S6 E7 - Patient Safety First: How Collaboration and Innovation Are Shaping Safer Patient Care

 In this episode of AXREM Insights, Melanie Johnson and guest host Anna Vaughan are joined by Linda Carruthers, Head of Oncology Physics at the Edinburgh Cancer Centre, to explore how patient safety in radiotherapy has evolved and the challenges it now faces. Linda reflects on the major technological advances that have transformed radiotherapy safety, alongside a cultural shift towards openness, learning and true multidisciplinary working. She highlights how end-to-end testing, human factors thinking and a no-blame culture have become essential in identifying risks early and embedding safer practice across the entire patient pathway. 

The conversation also looks ahead, examining the pressures of rising demand, increasing treatment complexity and rapid technological change, including the growing role of AI. Linda stresses that patient safety depends on combining innovation with human expertise, careful governance and collaboration across clinical teams, suppliers and organisations like AXREM. The episode reinforces the importance of shared learning, standardisation and partnership in ensuring that safety improvements are not only discussed, but consistently implemented for the benefit of patients across the NHS. 

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Transcript

This Transcript is AI Generated and their for Spelling errors may occur. This is meant as a guide to accompany the audio and not as a stand alone representation of the episode.

00:00.000 --> 00:05.440]  Welcome to Axrem Insights, developing healthcare through medtech and innovation.
[00:05.440 --> 00:10.560]  Join Melanie Johnson and Sully Edgington as they talk with our industry leaders and experts.
[00:11.520 --> 00:17.280]  Hello and welcome to Axrem Insights, our patient safety podcast. I'm Melanie Johnson and I'm here
[00:17.280 --> 00:23.600]  with Anna Vaughan, Axrem's future leader representative and senior account manager at Varian.
[00:23.600 --> 00:29.360]  Today we have the pleasure to be speaking to Linda Carruthus, head of radiotherapy at the
[00:29.360 --> 00:33.760]  Edinburgh Cancer Centre. Welcome Linda and thank you for being on the show today.
[00:33.760 --> 00:37.680]  Now let's get started by handing over to you to tell us a little bit about yourself,
[00:37.680 --> 00:40.640]  what's your story and how did you end up here today?
[00:40.640 --> 00:46.000]  Yeah thank you, thanks very much for having me today. My name is Linda Carruthus and I'm the
[00:46.000 --> 00:53.360]  head of oncology physics as we call it in Edinburgh. I started basically in my career in medical
[00:53.360 --> 00:57.840]  physics, partly by not knowing anything about it if I'm honest and during my physics degree
[00:57.840 --> 01:01.360]  somebody said to me there's this thing called medical physics, I'm going to find out about it,
[01:01.360 --> 01:06.640]  do you fancy coming along? And I just thought well why not, but then very quickly realised
[01:06.640 --> 01:11.120]  that was something that I wanted to get into. So after joining and going through the training
[01:11.120 --> 01:15.840]  scheme as a clinical scientist, I've moved to various different jobs and taken on more
[01:15.840 --> 01:22.560]  and more responsibility becoming head of department here in Edinburgh in about 2016.
[01:22.560 --> 01:27.520]  And so yeah I've been lucky to have those opportunities to progress. I think what's
[01:27.520 --> 01:32.800]  brought me here today is more some of the national work that I've been involved in and procurement
[01:32.800 --> 01:39.040]  and looking particularly at the Scottish fleet of radiotherapy equipment and that's really
[01:39.040 --> 01:44.720]  heightened my involvement in specification and technical evaluation of equipment and then you
[01:44.720 --> 01:49.440]  know our building relationships with suppliers etc and understanding the interaction between
[01:49.440 --> 01:55.760]  customers and suppliers. Oh great thank you. So just obviously moving on slightly so we can
[01:55.760 --> 02:00.720]  kind of get into the detail and obviously you can elaborate on that further. Patient safety isn't
[02:00.720 --> 02:05.360]  just a regulatory requirement, it's the heartbeat of effective care delivery. As we navigate
[02:05.360 --> 02:11.440]  challenges across the NHS from outdated technology to rise in demand, the role of innovation and
[02:11.440 --> 02:16.000]  collaboration becomes even more critical. So today I'd really like to explore how industry
[02:16.000 --> 02:20.800]  expertise, technological advancements and communities like Axrem can collectively
[02:20.800 --> 02:26.400]  strengthen patient safety standards in imaging and diagnostics and the wider healthcare sector.
[02:26.400 --> 02:31.760]  It's really over to you Anna, over to your question. Thanks Mel. Hi Linda, so the first
[02:31.760 --> 02:38.480]  question I have for you is how has the management of patient safety changed during your time in
[02:38.480 --> 02:45.200]  clinical leadership? Yeah thanks Anna. I mean I think there's been really quite astronomical
[02:45.200 --> 02:51.200]  changes throughout my career in patient safety and you know radiotherapy itself is very
[02:51.200 --> 02:57.360]  technologically driven and I think the huge advantages in technology over those years
[02:57.360 --> 03:03.360]  have had a significant impact on patient safety. It's now quite difficult to actually do something
[03:03.360 --> 03:07.440]  that's unintended and you have to go through quite a lot of safety mechanisms to do that.
