Current Gaps

In the UK, almost 3200 new cases of cervical cancer are reported every year, which counts to around 9 cases every year. It is the 14^th most occurring cancer, and females belonging to the age group of 30-34 are the most affected. However, in 2016, around 9% of women above the age group of 75 were affected with cervical cancer. The incidence rate of cervical cancer among females is 65% more than among the most deprived in comparison with the least ones. About 520 cases of cancer in the cervix every year is associated with deprivation (Cancer Research UK 2022). In England, it has been found that cervical cancer is occurring among women between the age group of 20-24. The increase was 2.7 to 4.6 per 100000 women from 2012 to 2014 (Castanon and Sasieni 2018). The cervical screening programme is a beneficial programme that reduces the chances of illness as well as death from cervical cancer. Women belonging to the susceptible age group are invited to have a cervical screening every 3 years. The process involves collecting cervical smears from several women. The ones who are at greatest risk as well as have positive results are the ones who are followed up at regular intervals (Patel, Moss and Sherman 2018).

The main aim of the cervical screening program is to reduce the incidence as well as mortality of women from cervical cancer through the encompassment of a systematic and population-based program of screening that assures quality for the women who are eligible. One should not confuse cervical screening with the test for cancer. This program of cervical screening mainly holds a vision of detecting CIN, which further prevents the development of invasive carcinoma. Another purpose of the screening program is reducing the risk associated with the disease of cervical screening along with associated mortality through detection and treatment of the precursor lesions prior to progressing invasive cancer of the cervix. According to Davies et al. (2017), the identification of stakeholders is extremely important for the implementation of complex programs of healthcare such as cervical screening. These people must be made to get involved in both designing as well as planning of the program before its implementation. There are three factors for achieving the involvement of the stakeholders (Chrysostomou et al. 2018). These include open and regular communication among all the stakeholders, well-sustained political support and making use of scientific pieces of evidence for justifying all the actions and discussions.

Vision

There are recommendations that are made to the stakeholders which involve an evidence-based approach with the aim of bringing down the occurrence of the disease, which will narrow the gaps that are targeted for the stakeholders. The recommendations are as follows:

• Publishing invitations for screening programs from the perspectives of leaders and policymakers while continuing the invitations so that the eligible individuals come forward and participate. Making requirement of test kits on request of the healthcare institutes. Invitations must be made in a way in which participation taboos and barriers among the various sections of the target group is overcome easily (Davis et al. 2017). Enforcing a proper monitoring and surveillance program is also recommended for making an evaluation of the interventions which have already been done.
• The introduction of HPV testing for the screening of cervical cancer must be introduced among different societies, governmental, and non-governmental agencies of health, which will make use of scientific presentations in the initial stages of the process. Scientific evidence about the effectiveness of the process must be presented to the stakeholders, such as the governmental and private organisations and bodies, along with conferences and meetings (Chrysostomou et al. 2018). The mass media must be involved to promote the message about the process of HPV testing so that enhanced and greater commitment can be obtained from the public.

Strengths

SWOT analysis forms the basis of investigations for the future (Benzghata et al. 2021). The rate of coverage of the target population and the counts of the national project has increased throughout the years. New and improved methods and tests of screening are being implemented. The Pap smear technique is the method that is used in countries of high income to bring down the incidence of cervical cancer along with its mortality. The quality of services provided for cervical screening tests has improvised over time (Costantino et al. 2019). Equipment has become advanced, and the service providers of screening have become efficient.

Weaknesses

The number of women who will receive screening shall depend upon the quota, which is decided by the central government of England, which suggests 10 million women per year (Misrahi 2018). It encompasses only 20% of rural women who turn out to be eligible. The funds provided by the government are insufficient to cover the entire program as a result of a large target population of England.

Opportunities

The cervical screening program is a means of recognising the importance of the health of women. This will enable reducing the incidence of mortality and morbidity among women. Improvement in the system of medical security along with relevant policies. Women have now started insuring their health under medical insurance (Misrahi 2018). There are subsidies provided by the government, but every time, these funds are not enough to pay off all the costs of treatment. Through the implementation of the cervical screening program, a well-defined screening network has been established, which can responsibly bring down the occurrence and incidence of cervical cancer. There was an emphasis on the expansion of coverage of the screening of cervical cancers.

