Ensuring health, ensuring safety: risk management by radiographers working in radiotherapy

Radiographers working in the control room are the last line of defence in radiotherapy before the actual treatment. They have two main goals: (i) ensuring patient health by providing daily care and avoiding appointment cancellations and (ii) ensuring patient safety by providing care under the prescribed conditions and avoiding incidents and accidents. Conflicts between these two goals may arise in non-nominal situations. The aim of this paper is to highlight the trade-offs radiographers sometimes make by analysing how they managed 59 non-nominal situations. In 47 of the situations, the radiographers resolved the conflict without being forced to make "sacrifice decisions" in support of one or other of the two goals. In the 12 remaining situations, the conflict management was accomplished by a trade-off between the goals of patient health and patient safety. When making sacrifice decisions, radiographers take into account the expected risks and benefits for the patients on the one hand, and the treatment phase, along with knowledge about co-workers' behaviour and patient satisfaction, on the other.' satisfaction.