Safety First: Developing and Deploying a System to Promote Safety and Quality in Your Clinic.

The terms "safety and quality" (SAQ) have become inextricably linked, highly used terms that together encompass a wide range of parameters within medical departments. Safety has always been a priority in radiation oncology; quality assurance has been foundational to our practice. Despite this increased focus and attention on SAQ, the "what" of SAQ remains ill-defined, largely because of the vast number of indicators that fall under this umbrella. Similarly, the "how" of developing and maintaining the highest standards of SAQ is not formulaic and varies based on the unique setting of individual practices. There are several excellent resources available to inform SAQ in radiation oncology, including the American Society for Radiation Oncology's "Safety Is No Accident," which provides an overview of safety and quality standards and resources. This review is intended as a brief summary of key considerations, with the goal of providing a practical framework and context for improving or developing a SAQ program in radiation oncology practices. We believe that the following 10 key elements, drawn from numerous reports that have appeared over the last decade examining this topic, should be considered when conceptualizing a practice-based approach to SAQ: establishing a strong safety culture; establishing a structured program for safety and quality; establishing up-to-date, relevant, and accessible policies and procedures; a system for peer review; systems to assess and reduce risk; an educational program focused on safety and quality; development and review of meaningful quality metrics; utilization of a physics quality control system; well-defined models for staffing, training, and professional development; and finally, validation from external bodies via accreditations and audits. These 10 items are addressed herein.