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Establishing a Culture of
Safety through Education
The Medical Physicist’s Role
AAPM Education Symposium
Michael G. Herman, Ph.D.
AAPM Board Chair
Professor and Chair, Medical Physics
Mayo Clinic, Rochester, MN
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Herman # 1
Medical Radiation
• Medical Radiation is Delivered to
– over 70 Million People for Diagnosis
– over 700,000 People for the Treatment of
Disease Annually in the US.
Outline
• Patient Safety
• Our Responsibility
• Education of Staff, Patients, Leadership
– Education of MP (next talk)
• Some Aspects of Education
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Herman # 2
THIS is Why We Are Here
It is ALL about Patient Care
• Ultimately, the result of our (the TEAM)
work, regardless of whether we do
research, provide education or deliver
clinical service, is the very best possible
patient care.
• Almost All of these are Performed
Safely and to the Benefit of Each
Patient
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Herman # 3
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Herman # 4
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Patient Safety is Paramount
• Expectation is that the treatment or
diagnostic procedure will be beneficial
• Complex system of technology and
humans
• There are many causes of errors
• There are many mechanisms by which
safety can be improved.
• Education is one
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Herman # 5
Education of Staff
Radiation Oncology and Radiology
• RT(T), dosimetrists and physicians
– Annual patient/rad safety
training/curriculum
– New procedure/technology education
– Ongoing vigilance
• Other staff in radiation environment
Safe, Successful Delivery of
Radiation
• Commitment to Quality and Safety
• Contemporary, Appropriate Knowledge
– For the Medical Team
– For the Patient
– For Leadership/Administration
• Medical physicists possess education and
technical knowledge to understand and
evaluate safety and teach others
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Herman # 6
Education for Patients
• Patients must (want to) be informed
• As appropriate for procedure and
individual
– Written documents
– Individualized as requested
– Nursing and support staff
– Initial and annual training
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Herman # 7
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Herman # 8
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Education for Leadership
Technical Staff Education
• Initial Education
• Leadership/Administration
– Critical role - Owners
– Facilitate (allocate resources)
– Support
– Set example
• Fundamental Safety Education
• Essential for Culture of Safety
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Herman # 9
Components: Staff Education
• Overview of ionizing radiation and
potential hazards
• Culture of safety
• Reporting and safety improvement
environment
• Examples of errors that have occurred
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Herman # 11
– New Staff
– New Technology or Procedure
– Organized and timely
• Annual Review/Refreshers
– Structured
– Documented
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Herman # 10
Components: Staff Education
• Solutions and error prevention lessons
– Local
– Regional/State
– National
– Practice Specific
• Specific technology education/operation
• Emergency training
• Annual in-service
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Herman # 12
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e.g. Content: Staff Education
• Develop a team covenant and safety
commitment
• Recognize the role of human factors
• Acknowledge the risks and their context
– Through evaluation and simulation
• Control the pace change
– In practice/process/technology
• There is a learning curve for new technology
– Learn limitations of technology/users
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Herman # 13
e.g. Content: Staff Education
• Develop and Use
– Time outs – called by any team member
– Check lists appropriately
• Reference resources
– profession-sponsored, public domain
– CT dose safety – lessons from meetings
– RT safety – lessons from meetings
• Identify safety champions
• Understand/Use reporting system
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Herman # 15
e.g. Content: Staff Education
• Consider workflow/processes
– Improvements in workflow reduce
risk/stress
– As complexity increases, control should be
simplified
• Standardize Operating Procedures
where possible
– With redundancy at critical steps
• Follow S.O.P.s AAPM 7/31/11
Herman # 14
Components: Other Staff
Education
• Broad Overview Radiation and
Radiation Safety
– Uses, effects
– Safety culture, error prevention
• Modality and Procedure Specific
– As appropriate
• Operational safety
• Recognition of unusual conditions
• Emergency training
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Herman # 16
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Components: Other Staff
Education
• Initial Education
Components: Patient Education
• Prepared Brochures and Reference
Material
– General Information about radiation and
radiation safety
– Focused providing concise descriptions at
patient level for specific procedure
– As procedure comes on line
– When new staff hired/transferred
• Ongoing
– Annual
• Clinical technological process
• Technology
• Safety Culture
• General refresher
• Procedure specific
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Herman # 17
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Herman # 18
Components: Leadership
Components: Patient Education
• Individual Consultation
– Upon physician, staff or patient request
and in context with specific situation
• Explain technology
• Explain safety
• Explain process
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Herman # 19
•
•
•
•
Implementing safe practice not trivial
Leaders have to own it
Leaders must facilitate and support
Safety is about
– Relationships
– Teamwork
– Mutual respect
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Herman # 20
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Components: Leadership
• Understand that safety requires
– Standardization
– Accountability
– Resources
• High level understanding of
– Radiation environment, risks, solutions
– Content from staff education
Education is Continuous
• There is no overnight, quick solution to
education in patient safety
• We must learn and teach
– Ourselves
– Our team members
– Our leaders
– Patients
• We have the skills to do this and it will
improve patient safety and patient care
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Herman # 21
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Herman # 22
Thank You
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Herman # 23
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