Threats

There was a crisis of health care personnel who is competent. The number of healthcare workers is immense (Misrahi 2018). However, the ones with the proper expertise, technical know-how and experience is low, which implies a significant barrier in the delivery of quality services in the screening of cervical cancer. Low knowledge and awareness among women of the target group regarding cervical cancer lead to a lack of participation of beneficiaries in the screening programs. Increased migration of women from rural to urban areas is a severe threat as the screening is done for women belonging to their original place of residence. Hence, increasing migration leads to the evaluation of false data and many women are left out from being subjected to proper screening services.

SWOT Analysis to Identify Gaps in Cervical Screening and Identifying Scopes of Improvement

From the above SWOT analysis, it is understood that besides having a number of strengths, there are several threats and weaknesses which must be overcome so that the opportunities of the screening program in England can be overcome. For this, continuous improvement has to be brought about for raising awareness about cervical screening (Public Health England 2020). These campaigns should be framed with the help of the PDCA cycle, which is a framework of continuous improvement. This cycle is a continuous loop involving planning, doing, checking and acting, which can solve problems as well as manage change (Isniah, Purba and Debora 2020). The awareness programs should be intended to increase the attendance of women to embrace screening of cervical cancer.

Proper execution of leadership is vital for the successful outcome of any healthcare program in a population. For the implementation of the cervical screening program and achievement of the vision, the appropriate model of leadership is systematic leadership. It is the extent and ability of the preparedness of a leader to take responsibility for the work which is done by them along with the impact executed upon others along with the subject which is involved (Isniah, Purba and Debora 2020). The framework of systematic leadership and development encompasses four domains which include- “relationships and connectivity”, “learning and building of capacity”, “individual effectiveness”, and “innovation and improvement”. These dimensions have specific roles that suit different situations. For the implementation of the screening program, “relationships and connectivity” is the appropriate element that can be used. As a leader executing the program, the followership theory of leadership is also important. It states that followers must acknowledge the decisions taken by their leaders along with leadership. In the cervical screening program, leaders must create and maintain appropriate relationships with the various communities where screening is to be conducted along with the partners. Here, people are gathering for a certain purpose, which is a service (NHS Leadership Academy 2022). The main aim remains to create consistency of the screening programme so that all the issues arising due to the program or the issues being solved in the program can be dealt with easily.

Motivation plays an important role in the successful outcome of any program. It is important to motivate the target population with absolute and proper communication. Motivations for screening of cervical cancer involves the requirement of comprehensive assessment, proper diagnosis and management of the ailments for ensuring good health, abolishing fear in the minds of the target group regarding the consequence of cervical cancer, the risk of developing the same and the wish of maintaining a proper relationship with the workers of health care (Bukirwa et al. 2015). There is a need for client-centred counselling so that it can support as well as overcome the misconceptions and fears so that fears and barriers among women regarding uptake of cervical screening can be overcome easily. The role of a leader is to motivate the followers to their ultimate potential so that the objectives of the program can be achieved. Through the execution of proper systematic leadership, a leader must set a proper example to ensure that the followers grow as well as achieve the cervical screening uptake in an effective manner (Salloum, Al-Emran and Shaalan 2018). In this manner, the vision of cervical screening can be achieved through the encouragement of the individuals.

Systems Leadership and Followership

According to Chollette et al. (2021), there are several frameworks for the competency of teamwork that are designed to achieve a successful outcome by procedure-driven teams in acute care settings. In general practice, teamwork can improve the quality of healthcare delivery. Teamwork involves collaborative practices, which include delegation of care, which in contemporary literature has been identified as the ideal way of general practitioners (GP) work at workplaces (Driskell, Salas and Driskell 2018). The flattening of the hierarchical gradient by the implementation of various communication strategies will promote effective teamwork that will ultimately improvise the safety of patients and quality care (Findlay et al. 2021). An example of a teamwork model stated that there were 9 GPs working in a clinic during the period of study. The screening was initially done by two GPs, and they sent reminder letters for follow-up. The aim of the practice was to improve access to cervical screening. From an audit of the same, it was seen that the rate of screening improved due to teamwork in terms of Pap smear test and no records of cervical screening. It was understood that the nurses were very effective in working and conducting the screening program. From the example, it can be understood that teamwork can improvise not only the rate of screening outcomes but also the quality of the programs.

