Radiation Safety and Trust As A Business Strategy

Dr. Matthew Katz, M.D. commented on yesterday's post here on Health Care Strategist, positing that cancer registry statistics place the official rate of radiation injury closer to 0.1% - far lower than the Times' 5% estimate. I'm tempted to split the difference. A 5% error rate may be too high, but given the pervasive under-reporting of medical errors, 0.1% is almost certainly too low.

Dr. Katz is right about one thing though: the greatest harm of all would occur if frightened patients avoid potentially life-saving care. And therein lies today's headline: it's all about trust.

Today The NY Times' Walt Bogdanich continues his series on radiation safety with an article spotlighting Intensity Modulated Radiation Therapy (I.M.R.T.), an expensive, complicated technology that's lifesaving in the right hands, dangerous in others.

Full disclosure on my part: I'm not a Radiation Safety Officer nor do I have those magical initials "M.D." after my name. I'm just some poor schlub strategist helping organizations translate grand visions into practical, realized outcomes.

So trust me when I say there's not a health care organization anywhere leaving "quality" out of its strategy. It's always there, as a "pillar" or a "priority for excellence" or a "critical success factor." Regrettably, there's too often a disconnect between the 'saying' and the 'doing.' And that's my point about trust: health care talks a better quality game than it delivers - a symptom of an industry much too cavalier about rupturing fragile bonds with customers.

Think it can't happen? From today's NY Times article, maintaining trust requires better performance than this:

"Government regulators have been slow to respond (to the lack of a clear strategy for maintaining the quality and safety of treatment.) Radiation accidents are chronically under reported, and a patchwork of laws to protect patients from harm are weak or unevenly applied, creating an environment where the new technology has outpaced its oversight, where hospitals that violate safety rules, injure patients and fail to report mistakes often face little or no punishment...

"In this largely unregulated marketplace, manufacturers compete by offering the latest in technology, with only a cursory review by the government, and hospitals buy the equipment to lure patients and treat them more quickly. Radiation-generating machines are so ubiquitous that used ones are even sold on eBay.

'“Vendors are selling to anyone,” said Eric E. Klein, a medical physicist and professor of radiation oncology at Washington University in St. Louis. “New technologies were coming into the clinics without people thinking through from Step 1 to Step 112 to make sure everything is going to be done right.”'

And this:

"Dr. Ibbott’s group also reported in 2008 that among hospitals seeking admission into clinical trials, nearly 30 percent failed to accurately irradiate an object, called a phantom, that mimicked the human head and neck. The hospitals were all using I.M.R.T., which shapes and varies the intensity of radiation beams to more accurately attack the tumor, while sparing healthy tissue.

'“This is a sobering statistic, especially considering that this is a sample of those institutions that felt confident enough in their I.M.R.T. planning and delivery process to apply for credentialing and presumably expected to pass,” said a task group investigating I.M.R.T. guidelines for the American Association of Physicists in Medicine."

It'd be nice if Dr. Katz was correct. I fear The Times is, and health care leaders better wake up and act accordingly. As a start, try not hiding mistakes behind a wall of silence then telling newspapers they don't have the full story. As a functional requirement, "transparency" is no longer limited to window glass.

Compare health care's approach to Toyota's. According to headlines today, Toyota CEASED production of 8 models until quality issues can be figured out. Health care leaders studying the Toyota Production System now have another lesson to learn - i.e. sometimes business as usual is anything but.

Suggestion for health care media leaders: be strategic and opportunistic by announcing how your organization has responded quickly and aggressively to The NY Times series. Let your marketplace know that you take their safety seriously and have acted accordingly by re-validating all your quality metrics and protocols. Spell out how you've calibrated and re-calibrated your brand new I.M.R.T. machine, re-examined the training and skills of your therapists and physicists, and reviewed outcomes data for overlooked complications.

Get out front of a story for once. Talk about it with your patients. Use it to build trust and confidence. If you're doing it right, you've got nothing to lose.