[03:08.000 --> 03:13.920]  So that in itself is definitely one of the big advantages I think and how have we got there I
[03:13.920 --> 03:20.080]  think is around sort of openness and a learning culture that we've adopted through various
[03:20.080 --> 03:24.480]  different things. Learning a lot as you know the basis of a lot of radiotherapy safety came from
[03:24.480 --> 03:31.280]  the airline industry and really recognising that actually radiotherapy is very safe in general
[03:31.280 --> 03:35.920]  but when things go wrong they can you know sometimes go quite significantly wrong so it's
[03:35.920 --> 03:41.360]  a bit analogous to airline travel being one of the safest forms of travel but you know we all
[03:41.360 --> 03:47.840]  hear about it if there is an issue that happens within the airline industry and I think the other
[03:47.840 --> 03:53.840]  one of the other big key things that's happened over those years is a change in the multi-disciplinary
[03:53.840 --> 04:00.800]  dynamic within radiotherapy. So going back to when I first started a long time ago there was very
[04:00.800 --> 04:07.040]  much more of a hierarchy that maybe the doctor had full control over everything, the physicists
[04:07.040 --> 04:12.560]  were sort of there to serve the doctors and the radiographers well they were you know they were
[04:12.560 --> 04:16.800]  delivering the treatment but you know that was kind of where their input stopped. As you fast
[04:16.800 --> 04:23.360]  forward to where we are now we truly recognise that none of us can deliver radiotherapy by ourselves
[04:23.360 --> 04:27.120]  we've all got something to bring to the table and we've all got quite different skills
[04:27.840 --> 04:34.640]  and I think the overlap of those has really evolved over those years but that also means
[04:34.640 --> 04:40.160]  that none of us are the expert in anything which we never really were but recognising that say
[04:40.160 --> 04:43.520]  it's the therapeutic radiographer that's actually going to be pressing the button there they're
[04:43.520 --> 04:47.920]  going to be the one who's actually going to irradiate those patients and they have to have
[04:47.920 --> 04:52.720]  full confidence in all the other things that have come beforehand to be able to deliver that as
[04:52.720 --> 04:59.520]  safely as they possibly can and recognising that that's not just something a sort of tick box
[04:59.520 --> 05:04.400]  exercise it's a really really important part of delivery of safe radiotherapy.
[05:05.760 --> 05:11.600]  So I think they're the main changes that have happened and I've got a good example of that
[05:11.600 --> 05:16.560]  kind of multidisciplinary working actually from my own experience whereby we were introducing a new
[05:16.560 --> 05:20.880]  treatment within Edinburgh and we'd employed a physicist to come and work the technique up and
[05:20.880 --> 05:26.800]  they've done loads of great scientific work they've run example plans on the Lanak etc
[05:27.520 --> 05:31.600]  they've written the documentation and we were ready to go we got our first patient in a really
[05:31.600 --> 05:39.600]  good compliant patient got them on the bed and we fell almost at the first hurdle because the
[05:39.600 --> 05:45.600]  physicist had mocked up the treatment in the way that they thought the radiographers would treat
[05:45.600 --> 05:49.600]  them which wasn't the way that it was done so the first thing was well we don't treat like that
[05:50.320 --> 05:54.480]  and then we hit a technological barrier where the equipment couldn't respond in the way that
[05:54.480 --> 05:59.200]  we wanted it to at that time and so we actually ended up treating one patient and taking another
[05:59.200 --> 06:06.000]  six months to iron out some of those issues so that kind of learning process is then fed into
[06:06.000 --> 06:10.720]  whenever we're introducing something new whether it's a change all the way through to a brand new
[06:10.720 --> 06:17.920]  technique or a huge piece of equipment thinking about that end-to-end test process not just that
[06:17.920 --> 06:23.520]  an end-to-end test has been done but that end-to-end test has been done by the people who would be doing
[06:23.520 --> 06:29.360]  it in real life on the patients and treating that end-to-end test as close as possible as
[06:29.360 --> 06:34.640]  a dry run that you could actually do with the patient and that's brought huge insight into
[06:35.280 --> 06:41.440]  that start to finish of that patient pathway and highlighted some things we've changed and
[06:41.440 --> 06:46.480]  been able to put in place before we've gone ahead and treated a patient so I think they're kind of
[06:46.480 --> 06:52.000]  the main sort of changes that I've seen as I say over the time that I've been working here in
[06:52.000 --> 06:58.880]  Edinburgh Cancer Centre. Fantastic, thanks Linda. I quite liked your comparison around the whole
[06:58.880 --> 07:03.360]  airline patient safety I've never really thought of that before but actually no it does kind of
[07:03.360 --> 07:09.360]  like resonate it as I say it's a catastrophic repercussions if anything goes wrong so yeah
[07:09.360 --> 07:14.000]  I love that and thank you for sharing that with us so I suppose really on to the next thing is
[07:14.000 --> 07:18.800]  around the biggest challenges so what are the biggest challenges you see in a clinical setting
[07:18.800 --> 07:26.480]  around managing and maintaining patient safety? Yeah so I think undoubtedly one of the biggest
[07:26.480 --> 07:32.800]  challenges we have is our capacity versus demand we know that demand is going up all the time for
[07:32.800 --> 07:37.200]  radiotherapy and we can measure things like demographic and incidence of cancer
[07:38.240 --> 07:44.400]  and the clinical elements of when radiotherapy might be being used within a patient treatment
[07:44.480 --> 07:49.760]  one of the things it's quite difficult to quantify and build into capacity and demand
