Tools and Quality Improvement

Question 1

define quality improvement

Answer 1

is a systemic approach to enhancing the quality of products, services, or processes within an organisation

Question 2

define quality indicator

Answer 2

is generally thought of as the most appropriate action for patient treatment given a certain disease and stage

Question 3

define quality measure

Answer 3

is a quantitative description of the degree of adherence to a quality indicator

Question 4

define action limits

Answer 4

define the degree to which measured quantities in the clinic are allowed to vary without risking harm to the patient

Question 5

define tolerance levels

Answer 5

define the boundary within which the process is considered operating normally

the acceptable range of variability in measurement or equipment performance. They define the limits within which equipment must operate to be considered acceptable for clinical use

Question 6

3 methods for quality improvement

Answer 6

• failure mode and effects analysis
• incident learning and root cause analysis
• statistical process control

Question 7

failure mode and effects analysis

Answer 7

is a structured approach used to proactively identify potential failure modes within a system, process, access the severity, likelihood, and detectability of their effects, and prioritise them based on risks

FMEA exercises consists of identifying a clinical process for evaluation and then identifying all of the ‘failure modes’ that can occur in all the steps in the process

Question 8

what is traceability

Answer 8

property of a measurement result whereby the result can be related to a reference through a documented unbroken chain of calibrations, each contributing to the measurement uncertainty

being able to link every measurement and calibration back to a trusted reference standard. This ensures that the radiation dose given to patients is accurate and consistent with recognized standards, making treatment safe and reliable.

measurement traceability is often needed to fulfil regulatory requirements and supports confidence in QA results for the practitioner and for the patient

Question 9

quality measures are

Answer 9

• a form of monitoring
• should be specific and actionable
• guide quality improvement methods

Question 10

incident learning

Answer 10

refers to the identification of problems in the care delivery process and the subsequent investigation of those problems to uncover and address casual factors and latent conditions for error

Question 11

root cause analysis

Answer 11

is a process analysis used to identify the underlying causes of system failures

it provides the information needed to solve problems and address these failures

Question 12

compare FMEA and RCA

Answer 12

FMEA
- pro-active
- aimed at predicting the adverse outcomes of various human and machine failures, and system states
- deal with hypothetic failures
- look forward in time

RCA
- a reactive process
- takes place after the harm has been done
- deal with actual failures
- look backwards

Question 13

statistical process control (SPC)

Answer 13

a method to measure and control variability in processes. an analytical decision-making tool that employs statistics to measure and monitor a system process

is a statistical method used to monitor and control process variability. It involves collecting data on a process over time, plotting it on control charts, and analyzing the data to identify patterns, trends, and deviations from the expected performance. SPC is used in radiation therapy to track various metrics, such as linac output, treatment planning time, and patient wait times.

Question 14

SPC steps

Answer 14

1. define the process
2. select quality characteristics
3. collect data
4. create control charts (graphical tools)
5. determine control points
6. collect and plot control chart
7. analyse and interpret control chart
8. take corrective action
9. document and communicate

Question 15

measurable endpoint for SPC

Answer 15

• physics related quality measures (eg. linac output)
• clinical practice measures (eg. time from simulation to planning)
• patient related measures (treatment breaks)

Question 16

survey meter

Answer 16

a hand-held ionising radiation measurement instruments are used to check personnel, equipment and the environment for radioactive contamination

Question 17

What should you consider with ion chambers and electrometers?

Answer 17

Linearity, drift, and repeatability

linearity –>

drift –>

repeatability –> the device is exposed to the same amount of dose and it should be the same recording every time

Question 18

digital vs mercury thermometer

Answer 18

digital is less accurate with readings as it is always exposed to radiation, however, easier to read

mercury is more accurate with readings in the treatment room

Question 19

why do we use thermometers

Answer 19

to assess the temperature of the environment –> eg. if the machine doesnt overheat

as environment affects output and the performance of the machines

Question 20

in FMAE, 3 scores are assigned to each failure mode and causes

Answer 20

severity (S), probability of occurrence (O), and probability that the failure would go undetected (D)

Question 21

how can AI be used to enhance and automate the FMAE process

Answer 21

1. data analysis and pattern recognition –> AI can analyse large datasets of historical failure data and identify patterns and trends that may not be immediately apparent to human analysts. This can help in the identification of potential failure modes and their associated effects
2. risk assessment –> AI can assist in the risk assessment phase of FMEA by calculating risk scores based on
   historical data, probabilities, and consequences. This can help prioritize which failure modes to focus on.
3. recommendations –> AI algorithms can generate recommendations for mitigating or preventing specific failure modes based on historical data and expert knowledge. These recommendations can help in the development of effective preventive
   and corrective actions
4. automating documentation –> AI can assist in generating documentation for the FMEA process, including failure mode descriptions, risk assessments, and recommended actions. This reduces the administrative burden on FMEA teams
5. real-time monitoring –> n some industries, AI-driven sensors and monitoring systems can provide real-time data on equipment and processes. AI can analyze this data to detect abnormal conditions and potential failure modes in real-time, allowing for proactive maintenance and intervention.
6. continuous improvement –> AI can help in continuously improving the FMEA process itself by analyzing historical FMEA data and suggesting refinements to the methodology or criteria used for risk assessment

Question 22

incident learning

Answer 22

refers to the identification of problems in the care delivery process and the subsequent investigation of those problems to uncover and address causal factors and latent conditions for error

Focuses on understanding the factors that contributed to the incident and identifying lessons learned to prevent similar events in the future.

Question 23

root cause analysis

Answer 23

is a process analysis used to identify the underlying causes of system failures. It provides the information needed to solve problems and address these failures

Question 24

FMAE vs RCA

Answer 24

FMAE
- proactive
- looks forwards
- Aimed at predicting the adverse outcomes of various human and
machine failures, and system states
- Deal with hypothetic failures

RCA
- reactive
- looks backwards
- Takes place after the harm has been done
- Deal with actual failures