Welcome to module no 5: mitigate from our seven weeks online course “Best Practices of Risk Management in 7 modules”. This module is where we make Radiotherapy safer and lay the foundation for process optimisation.

Content: Risk Evaluation & Treatment, Final Risk Rating

A lot of the steps we perform every day are verification steps. They are only done to reduce risks. It is an interesting excersise to look at our treatment steps and divide them into functional steps and verification steps. An obvious example: Delivering an IMRT treatment is an functional steps and doing a phantom measurement for an IMRT plan is a verification step.

Often the verifications steps become so embedded into our routine work that we stop assessing their value. Especially, because doing less is so hard for us humans. We want to do the best for the patients and doing less feels just not right. Risk management gives us a measure to assess the value of our verification steps. But first things first! The risks need to be evaluated! Optimisation based on essential risk management will be a topic discussed in a dedicated tutorial.


Risk Evaluation

In module 4 we rated risks without taking implemented mitigation measures into account. Why? To understand how big the risks actually are and to understand what effect the current verification checks have. Now it is time to discuss and decide how to handle the individual risks. The next two tables are part of the essential risk management workflow .

For each risk the team needs to decide on how to handle it?
The risk evaluation table suggest some possible ways.

Risk Evaluation Tabel:

Do nothing further i.e. accept the risk on the basis that you are doing all things reasonable, or that you can live with the consequences because the risk is rated low or minor.
Consider risk treatment options: reduce the likelihood of the risk or the consequences upon occurrence of the risk. Describe mitigation measurein the risk treatment tabel.
Undertake further analysis to better understand the risk. Add a measure called „to be defined“ to the Risk Treatment table, and assign a task to do the analysis.
Maintain existing controls.
Avoid the risk by discontinuing this activity – don’t do it. It is not worth the benefit, considering the cost upon occurrence.
Transfer the risk by way of contract, insurance, …
Other describe.

All risks you can’t accept after the risk rating ignoring all mitigation measures, need to be reassessed.

Risk Treatment

Ask yourself:

  • Do we already mitigate the risk? If yes, how?
  • If no. What can we do about the risk?
  • What need to be done?
  • Who is doing what?
  •  When is it done?

Record your answers in the risk treatment table:

Risk Treatment Table

Final Risk Rating:

To complete the analysing and mitigating part of the essential risk management activities: each risk is rated again. This time taking implemented mitigation measures (verification checks) into account.

This resulting risk rating will describe the risk as it is currently.

To have no confusion between implemented and planned mitigations, the planned should be recorded in the risk treatment table. They should not be part of the final risk rating. To avoid a false sense of safety.

When the planned measures are implemented the risk needs to be re-rated and the document updated.