Though there are several models of change management such as ADKAR, Lewin’s and McKinsey’s 7s model, Kotter’s change management model is considered to be the best and most used (Galli 2018). Implementation of change is the only way in which a reduction in the rate of cervical cancer can be achieved. The change management model of Kotter can be used as a framework for the current scenario. Following are the steps which must be embraced for bringing about change:

Step 1: Creating a Sense of Urgency

For a chance to be implemented effectively, it is important to develop a sense of urgency among the stakeholders (Rajan and Ganesan 2017). From the various reports published on the progress of the cervical cancer screening program, the government of England, along with the person dealing with the management of finance as well as human resources, must be aware of the stakeholders about a sense of change. The results can be compared with that of the previous years so that the seriousness of cervical cancer mortality can be portrayed as a serious threat to the women of England.

Impact of Motivation and Communication with Organisation and Target Population

Step 2: Forming a Coalition

To implement a change successfully, there should be a right of coalition among powerful people (Akbar et al. 2019). A coalition can be formed among various organisations when systematic leadership is undertaken. Employees from both public and private organisations of England can be invited to propose better ways so that the potential participants can be approached. The main traits used for guiding coalition are expertise, power, credibility as well as leadership (Rajan and Ganesan 2017). When various organisations working for achieving the same vision is working in a coalition, it will lead to proper change implementation.

Step 3: Creating a Vision For Change

When a proper vision for the change is not created, the goals of change management becomes confusing to the stakeholders (Tang 2019). Hence, a clear vision of reducing the mortality rate due to cervical cancer among women has to be conveyed to the stakeholders of all the participating organisations supported by evidence-based practices. When every participating organisation conveys their vision, it shall be communicated to all participating organisations.

Step 4: Communicating the Vision

Any process of change requires proper communication. Various approaches of communication would be adopted to convey the vision to the participants. Emphasis should be laid upon highlighting the evidence-based recommendations (Harrison et al. 2021). Emails, campaigns, posters, story-telling sessions are some of the ways which can facilitate communication of the changes that are to be brought about.

Step 5: Removing Obstacles

Any barrier to the successful accomplishment of the vision of the cervical screening program should be removed by hinting at the structures, skills, supervisors as well as systems (Tang 2019). These barriers shall be removed by a systematic approach of leadership.

Step 6: Creating Wins of Short-Term

When changes are materialised, it becomes a source of embracing the targets of attaining goals in the long term. All organisations participating in accomplishing of vision should clearly understand the meaning of short-term wins, which has to be fostered to a systematic leadership approach. Short-term wins and accomplishments have to be rewarded and recognised. In the cervical cancer screening program, any incident that increases the screening rate shall be considered as a short-term win.

Step 7: Building on the Change

Though short-term wins have to be recognised, it is vital that they should not be considered as the ultimate win. Organisations participating must keep on getting motivated through these and keep on working hard to achieve more increases in the screening rates. Only then will the mortality rate be reduced at an alarming rate.

Step 8: Anchoring the Change

When the change is completely achieved, it has made a milestone that can be achieved in the future. This should be done at a point when the pressure of change can fade away (Baloh, Zhu and Ward 2018). The leaders, through execution of leadership, must reflect upon the journey which was followed for the process of change. This would help future leaders to adopt strategic change management.

Conclusion

As a leader in public health, it can be concluded that through the implementation of the above-mentioned change management process and execution of a systematic leadership approach adopting Kotter’s model of change management, the screening uptake of cervical cancer can be taken beyond the optimum target of 80%. Proper teamwork of the GPs and motivation of the target group can bring about the achievement of the vision quite efficiently. It can be understood that change is a dynamic process, and when performance is up to the mark, it can bring success at any cost. There has to be a proper revision of policies at regular intervals, and any recommendation for change has to be embraced for further betterment of the process.  The SWOT analysis has been used for understanding the weakness and threats which can hinder proper execution of the screening program. They shall be mitigated through systematic leadership and teamwork so that the aim or vision can be achieved easily. Moreover, Kotter’s 8-Step model will bring about the changes in an orderly manner and the cervical cancer screening uptake will be implemented and elevated eventually.

