275 Background: Patient safety organizations recommend the use of policy and procedure manuals (PPM) to effectuate standards and guidelines in practice. In this work we explored inter-physicist variability in the interpretation of five established physics policies amongst physicists in our department. Methods: The policies for treatment planning, 2nd physics checks, 1st day physics checks, weekly chart checks and final physics checks were reviewed by members of the quality management team in our department. Specific definitive statements were extracted into a spreadsheet and provided to 11 physicists and 6 dosimetrists. The intent was to obtain individual responses on adherence to the statements and thereby assess the level of standardization in perception and practice amongst the staff using free-margin kappa statistics. The responses were limited to affirmation, rejection or non-applicability. A total of 732 responses were assessed. Results: Based on the Landis-and-Koch criteria for interpretation of kappa values, the consistency amongst the respondents varied from moderate (0.40-0.60) to good (0.60-0.80). The kappa scores for the statements assessed were 0.56 for treatment planning, 0.64 for second physics check, 0.70 for the first day physics check, 0.54 for the weekly physics check and 0.73 for the final physics check. Conclusions: Validating the effectiveness of PPMs by measuring uniformity in staff interpretation is an important step in establishing their effectiveness. Mere existence of a PPM may not be sufficient. This work demonstrated reasonable uniformity of interpretation of existing policies, but underscored the need for further improvement. The review of specific policy statements with weaker consensus may lead to more effective revisions and in-servicing to enhance clarity and reduce ambiguity, re-testable using the same approach. Absence of validation will tend to retain ambiguity, thereby rendering the policy not as effective as it could be.
Teaching Quality Management Model for the Training of Innovation Ability and the Multilevel Decomposition Indicators
