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Evaluation of Time- and Cost-Saving Modifications of HFMEA: An Experimental Approach in Radiotherapy

Objective: This study aimed to evaluate different shortcuts of Healthcare Failure Mode and Effects Analysis (HFMEA) in a radiotherapy setting. Design: A 2 × 2 study design was set up, in which 4 similar groups analyzed separately the possible risks of the same process by using different versions of HFMEA. Setting: In the Maastricht Radiation Oncology clinic, a radiotherapy institute in the Netherlands, treatment of cancer patients is organized within 3 different units, each focusing on a specific area (thorax, abdomen, and neck-head). The institute plans to treat all radiation areas in one generalized unit (Linac-pool). Participants: All 4 teams were composed of 3 radiation technologists (1 from each working unit), 1 manager radiation technologist, and 1 facilitator. Interventions: Prospective risk analyses were completed in parallel within 1 month. Main Outcome Measures: Time investment and cost data on the different steps of the HFMEAs were registered from the organizations' perspective. Each team suggested a number of corrective actions for the Linac-pool. The quality and feasibility of the proposed actions were assessed by an expert panel (managers and safety staff). Results: The HFMEA analyses resulted in direct costs varying from 1028.6 to 1701.6 euros. In total, the expert panel assessed 86 corrective actions, of which 43 (50%) were relevant to implement before the start of the Linac-pool. Many of these actions related to the compliance, control, and education of standard operating procedures in daily practice of radiotherapy. Conclusions: On the basis of the results of this case study, it seems feasible to develop less time- and cost-consuming versions of HFMEA, which would increase even more the added value of prospective risk analysis tools for health care organizations.