[07:49.760 --> 07:56.640]  models is complexity and we are almost victims of our own success in the sense that we're able to
[07:56.640 --> 08:02.320]  target radiotherapy so much more effectively now and reduce side effects but that's meaning that
[08:02.320 --> 08:08.400]  patients are living a higher quality life potentially for longer but also then able to
[08:08.400 --> 08:13.680]  tolerate additional treatments and so if we have a patient who's come in for a treatment and then
[08:13.680 --> 08:20.560]  they come in a year later for another treatment that's not doing two separate radiotherapy plans
[08:20.560 --> 08:24.720]  it's more work than that because you have the two separate radiotherapy plans but you also then have
[08:24.720 --> 08:30.640]  to give real consideration to the impact of the first one on the second and the compromise with
[08:30.640 --> 08:36.480]  that requires a lot of interaction again requires quite a lot of input from the physics team as well
[08:36.480 --> 08:41.760]  as the medical team and the radiographers and that complexity matrix is something which is very
[08:41.760 --> 08:49.440]  difficult i think for us to us to keep up with and we're also moving towards there aren't any
[08:49.440 --> 08:54.800]  simple radiotherapy treatments anymore so again there's a perception really that some tumor sites
[08:54.800 --> 09:00.240]  were a bit easier if you like to treat than others but most of these are now becoming very complex in
[09:00.240 --> 09:07.440]  their own right so that complexity is is one of the main parts i think one of the other big challenges
[09:07.520 --> 09:12.960]  is the rate of change that we have in radiotherapy so as i said before we're
[09:12.960 --> 09:19.120]  very technologically driven and that those increases in or the changes in technology
[09:20.080 --> 09:24.480]  can also help us with that complexity so trying to deliver highly complex radiotherapy on one
[09:24.480 --> 09:27.760]  of the new machines is a lot easier than delivering it on one of the older machines
[09:28.320 --> 09:34.720]  undoubtedly because the workflows and the even the speed of the technology the processing power
[09:34.720 --> 09:42.960]  is is has caught up with some of the things that we're doing but it's also new learning
[09:42.960 --> 09:49.840]  for everybody for all sorts of different things and we talk we tend to talk within radiotherapy
[09:49.840 --> 09:55.600]  about categories of tumor types that patients might have so we might talk about breast radiotherapy
[09:56.320 --> 10:01.600]  but within breast radiotherapy there are now so many sub-sectors of what a treatment might look
[10:01.600 --> 10:06.320]  like whether we might be doing that in breath hold whether we be irradiating the nodal area
[10:06.320 --> 10:12.480]  or just the breast or just the chest wall and so within every tumor site there's more and more
[10:12.480 --> 10:18.880]  options that we're using clinically which require different decisions to be taken in advance of the
[10:18.880 --> 10:25.440]  treatment during the treatment and after the treatment so overall those things are probably
[10:25.440 --> 10:31.120]  the hardest things to manage along with that pace of change because we just don't stand still
[10:31.600 --> 10:35.600]  which I think is one of the things that makes it a really rewarding career to work in and certainly
[10:35.600 --> 10:40.080]  something which I've loved as I've moved forward each time you think you're getting to a point
[10:40.080 --> 10:46.400]  where we're doing things as well as we can something new comes along but managing change
[10:46.400 --> 10:52.160]  in an effective way with people who are under pressure and already working at capacity is
[10:52.160 --> 10:57.520]  probably one of the biggest challenges and maintaining safety around that again therefore
[10:57.520 --> 11:04.720]  is one of the biggest things that we need to take into account when we're planning change
[11:04.720 --> 11:09.200]  within radiotherapy as I say even if it's a workflow thing or a new treatment or a new
[11:09.200 --> 11:15.920]  piece of equipment yeah absolutely I think as well just think about what you're saying there
[11:15.920 --> 11:22.880]  how do you communicate that so well obviously because I suppose with patient safety there
[11:22.880 --> 11:28.000]  could be a lot of issues around human error as well so how do you kind of overcome that how
[11:28.000 --> 11:33.520]  would you communicate all this fast changing technologies and stuff within your departments
[11:35.200 --> 11:39.520]  I think the first thing that we have to acknowledge is that human error is a real thing
[11:39.520 --> 11:45.600]  and and again I suppose that is another part which has changed hugely over the years
[11:45.600 --> 11:50.560]  in terms of recognizing that when somebody makes a mistake it's not because they're not trained
[11:50.560 --> 11:56.080]  properly or they haven't been paying attention or you know they're not very good at their jobs
[11:56.080 --> 12:00.640]  a lot of the time that a mistake has been almost enabled to be happened because the
[12:00.640 --> 12:07.760]  way we've designed it designed our processes and our pathways really so I think the whole human
[12:07.760 --> 12:14.080]  factor element that's come in is something which has really allowed us to help staff recognize
[12:14.080 --> 12:20.000]  that when mistakes are made it's about trying to look for a process change that might stop that
[12:20.000 --> 12:24.240]  from happening again it's almost like rather than finger pointing to say to somebody you made a
[12:24.240 --> 12:29.120]  mistake and this happens it's a bit like you've identified a place where a mistake could be made
[12:29.120 --> 12:35.040]  so let's try and work out how we can then go and change what we're doing to minimize the risk of
