21 March 2016
Cervical cancer affects around 160 women in New Zealand per year, leading the Ministry of Health to prioritise the national cervical screening programme and aiming to have 80% of all women aged between 25 and 69 to be screened every three years. Achieving this result in practices is no small feat; two of Alliance Health Plus’s practices share their experiences on their journey to reach the 80% target.
Rosebank Road Medical Services are one of our highest performing practices; ensuring their women are screened has been business as usual for years. About six years ago they calculated how many women they would need to screen to increase from their then performance of 70%: about one per day. Working together as a team towards their goal has proved a success – at one stage they were doing up to five smears per day! But it was important to make the goal achievable so that staff stayed motivated. The receptionist does a lot of the work; she checks for women who are due, and starts the consent process for opportunistic smears.
Dr Geeta Murali Ganesha, Practice Nurse Nalini and the rest of the team make it easy for women to be screened. Smears are done free and they take the opportunities to educate their patients – showing them the speculum and how it’s done prior to getting them on the bed. When patients join the practice they have a discussion about smears and offer one at the time. The team are conscious of which women are more comfortable with different members of the team and accommodate their preferences. They also offer swabs for STIs at the same time - the team add value to their services by doing several things at once.
Greenstone Family Clinic have been consistently achieving the target for over six months – how did this happen? Teamwork and persistence. In May 2015, Nurse Manager Devika Dayal sat down with the Greenstone team to devise their strategy during a staff meeting and allocated the specific role of each team member. Every morning Devika scans the list of patients booked for the day for women who are due for their smear (and other screens or assessments). When the women come in for their appointments the receptionists mark the arrival slip with pink highlighters so the GPs know they are due. The GP then talks to the woman about getting their smears done, and if the woman consents the GP either does the smear or refers them to a nurse on duty. This strategy has been very successful at getting opportunistic smears done.
The staff at Greenstone have implemented a number of methods to encourage both patients and staff. The opening of an after-hours clinic on Saturday mornings and during the evenings, staff incentives to healthy home cooked meals, and the regular use of AH+’s cervical screening tee-shirts. Devika says: “Every Friday the whole team wears the t-shirts. They remind the staff as well as the patients to think about cervical smears”. Giving a performance update, Devika informs us that asking women to get their smears done has become hard-wired amongst the staff. “It involves a bit of gentle reminding. We call everyone up to 2 to 3 times, including just before the appointment. We send texts and letters on pink paper at the same time. The women like the different coloured paper.” Nine months down the track this team approach has become embedded.
Mangere Family Doctors is on their way to reaching the 80% target and the practice’s focus is also on teamwork and doing smears opportunistically. Nurse Manager Liz Dixon knew that the rate of smears had been static for some years, although women had been presenting for other things. After attending a conference demonstrating the benefits of a team approach, Liz decided to try this technique in improving their cervical screening performance. The team put together a campaign for opportunistic smear taking with several elements: each member of the team working to refer women to the nurse led clinic, breaking down the barriers for women to consent to have a smear at the spur of the moment, and measuring their progress.
When women walk into Mangere Family Doctors their records are checked, and if due they are offered a smear at that time. Staff work hard to encourage women to do the smears on the day and feminine wipes are offered to those who are reluctant. This approach has been very successful; the idea that most women won’t get a smear done if they haven’t planned for it has been dispelled amongst the team.
The cervical screening performance at Mangere Family Doctors has been steadily increasing since November when the campaign started. It will be the long game to reach 80%, but the team are committed. Liz’s thoughts on how to get there: “Opportunistic smears are definitely the way, it’s a matter of not taking no at face value, enquiring what people’s barriers are. After all, no one’s ever died from having a smear, but they have died from not having a smear”.