Safety Culture and Incident Learning Systems in Radiation Oncology across Australia and New Zealand

Abstract

Radiation therapy is a highly complex cancer treatment using individualised patient plans to provide treatment over multiple fractions. The treatment planning and delivery process requires high dosimetric and geometric precision overall but has multiple steps and interfaces that have the potential to introduce error. Three primary radiation oncology professional groups work closely together to safely and accurately accomplish the many steps within the patient pathway: radiation oncologists, radiation oncology medical physicists and radiation therapists. Radiation oncology incorporates detailed quality assurance protocols to mitigate risk; however, errors can still occur. To monitor errors, incident reporting is used; and incident learning to identify causes and improvements. The aim of this work was to investigate and quantify the understanding and utilisation of incident learning systems (ILSs) and perceptions of safety culture (SC) in radiation oncology professionals. The work reviewed current knowledge to identify any gaps related to Australia and New Zealand (ANZ) and to design assessment tools. It then investigated ILS and SC at a local departmental level using tailored questionnaires and at a bi-national level across ANZ using a validated survey tool. The locally identified issues guided a quality improvement project developing and implementing a new local ILS that suited the specific needs of the radiation oncology department. The bi-national results and findings provide benchmark understanding of ILS and SC for ANZ, that other departments can use for their local SC comparison and provides a set of recommendations for future discussions and developments on national consensus approaches to ILS.