[12:35.040 --> 12:42.160]  that happening and I think also that some of the analyses of these errors has come on a long way
[12:42.160 --> 12:47.680]  because we used to be very fall into the trap of putting in a safety barrier at the end of a process
[12:47.680 --> 12:53.040]  because that's where we detected it and so often we detect our errors in radiotherapy at on the
[12:53.040 --> 12:56.720]  treatment set when we're actually treating the patient but actually the fundamental error happened
[12:56.720 --> 13:04.320]  way back in the pathway and so being able to use some of the you know well recognized analysis
[13:04.320 --> 13:08.880]  of errors to be able to identify where it's the earliest part in the pathway that we might have
[13:08.880 --> 13:15.120]  been able to do something different that would catch this so that bit then about translating
[13:15.120 --> 13:21.200]  that into when we're managing change one of the key things is who are the people that are involved
[13:21.200 --> 13:29.040]  in that change so again traditionally say that it the physics team may well have been the ones that
[13:29.040 --> 13:32.400]  said we're going to make this change and this is how we're going to do it go away and do that to
[13:32.400 --> 13:39.040]  the other people whereas we've all learned that the most effective way to design something new
[13:39.040 --> 13:44.240]  is co-design having the right people involved in the right place at the right time and really
[13:44.240 --> 13:50.160]  having developing that listening culture to listen and actually understand why something might be
[13:50.160 --> 13:53.280]  more difficult for somebody further down the line than you thought it was going to be
[13:54.000 --> 14:00.480]  and we do joke you know within radiotherapy that if I plan a plan the radiographers don't deliver
[14:00.480 --> 14:05.920]  it in the way that I think they're going to and they don't talk about it in the same way as I talk
[14:05.920 --> 14:11.120]  about it so we need to translate even when we're all working in a very niche part of health care
[14:11.200 --> 14:16.480]  we need to translate between each other so I think the involving the right people at the
[14:16.480 --> 14:24.160]  right place right time is really important and then recognising that we need to make sure that
[14:24.160 --> 14:28.960]  the structures that we have to support that are appropriate so that may well be documentation
[14:28.960 --> 14:34.720]  and again we work obviously in the UK at least and and many of the of the westernised countries
[14:34.720 --> 14:40.320]  within a quality system environment and getting that right so it's not a document which you write
[14:40.320 --> 14:44.800]  once and nobody ever looks at ever again but it's actually a working document which supports the
[14:44.800 --> 14:51.120]  work on the on the ground and more recently we've translated that actually with the work that we did
[14:51.120 --> 14:57.120]  when when Anna and I first were working together was around our digital workflow and this is another
[14:57.120 --> 15:04.560]  area where the changes in technology the changes in use of digital tools has allowed us to build in
[15:04.640 --> 15:11.440]  safety mechanisms checks and balances and cope with differing circumstances that come up
[15:11.440 --> 15:16.880]  by utilising those digital workflow tools in the right place at the right time at the point of need
[15:17.600 --> 15:22.400]  so when you've got these things in place a little bit it's far easier to bring people along with you
[15:22.400 --> 15:27.920]  because you can go and demonstrate things to them you can answer that what what about ifs and
[15:27.920 --> 15:33.680]  ands and pots and pans that always come in and then you can also be a little bit more
[15:33.680 --> 15:38.160]  dynamic in the way that we can react to changes when people say oh but we didn't think about
[15:38.160 --> 15:42.240]  that you actually you know you're right we didn't think about that element of this
[15:42.240 --> 15:48.080]  so now we are thinking about it and we can quite quickly sort of integrate that into our processes
[15:49.200 --> 15:55.360]  so it's not easy and we do get people with what I call change fatigue I think who are sometimes
[15:55.360 --> 16:01.680]  a bit like can we not just stand still for one minute but that's part of change management in
[16:01.680 --> 16:06.480]  terms of trying to plan out and be strategic about when you're introducing the new changes
[16:06.480 --> 16:11.280]  and not necessarily doing everything all at once yeah no definitely thank you for that
[16:12.880 --> 16:18.560]  great some really nice points covered there linda really enjoyed the kind of highlighting
[16:18.560 --> 16:24.560]  the no blame culture and the kind of co-creation of processes which leads me on very well to
[16:25.520 --> 16:30.560]  our next question so when we think about kind of trying to look at processes and
[16:30.560 --> 16:37.840]  automating processes this question is is a very hot topic so AI and its implementation
[16:37.840 --> 16:43.680]  into NHS workflows how do you see it affecting the future of patient safety
[16:45.760 --> 16:50.320]  yeah I mean obviously this is a really hot topic at the moment and there's no doubt that AI
[16:50.320 --> 16:55.440]  is exciting in terms of the potential that it has to help us with quite a lot of aspects of
[16:55.520 --> 17:02.080]  healthcare in general and radiotherapy specifically I also think that we're perhaps at a stage where
[17:03.040 --> 17:07.600]  it's one of those things that everybody's looking at and just sort of saying AI is going to solve
[17:07.600 --> 17:13.280]  this problem for us AI is going to to be the thing that works this out but we must never ever lose
[17:13.280 --> 17:19.840]  sight of the fact that we are treating people and people are not and they can't be categorized
[17:19.840 --> 17:25.120]  and we can we might be quite predictive in some of our behaviors or maybe some of our anatomy if
