This thesis relates to the patient safety, more particularly in the field of the radiotherapy, medical speciality which uses ionizing rays for the treatment of cancers. The aim of this thesis is to bring elements of comprehension on the safety management in radiotherapy and to provide tracks of improvement of patient safety, through the development of the collective safety culture.
Consequently, three empirical studies were led: initially, 14 individuals (radiation oncologist, medical physicists, dosimetrists and radiographers) analyzed situations of variation to the standard rules; in the second time, the activity of the radiographers was analyzed by systematic observations; finally, 14 medical physicists could, via individual allo-confrontations, to comment on the dosimetries carried out by their colleagues.
This thesis leads to a vision of the total safety which articulates quality and safety - regulated or managed - where quality is dependent on safety. The results showed the lack of formal procedures relating to the patient safety and the existence of subcultures of safety specific to the professions and the hospitals; Moreover, the data indicate that total safety rests partly on the knowledge of the colleagues’ work. In a general way and in order to be able to ensure the total safety, i. E. The production of quality (health) in safety, it is necessary to grant to the organizations material and human resources as well as a place for the development of the collective and prescribed organization.