IAEA E-learning Program

IAEA E-learning Program
Safety and Quality in Radiotherapy

Safety and Quality in Radiotherapy
MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Sections: 12.1 Building a Safety and Quality System 12.2 Implementing the Tools 12.3 Continuous Improvement

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Sections: 12.1 Building a Safety and Quality System 12.2 Implementing the Tools 12.3 Continuous Improvement We don’t live and work in a static environment. Our professional colleagues come and go as established staff move on to new positions or retire and technology continues to evolve presenting new opportunities for improving the care offered to patients. For these reasons, enhancing safety and quality is on-going activity. In this section we will look at how we can maintain the momentum that will lead to continuous improvement.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement OBJECTIVES To discuss the challenges, and possible solutions, to maintaining a strong safety culture. To suggest a few more projects for the Safety and Quality Assurance Committee. These are our objectives for this section. We will discuss some of the challenges, and possible solutions, to maintaining a strong safety culture which is necessary for continuous quality improvement. We will also suggest a few more projects for the Safety/Quality Assurance Committee.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement OBJECTIVES To discuss the challenges, and possible solutions, to maintaining a strong safety culture. To suggest a few more projects for the Safety and Quality Assurance Committee. First of all we’ll consider a few strategies we might employ to maintain momentum.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Maintaining momentum The growth phase of most projects, including strengthening safety culture in the clinic, is exciting – the team brings a lot of energy to the project. The challenge is to maintain enthusiasm and interest as time progresses. The clinical landscape is continuously changing and with it the need to constantly focus on safety and quality issues. We need to maintain the momentum established during the project start up if a sustainable safety culture is to be established. The growth phase of most projects, including strengthening a safety culture in the clinic, is exciting – the team brings a lot of energy to the project. The challenge is to maintain enthusiasm and interest as time progresses. The clinical landscape is continuously changing and with it the need to constantly focus on safety and quality issues.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Maintaining momentum Here are a few ideas for maintaining momentum and building a sustainable safety/quality culture. Prioritize communication with the clinical team. Department meetings blasts Here are a few ideas for maintaining momentum and building a sustainable safety/quality culture. Firstly, prioritize communication with the clinical team. As we saw in Module 10, a culture is the manifestation of shared values and beliefs. Effective communication is the means by which the whole clinical ream will coalesce around those values and beliefs that are central to a safety culture. Department meetings are an effective method for communicating with the clinical team. Such a format encourages exchange of ideas with the whole clinical team. If time doesn’t permit the holding of Departmental meetings the next best communication option might be . s should be short and to the point – most staff in the clinic are busy and appreciate concise information. Or we could, of course, use a combination of meetings and s. Whichever communication methods are adopted it’s important to make sure that communication happens regularly. Staff need to know that quality and safety are year round priorities and not issues that are addressed infrequently.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Communication What needs to be communicated? Completed Safety and Quality projects. Status of on-going projects. Lessons learned from recent incidents in the clinic. Recognition of clinic staff for support of the Safety and Quality initiative. Requests for ideas on future Safety and Quality projects. What needs to be communicated? Here are a few ideas: Completed safety/quality projects. We’ll talk about celebrating success shortly The status of on-going projects. Lessons learned from recent incidents in the clinic. If we can show that reporting incidents has resulted in real changes this will reinforce the staff’s commitment to learning from incidents. Recognition of clinic staff for support of the safety/quality initiative. Such recognition is not only appropriate but will help cement commitment to the initiative. Further cementing engagement of the staff can be achieved by actively soliciting their input into the safety/quality initiative.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Communication So, what resources are involved? Let’s assume 2 Departmental Quality and Safety meetings per year and 2 blasts per year. Thus there is some form of communication on these issues every 3 months. If Departmental meetings last 1 hour and it takes 15 minutes to read a Quality and Safety then the time commitment per staff member is 2.5 hours per staff member per year. As we did in the previous section, let’s try to estimate what resources might be involved with a simple communication plan. Let’s assume 2 Departmental Quality/Safety meetings per year and 2 blasts per year. Thus there is some form of communication on these issues every 3 months. If Departmental meetings last 1 hour and it takes 15 minutes to read a quality/safety then the time commitment per staff member is 2.5 hours per staff member per year. This time commitment amounts to slightly more than 0.1% of typical annual working hours. To this estimate we should add the time the Safety/Quality Assurance Committee devotes to preparing for the meetings or s. A generous estimate would be 3 person hours 4 times per year for a total of 12 person hours.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Maintaining momentum Here are a few ideas for maintaining momentum and building a sustainable Safety and Quality culture. Prioritize communication with the clinical team. Department meetings blasts Celebrate success. Nothing succeeds like success. It will definitely help to maintain momentum if it’s clear that the initiative is being successful. Celebrating success should be an important aspect of the communication plan.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Celebrating success There are multiple ways in which the success of the endeavor could be demonstrated. As a start, progress on the projects we discussed in the previous section would be appropriate: Safety Profile Assessment Incident Learning Process Mapping Failure Modes and Effects Analysis Continuing Professional Development Celebrating success. There are multiple ways in which the success of the endeavour could be demonstrated. As a start, progress on the projects we discussed in the previous section would be appropriate. These projects were: The AAPM’s Safety Profile Assessment Incident Learning perhaps using SAFRON Process Mapping which we saw is equivalent to developing standard operating procedures. Failure Modes and Effects Analysis And Continuing professional development

