title: Does compliance to patient safety tasks improve and sustain when radiotherapy treatment processes are standardized?
abstract: OBJECTIVE
  To realize safe radiotherapy treatment, processes must be stabilized. Standard operating procedures (SOP's) were expected to stabilize the treatment process and perceived task importance would increase sustainability in compliance. This paper presents the effects on compliance to safety related tasks of a process redesign based on lean principles.
  
  
  METHODS
  Compliance to patient safety tasks was measured by video recording of actual radiation treatment, before (T0), directly after (T1) and 1.5 years after (T2) a process redesign. Additionally, technologists were surveyed on perceived task importance and reported incidents were collected for three half-year periods between 2007 and 2009.
  
  
  RESULTS
  Compliance to four out of eleven tasks increased at T1, of which improvements on three sustained (T2). Perceived importance of tasks strongly correlated (0.82) to compliance rates at T2. The two tasks, perceived as least important, presented low base-line compliance, improved (T1), but relapsed at T2. The reported near misses (patient-level not reached) on accelerators increased (P < 0.001) from 144 (2007) to 535 (2009), while the reported misses (patient-level reached) remained constant.
  
  
  CONCLUSIONS
  Compliance to specific tasks increased after introducing SOP's and improvements sustained after 1.5 years, indicating increased stability. Perceived importance of tasks correlated positively to compliance and sustainability. Raising the perception of task importance is thus crucial to increase compliance. The redesign resulted in increased willingness to report incidents, creating opportunities for patient safety improvement in radiotherapy treatment.
authors: Hasselt University, Faculty of Business Economics, Martelarenlaan 42, B-3500 Hasselt, Belgium. Electronic address: pascale.simons@uhasselt.be.
authors: Pascale A M
authors: PA
authors: Simons
authors: MAASTRO Clinic, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands; Dept. of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: ruud.houben@maastro.nl.
authors: Ruud
authors: R
authors: Houben
authors: KU Leuven, Centre for Sociological Research (CESO), Parkstraat 45, B-3000 Leuven, Belgium. Electronic address: jos.benders@soc.kuleuven.be.
authors: Jos
authors: J
authors: Benders
authors: MAASTRO Clinic, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands; Dept. of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: madelon.pijls@maastro.nl.
authors: Madelon
authors: M
authors: Pijls-Johannesma
authors: Hasselt University, Faculty of Business Economics, Martelarenlaan 42, B-3500 Hasselt, Belgium; Ghent University, Faculty of Medicine and Health Sciences, De Pintelaan 185, B-9000 Ghent, Belgium. Electronic address: dominique.vandijck@uhasselt.be.
authors: Dominique
authors: D
authors: Vandijck
authors: Hasselt University, Faculty of Business Economics, Martelarenlaan 42, B-3500 Hasselt, Belgium. Electronic address: wim.marneffe@uhasselt.be.
authors: Wim
authors: W
authors: Marneffe
authors: MAASTRO Clinic, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands. Electronic address: huub.backes@maastro.nl.
authors: Huub
authors: H
authors: Backes
authors: School for Public Health and Primary Care (Caphri), Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands. Electronic address: s.groothuis@maastrichtuniversity.nl.
authors: Siebren
authors: S
authors: Groothuis
mesh_terms: D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D009859:Oncology Nursing / Q000379:methods*; D061214:Patient Safety / Q000592:standards*; D017410:Practice Guidelines as Topic; D011878:Radiotherapy / Q000592:standards*; D012015:Reference Standards; D017751:Safety Management / Q000458:organization & administration*
keywords: Compliance; Incident reporting; Lean management; Patient safety; Standard operating procedures; Task importance