The Buck Stops With Us: The Role of the Clinical Radiation Therapist in Assuring Quality Radiotherapy in Canada

A Culture of Safety? An International Comparison of Radiation Therapists' Error Reporting

BACKGROUND

The process of radiation therapy planning and delivery is increasing in complexity, and errors that occur can have serious repercussions for patients. Many radiation therapy departments use incident learning systems (ILSs) to report, analyze, and learn from errors. The success of an ILS relies on a nonpunitive workplace culture in which practitioners are comfortable reporting errors. This study examines the error reporting culture of radiation therapists and dosimetrists in Canada and the United States.

METHODS

A survey assessing perceptions regarding communication among staff, comfort in error reporting, and associated obstacles was mailed to a national sample of 1,500 radiation therapists and 528 dosimetrists in the United States. A similar survey was sent electronically to 1,500 Canadian radiation therapists, and the results from both surveys were compared and summarized using descriptive statistics.

RESULTS

The quality of communication between radiation therapists and physicians, physicists, and administrators is good in both countries, but there are differences between the three groups, with administrators ranked lowest. There was better perceived communication between radiation therapists, physicians, and physicists in the US cohort. Both cohorts felt they had opportunities to speak to physicians, physicists, and administrators, but the US cohort felt they had better opportunities than the Canadians. Most respondents felt there was a system for reporting errors in their departments, but this was higher in the Canadian group (88% in the United States, 98% in Canada). The majority of respondents felt that they were encouraged and felt comfortable to report errors in the clinic, and this result was significantly higher in the Canadian group. The majority of respondents felt that they had not been reprimanded for reporting an error; more people reported knowing of other staff being reprimanded rather than themselves. The largest obstacles to error reporting in both cohorts were fear of reprimand, poor communication, and hierarchy.

CONCLUSIONS

The majority of staff in both countries feel that communication in their department is good and that there are adequate systems for error reporting. However, a number of respondents felt that they, or a colleague, had been reprimanded in the past, and there are still perceived barriers to the use of an ILS. There is still work to do on improving positive perceptions of error reporting and departmental communication.