Reference List

Akbar, M.A., Sang, J., Khan, A.A., Mahmood, S., Qadri, S.F., Hu, H. and Xiang, H., 2019. Success factors influencing requirements change management process in global software development. Journal of Computer Languages, 51, pp.112-130.

Baloh, J., Zhu, X. and Ward, M.M., 2018. Implementing team huddles in small rural hospitals: How does the Kotter model of change apply?. Journal of nursing management, 26(5), pp.571-578.

Benzaghta, M.A., Elwalda, A., Mousa, M.M., Erkan, I. and Rahman, M., 2021. SWOT analysis applications: An integrative literature review. Journal of Global Business Insights, 6(1), pp.55-73.

Bukirwa, A., Mutyoba, J.N., N Mukasa, B., Karamagi, Y., Odiit, M., Kawuma, E. and Wanyenze, R.K., 2015. Motivations and barriers to cervical cancer screening among HIV infected women in HIV care: a qualitative study. BMC women’s health, 15(1), pp.1-11.

Cancer Research UK, 2022. Cervical cancer statistics. [online] Cancer Research UK. Available at:

<https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer#heading-Zero> [Accessed 23 March 2022].

Castanon, A. and Sasieni, P., 2018. Is the recent increase in cervical cancer in women aged 20–24 years in England a cause for concern?. Preventive medicine, 107, pp.21-28.

Chollette, V., Doose, M., Sanchez, J. and Weaver, S.J., 2021. Teamwork competencies for interprofessional cancer care in multiteam systems: A narrative synthesis. Journal of Interprofessional Care, pp.1-9.

Chrysostomou, A.C., Stylianou, D.C., Constantinidou, A. and Kostrikis, L.G., 2018. Cervical cancer screening programs in Europe: the transition towards HPV vaccination and population-based HPV testing. Viruses, 10(12), p.729.

Costantino, C., Mazzucco, W., Marotta, C., Saporito, L., Bono, S., Fiorino, G.R., Graziano, G., Maniglia, M., Marchese, V., Napoli, G. and Palmeri, S., 2019. Methodological issues in a cross-sectional survey on cervical cancer screening using telephone interviews in Sicily (Italy): a SWOT analysis. Journal of International Medical Research, 47(10), pp.5174-5184.

Davies, P., Valuta, D., Cojohari, N. and Sancho-Garnier, H., 2017. Implementing an organised cervical screening programme in the Republic of Moldova—stakeholder identification and engagement. Cancer epidemiology, 50, pp.272-277.

Driskell, J.E., Salas, E. and Driskell, T., 2018. Foundations of teamwork and collaboration. American Psychologist, 73(4), p.334.

Galli, B.J., 2018. Change management models: A comparative analysis and concerns. IEEE Engineering Management Review, 46(3), pp.124-132.

Harrison, R., Fischer, S., Walpola, R.L., Chauhan, A., Babalola, T., Mears, S. and Le-Dao, H., 2021. Where do models for change management, improvement and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of healthcare leadership, 13, p.85.

Isniah, S., Purba, H.H. and Debora, F., 2020. Plan do check action (PDCA) method: literature review and research issues. Jurnal Sistem dan Manajemen Industri, 4(1), pp.72-81.

Misrahi, Y., 2018. Results from a Visual-Based Cervical Cancer Screening Program. Telehealth and Medicine Today, 1(1).

NHS Leadership Academy, 2022. Developing Systems Leadership. [online] Leadershipacademy.nhs.uk. Available at:

<https://www.leadershipacademy.nhs.uk/wp-content/uploads/dlm_uploads/2018/10/Developing-Systems-Leadership-July-2017.pdf> [Accessed 23 March 2022].

Patel, H., Moss, E.L. and Sherman, S.M., 2018. Hpv primary cervical screening in England: women’s awareness and attitudes. Psycho?Oncology, 27(6), pp.1559-1564.

Public Health England, 2020. Cervical screening: ideas for improving access and uptake. [online] GOV.UK. Available at:

<https://www.gov.uk/guidance/cervical-screening-ideas-for-improving-access-and-uptake> [Accessed 21 March 2022].

Rajan, R. and Ganesan, R., 2017. A critical analysis of John P. Kotter’s change management framework. Asian Journal of Research in Business Economics and Management, 7(7), pp.181-203.

Tang, K.N., 2019. Change management. In Leadership and change management (pp. 47-55). Springer, Singapore.