Implementation of a ‘No Fly” Safety Culture in a Multi-Center Radiation Medicine Department

Abstract

The delivery of radiation therapy requires multiple disciplines and interactions that must perform flawlessly for each patient. Because treatment is individualized and every aspect of the patients care unique, it is difficult to regiment a delivery process that works flawlessly. The purpose of this study is to describe one component of our quality program called the ‘No Fly Policy’ (NFP). Our quality assurance program for radiation therapy reviewed the entire process of care, prior, during and after a patient's treatment course. Each component of care was broken down and rebuilt within a matrix of multidisciplinary safety quality checklists (QCL). The QCL process map was subsequently streamlined with revised task due dates and stopping rules. A NFP was introduced to place a holding pattern on treatment initiation pending reconciliation of associated stopping events within the QCL. The NFP was introduced in a pilot phase using a 6-sigma DMAIC [Define, Measure, Analyze, Improve and Control] approach. Quantitative analysis on the performance of the new NFP QCLs was performed using crystal reports in the OIS (Mosaiq). Root cause analysis was conducted. Notable improvements in QCL performance were observed. The variances amongst staff in completing tasks reduced by a factor of at least two suggesting better process control. Steady improvements over time indicated an increasingly compliant and controlled adoption of the new safety oriented process map. Stopping events led to rescheduling treatments with average and maximum delays of two and four days respectively with no adverse effects. The majority of stopping events were due to incomplete plan approvals stemming from treatment planning delays. Whereas these may have previously solicited last-minute interventions including IMRT QA, the NFP enabled non-punitive, reasonable schedule adjustments to mitigate compromises in safe delivery. Implementation of the NFP has helped to mitigate risk expedited care, convert reactive to proactive delays, and created a checklist, process driven and variance-reducing culture in a large, multi-center department.