Methodology for selecting requirements and indicators

The European QA scheme is a collection of requirements and indicators. Its implementation guarantees that compliant breast cancer services can offer to users (women, patients and carers) top quality and most updated procedures for breast cancer screening and care. The requirements focus on the person’s needs and are based on the most updated evidence-based guidelines.The European QA scheme Scope describes in detail the interventions and services covered, the quality dimensions and future implementation according to the European legislation for accreditation. After its piloting, the European QA scheme will be available to all interested breast cancer services (hospitals, clinics, diagnostic centres, etc.) worldwide. On this website you will find all accredited breast cancer services as soon as they will implement the European QA scheme.

The European QA scheme includes a set of requirements that breast cancer services have to comply with in order be certified under the scheme. It covers care processes from screening to end-of-life care. Compliance with these requirements and their impact on outcomes will be evaluated, whenever appropriate, via indicators.

Requirements, which are oriented towards RAND/UCLA methodology, are selected in a structured way by an expert panel. The procedure is illustrated in the figure below and comprises the following essential steps:

1. Collection of requirements

Requirements/indicators for all breast cancer care processes (from screening to follow-up until end-of-life care) are researched in the literature, guidelines, indicator databases and existing quality assurance schemes. They are presented with reference to their evidence. In cases where the requirements/indicators retrieved do not address all the relevant quality potentials in the treatment pathways for breast cancer care, new ones are developed. Those requirements not meeting predefined inclusion criteria are excluded.

2. Panel process

In Delphi-like rounds, requirements/indicators are selected by a multi-disciplinary panel which is represented by the Quality Assurance Scheme Development Group (QASDG). Requirements/indicators are rated remotely and then during an on-site panel meeting for understandability and relevance and by considering their evidence upon which they are based. Relevance relates to the significance of the requirements/indicators for a person-oriented outcome of care. In a subsequent Delphi round, those requirements/indicators rated as positive are then rated for feasibility, once again remotely and in an on-site panel meeting. Feasibility relates to the ability of the requirements/indicators to actually be implemented and to provide meaningful data at the service-provider level.

3. Countries consultation

The set of requirements/indicators selected by the expert panel is made available for consultation to all European Countries involved in the ECIBC. Countries are consulted on whether the requirements/indicators can actually be implemented within the existing legal and structural conditions of their respective healthcare systems.

4. Pilot testing

Requirements/indicators that have passed the country consultation are tested in a pilot run. They are amended according to the experiences gathered during the pilot run and then implemented within the European QA scheme.

Procedure of requirement/indicators development


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* For quality potentials where no pre-existing requirements are available, new requirements will be developed.
** For evaluating feasibility, the requirements will be presented to the panel including options on how to measure them, and presentation of the indicators related to those requirements.