Client Story

How Ireland’s National Screening Service achieved 50% SMS response rates

Dr. Alan Smith, Specialist in Public Health Medicine at HSE, National Screening Service

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 the 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.

“Our response rates have been very high at 50% for our patients after their colonoscopy. To hear our survey uptakes being just as good, if not better than anywhere else, seemed to be an extra bonus. It seems to have struck home.”

Dr. Alan Smith

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.

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.

“The uptake numbers are telling us that we’re not doing as well with bowel 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 the goal is to reduce mortality”

Why Digital PRMs?

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.

“People’s experience of our screening services is important. This can be a stressful time for people, so we want to make the screening service as simple, reassuring, and effortless as possible for them. We also want to create advocates for screening. If everyone who goes through the screening service talks to their friends and reassures them, we have the potential to start building participation rates at pace.”

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 designed and 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.

“Our proof of concept with Cemplicity demonstrates how people’s feedback can be used in a systematic and continuous approach. We are confident that we will identify areas for improvement from the patient perspective as a result.”

“Feedback that is gathered and reported in real-time so we aren’t waiting months to know where our communication, processes or clinic experiences can be improved.”

Response rates

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 paperbased 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.

“It proved to be the same as any survey done in other countries, and in many ways even better.”

“Irish people, both men, and women between the age group of 60 to 69, are more than capable of engaging and clearly like to engage digitally.”

Designing for participation

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.

“We didn’t want anybody confused or worried by getting the text message and being fearful that it was part of a scam.”

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.

“I certainly think telling the client beforehand sensitises them to the fact that this was going to happen and to expect a text.”

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.

“We briefed all our teams very early at the start about the project, saying what was coming down the line, that we will be coming to them later in the year with a reporting dashboard. We explained that there are probably opportunities here for them to identify areas of improvement in their own hospital that would benefit not only patients but also staff. Too often we only hear about complaints. We don’t hear of the many compliments. So, framing it as an opportunity to quality improve their services and to read the many positive things our patients have to say.”

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

Vision for the future

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 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:

“The capture of patient experience in real time is going to become a very critical component of healthcare, even more than it currently is.”

“The data it provides, both quantitative and qualitative, will drive decisions. So, it’s important now from my perspective to have a proven project plan so that we have a template that we can use for other programs as well.”

Optimising response rates through engagement

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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