Tool: The Five "Whats" of Diagnostic Reflective Practice (KAICS)
The five‐question mnemonic “KAICS” can help develop a reflective mindset and aid in the situation monitoring process.
- What do I KNOW? Review objective and subjective data given the evidence, possible biases, and assumptions.
- What are the ALTERNATIVES? Explore what else could be going on. Avoid premature closure by considering at least three other possibilities. Question the first answer; reflect whether the answer makes sense, whether the evidence adds up, or whether other options exist. What do I see now that I did not see before?
- What INFORMATION would help and where can I get it (or from whom)? Reflect on what is known and what is uncertain. Examine assumptions for bias. Do other team members have different ideas? Did anyone ask the patient and family caregivers for their perspectives? Listening to all team members helps provide a more well‐rounded perspective of the situation and may uncover additional information.
- What are the CONSEQUENCES? Actions have consequences, so if this, then what? You may imagine the worst case patient scenario to rule out possibilities and safeguard against diagnostic errors. Consider the impact of your actions and recommendations on the patient and family. Ask yourself, if this were my family member, would I think the same way?
- What are the next STEPS? Developing an action plan involves who, what, how, and when. Diagnostic reflective practice includes action, including communicating with the patient and family caregivers what will follow and how. What processes are involved? It is important to continuously assess and update the plan throughout the diagnostic journey.
For more information on how the five “Whats” of diagnostic reflective practice (KAICS mnemonic above) can foster awareness of all the information relevant to accurate diagnosis, review the clinical diagnosis case of Mr. Kane. TeamSTEPPS for Diagnosis Improvement: The Case of Mr. Kane (PDF, 2 KB)
Diagnosis is frequently challenging and a common cause of avoidable harms. Information on applying the full set of TeamSTEPPS tools to foster diagnostic accuracy is contained in TeamSTEPPS for Diagnosis Improvement.
