The Big Picture

Jane O’HallahanClinical Director National Screening Unit

Which approach?

• a nationally led programme with all aspects of the screening pathway implemented and monitored centrally

• a nationally led quality improvement programme with the development of national guidelines alongside DHB implementation and monitoring

• sector led implementation with screening part of improvements in routine care

Criteria for screening programmes

• The condition is suitable for screening• There is a suitable test• There is an effective and accessible treatment for the

intervention for the condition identified through early screening

• There is evidence that the programme is effective in reducing mortality and morbidity

• Potential benefits outweigh harms• There is appropriate follow-up and programme evaluation• There is consideration of social and ethical issues• Cost-benefit

Principles

1. Benefits of screening outweigh the harm2. People centred3. Achieve equitable access to the screening

pathway and equitable outcomes for all populations

4. Informed consent a priority throughout the screening pathway.

5. Monitored and evaluated regularly6. Continuous quality improvement in programme

management and clinical service delivery

Essentials of Screening

1. A central agency to lead and co ordinate the screening pathway

2. Clinical Governance

3. Infrastructure and systems to manage a screening programme

4. Monitoring and evaluation

5. Quality cycle

A central agency to lead and co ordinate the screening pathway

• Leadership on equity• Standards and indicators• Research and evaluation• Workforce development

Clinical Governance

• National Screening Advisory Committee

• DHB

Infrastructure and systems to manage a screening programme

• Fit for purpose population registers

• Policy framework

Monitoring and evaluation

• Individual performance monitoring

• Programme monitoring• Programme evaluation• Ethnicity data accuracy• Contract monitoring

The incident in a nutshell

• 4.5 million kiwis• 60,000 annual births • 20 DHBs• 150 screeners• 14 not following protocol• 5000 incorrectly screened (~3yrs)• 30 % responded to recall• 9 babies identified• 18 months

Key learnings

1. Robust coordinator role & training 2. Day to day oversight & support for

screeners3. Rigorous data monitoring (refer rate,

timings)4. Screeners aware of data monitoring 5. Open culture to avoid “hiding” mistakes6. Governance in DHB

Quality Cycle

• Incident management• Public reporting• Audit• Plan Do Study Act cycles (PDSA)

Essentials of Screening

1. A central agency to lead and co ordinate the screening pathway

2. Clinical Governance

3. Infrastructure and systems to manage a screening programme

4. Monitoring and evaluation

5. Quality cycle

Quality needs to drive screening. If adequate quality components are not in place, screening programmes should not operate, and new screening programmes should not be started.