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Safety First Culture – One Administrator's Perspective

By Patricia Saponaro

If ever there was a field for which safety culture is critically important, it is radiation oncology. This is due, in part, to the danger posed by introducing radiation to the human body. Add to this multiple human roles in processing every treatment plan, and the psychological complexity of dealing with cancer patients and their hopes, fears and expectations. It becomes important to explore: what are the necessary ingredients to create a successful safety culture? I think there are four pertinent criteria to safety first culture:

Leadership vision

At an academic medical center, it is typically the chair who expresses the importance of quality/safety improvement. And usually, the top leader officially designates who has oversight and responsibility for building a robust safety culture. Equally important is the MD champion who visibly, actively and collaboratively promotes and contributes to the safety culture.

Strong systems to address safety concerns

An incident learning system is most effective if it is easy to use and offers data that can be tracked over time. Additionally, reporters of incidents must be constantly encouraged and cultivated through meaningful feedback regarding what they have reported.

Blame-free use of information

While true that “It’s about the process, not the person,” it can be challenging to help employees have confidence in a culture of reporting. Some facilities find it beneficial to have the option to report anonymously; however, when specific details are reported it is more effective to complete a root cause analysis, which cannot be done anonymously. Arguably, the highest level of reporting culture is when staff feel confident enough to self-report their own good catch or near miss experiences.

Effective change management

As with most significant change efforts, sufficient training and frequent communication with transparency at all levels is a must. Using data to track and widely/regularly report trends will enhance legitimacy. Safety leaders will actively solicit and address concerns, and top leadership will set clear goals for all—including how to address participation in the safety culture, in individual performance reviews.

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While the ideas outlined will enhance success, there are no guarantees (remember the human element)! That’s why the most important feature of a safety culture is the ability to make change over time… the administrator will play an active role in helping stay the course and persist, despite challenges that are sure to occur.

I would love to hear your opinions about safety culture in your department. Leave a comment with your thoughts!


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