[17:25.120 --> 17:32.000]  you like but we're inherently people and we're using people to treat people and design those
[17:32.000 --> 17:38.320]  those treatments and so AI will never be able to replace a radiographer setting up a patient on
[17:39.440 --> 17:46.960]  on a treatment couch they will never be able to replace that part of engaging with the patient
[17:47.600 --> 17:53.280]  listening and hearing their concerns and also looking out for what's actually happening with
[17:53.280 --> 17:59.680]  them during treatment and whether that's through a sort of analysis of some of the things that's
[17:59.680 --> 18:06.720]  going on with them or or the personal touch so that radiotherapy is inevitably going to be
[18:06.720 --> 18:13.360]  positively influenced by AI but I also heard a descriptor of it when it was actually about
[18:13.360 --> 18:21.120]  radiology and the use of AI within the diagnostic space and what this said was that AI will not
[18:21.120 --> 18:27.520]  replace radiologists but radiologists that use AI will replace radiologists that don't and I think
[18:27.520 --> 18:35.280]  that's something which I've held quite close to myself as I'm planning out with some of our AI
[18:35.280 --> 18:41.760]  changes that we might make that overall AI plus human trumps AI alone or human alone
[18:41.760 --> 18:48.240]  so what we've got to be able to do is be able to use it but we also must fundamentally understand
[18:48.240 --> 18:52.880]  where its limitations are where where it might fall down where it's advantageous
[18:53.520 --> 18:58.320]  but it really will if we get that right will give us the real opportunity to be able to
[19:00.000 --> 19:07.200]  use AI most effectively for the things where that kind of individualization the patient specific
[19:07.200 --> 19:12.080]  bit of it is less likely to influence it so we might be able to do some more routine things
[19:12.080 --> 19:17.280]  more quickly more effectively with AI but that will then allow us to be able to concentrate
[19:17.280 --> 19:23.040]  our expertise on these ever greater complexity cases the ones that actually really need more
[19:23.040 --> 19:30.160]  investment of our time because our time will be better spent you know looking at some of those
[19:30.160 --> 19:36.240]  those particular complexities on the other hand we've also got to recognize that we ourselves
[19:36.240 --> 19:41.840]  are human beings and we can't do highly complex work all day every day if you take away all the
[19:41.840 --> 19:47.760]  stuff that we do which is a little bit lighter in terms of like it's told upon us you know even
[19:47.760 --> 19:53.200]  just you know some of the jobs we don't like but sorting through emails or you know doing some
[19:54.080 --> 19:58.160]  for the doctors actually sitting and doing some outlining if you're only ever asking people to
[19:58.160 --> 20:02.160]  do very very complex work all day every day they're going to burn out really really quickly
[20:02.880 --> 20:09.120]  so we're going to have to adapt the way in which we expect our workers to work when we've got AI
[20:09.920 --> 20:16.000]  but we are going to be able to see I think some capacity benefits to it but we have to have a
[20:16.000 --> 20:22.160]  note of caution in terms of the way that we implement it the way we understand what it's
[20:22.160 --> 20:27.920]  doing the way when we see where it might not work and then also another big key part of it is how
[20:27.920 --> 20:32.480]  it will fit into our governance particularly working under the you know the ionizing radiation
[20:32.480 --> 20:37.840]  regulations under ERMA and sort of saying well who who is the operator now if it's an AI that's
[20:37.840 --> 20:44.000]  gone and done all of this who's the practitioner but we can move with that as a profession but I
[20:44.000 --> 20:49.760]  think there's a lot of caution that we'll have to have around just securing the responsibility of
[20:49.760 --> 20:55.680]  each of those parts of the pathway like we do at the moment so I think that I think they're the
[20:55.680 --> 21:01.680]  kind of main issues that we will see with AI but I mean probably you'll ask me this question again
[21:01.680 --> 21:06.400]  in even six months and I may have a completely different answer because it's such a fast evolving
[21:06.400 --> 21:11.920]  space that we're working in yeah absolutely 100 agree with you that AI anything AI at the
[21:11.920 --> 21:18.240]  moment is just absolutely crazy it's just the conversation of everything to be honest
[21:18.960 --> 21:25.040]  but I think from my perspective as I say obviously not working in the HS but I've slowly started
[21:25.040 --> 21:31.680]  introducing AI into my everyday work but it's sensible to be cautious 100 agree but it I am
[21:31.680 --> 21:36.720]  slowly starting to see the benefits so I think once you kind of start seeing some benefits
[21:37.440 --> 21:44.400]  it helps you to kind of build that trust with it so I think yeah but I totally agree as I say I
[21:44.400 --> 21:49.360]  think it's going to be ever evolving and it's quite exciting really to see where it will go
[21:49.360 --> 21:53.600]  I know there is an element of a bit of worry thinking where will it go but I also do think
[21:53.600 --> 21:57.840]  that there is a lot of excitement around it and it is exciting to see where the future goes with
[21:57.840 --> 22:01.920]  it but you're just moving on just and this kind of works quite nicely actually because
[22:01.920 --> 22:07.360]  you've just been speaking around human and AI collaboration but I just want to just touch on
[22:08.080 --> 22:14.400]  Axrem strategic priorities 25 to 27 so a big part of that highlights patient safety first and
[22:14.400 --> 22:20.640]  foremost so within all of the special focus group meetings we hold when we're considering
[22:20.640 --> 22:26.640]  a piece of work we always bring it back to the patient which I think is is really important and
