From the School of Global Policy and Strategy, University of California, San Diego, California.
Department of Mathematics and Industrial Engineering, Polytechnique Montreal, Montreal, Quebec, Canada.
J Patient Saf. 2020 Dec;16(4):e352-e358. doi: 10.1097/PTS.0000000000000560.
All organizations seek to minimize the risks that their operations pose to public safety. This task is especially significant if they deal with complex or hazardous technologies. Five decades of research in quantitative risk analysis have generated a set of risk management frameworks and practices that extend across a range of such domains. Here, we investigate the risk culture in three commercial enterprises that require exceedingly high standards of execution: radiation oncology, aviation, and nuclear power.
One of the characteristics of high reliability organizations is their willingness to learn from other such organizations. We investigate the extent to which this is true by compiling a database of the major publications on risk within each of the three fields. We conduct a bibliographic coupling analysis on the combined database to identify connections among publications. This analysis reveals the strength of engagement across disciplinary boundaries and the extent of cross-adoption of best practices.
Our results show that radiation oncology is more insulated than the other two fields in its adoption and propagation of state-of-the-art risk management tools and frameworks that have transformed aviation and nuclear power into high reliability enterprises with actuarially low risk.
Aviation and nuclear power have established risk cultures that cross-pollinate. In both nature and extent, we found a distinct difference in radiation oncology's engagement with the risk community, and it lags behind the other two fields in implementing best practices that might mitigate or eliminate risks to patient safety.
所有组织都力求将其运营对公共安全构成的风险降至最低。如果他们处理复杂或危险的技术，这项任务就显得尤为重要。五十年来，定量风险分析的研究产生了一系列风险管理框架和实践，涵盖了一系列此类领域。在这里，我们研究了三个需要极高执行标准的商业企业的风险文化：放射肿瘤学、航空和核能。
高可靠性组织的特征之一是愿意向其他此类组织学习。我们通过编制每个领域的主要风险出版物数据库来调查这种情况的真实性。我们对合并的数据库进行了书目耦合分析，以识别出版物之间的联系。该分析揭示了跨学科界限的参与程度以及最佳实践的交叉采用程度。
我们的结果表明，与其他两个领域相比，放射肿瘤学在采用和传播已经将航空和核能转变为具有精算低风险的高可靠性企业的最先进风险管理工具和框架方面更加孤立。
航空和核能已经建立了交叉授粉的风险文化。在性质和程度上，我们发现放射肿瘤学与风险界的参与存在明显差异，并且在实施可能减轻或消除患者安全风险的最佳实践方面落后于其他两个领域。
