‘Engineering’ Patient Safety

K22961_cover_2By Lukasz Mazur: Most continuous quality improvement (CQI) programs in healthcare industry are nowadays structured to transform leaders into effective change agents, design efficient, effective, and ‘waste-free’ workplaces, and develop people into creative problem solvers. However, despite many ‘positive’ reports about CQI programs in the academic literature, books, and lay press, it is still difficult to determine whether leaders, workplaces, and front line staff are transforming into reliable forces towards safety mindfulness.

Thus, recently we (Marks, Mazur, Chera, Adams) wrote a book (see Figure) to showcase how broad application of safety mindfulness at all levels of the organization could make healthcare delivery more efficient and safer. Specifically, in this book we illustrated our initial efforts at the University of North Carolina to address these challenges; i.e. keeping our patients safe while continuously improving our care delivery processes. The book was written with a mixed readership in mind: medical and administrative radiation oncology employees, industrial and management engineers, human factors professionals, safety managers and reliability engineers – and, of course, their current and future students.

The book is divided into 2 parts and 8 chapters.

Part 1: Provides an introduction to basic concepts, methods, and tools that underlie our approach to high reliability and value creation; and an overview of key safety challenges within radiation oncology. Chapter 1: Provides a broad overview of how the safety challenges within radiation oncology are currently perceived; i.e. with the focus on advanced technologies. Chapter 2: Provides a broad overview of ‘past’ and ‘current’ challenges of patient safety issues within radiation oncology. An overview of incident rates and events reported is included. Chapter 3: Provides a broad overview of the best practices from high reliability organizations and offers a preliminary assessment of how these practices can be applied to radiation oncology.

Part 2: Based on the beliefs outlined in the prior chapters, we describe our journey to high reliability, value creation, and safety mindfulness at the University of North Carolina. Chapter 4: Provides an in depth account of changes and initiatives taken at the organization level. Chapter 5: Describes our efforts to optimize workplaces and work processes for people, so human error can be minimized. Chapter 6: Here we focus on people, their decision making processes and behaviors. We provide careful analysis of events in which we failed to deliver optimal care to our patients. Chapter 7: Summarizes our research program on mental workload that is synergetic with our clinical activities. We also provide ideas for future research at the organizational, workplace, and people levels. Chapter 8: Provides summary of key learnings and concluding remarks.

I hope you will find this book useful and ‘fun’ to read. I highly recommend it for students interested in quality and safety as related to healthcare deliver.