Dr. Alan Smith, Specialist in Public Health Medicine at HSE, National Screening Service (NSS) in Ireland, recently tested the feasibility of moving from traditional paper-based surveying of patients being screened for bowel cancer, to real-time capture of patient views. After 5 months, the team led by Alan, has not only proven feasibility, but exceeded expectations with an unprecedented 50% survey completion rate through SMS. He would love to see digitised Patient Reported Measures (PRMs) being utilised across all population screening programs in Ireland.

The team’s success hasn’t happened by chance. Through clear communication strategies and focused staff engagement, Alan and the team engineered their project for success.

This is how they did it.

Like many who make the jump into public health medicine, Dr. Alan Smith started out on the frontline of healthcare in general practice. Driving him was a desire to have an influence on healthcare at a population scale rather than just on a one-on-one basis. With this, he found his way into the then National Cancer Screening Service, being part of the team that delivered Ireland’s first population screening programs for breast, cervical, and bowel cancer.

BowelScreen, the national bowel screening programme is the newest cancer screening programme in Ireland. Alan was keen to see participation rates surpass the existing volume of 45%, to the impressive and considerably higher levels achieved in breast and cervical cancer screening programmes. “The uptake numbers are telling us that we're not doing as well with bowel cancer screening. While it’s the new kid on the block in terms of programmes in Ireland I think we all currently feel that we can do better to try and get more people to take up the offer of free screening. Ultimately, our goal is to reduce mortality.”

If Alan and the team could capture patient feedback highlighting what was working during the screening process, and what wasn’t, he believed it may identify improvement opportunities and encourage the completion of screening tests by the population.

Alan had researched and knew the potential power that patient-reported experience measures held to drive better informed decision-making and in turn, drive higher screening participation rates.

Before working with Cemplicity, patient surveys were normally delivered through paper and pen. Harnessing patient feedback through SMS had not yet been proven for cancer screening programmes in Ireland, and it was this that provided the starting point of Alan’s hypothesis. “I wanted to test the feasibility of moving from a traditional paper-based system of surveying patients to real-time capture of patient views. Will it work? Can it work? Will patients like it? And what sort of outcomes are we getting?”

With these questions in mind, Alan with members of the Public Health and BowelScreen programme team together with Cemplicity, implemented the design and capture of digitised patient reported experience measures. It was designed to ensure that the project team could see information in real-time, and in a way that made it easy to see what areas need to be improved.

A big part of the test was seeing whether the digital PRMs system would work for this specific demographic of the Irish population, those aged 60-69 years. Would people respond to surveys through digital means? Response rate expectations were initially low, due to the paper-based surveys rates of the past, which were often at 10% or less.

To Alan and the team’s delight, the proof of concept has far exceeded those expectations, with a near 50% survey completion rate for those having had a colonoscopy and a 34% completion rate for those undertaking at-home FIT screening tests.

These excellent response rates weren’t an accident though. From the very start, Alan and the team emphasized engaging patients in the process and priming them for participation in advance of the actual survey.

Preparing the ground began by sending survey information to patients throughout their screening care pathway. This ensured that patients expected and knew that they would receive a future text message inviting them to participate in a survey. Alan and the team knew that building trust and awareness through communications and preparing patients for the survey was critical to success.

The BowelScreen team also ensured that frontline teams in the hospital screening colonoscopy units positively conversed with patients about the surveying tool. The endoscopy unit nurses understood the benefits of the surveying programme and told the patient to expect a survey upon discharge after their colonoscopy. The nurses were also armed with survey patient information leaflets to give to their patients to take home with them.

It wasn’t just nurses that the team engaged with. All relevant teams in the wider National Screening Service Organisation understood the planned survey programme and what was expected of them. For example: “The helpline was well briefed in what to expect if they got a call from potential patients. The nurses were also well versed and updated and briefed on what was happening. Once everyone saw the final end product from Cemplicity, everything disappeared in terms of our concern and worries.”

For Alan, the key to staff engagement was to frame the surveying programme in a positive light that would benefit both staff and patients.

NSS also included materials about the survey during bowel awareness month, traditionally April, including a blog and patient FAQs on www.bowelscreen.ie - This was all designed to familiarise patients with the surveying tool so they’d be more receptive to it when it really mattered.

While the proof of concept for the digitised PRMs system was targeted for BowelScreen – the national bowel screening programme, Alan is convinced that the programme has applications and wider benefits across the National Screening Service organisation as a whole and is seeing interest from colleagues in this regard. “I envision that the tool will be a permanent feature of all our population screening programs. While each one will obviously be tailored to the specifics of the programme in question, I think the methodology will be beneficial and scalable not only to the three cancer screening programs we have but also Diabetic RetinaScreen, our diabetic retinopathy screening programme.”

And for Dr. Smith, this capability couldn’t have come at a better time:

Dr. Alan Smith and the NSS perfectly demonstrate the effectiveness of engaging with both health care teams and patients to achieve high response rates. Engagement from the start and providing information and a process for frontline teams to follow means they feel appreciated and involved, understand what to do and ensure the right information is passed onto patients at the right time. When patients know the survey is coming and understand its purpose, they are more likely to respond.

Coupled with a health care team that is well versed in the survey programme, this leads to feedback that is listened to and acted upon. With optimal response rates the team can trust, the feedback being pulled is reflective of the needs of their patient population. This allows for accurate identification of improvement opportunities, driven in areas that really matter. As a result, more people take screening tests, and more lives are being saved, making this a win for everyone.

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Want to learn more about improving response rates? Check out our best practice recommendations here.

Also, be sure to utilise our resources and templates that can support you in communicating your survey programme to patients and staff.