Since the radiotherapy accidents which occurred in Epinal (2006) and
Toulouse (2007) were detected, every French radiotherapy units have been
required to set up spaces for reflection to analyze the undesirable events and
to perform prospective analyses of the risks likely to be met by patients
during the healing process. The present research falls within the fields of
risk management and patient safety. It focuses exclusively on the
implementation of the prospective approach through the Failure Mode Effects
Analysis (FMEA) implementation in radiotherapy.
This research is in the field of risk management and patient safety. It
aims to develop a methodology for investigating the weakening of real work of a
medical team and to cope with methodological difficulties encountered by
radiotherapy centers when analyzing patients’ risks incurred the therapeutic
process with FMEA method. This thesis is a theoretical and empirical
contribution about "safety in reflection" in discussion spaces that
is distinguished within "safety in action".
This work seeks to identify a new link between safety and risk
management by giving a predominant place to a methodological step often
neglected: risk identification. Considering that safety of care would be
depending mainly of day-to-day practices of caregivers, analysts would have to
make the connection between a generic risk (eg. overexposure of patients to
radiation) and its construction, its spread in the real work of healthcare
team. This research proposes to elaborate this link collectively in discussion
spaces classically mobilized by the sciences of management to implement a
change or improve the performance of the organization and to adapt these forums
to identify risks in the daily work of a radiotherapy team.
The thesis in ergonomics argues that patient safety depends on the
production of a new knowledge: 1) on the complexity of the daily work of the
healthcare team, 2) on success modes mobilized to reduce it and 3) on weakening
conditions of these success modes. In other words, risk analysis would be a
data collection process dedicated to what is really happening in the daily work
and what is affecting it.
This data collection would seek to improve information held individually
in relation to the complexity of the cross-functional collective work, to make
visible dimensions that are difficult to access (politic, strategic,
organization, context…) and to make links between complexity of work and risks
incurred by patients. The aim of “spaces for sharing and exploring the
complexity of work” is to improve individual and collective knowledge on the
development of risky situations, to share them in the team in order to maximize
the real safety.
From a theoretical perspective, we consider that the concepts of risk
and risk analysis remain interesting to consider. However, the present research
work suggests redefining these concepts. Regarding radiotherapy safety issues,
we prefer to use the concepts of safe performance and risky performance instead
of the concept of balance between rules and practices.