[22:26.640 --> 22:30.240]  I just obviously want to just highlight a piece of work that we've done recently around our
[22:30.240 --> 22:35.440]  radio patient radiotherapy patient video as I say this was kind of designed by the radiotherapy
[22:35.440 --> 22:41.760]  special focus group and it's aimed at patients to understand what radiotherapy is and hopefully
[22:41.760 --> 22:46.640]  combat any of those kind of scary myths so again obviously if anybody's going through this at the
[22:46.640 --> 22:50.640]  moment I would direct you to the Axrem website just to have a little look at that it is really
[22:50.640 --> 22:55.840]  it is really useful and hopefully you'll find it useful too but I think going back to obviously
[22:55.840 --> 23:00.880]  my question I was going to ask is just what do you think the role of collaborative communities
[23:00.880 --> 23:09.680]  like Axrem in spreading best practices across the trusts should be? I think there is there's an
[23:09.680 --> 23:15.600]  important role and my obviously my experience is within radiotherapy and I would say radiotherapy
[23:15.600 --> 23:20.880]  is unlike some other areas in terms of the relationships that we have with the main
[23:20.880 --> 23:26.160]  manufacturers and vendors because there's not huge numbers of people out there and so
[23:27.040 --> 23:32.960]  when we you know when we meet with the sales people it's not like a sales culture it's not
[23:32.960 --> 23:38.160]  like a hard sell it's much more of a partnership because we're working towards the same thing
[23:38.800 --> 23:44.640]  that partnership element of it allows us to to go a little bit deeper into the how we're using it
[23:44.640 --> 23:51.520]  and the why we're using it being able to learn about things and really think well how does does
[23:51.520 --> 23:56.960]  my piece of equipment do that you know does that translate is that something which only happens
[23:56.960 --> 24:02.960]  with something else so being able to to have genuine collaboration with a view to safety is
[24:02.960 --> 24:07.600]  is one of the most important things so you're transcending the bit that says my piece of
[24:07.600 --> 24:12.080]  equipment is better than your piece of equipment or it does this or it does that is it fundamentally
[24:12.080 --> 24:18.240]  safe and safe for the staff to use so that's one thing that I think is really important I
[24:18.240 --> 24:24.560]  think the other thing is when we do get some guidance or publications so such as recently
[24:24.560 --> 24:29.280]  we've had the advancing safer radar radiotherapy that was published through the radiotherapy board
[24:29.280 --> 24:35.760]  it's vitally important that the trade people are aware of that and and think and use that to inform
[24:35.760 --> 24:40.960]  that some of their strategic decision making and I appreciate that for many of the big companies
[24:40.960 --> 24:46.560]  you know the UK is a relatively small part of their market but that is what we're working
[24:46.560 --> 24:52.400]  under and being able to assess and highlight where equipment may or may not support those
[24:52.400 --> 24:58.640]  kind of approaches is something again which is very important and thirdly again is some of the
[24:58.640 --> 25:04.320]  the work that's been done say in support of radiotherapy UK and just raising the profile
[25:04.400 --> 25:11.040]  of what we do and that there's a requirement for it so that patients can benefit from it rather
[25:11.040 --> 25:16.880]  than so that more things can be sold etc I think is really something which I've really
[25:16.880 --> 25:21.840]  recognised and supported by Axram is something which is very very important that people can
[25:21.840 --> 25:25.760]  leave their company that they work for at the door but actually go and have a conversation around
[25:25.760 --> 25:30.080]  that and I listened to one of the previous podcasts that had I think some of the people
[25:30.080 --> 25:34.560]  from the radiotherapy working group on it and it's quite rewarding to hear that that
[25:34.560 --> 25:40.160]  professionals who as I say are in there essentially to make money are able to have
[25:40.160 --> 25:46.720]  that kind of collaboration and if that really is as focused as it can be on how we use equipment
[25:46.720 --> 25:52.800]  and the limitations of it that in itself is very reassuring to us as staff and the consequence of
[25:52.800 --> 25:58.560]  that will hopefully be that increase in patient safety. Yeah no thank you for that so just
[25:58.560 --> 26:04.320]  obviously for your awareness really I suppose. Axram at the moment are trying to increase our
[26:04.320 --> 26:10.640]  visibility with clinicians so we feel like as Axram obviously our presence within government
[26:10.640 --> 26:14.320]  etc and our government affairs work that we're doing at the moment we feel like we can really
[26:14.320 --> 26:19.600]  help obviously elevate and amplify the voice of clinician teams as well so from our perspective
[26:19.600 --> 26:26.240]  it's really really key that obviously the NHS colleagues etc are liaising with us and making
[26:26.240 --> 26:32.640]  sure we're part of that kind of process but I suppose we can obviously help shape as well that
[26:32.640 --> 26:38.240]  national safety guidelines as well and any kind of standards so we've got that kind of bigger
[26:38.240 --> 26:42.640]  picture because obviously we're all part of this it should be a collaborative effort in my opinion
[26:43.520 --> 26:47.680]  and I suppose I've just got another question just off that if that's okay is what do you think
[26:48.480 --> 26:54.320]  these communities can do to ensure best practice is not just shared but actually
[26:54.320 --> 26:58.560]  implemented across different trusts because I know they act very independently
[26:58.560 --> 27:04.800]  so what could we do better I suppose to make sure it is kind of seen across all trusts?
