How to Improve Patient Safety in Radiation Oncology with LifeWings

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The rigor and standardization introduced into the radiology oncology practice at Memorial Cancer Institute following the LifeWings training, resulted in an increase in communication and teamwork that improved both safety and efficiency while improving both staff and patient satisfaction.

Communication patterns and protocol rigors of a methodology called crew resource management (CRM) can be adapted to a radiation oncology environment to create a culture of patient safety. LifeWings CRM training program was introduced at Memorial Cancer Institute radiology oncology department in Hollywood, Florida beginning in 2009.

The LifeWings program helped Memorial create and implement important safety tools such as checklists, communication scripts, handoff tools, briefing guides, protocols, and standard operating procedures.

Memorial's 3-day on-site workshop, conducted with six to eight key personnel, created site-specific systems to “operationalize” effective physician and staff teamwork behaviors into daily work life.

Memorial Cancer Institute consisted of 34 full-time staff seeing 100-125 patients daily on 2 hospital campuses. They were assisted by LifeWings a consulting group with considerable experience in helping hospitals incorporate CRM principles and practices.

Implementation steps included developing change initiative skills for key leaders, providing training in teamwork and communications, creating site-specific tools for safety and efficiency, and collecting data to document results.

The goals were to improve patient safety, teamwork, communication, and efficiency through the use of tools they developed that emphasized teamwork and communication, cross-checking, and routinizing specific protocols. The CRM plan relies on the following 4 pillars: patient identification methods; “pause for the cause”; enabling all staff to halt treatment and question decisions; and daily morning meetings.

Results at Memorial were an improved safety record. The near-miss rate before CRM implementation averaged 11 per month; the near-miss rate currently averages 1.2 per month. In the 5 years prior to CRM implementation, there was 1 treatment deviation per year, although none rose to the level of “mis-administration.” Since implementing CRM, the current patient treatment setup and delivery process has eliminated all treatment deviations. The practices have identified situations where ambiguity or conflicting documentation could have resulted in inappropriate treatment or treatment inefficiencies.

The staff members have developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety and have spoken up when they considered something potentially unsafe. The hospital increased their efficiency (and profitability); in 2012, the units of service were up 11.3% over 2009 levels with the same staffing level.

The rigor and standardization introduced into the radiology practice following the LifeWings training, resulted in an increase in communication and teamwork that improved both safety and efficiency while improving both staff and patient satisfaction. CRM principles are highly adaptable and applicable to the radiation oncology setting.

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About LifeWings:
LifeWings Partners creates documented, sustainable improvements in cost reduction, efficiency, reliability, safety, and quality by combining the best of Lean and TeamSTEPPS. LifeWings has improved the financial bottom line and patient safety record of over 140 hospitals worldwide. The LifeWings coaching cadre of pilots, astronauts, physicians, nurses and Toyota-trained Lean experts train more than 13,000 administrators, physicians and staff per year. Measurable results are guaranteed in all LifeWings’ initiatives. Documented return on investment typically exceeds 300%. To find out more, please visit or or follow us on Twitter @LifeWingsLLC.

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Stephen Harden
Lifewings Partners, LLC
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Angela Myers
LifeWings Partners, LLC
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