Towards Safer Radiotherapy

technology tends to impair individuals’ expertise if they no longer have to exercise their skills
on a regular basis.
2.1.5 Poor communication and lack of teamworking
This is one of the most frequent causes of errors, and misunderstandings and incorrect
assumptions have been implicated in a number of radiotherapy incidents. 6
Poor communication is more likely if staff roles and responsibilities are not clear. Units which
maintain strong professional boundaries, rather than fostering multidisciplinary working, are
likely to experience communication problems between professions.
2.1.6 Hierarchical departmental structure
Historically, the hierarchical structure in healthcare has made junior members of the team
reluctant to question senior staff. Hierarchical structures make it more difficult to point out
failure to comply with protocol.
10
All healthcare professionals have a responsibility as defined in their code of conduct to
question decisions that affect patient care. 23–25 However, a junior member of staff may feel
uncomfortable in questioning the work of a much more senior colleague whom they observe
to be ignoring the established protocol that they have been trained to use. Conversely, a
more senior person may also feel constrained from pointing out the non-compliance of a
junior, particularly in a different professional group, for fear of their comments being seen as
a form of bullying. Managers should be aware of these issues and seek to establish and
maintain an open and fair culture which encourages the discussion of safety issues.
2.1.7 Staffing and skills levels
There must be adequate resources in place to meet the demands of the service with
sufficient staff, of the correct skills and experience, to carry out the workload. Staff should
be given time to carry out the necessary tasks without undue pressure.
Inadequate support services may also be a threat to safety if staff are diverted from their
clinical duties to deal with routine administrative matters.
2.1.8 Working environment
Errors may be precipitated by such factors as poor design of equipment, poor room layout or
the physical features of the workplace; for instance, excessive heat or cold. 6
Staff cannot provide a safe and effective service with poorly designed, poorly maintained or
out-of-date equipment. The support and active engagement of management is critical to
maintaining and operating a safe service.
2.1.9 Changes in process
In complex processes, any alteration may have an unexpected knock-on effect many steps
downstream. This particularly applies to the implementation of new technology; for example,
new computer planning systems. 5,7,26
One of the effects of introducing new processes and equipment may be to make redundant
the checking and verifying procedures that had previously been considered as essential. This
should be considered in the introduction of change because continuing with an unnecessary
step is potentially harmful because it distracts from remaining critical procedures.
Towards Safer Radiotherapy