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Celebrating success The AAPM’s Safety Profile Assessment lends itself to not only promoting safety/quality initiatives but also to monitoring progress. The AAPM’s Safety Profile Assessment lends itself to not only promoting safety/quality initiatives but also to monitoring progress. Thus, the Safety Profile Assessment is an easy and convincing way of demonstrating the success of the quality/safety initiative. Year 2 Year 1

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Celebrating success SAFRON is another tool that can be used to generate quantitative data on the level of activity in the area of incident learning. SAFRON is another tool that can be used to generate quantitative data on the level of activity in the area of incident learning. It’s very easy to extract data of the type shown here for a particular clinic or for all subscribers to SAFRON. Again, we have access to quantitative data to demonstrate success.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Celebrating success We could report on the number of process maps and Failure Modes and Effects Analyses performed. A summary of Continuing Professional Development activities would also be of interest to the staff. Real concrete evidence of progress will help keep staff’s interest and commitment to the Safety and Quality initiative. We could report on the number of process maps and Failure Modes and Effects Analyses performed. A summary of Continuing Professional Development activities would also be of interest to the staff. Real concrete evidence of progress will help keep staff’s interest and commitment to the safety/quality initiative.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Celebrating success So, what resources are involved? Celebrating success has already been included in our communication plan. The Safety Profile Assessment would have to be re-run for an incremental commitment of 12 person hours. What resources are involved in celebrating success in the way we have outlined. Celebrating success has already been included in our communication plan. The Safety Profile Assessment would have to be re-run for an incremental commitment of 12 person hours.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Maintaining momentum Here are a few ideas for maintaining momentum and building a sustainable Safety and Quality culture. Prioritize communication with the clinical team. Department meetings blasts Celebrate success. Start new projects within the Safety and Quality environment. Starting new projects in addition to continuing with existing projects, such as documenting procedures and performing failure modes and effects analyses can help maintain enthusiasm.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement OBJECTIVES To discuss the challenges, and possible solutions, to maintaining a strong safety culture. To suggest a few more projects for the Safety and Quality Assurance Committee. So let’s think about a few more projects that we could embark on.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement New Projects The list of possible new projects is really endless. We could think of: Participating in an external dosimetry service such as we discussed in Module 11. The list of possible new projects is really endless We could think of: Participating in an external dosimetry service if we don’t already.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement New Projects We could also think of: Inviting external auditors to review our program. We could also think of: Inviting external auditors to review our program. We discussed the QUATRO program in Module 11 too.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement New Projects And a few more ideas: Prepare a publication or presentation on experience with the Safety and Quality initiative. Develop in-house continuing education programs. Reward staff who participate in on-line educational programs. Recognize staff for commitment to Quality and Safety issues through the annual performance appraisal procedure. And here are a few more ideas: Prepare a publication or presentation on experience with the safety/quality initiative. Develop in-house continuing education programs. Reward staff who participate in on-line educational programs. Recognize staff for commitment to quality/safety issues through the annual performance appraisal procedure. The list is really endless.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement New Projects So, what resources are involved? We can’t provide a specific answer to this question. Obviously it all depends on which projects we adopt. Ultimately the availability of resources will limit what can be achieved. The best way of accessing more resources for safety and quality is to demonstrate the success we have achieved to date. So, what resources are involved? We can’t provide a specific answer to this question. Obviously it all depends on which projects we adopt. Ultimately the availability of resources will limit what can be achieved. The best way of accessing more resources for safety and quality is to demonstrate the success we have achieved to date.

