnostic safety movement can evolve from fragmented initiatives to a cohesive, sustainable worldwide strategy, aiming for safer, more reliable diagnosis by 2035.