Table 5.

Parallels between proven culture change for therapeutic safety and those anticipated in the future for diagnostic safety, using specific exemplars.

Stage in safety culture and teamwork transformation	Now: Therapeutic (CLABSI) [49, 50]	Future: Diagnostic (missed stroke in acute dizziness and vertigo)
Safety leaders introduce team concept for safer care with a specific issue where there are known errors and harmful outcomes	ICU nurses completely unwilling to even consider ‘interfering’ with ICU physicians inserting a central venous catheter (“How can we tell a physician how to do their job?”)	ED nurses completely unwilling to even consider ‘interfering’ with ED physician diagnostic processes (“How can we tell a physician how to do their job?”)
Appeal to patient-centeredness by safety leaders (“If the patient’s health is your ‘north star’, how can you stand by and knowingly watch another provider do things likely to harm the patient?”)	ICU nurses consider the possibility of engaging the physician around catheter insertion protocols, but fear repercussions given the hierarchical relationships	ED nurses consider the possibility of engaging the physician around dizziness diagnosis protocols, but fear repercussions given the hierarchical relationships
Top-level leadership buy-in and support from the outset (Department or Division Director plus local Unit Director or Manager – “If any physician gives you the slightest trouble, you call me right then, even if it is 2 AM, and I will make it clear to them what I expect.”)	ICU nurses begin intervening when physicians do not follow sterile precautions checklists during line insertion – “Doctor, shouldn’t we use a full-body sterile drape, as in the protocol?” (it is not important that nurses do not know how and are not allowed to insert a central line themselves)	ED nurses begin intervening when physicians do not follow diagnosis protocol for dizziness – “Doctor, is someone going to examine the patient’s eyes before ordering neuroimaging, as in the protocol?” (it is not important that nurses do not know how and are not allowed to diagnose dizziness themselves)
Feedback enhances individual and team calibration (adjusting their approach to diagnosis using prior performance in diagnostic accuracy as a guide), as well as creating greater teamwork and camaraderie	ICU teams monitor rates of catheter-related sepsis and engage in transdisciplinary team processes to create new interventions that reduce catheter sepsis even further; success creates a virtuous cycle	ED teams monitor rates of dizziness and stroke misdiagnosis and engage in transdisciplinary team processes to create new interventions that reduce misdiagnosis even further; success creates a virtuous cycle

CLABSI, catheter-line-associated blood stream infection, a healthcare associated infection.