No Fly Program Initiative
The safe delivery of radiation therapy requires multiple disciplines and interactions to perform flawlessly for each patient. To mitigate risks associated with rushed completions of high-risk tasks, the Department of Radiation Medicine developed and implemented a ‘no-fly policy’ that proactively delays the start of patient treatment if such delay-rushed processes occur. The policy provides a thorough process to avoid potentially unsafe treatment starts and has transformed the department culture from ‘treat on time’ first to ‘treat safely’ first.
The complexity of radiation therapy is ever increasing with the potential for more precise treatments for patients. Because treatment is individualized, and every aspect of the patient's care is unique, it is difficult to regiment a fully standardized delivery process that works flawlessly. While the focus on patient safety is not new, the emphasis in radiation medicine is shifting toward recognizing and addressing the patient safety risk environment created by the use of more sophisticated treatments. The quality management program for radiation therapy reviewed the entire process of care prior, during, and after a patient's treatment course. It became clear that the start of radiation treatment represents the stress point in the process and that the piling up of various activities is done to maintain that schedule.
There are demands from many constituents to meet deadlines; the referring and treating physicians, research protocols, the patients, and the self-satisfaction of staff that strive to meet assigned deadlines, regardless of last minute work. Key to the No Fly Policy is to have the staff recognize that delays may be needed and to proactively implement a stopping event, rather than subject a patient to a reactive, last minute stop. These reactive stops are the most disruptive and disturbing to both the staff and patient. Therefore, the goal is to proactively rather than reactively identify stopping events. A secondary goal has been to modify and improve processes to be more streamlined so as to minimize the likelihood of delays in tasks.
Implementation of the No Fly Policy has helped to mitigate risk from accelerated care, convert reactive to proactive delays, and created a safety culture in the large, multicenter department. Overall, there has been a steady trend showing a drop in high-risk task delays as well as a drop in patient treatment start delays. The department has seen sustained improvements over the past three years of implementation. Now in effect for over four years, the sustained changes in the departmental culture and operations have contributed to a new paradigm in how to manage the radiation oncology process that is being copied and implemented nationally.