Study On The Synthetical Evaluation System And Empirical Research Of Medical Institutions’Radiation Safety Culture Level

BackgroundThe ionizing radiation was increasingly applied in various areas since X-rays was discovered by Roentgen in November1895. With advances in medical science and technology, the medical industry has become the area where the radiologic technology is most widely used. X-ray diagnosis, clinical nuclear medicine, radiation therapy and interventional radiology became the important components of the modern medicine, bringing great benefits to the prevention and curation of human disease. However, risks can come with benefits; the protection from potential damage caused by medical radiation has drawn attentions. According to a report by the United Nations Scientific Committee on the Effects of Atomic Radiation, the medical exposure is a public to ionizing radiation suffered the largest artificial origin. Today, medical radiation protection becomes an important problem of public health because it involves all members of the public and their descendants.To strengthen the medical radiation protection and improve the safety of the working staff in this industry and the public, a lot of international and domestic regulations and standards were developed. But studies show that only low level of safety can be achieved through technological measures. While high level of safety can be achieved through management and organizational measures, it is the setup of safety culture that could bring about safety of fundamental level. Safety culture was "the sum of characteristics and attitudes which exists in the various units and personnel" and "a long-term awareness on the value and priority of security for workers and the general public of all levels of an organization, groups or individuals". It is clear that safety culture is a kind of Ideology or a concept independent of laws and regulations. It is intangible yet affected by many specific factors, and reflected from tangible and specific matters. So, it has great significance to evaluate the radiation safety culture rationally, comprehensively and scientifically.The arguments of this study are as below:First, it is an urgent requirement of medicine reality. Nowadays, medical radiation technology is widely used, more and more clinicians entered the ranks of radiation workers and more and more sophisticated equipments were used in the hospital almost to exceed the developed countries. But there has not been a corresponding increase in the awareness of radiation safety. With the increasing popularity of radiation treatment which means medical radiation dose increased as the greatest contribution of public ionizing radiation. It is especially urgent to focus on the issues of radiation safety, especially the medical exposure.Second, there is a lack of researches in the area of radiation safety culture. The research and evaluation of safety culture are prevalent in the areas like coal, aviation, nuclear energy and other fields, but it is much less in the medical industry. There is now serious lack of basic research of evaluation system, evaluation indicators and evaluation criteria.Thirdly, it is supplement of regulations and management rules. At present, China has its radiation safety management system model, which is effective on the rational allocation of radiation equipment, radiology permit access and occupational exposure hazard control. But it is not as satisfactory in terms of the development of radiation safety awareness and professional ethics, and the medical exposure hazard control. Enhancing radiation safety culture is a good complementary to the current health policy and a fundamental guarantee for healthy service development. ObjectiveBased on the research of safety culture theory and the survey of medical radiation safety culture, to develop a comprehensive evaluation model and evaluation methods to assess the different levels of radiation safety culture in Chinese health institutes; meanwhile, to explore the research method to establish evaluation indicators, evaluation criteria and scoring methodology principles, and to conduct empirical survey of the safety culture and safety management in hospitals. This study has great significance on the development of Chinese medical and health industry and will provide a solid theoretical and methodological foundation for the health policies.MethodsBased on the literature review, with the guidance of safety culture theory and the human error theory, this study developed research approaches on the comprehensive evaluation to radiation safety culture and established an indicator system and evaluation model of radiation safety culture according to the research approaches. The research steps of this study are:build the evaluation framework, establish initial indicators, define indicators, determine the weight of indicators, and empirical practice of the evaluation in hospitals.Related literature and industrial research results had been extensively reviewed for the framework study and data collecting, discussion and suggestion from experts and pre-experiment had been considered for the indicators defining, and Delphi method had been adopted for the weights of indexes. Finally, the reliability and validity of the evaluation model were also tested.Results1. There was a deep analysis on different influencing factors based on the survey of130radiation workers in42hospitals in Shandong.14factors were considered, which are:safety awareness of medical staff, safety needs, organizational commitment, management participation, incentive systems, authorized