RAISE the Bar

We established the Raise the BAR (BreastScreen Assessment Redesign) project to improve diagnostic care for patients at BreastScreen NSW South Eastern Sydney Illawarra. The project ensures timely and consistent care across all assessment clinics.

Early detection of breast cancer saves lives, but only when abnormal screening results are followed up quickly.¹ In 2024, more than one-third of clients recalled to BreastScreen NSW South Eastern Sydney Illawarra waited longer than the National Accreditation Standard of 28 days² to attend an assessment clinic. These delays undermine the prognostic advantages of screening³ and increase potential harm through increased client anxiety, reduction in future screening participation and delayed diagnosis.⁴

Our project aimed to deliver clients access to timely, equitable and effective breast cancer diagnostic care by optimising scheduling, redefining clinical roles, standardising diagnostic workflows and strengthening communication between teams. It also aimed to ensure BreastScreen NSW remains sustainable and responsive to growing screening and assessment demand.

Uneven workflows and workforce pressures drive the need for redesign

BreastScreen NSW South Eastern Sydney Illawarra is the largest of 9 screening and assessment services in NSW, screening over 70,000 clients in total each year and recalling over 3,000 for assessment at Randwick, Kogarah and Wollongong clinics.⁵ As one of the state’s busiest services, meeting the standard for timely access to assessment has become increasingly difficult due to inefficient workflows and inconsistent models of care between sites. These pressures affect both staff and clients, contributing to:

• long clinic days
• delayed results
• growing pressure on limited medical resources.

Currently, 43% of clients who require a needle biopsy spend more than 4 hours in assessment, with over half of that time spent waiting between stages of care. This strain on clinic flow is compounded by limited specialist capacity – only 3 long-serving radiologists completed more than half of all client assessments during 2024-25. These workforce pressures, together with variation in workflow and imaging resources across sites, overtime clinics and fragmented communication, have made the system unreliable and contributed to staff fatigue and burnout.

Breast cancer rates in Australia have continued to rise over the past 25 years,¹ and global projections suggest a further 40 percent increase in new diagnoses within the next two decades.⁶ Without redesign, the current model risks longer waits, increased client stress and reduced access to less invasive treatment options. We recognised the need for change to improve timeliness, consistency and sustainability while ensuring equitable access to high-quality care for every client.

Building a sustainable, skilled, future-ready workforce

Following an intensive diagnostic phase and collaboration with key stakeholders across the service, we developed the following solutions to address the key challenges identified within assessment clinics.

1. We implemented a data monitoring and forecasting tool that uses recall rate information to forecast a 12-month assessment schedule, supporting clear data-driven scheduling.
2. We established a dedicated client navigator role to serve as a single point of contact for clients and staff, coordinating appointments and ensuring clients receive timely, personalised information throughout their assessment journey.
3. To address workforce pressure and long wait times, we are recruiting and training breast sonographers to work within the assessment clinic model, performing ultrasound imaging previously limited to radiologists. We are also introducing breast physicians skilled in clinical examination, ultrasound and biopsy, to expand medical capacity and enable clinics to operate with remote radiologist support when required. In parallel, we’ve introduced breast imaging subspecialty training opportunities for radiology trainees and fellows, to strengthen recruitment and long-term workforce sustainability of the service.
4. We introduced a standardised work-up imaging protocol across all sites to reduce variation, improve efficiency and increase radiographer confidence. We are also standardising imaging equipment to ensure each site has consistent technical capacity to perform image-guided biopsies while other clients continue with assessment imaging. This dual approach supports smoother clinical flow and reduces unnecessary downtime between clients.
5. We are piloting a remote work-up assessment model to streamline care for clients with screen-detected equivocal lesions. These clients first attend an imaging-only clinic and, if they require a biopsy, return within 7 days for a biopsy-only appointment. Early results show this approach reduces waiting time and increases client satisfaction.
6. To strengthen culturally safe care, Aboriginal Health Workers and local community representatives are involved in the redesign and delivery of these initiatives. Clinic staff now attend Aboriginal community engagement events to build trust, maintain continuity of care and ensure clear, respectful communication about the recall and assessment process.

Implementing bespoke solutions for local issues

Our project is in the initial stages of solution implementation. While evaluation data is not yet available, lessons learnt so far include:

• Bespoke solutions are required for local issues: BreastScreen NSW South Eastern Sydney Illawarra operates across two LHDs, with assessment delays differing between the two. Clients attending the Wollongong clinic face the longest waits, with some waiting up to 8 weeks from screening to assessment. Site limitations prevented us from implementing standardised imaging equipment at this location, so we are testing a remote work-up model to address specific radiologist resourcing needs.
• Harnessing virtual care: Remote imaging clinics have previously supported screening in rural and remote areas, and this approach is now being expanded to support assessment. With approval from the Cancer Institute NSW, we are trialling a remote radiologist model of care with the work-up clinic for Wollongong clients. Using live ultrasound streaming, remote image review and video consultation, early results indicate this model can increase clinic capacity and improve access across the service.
• The value of measuring client experience: We recorded a high baseline of client satisfaction during the diagnostic phase. Both qualitative and quantitative client-reported experience measures have challenged staff assumptions about what matters most to clients and how change is perceived. Ongoing measurement of client experience will remain a key balance measure to ensure that improvements in efficiency do not compromise the quality of care.

View this project's poster from the Centre for Healthcare Redesign graduation December 2025.

References

1. Chiarelli AM, Muradali D, Blackmore KM, et al. Evaluating Wait Times From Screening to Breast Cancer Diagnosis Among Women Undergoing Organised Assessment vs Usual Care. Br J Cancer. 2017;116(10):1254-1263. DOI: 10.1038/bjc.2017.87
2. BreastScreen Australia. National Accreditation Standards. Canberra: Australian Government; 2022 [cited 27 Oct 2025].
3. Reece JC, Neal EF, Nguyen P, et al. Delayed or Failure to Follow-Up Abnormal Breast Cancer Screening Mammograms in Primary Care: A Systematic Review. BMC Cancer. 2021;21:373. DOI: 10.1186/s12885-021-08109-3
4. Pineault P. Breast Cancer Screening: Women’s Experiences of Waiting for Further Testing. Oncol Nurs Forum. 2007;34(4):847-853. DOI: 10.1188/07.ONF.847-853
5. BreastScreen NSW. Management Dashboard [cited 27 Oct 2025].
6. Arnold M, Morgan E, Rumgay H, et al. Current and Future Burden of Breast Cancer: Global Statistics for 2020 and 2024. The Breast. 2022;66:15-23. DOI: 10.1016/j.breast.2022.08.010