Mitigating the Barriers to a Culture of Quality and Safety in Radiation Oncology

Application and Challenges of Statistical Process Control in Radiation Therapy Quality Assurance

Quality assurance (QA) is important for ensuring precision in radiation therapy. The complexity and resource-intensive nature of QA has increased with the continual evolution of equipment and techniques. An effective approach is to improve the process control technology and resource optimization. Statistical process control is an economical and efficient tool that has been widely used to monitor, control, and improve quality management processes and is now being increasingly used for radiation therapy QA. This article reviews the development and methodology of statistical process control technology, evaluates its suitability in radiation therapy QA practices, and assesses its importance and challenges in optimizing radiation therapy QA processes.

The impact of COVID-19 workflow changes on radiation oncology incident reporting

Background

The Ottawa Hospital's Radiation Oncology program maintains the Incident Learning System (ILS)—a quality assurance program that consists of report submissions of errors and near misses arising from all major domains of radiation. In March 2020, the department adopted workflow changes to optimize patient and provider safety during the COVID‐19 pandemic.

Purpose

In this study, we analyzed the number and type of ILS submissions pre‐ and postpandemic precautions to assess the impact of COVID‐19‐related workflow changes.

Methods

ILS data was collected over six one‐year time periods between March 2016 and March 2021. For all time periods, the number of ILS submissions were counted. Each ILS submission was analyzed for the specific treatment domain from which it arose and its root cause, explaining the impetus for the error or near miss.

Results

Since the onset of COVID‐19‐related workflow changes, the total number of ILS submissions have reduced by approximately 25%. Similarly, there were 30% fewer ILS submissions per number of treatment courses compared to prepandemic data. There was also an increase in the proportion of “treatment planning” ILS submissions and a 50% reduction in the proportion of “decision to treat” ILS submissions compared to previous years. Root cause analysis revealed there were more incidents attributable to “poor, incomplete, or unclear documentation” during the pandemic year.

Conclusions

COVID‐19 workflow changes were associated with fewer ILS submissions, but a relative increase in submissions stemming from poor documentation and communication. It is imperative to analyze ILS submission data, particularly in a changing work environment, as it highlights the potential and realized mistakes that impact patient and staff safety.

Evaluating incident learning systems and safety culture in two radiation oncology departments

INTRODUCTION

Radiation oncology patient pathways are complex. This complexity creates risk and potential for error to occur. Comprehensive safety and quality management programmes have been developed alongside the use of incident learning systems (ILSs) to mitigate risks and errors reaching patients. Robust ILSs rely on the safety culture (SC) within a department. The aim of this study was to assess perceptions and understanding of SC and ILSs in two closely linked radiation oncology departments and to use the results to consider possible quality improvement (QI) of department ILSs and SC.

METHODS

A survey to assess perceptions of SC and the currently used ILSs was distributed to radiation oncologists, radiation therapists and radiation oncology medical physicists in the two departments. The responses of 95 staff were evaluated (63% of staff). The findings were used to determine any areas for improvement in SC and local ILSs.

RESULTS

Differences were shown between the professional cohorts. Barriers to current ILS use were indicated by 67% of respondents. Positive SC was shown in each area assessed: 69% indicated the departments practised a no-blame culture. Barriers identified in one department prompted a QI project to develop a new reporting system and process, improve departmental learning and modify the overall ILS.

CONCLUSION

An understanding of SC and attitudes to ILSs has been established and used to improve ILS reporting, feedback on incidents, departmental learning and the QA program. This can be used for future comparisons as the systems develop.