It is essential to understand and manage the complexities of radiotherapy systems and procedures if we are to maintain high standards of quality and safety in an increasingly changing environment. As technology advances, so do the challenges in the integration of safe practices across all aspects of treatment planning and delivery. This article explores strategic approaches that are rooted in the Safety-I and Safety-II frameworks; it aims not only to prevent errors but also to enhance resilience in radiotherapy systems.

Some examples of challenges in the radiotherapy process

1. Enhance Knowledge-Sharing as Personnel Capacity Expands

As radiotherapy departments grow, new members of the workforce must integrate smoothly into established workflows, so effective knowledge transfer is a priority.

Strategies

• Develop standardised protocols and documents that outline essential information for new team members.
• Cultivate a culture of mentorship and continuous learning to support knowledge-sharing between experienced professionals and newcomers.

2. Support Experienced Professionals to Adapt to Technological Advances

As radiotherapy evolves, departments may encounter challenges in the adaptation of established practices to new technologies. While the expertise of seasoned professionals is invaluable, they may benefit from additional resources to stay current with rapid advancements.

Strategies

• Offer targeted training and upskilling programmes to support adaptability and continuous growth.
• Promote cross-generational collaboration to blend extensive experience with new perspectives.
• Foster a supportive environment that encourages ongoing professional development for all team members.

3. Diverse Equipment Options and Their Impact on Clinical Service

The integration of a variety of treatment systems into a clinical department can add complexity, as each system may demand specialist knowledge and unique protocols.

Strategies

• Develop comprehensive competency programmes to develop staff proficiency across all systems.
• Establish clear guidelines that outline the rationales for selecting specific systems in different clinical scenarios.
• Implement tailored quality assurance procedures for each system to maintain consistent safety and performance standards.

4. Increasing numbers of treatment approaches implemented in local practice

The rapid increase in treatment options for the various sites and their associated unique protocols can overwhelm professionals and increase the risks of errors in the provision of services.

Strategies

Provide regular staff updates on the latest treatment protocols and the evidence base to support their implementation in local practice.

• Provide training to develop competencies in new practices where appropriate.
• Develop decision trees to guide practitioners through complex treatment options.
•  Streamline protocols where possible to facilitate safe implementation in clinical practice.

 

5.  Complexity vs. Complication Dynamics in Radiotherapy

Steps in process and the interdependence of steps in the process are changing.

From complicated systems:

 

As before:

• Recognise complexity in radiotherapy systems and procedures.
• Follow specific frameworks to promote resilience in radiotherapy systems and procedures and maintain safety and quality:

• SAFETY 2 emphasises resilience and adaptability. It acknowledges that complex systems require flexible responses.
• SAFETY 3 is focused on learning from success and understanding when things go right.

Specific tools to facilitate analysis and management of resilience in healthcare systems:

• the resilience assessment grid (RAG) is used to assess resilience performance; it considers four factors: respond, monitor, anticipate and learn; and
• the functional resonance analysis method (FRAM) is used to gain insights into system behaviour and interactions.

Fig. 1 A framework to address complexity in radiotherapy

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Petra Reijnders-Thijssen M.A.

Course director, RISK management course, ESTRO

Faculty member of risk management course of ROSEIS (Radiation Oncology Safety Education and Information System), endorsed by ESTRO

Chair of ESTRO Radiation Oncology Safety and Quality Committee (ROSQC)

Manager quality and safety, Maastro
Maastricht, The Netherlands
petra.reijnders@maastro.nl

Maeve Kearney MPH, B.Sc. (Hons)

Member of ROSQC

Assistant professor, Discipline of Radiation Therapy, Trinity College Dublin, Ireland