Safety First Culture – One Administrator’s Perspective

By Patricia Saponaro posted 04-10-2019 11:20

Safety First Culture – One Administrator’s Perspective - Team hands

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.

SROA Blog_Safety First Culture_Administrator's Perspective_Adults brainstorming

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!




04-26-2019 12:15

​​Interesting read!  We too struggle as Jana stated reporting incidents; the staff feel like they are being called out for their mistakes.  Especially difficult in smaller departments as Jan mentioned.

04-11-2019 12:26

​Great topic Patricia,
Enjoyed it very much and I agree with everyone.  Here in our academic based facility we report with two safety systems.  The hospital uses "RL Solutions" and we also use "Roils" for radiation oncology.  I would say we have a very forward thinking culture of safety, it is always patient first.  We encourage our staff to self report and we have incorporated safety awards called "Good Catch" - employees that receive the award receive a certificate but also snacks like cookies and candy and provided for the entire staff to honor the good catch recipient.

04-11-2019 10:14

Great blog, Patti!!!
I think one of the most difficult things we encounter with trying to cultivate a safety-first culture is trying to get rid of the blame game.  RO-ILS and other incident reporting systems are very useful but I sometimes, find my staff still fell like their are being called out for their mistakes.  While we try to remind staff that this is an important part of continuing education and safety, they don't always see it like that if it was their "error" that is being reported.  So constant assurance that these systems are for learning is sometimes hard to accomplish.
I also like your point of a champion.  This is a great concept in all initiatives. Buy-in is integral to any success!
Thanks again for your thoughts-this was a great read!

04-10-2019 14:27

Thanks Patricia.  Interesting read and definitely a culture shift.  We do pretty well but it took us a while to get over the blame free environment.  Once we made the change to learning, our staff have done exceptionally well on reporting incidents.
Thanks for the info.

04-10-2019 12:57

Nice blog, and I agree with you perspective. The biggest hurdle I have faced is getting staff buy-in. Particularly difficult in smaller departments where it is more clear as to who said what, even with consistent messaging regarding the focus on process.  I am interested in ideas for increasing staff engagement in safety culture initiatives.