Use of the AAPM Safety Profile Assessment Tool to Evaluate the Change in Safety Culture After Implementing the RABBIT Prospective Risk Management System.

Purpose: Hospitals traditionally focus on reactive risk management such as incident reporting, but prospective risk management systems such as failure modes and effects analysis are also important tools to reduce risks and improve the safety culture. In 2015, the St George Cancer Care Centre (STGCCC) developed a multidisciplinary risk-based system for the safe and effective implementation of new technologies and techniques, using risk and benefit balance impact templates (RABBIT) developed in-house. The purpose of this study was to determine whether risk management and the safety culture in radiation oncology were perceived to have improved since the introduction of the RABBIT system.

Methods and materials: In 2017, radiation oncologists, radiation therapists, and medical physicists were asked to rate the department before and after the introduction of the RABBIT using questions from the American Association of Physicists in Medicine Safety Profile Assessment (SPA) tool. Answers relating to the implementation of new technology/techniques are presented.

Results: STGCCC staff confirmed that the RABBIT system has improved the implementation of new technology/techniques, with an average SPA question score improvement from 3.9 to 4.4 (of 5.0). This compares favorably with the SPA world average of 3.5 (October 2017). The improvement is attributed to risks being formally identified and managed and adequate staff training being mandatory and systematic. There were also perceived improvements in teamwork, probably because the introduction of structured multidisciplinary teams resulted in each group having a better understanding of the workflows and priorities of the other groups.

Conclusions: This study shows that prospective risk management at STGCCC has improved the perceived quality of the implementation of new technology/techniques. The RABBIT is a simple and effective method for achieving this improvement in safety culture. The American Association of Physicists in Medicine SPA is a valuable tool for assessing the success of quality initiatives and identifying opportunities for further improvement.