Using a systems-theoretic approach to analyze safety in radiation therapy-first steps and lessons learned

Facilitating the application of systems‐theoretic process analysis in healthcare: Creating control structures using process maps

“…Even though STPA has been applied in healthcare (e.g., for radiotherapy, anesthesiology, sepsis treatment, etc. ; Adesina, Hussain, Pandit, Rejzek, & Hochberg, 2017; Chen, Khastgir, & Jennings, 2021; Kaya, 2021; Patriarca et al., 2019; Pawlicki, Atwood, McConnell, & Kim, 2019; Pawlicki et al., 2016; Samost‐Williams & Nanji, 2020; Silvis‐Cividjian, Verbakel, & Admiraal, 2020), the application of STPA can be challenging. In a small study, 65% of healthcare practitioners found the graphical system model used in STPA (i.e., the control structure) difficult to understand (Jun & Waterson, 2019).…”

“…In a small study, 65% of healthcare practitioners found the graphical system model used in STPA (i.e., the control structure) difficult to understand (Jun & Waterson, 2019). Creating a control structure was also felt to be effortful and a “complete re‐conceptualization” compared to process maps (Adesina et al., 2017; Silvis‐Cividjian et al., 2020). Furthermore, the engineering language of STPA may be unfamiliar to healthcare practitioners (Adesina et al., 2017).…”

“…Moreover, STPA utilizes a comprehensive analysis framework that considers unsafe interactions among components as well as environmental conditions. When compared with conventional techniques that focus on component failures, previous STPA applications in healthcare identified causal scenarios not identified with conventional techniques and produced new safety recommendations (Adesina et al., 2017; Pawlicki et al., 2016; Silvis‐Cividjian et al., 2020).…”

“…The general control structure is then expanded to show the embedded controllers and interactions. Previously published STPA analyses followed this practice (Adesina et al., 2017; Patriarca et al., 2019; Pawlicki et al., 2016; Samost‐Williams & Nanji, 2020; Silvis‐Cividjian et al., 2020). Control structure development stops after agreement is reached by the analysis team that the system is adequately modeled or when no new information surfaces (Kaya, 2021; Samost‐Williams & Nanji, 2020).…”

“…Control structure development stops after agreement is reached by the analysis team that the system is adequately modeled or when no new information surfaces (Kaya, 2021; Samost‐Williams & Nanji, 2020). If other parts of the system become relevant as revealed during the subsequent steps of STPA, the control structure is then iteratively revised (Kaya, 2021; Silvis‐Cividjian et al., 2020). To the best of our knowledge, a method to create control structures from process maps has not been previously developed and published.…”