employees, communication systems, education and training, safety working environment, social safety values, social safety needs, socio-economic and productivity levels of development, and the national safety laws and regulations. By employing multiple regression and factor analysis, the research draws the following conclusion:the14influencing factors can explanation92.9%of safety culture system of medical radiation. In general, radiation safety culture level is low.2. A cross-sectional study of radiation safety culture and radiation safety management was investigated, and result shows the obvious difference between different levels of hospitals. Level3hospitals have better situation compared with level2or other hospitals on radiation safety culture awareness and responsibilities, safety management system, safety personnel, leadership commitment to safety duties, personnel qualification and training, and safety protection facility. In general, radiation safety culture level is low, most patients were not under attention of the medical worker during the radiation treatment and the safety protection facility is not used timely and properly.3. On the ground of the human error theory, the author traces human errors back to their cultural root in the complex socio-technical system, and establishes the assessment system of radiation safety culture in medical institutes, in which3assessment main bodies:decision level of hospital, management level of department, and execution level of general staff were included. The evaluations of the main body are in the context of the working environments. This complete assessment index system consist4first-class indicators,14second-class indicators and92third-class indicators. Every indicator has its weight on the basis of experts’ advices.4. In order to define the effectiveness and operational practice of safety culture system in health institutes, the author conducts safety culture evaluation in26hospitals in Shandong. Through the comparison of overall level of radiation safety culture, evaluation decision level of hospital, management level of department, execution level of general staff and the working environment, the evaluation draws the following conclusions:most hospitals’ score is among55to75, which means the safety culture grade is medium and needs improvement; the score of34.62%of hospitals is among75-95, which means their safety grade is relatively high and safety culture still has space to improve;3hospitals’ score is below55, which is the lowest grade and safety culture needs much improvement; only1hospital’s score is above95, and the radiation safety culture should be maintained.5. Reliability and validity assessment:①Internal consistency is good, Cronbach’s a coefficients of all indicators are higher than0.80or between0.60and0.80, some of them are even higher than0.9;②Content validity is good. The research has obtained various experts’suggestions and is recognized by professionals as well;③Construct validity is good, factor analysis is in line with logic relation, and the common factor extraction has good explanation of radiation safety culture system.Conclusions and suggestions:Based on the results of the research, following conclusions were reached. First, it can be certified that the assessment system is reliable, valid and comprehensive. Second, the methodology of the study of indicators and system is reasonable and feasible. Third, the weights of the indicators are scientific and accurate. Fourth, the evaluation model in the empirical research is reliable and effective.In view of the lower level of radiation safety culture in China, the suggestions were given below. First, advocate concept building to increase ideological cognition. Secondly, establish the institutional control to regulate management activities. Thirdly, strengthen supervision and management to improve security system. Fourthly, set up incentives to encourage proper healthcare behavior. Fifthly, advertise to the public to create good atmosphere of safety.Innovations and limitations:The innovations of this research were as follows:First, there are few studies on radiation safety culture currently. The researcher combine safety culture theory and the practice of the theory in medical institutions, to improve the radiation safety culture theory by deeply summarizing and analysing the connotation, characteristics and influencing factors of the safety culture theory. Second, it is a large-scale sample survey of the cognition of the radiation safety culture. It reveals the problems in the current radiation protection and medical management and the necessity and ways to upgrade the safety culture level.Third, this research establishes a comprehensive evaluation of radiation safety culture and allocates accurate weights for different indicators. The establishment of the evaluation system fills the gaps in this area and reduces the distance with other industries.Fourth, it shows that the evaluation model has relatively good reliability and validity. It can be a good method to self-evaluate for the medical institutes and a good supplement to the administrative policies and measures.Limitations:First, several indexes can be improved. The ultimate goal of establishing the evaluation model is to put it into practice, but it is very difficult to measure the indiscernible of the safety culture. It needs a lot of research to make the evaluation system perfect.Second, there are other methods being used in different areas and industries, it will be a great complement to to the system if these methods were used and comparative study be conducted.