[27:06.080 --> 27:10.720]  Yeah I mean that's a good question it's quite difficult to answer but on the other hand
[27:11.280 --> 27:18.080]  there is the bit about visibility and there's a bit about then translating some of that learning
[27:18.080 --> 27:24.720]  into the products and the pathways that come with it so I think
[27:26.240 --> 27:31.200]  whilst I was saying that we are able to be relatively customisable we are able to
[27:31.200 --> 27:36.080]  customise our workflows quite well and quite quickly we are still working within the
[27:36.080 --> 27:40.480]  parameters of the software that we're using it's not completely and utterly customisable
[27:40.480 --> 27:44.240]  and so actually building some of those sorts of things to give us tools which we can then
[27:44.800 --> 27:48.800]  adapt a little bit to our own areas is definitely one of those things
[27:49.840 --> 27:55.520]  I mean obviously we can often just point the finger at resource to say that if a trust can't
[27:55.520 --> 28:01.120]  afford to buy x y or z then there's no way that they're going to be able to implement it
[28:01.120 --> 28:07.600]  so that kind of support with that campaigning for you know appropriate technology within healthcare
[28:07.600 --> 28:13.600]  and appropriate replacement it's vital that we keep our equipment as up to date as we can not
[28:13.600 --> 28:19.040]  just because we want to shine a new thing or you know it's nice to have but we've spent a lot of
[28:19.040 --> 28:25.920]  time here talking about technological advantages advances and things which can be learned so we
[28:25.920 --> 28:30.960]  need to be having more up-to-date equipment to be able to have the most up-to-date tools that has
[28:30.960 --> 28:36.880]  embedded that learning within the product that we're actually using so I think that kind of
[28:36.880 --> 28:42.800]  that bit of sort of campaigning about it is important the rest of it probably is a bit more
[28:42.800 --> 28:47.920]  to do with the community itself to be able to to try and work on some of those things and undoubtedly
[28:47.920 --> 28:52.080]  that sort of more standardization of approach is something that we are all working towards
[28:52.640 --> 28:57.920]  partly because we're limited in our resource you know we know there's a massive shortage
[28:57.920 --> 29:02.240]  worldwide of clinical oncologists medical physicists and therapeutic radiographers
[29:03.040 --> 29:09.600]  therefore we have to use our resources most effectively as we possibly can and the days of
[29:09.600 --> 29:14.160]  us all being able to do five different approaches to something that is just not practical anymore
[29:14.160 --> 29:19.520]  even if people would like to do it so there's a lot of work that we have to do but again being
[29:19.520 --> 29:24.240]  able to make product change requests and being able to have them acted upon or at least get
[29:24.240 --> 29:28.000]  answered even if it's not acted upon even if somebody you can't make a change but to get an
[29:28.000 --> 29:32.960]  answer from it they're the sorts of interactions with manufacturers which are really useful
[29:32.960 --> 29:38.320]  really useful to us as clinicians on the ground so I think they're probably the main ways that
[29:38.320 --> 29:45.600]  that kind of the community can help us as clinicians in their actual you know cancer
[29:45.600 --> 29:51.040]  centers yeah no thank you Anna do you have anything to kind of add on that from a like supplier
[29:51.040 --> 29:56.960]  perspective at all yeah completely I mean I think the points of kind of standardization
[29:57.680 --> 30:03.680]  of workflows is such an important thing and making sure that you know what the customer needs to use
[30:03.920 --> 30:08.720]  is appropriate and suitable and you know meets the needs of their day-to-day like you know
[30:08.720 --> 30:15.120]  brady therapy ultimately scan planning and treating but there are nuances in each center so
[30:15.120 --> 30:22.720]  you know it's so important that I guess as a trade association representation in terms of
[30:22.720 --> 30:28.640]  axiom you know all the manufacturers coming together listening to the requirements campaigning
[30:28.640 --> 30:35.600]  for what's needed campaigning for um you know what's important um I really think is is yeah
[30:35.600 --> 30:40.960]  the the be all and end all really brilliant thank you right we're going to have a little bit of a
[30:40.960 --> 30:46.640]  change in uh kind of question now so I haven't said this for quite a while now quirky question
[30:46.640 --> 30:53.280]  time uh so um I'll go to you first Linda um and Anna I'm going to come to you next because I
[30:53.280 --> 30:58.400]  want you to answer this as well so if you could swap brains with any historical figure for a day
