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Influencing organisational culture is key to successfully implementing root cause analysis to tackle late cancer diagnosis
  1. Imogen C M Staveley1,2,3,
  2. Emma S Bointon4
  1. 1 Healthy London Partnership, NHS England, London
  2. 2 Bedworth Health Centre, Bedworth, Warwickshire
  3. 3 Warwickshire North CCG, Nuneaton, Warwickshire
  4. 4 Sustainable Insights Team, NHS Camden Clinical Commissioning Group, London, UK
  1. Correspondence to Dr Imogen C M Staveley, Bedworth Health Centre, Bedworth, Warwickshire, CV12 8NQ , UK; imogenstaveley{at}


Introduction Late diagnosis of cancer increases morbidity and mortality, and the overall cost of care. Camden Clinical Commissioning Group (CCG) improved the percentage of patients diagnosed at stage I and II cancer, from 39% in 2012 to 47% in 2015;there remained a need to identify the issues leading to late diagnosis.

Method Camden CCG adapted the Royal College of General Practitioners’ cancer significant event analysis (SEA) tool to be used by general practitioner (GP) surgeries to identify the causes of delayed cancer diagnoses and to find ways to increase early diagnosis. The effective collection of findings through an online portal, comprehensive communication of these to GPs and clear display of these to commissioners ensured the necessary information to transform systems to facilitate early diagnosis. GPs were encouraged to complete a SEA through financial incentivisation, clinical leadership and Cancer Research UK (CRUK) Facilitator input.

Results 49 root cause analyses were completed and the findings led to changes in behaviour to improve early diagnosis of cancer.

Conclusion Results show that for SEA to be successfully used across a borough to change individual clinician’s behaviour and to induce system transformation, multiple approaches are required: involvement of all stakeholders from the start, clinical leadership, support from CRUK Facilitators, education and financial incentivisation.

  • analysis
  • behaviour
  • clinical leadership
  • engagement
  • gp

Statistics from


  • Contributors ICMS was the Clinical Lead for the project; she also designed it. She acquired and analysed and interpreted the data. She alongside ESB drafted and revised the article. ESB created the figures from data acquired by an interpreted by ICMS. Both ESB and ICMS approved the version to be published. Both ESB and ICMS are accountable for all aspects of the article including accuracy and integrity of the work.

  • Funding Camden Clinical Commissioning Group provided the funding for the SEA project and for the CRUK Facilitator time.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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