Safety and Quality Staff Commitment
MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Safety and Quality Staff Commitment Core Team Project Estimated time commitment (person hours) Annual time commitment (person hours) Safety/QA Committee 20 per 2 weeks 520 Safety Profile Assessment 12 per year 12 Incident Learning 8 per month 100 Process Mapping FMEA 100 per quarter 400 Preventive Actions 700 (including staff training) Total 1800 (approximately) Returning to our budget estimates the only additional resources we have identified in the discussion of the maintenance phase are the times for communication activities with all staff and the effort required for new projects that could not be accommodated within the proposed Safety/QA Committee structure. We estimated communication to require about 2.5 hours per year per staff member. As we have just mentioned the ability to take on new projects will be constrained by resources. Based on these estimates the total commitment of front line staff to structured quality/safety activities and who are not members of the core team is less than one day per year – a very small commitment considering the potentially huge benefit for patients. Incident Learning Reporting Commitment = 1 hour per year per staff Continuing Professional Development Commitment = 4 hours per year per staff Communication = 2.5 hours per year per staff Safety and Quality Staff Commitment

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Safety and Quality Staff Commitment A comprehensive Safety and Quality initiative of the type proposed here would require the allocation, or re-allocation, of one full time equivalent staff position, spread over perhaps 6-10 people, to carry out core activities. Additionally 7-8 hours per year of every staff member should be recognized as being devoted specifically to learning from incidents, continuing professional development and communication on quality and safety issues. What’s the bottom line of our budget discussion? A comprehensive safety/quality initiative of the type proposed here would require the allocation, or re-allocation, of one full time equivalent staff position, spread over perhaps 6-10 people, to carry out core activities. Additionally 7-8 hours per year of every staff member should be recognized as being devoted specifically to learning from incidents, continuing professional development and communication on quality and safety issues. Additionally, 7-8 hr per year of every staff member should be recognized as being devoted specifically to learning from incidents, continuing professional development and communication on quality and safety issues. We have also budgeted some time for training staff in new procedures and that was included in our budget table.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement Safety and Quality Staff Commitment And if the resources just aren’t there? Then we have to scale back our activities. The time estimates we have discussed in this Module provide the basis for making these difficult decisions. What is not an option, if we really have patients’ best interests at heart, is to have no action plan for improving safety and quality in our clinic. And if the resources just aren’t there? Then we have to scale back our activities. The time estimates we have discussed in this Module provide the basis for making these difficult decisions. What is not an option, if we really have patients’ best interests at heart, is to have no action plan for improving safety and quality in our clinic.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 3: continuous improvement This e-Learning Program is designed to equip radiotherapy professionals with the knowledge to enhance the safety and quality of their practice and hence to provide patients with optimum outcomes. It’s all about the patient! Finally a reminder of what we set out to do in this program. This e-Learning Program is designed to equip radiotherapy professionals with the knowledge to enhance the safety and quality of their practice and hence to provide patients with optimum outcomes. At the end of the day, it’s all about the patient. Keeping this in mind will motivate us continuously to do better.

MODULE 12: and now what? Enhancing quality and safety in your clinic Safety and Quality in Radiotherapy Section 2: implementing the tools summary In this section we have: Discussed the challenges, and possible solutions, to maintaining a dynamic safety culture. Suggested a few more projects for the Safety and Quality Assurance Committee. In this section we have: discussed the challenges, and possible solutions, to maintaining a dynamic safety culture and suggested a few more projects for the Safety/Quality Assurance Committee.

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