[30:58.400 --> 30:59.680]  who would it be and why
[31:02.320 --> 31:07.840]  so again I think this is an interesting question I think and my first thought was to to um swap
[31:07.840 --> 31:12.720]  with somebody that you know I felt has had some kind of inspiring impact on something which is
[31:12.720 --> 31:18.000]  quite tangible to me so the person I first thought of is not particularly historical in
[31:18.000 --> 31:23.600]  fact is still alive it's actually um a marathon runner who the first woman to run the boston
[31:23.600 --> 31:30.320]  marathon so a woman called kathrine switzer who entered the boston marathon in 1979 I think it
[31:30.320 --> 31:39.040]  was or maybe even before then I think 1972 it was um entered just using her initials uh got a man
[31:39.040 --> 31:45.520]  to go and collect her bib etc started running with a wearing a hoodie um and was running the
[31:45.520 --> 31:51.040]  marathon obviously the hoodie kind of came off and partway through the marathon um then the
[31:51.680 --> 31:57.840]  the course organizer discovered that there was a woman and became so irate that chased after her
[31:57.840 --> 32:04.720]  and tried to rip the bib um off her to sort of say give me back my number um and anyhow was
[32:04.720 --> 32:09.200]  fought off and she went on and completed the marathon and it was you know it's very inspiring
[32:09.200 --> 32:14.880]  because there's somebody who's gone to utilize utilize their sort of position to try and make a
[32:14.880 --> 32:20.640]  fundamental change and it really shook up athletics but what I was thinking about was changing brains
[32:20.640 --> 32:25.680]  with somebody what the person I'd actually like to change the brain with is actually the course um
[32:25.680 --> 32:32.720]  the you know organizer on that day to understand why somebody could be so angry about something
[32:33.440 --> 32:39.200]  which was that a woman was too fragile to run a marathon um what wasn't sort of you know something
[32:39.200 --> 32:43.520]  that they could they could get their head around but to get so angry that you'd want to chase after
[32:43.520 --> 32:49.280]  and try and knock somebody down but then the interesting next part of the story is that they
[32:49.280 --> 32:55.760]  then became friends thereafter and then women were were allowed not until five years later
[32:55.760 --> 33:00.560]  to actually enter the boston marathon but that process of change that that person went through
[33:00.560 --> 33:06.080]  from from this position of anger and absolute defiance that women would not be allowed to enter
[33:06.080 --> 33:11.280]  in to be able to recognize that it was okay and it's something that should be supported and
[33:11.280 --> 33:16.080]  actually then to become friends with that person I think that that thinking would be very interesting
[33:16.080 --> 33:21.440]  to uh to experience in real life absolutely when you first mentioned about the brain of a marathon
[33:21.440 --> 33:28.160]  runner I was thinking brain yeah legs no it was my first thought but no no that that's really
[33:28.160 --> 33:32.960]  interesting actually I've not heard that story before so thank you for sharing that um and over
[33:32.960 --> 33:40.160]  to Anna so who would you like to swap brains with so keeping to the theme of the podcast and
[33:40.160 --> 33:46.880]  radiotherapy I think um stopping brains with mercury would be pretty fascinating um obviously
[33:46.880 --> 33:54.160]  she's renowned for changing the world um one not once but twice she obviously founded the science
[33:54.160 --> 34:02.480]  of radioactivity um discovered um and launched effective cures for cancer um she won the noble
[34:02.480 --> 34:09.680]  peace prize twice um which is pretty epic but really it's more so um as a woman in science
[34:09.680 --> 34:15.360]  and again on the theme of I'm sure it was a tricky time to have been a woman in science
[34:15.360 --> 34:20.160]  and the types of challenges she would have had to come up against and also overcome I think it would
[34:20.160 --> 34:24.480]  be really interesting to swap brains with her yeah no it would have been it would be interesting
[34:24.480 --> 34:29.280]  person actually that's a good one so thank you it's been great to get to know a little bit more
[34:29.280 --> 34:34.000]  about Linda and get some further insights into how patient safety is dealt with within a clinical
[34:34.000 --> 34:40.240]  setting a big thank you to Linda for joining us today thanks to Anna for being our guest host and
[34:40.240 --> 34:44.320]  thank you to all the listeners if you have enjoyed today's podcast don't forget to hit
[34:44.320 --> 34:50.880]  subscribe or feel free to share the podcast with friends