Learning from risk assessment in radiotherapy

The lessons learned from completing a risk assessment of a radiotherapy information system in a public hospital are presented. A systems engineering perspective with respect to the risk assessment was adopted. Standard engineering tools modified for application in healthcare environments were applied, e.g. HFMEA^TM. It was found that there was a complete absence of the application of systems engineering at the development stage of the radiotherapy system, however aspects of quality systems, i.e. process improvement, were present at the operating stage. Team work played a significant role in the successful operation of the system. However, in contrast to most engineering systems, team composition was highly heterogeneous as roles were clearly defined by professional qualification. There were strong boundaries between the radiotherapy team and other teams in the hospital. This was reflected by their lack of concern regarding the availability of patient information beyond their own department.