Engineering Patient Safety in Radiation Oncology: University of North Carolina's Pursuit for High Reliability and Value Creation

Engineering Patient Safety in Radiation Oncology: University of North Carolina's Pursuit for High Reliability and Value Creation


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Product Details

ISBN-13: 9781482233643
Publisher: Taylor & Francis
Publication date: 04/07/2015
Pages: 312
Product dimensions: 6.20(w) x 9.30(h) x 0.80(d)

About the Author

Lawrence Marks was born and raised in Brooklyn, New York. He studied chemical engineering at Cooper Union and obtained his MD from the University of Rochester. He did his residency training in radiation oncology at Massachusetts General Hospital and then served on the faculty of Duke University for 19 years. There, he studied radiation-induced normal tissue injury and became interested in human factors engineering and patient safety. In 2008, he moved to the University of North Carolina to become the Dr. Sidney K. Simon Distinguished Professor of Oncology Research and the chairman of the Department of Radiation Oncology. Over the last six years, he and Dr. Mazur and others have been systematically applying engineering principles from high-reliability and value creation organizations to improve safety. In his clinical work, he has particular interest in the care of patients with cancers of the lung or breast. He has been active in ASTRO (American Society for Radiation Oncology) and currently serves on its Board of Directors as the chairman of the Clinical Affairs and Quality Council. He lives with his wife of 29 years, Caryn Hertz, in Chapel Hill. They have three sons, none of whom is planning a career in medicine.

Lukasz Mazur earned his BS, MS, and PhD in industrial and management engineering from Montana State University. As a student athlete at Montana State University, he earned a spot in the Bobcats Hall of Fame for his efforts on a tennis team. While working at North Carolina State University, he was awarded the Alumni Outstanding Extension Service Award for his outreach work, highlighting his passion for quality and safety work in the healthcare industry. Currently, he is an assistant professor in the Radiation Oncology Department at the UNC School of Medicine. His research interests focus on engineering management as it pertains to continuous quality and safety improvements and human factor engineering with a focus on workload and performance during human computer interactions.

Bishamjit S. Chera is an assistant professor and director of patient safety and quality in the Department of Radiation Oncology at the University of North Carolina. He received his BS in biology from Winthrop University in 2000 and an MD from the Medical University of South Carolina in 2004. He completed his residency training in radiation oncology at the University of Florida. His clinical expertise is in head and neck and skin cancers. His major areas of research pertain to head and neck cancer and translating quality assurance/control/improvement principles and methodologies from high-reliability organizations to radiation oncology. He has written on the incorporation of practical quality assurance approaches (e.g., process/human factors engineering and Lean methodologies) in the daily activities of radiation oncology departments/clinics.

Robert Adams earned his BS in biology/radiology from Averett University, a MS in healthcare administration from the University of North Carolina, and a doctorate in higher education administration from North Carolina State University. He is an assistant professor in the Radiation Oncology Department at the UNC School of Medicine, and directs both the UNC healthcare radiation therapy and the medical dosimetry educational programs. He is certified in radiation therapy and medical dosimetry. His research interests focus on clinical work practices, patient safety, and educational issues for radiation therapists and medical dosimetrists. He has served on several national and international boards of directors and editorial review boards. He is both a Fellow and an Award of Excellence recipient from the American Association of Medical Dosimetrists. He has published over 50 peer-reviewed articles, 10 book chapters, and recently completed an R25 National Cancer Institute recent grant developing "Computer-Based Medical Dosimetry Clinical Learning Modules."

Table of Contents

An Introduction and Guide to This Book
Learning Objectives
A Brief Overview of the Safety Challenges Within Radiation Oncology
The Focus of Safety Initiatives on Technical/ Education versus Organizational/Workplace/ Behavioral Issues
The Challenge in Promoting Safety in Radiation Oncology: Lessons from High-Reliability and Value Creation Organizations
Organizational Level
Culture of Safety
Improvement Cycles
Workplace Level
Human Factors Engineering
People Level
Safety Mindfulness

Broad Overview of "Past" and "Current" Challenges of Patient Safety Issues in Radiation Oncology
Learning Objectives
Brief Introduction to Radiation Therapy Processes
Rates and Types of Events Reported and the Need for Better Reporting
Population/Registry Data
Institutional Data
Type of Events
The Need for Better Reporting
The Changing Practice of Radiation Oncology
2D to 3D to IMRT
2D to 3D
3D to IMRT
Reliance on Image Segmentation
Evolving Role of the Radiation Therapists
Image-Guided Therapy and Tighter Margins
Time Demands/Expectations
Increased Time Demands of the Changing Work Flow
Addressing Expectations
Shorter Treatment Schedules
Additional Factors that Affect Medicine/Society More Broadly
Electronic Health Records
Sicker Patients
Combined-Modality Therapy
Societal Expectations
Administrative Concerns

