By Colette Brett, Head of Quality, Safety and Risk, National Screening Service
We deliver four national population-based screening programmes - for bowel, breast, and cervical cancer, and for diabetic retinopathy in people who have diabetes. Screening programmes must constantly balance the benefits and harms that are a recognised part of population-based screening. Robust and effective quality assurance (QA) is required to help maintain this balance.
So, what is QA?
It’s the process through which our screening staff and teams are accountable for the quality and safety of screening, and of the experience of everyone who takes part. We specify the standards that we hold ourselves accountable to and we outline the actions we take to show that our screening programmes are doing what they were set up to do.
QA covers the entire screening pathway - from identifying those eligible for screening, to inviting people for screening, and referring people for further tests and treatment where this is needed. We have QA standards for each of our four screening programmes. Our standards are in line with the highest international standards and promote practice that is consistent, effective and evidence-based.
Governance
We have four QA committees – one for each screening programme.
- Our screening programme management teams measure and monitor their respective QA standards and report to their QA committee.
- The QA committees report to our overall Quality, Safety and Risk Management committee.
- This committee provides assurance to our Chief Executive, and in turn to the HSE board, that the quality and risks relating to our screening programmes are being effectively managed.
A standardised approach
We’re creating a standardised, cross-programme approach to quality assurance. We’ve developed a Quality Assurance Policy Framework to support our screening programmes to make use of structures, policies and procedures in a standardised and consistent manner, enabling them to identify opportunities for improvement.
This framework was our starting point in the development of further supports. The first support is our Standard Setting and Revision Procedure which provides a standardised and consistent approach to setting quality standards for each programme. This new approach can be seen in the recent edition of our Standards for Quality Assurance in Colorectal Screening. We will apply it to our other programme standards when they are due for review.
As we progressed through our QA work, it was evident that there are common themes across the programmes, including communications, risk and incident management, and information governance. This led to the development and recent publication of our Quality Manual for Population Screening Programmes which sets out the QA structures and processes for these common themes. This means that standards for our screening programmes can focus specifically on the programme.
Our QA framework, standards and supporting documents are published on our website.
Continuous improvement
We monitor the quality of our screening programmes against all standards. This helps to:
- identify the strengths of our screening programmes
- highlight areas that may need improvement
- demonstrate what safe, high-quality care should look like and what to expect from the service
- continuously improve the performance of all parts of the screening pathway.
QA work never ends. We continue to strengthen our QA structures, processes and procedures. We’re now developing QA governance information supports and we’ve started a review of our QA framework.
We work to continually improve what we do, to demonstrate our accountability to our screening participants, and to build trust and confidence in our screening programmes to support people to choose screening.