the big picture jane o’hallahan clinical director national screening unit
Post on 03-Jan-2016
221 Views
Preview:
TRANSCRIPT
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.
top related