Best Practices from High-Reliability and Value Creation Organizations: Their Application to Radiation Oncology
Learning Objectives
High Reliability and Value Creation
Normal Accident Theory
Linear versus Interactively Complex Systems
Loosely Coupled versus Tightly Coupled Systems
How Complexity and Coupling Are Related to Risk?
Applying These Constructs to Radiation Oncology
An Additional Sobering Realization: Feta vs. Swiss Cheese
A Related Construct: Mechanical-Based versus Software-Based World
High-Reliability Organization Theory
Broad Overview of Our Application of These High-Reliability and Value Creation Concepts to Radiation Oncology
Organizational Level
Leadership Style and Behaviors
Infrastructure for Culture of Safety
Improvement Cycles
Workplace Level
Hierarchy of Effectiveness
Workload and Situational Awareness
Electronic Health Records
People Level
Transitioning People to Safety Mindfulness
Transitioning from Quick Fixing to Initiating
Developing Enhancing Behavior
Beyond Formal Leaders: Who Does All of This Apply to?

Driving Change at the Organizational Level
Learning Objectives
Larry’s Personal Reflection: A Selfish Desire for Order and Reliability
Order and Reliability
Rediscovering Human Factors Engineering
Getting Started at the University of North Carolina
Timing and Serendipity
Reliability versus Autonomy
Altruism versus Selfishness
Promoting High Reliability and Value Creation
Promoting a Leadership Infrastructure for Formal Improvement Activities
Promoting a Process Infrastructure for Formal Improvement Activities
Promoting High Reliability and Value Creation by Leadership Actions
If We Could Do It Over Again

Driving Change at the Workplace Level
Learning Objectives
Creating Safe and Efficient Environments: Two Critical Core Concepts
Human Factors Engineering
Hierarchy of Effectiveness
Moving Processes to the "Top" of the Hierarchy of Effectiveness: Examples Applying Automation and Forcing Functions
Consistent Naming of Radiation Treatment Plans
Goal Sheets
Pacemaker, Pregnancy, Prior Radiation
Detailed Simulation Instructions
Patient Self-Registration
Encouraging Staff to Wear Their UNC ID Badges
Moving Processes "Up" the Hierarchy of Effectiveness: Examples of Applying Standardization
Defining a Standard Way for Communication Regarding Patient Status in Our "Holding Area"
Standard Work Space for Providers (the "Physician Cockpit")
Standardizing/Clarifying Clinic Cross Coverage
Electronic Templates
Moving Processes Onto the Hierarchy of Effectiveness: Examples of Applying Policy/Procedures and Training/Education
Workplace Changes Intended to Facilitate Desired Behaviors and Outcomes
Monitors in the Treatment Room Maze to Facilitate Patient Self-Identification
Communication among Staff and between Patients and Staff
Patient Discharge Instructions in the Rooms
Color Coding Supplies in the Nursing Room
Retrieving the Self-Registration Cards from Patients at the End of Therapy (to Prevent Them from Trying to Use Them at a Follow-up Visit)
Lobby versus Waiting Room
Mirrors in Hallways to Prevent Collision
Example Changes Aimed to Improve Workload and Reduce Stressors
HDR Brachytherapy Workload
Reducing the Frequency and Sources of Stressors
"Going Paperless": Example Changes Instigated by Our Adoption of a Radiation Oncology Electronic Health Record System
Clinic Work Flow
Using Electronic Work Lists to Help Track Work Flow and Tasks

Driving Change at the People Level
Learning Objectives
People Level
The Importance of "People"
Formalizing People-Driven Quality Initiatives: A3 Thinking and Plan-Do-Study-Act
Approval Process and Implementation
Visual Management
Rewards and Recognition
Challenges with the A3 Program
Ordering Laboratory Studies
Coordinating Chemotherapy
Encouraging People to Report "Good Catches"
Integration of Good Catch and A3 Programs: Case Study with Common Challenges
Patient Safety Culture: Our People’s Perception of Organizational Culture
Safety Mindfulness, Behaviors, and Decision Making
Transforming Quick Fixing Behaviors to Initiating Behaviors
Reducing Expediting Behaviors
Transforming Conforming Behaviors to Enhancing Behaviors
Initiatives Aimed to Promote Safety Mindfulness.....196
Departmental, Clinical Team, and Physics/Dosimetry Huddles
Safety Rounds
Daily Metric
Physicist of the Day (POD) and Doctor of the Day (DOD)
Patient Engagement

Learning Objectives
Workload during Information Processing
Factors Influencing Workload
Research Endpoints and Broad Overview of Results
Research Performed in the Clinical Environment
Subjective Evaluation of Mental Workload
Relationship between Mental Workload and Performance
Research Performance in the Simulated Environment
Subjective Evaluation of Mental Workload
Objective Evaluation of Mental Workload
Planned Future Research on Workload and Performance
"Laundry List" of Potential Research Projects
Personal Transformation to Safety Mindfulness
Leadership Style and Behaviors
Plan, Do, Study, Act (PDSA)
Facility and Work Space Design
Interface Design and Usability
Lessons from Computer Science and UNC’s Experience with Our Treatment-Planning Software
Lessons from Advertising and Education: Comprehension
Figure Labeling
The Need for Rapid Action

Summary of the Book
Context of the Book
Concluding Remarks


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