Testing

A new programme and all its components should be tested, to demonstrate that the programme works as expected and planned for. The time for piloting in a controlled fashion is before national roll-out. Testing phase also applies to modification, i.e. new procedures in an existing programme.

The actual results of the pilot are very important for informing the policy makers, service providers and the population at large about the success or potential barriers.

What about initial training and development of competence? This could be solved by setting up a national centre for screening or similar or area, where feasibility testing, and piloting can be based. Training needs an extension towards centers and service providers during the roll-out phase, too.

The invitational procedures may provide challenges. These include:

• call and recall
• acceptance of testing and management
• communication with the screened person
• reducing barriers and social inequalities
• delivery of further investigations (e.g. diagnostics and treatment)
• costs
• training and capacity building for rollout (if indicated)
• other details not yet known at launch may provide challenges

For example, the uptake of screening may depend on the premises where samples are taken, opening hours, public traffic, personnel (women for breast or cervical cancer screening) among many other factors. Success of the pilot has to be assessed against all the relevant challenges.

Step back or continue to rollout

It is beneficial to have benchmark values relevant for a pilot program to justify a decision towards national rollout; or possibly for stopping a pilot or a programme.

After the piloting phase, the programme can be rolled out after modifications and corrections deemed necessary based on pilot evaluation. The full implementation of the programme may take several years to achieve coverage and ensure optimal function.

A gradual build up is usually needed to ensure practical resources, for example colonoscopy services for those who are positive for faecal occult blood test. Integrated comprehensive quality assurance allows for further incremental improvement in a continuous quality cycle.

A high level of organization with solid governance and coordinating functions also give better opportunities to stop ineffective or harmful activities in a controlled fashion.

If existing screening does not fulfill quality requirements, the decision must be either to reorganize by following EU guidelines or ultimately to stop the ineffective programme. Continuation of an ineffective programme is unacceptable.