Table 2 Historical facilitators to CRC screening (n = 55)

Overall focus on quality and prevention as a primary part of organization’s mission and values

“The one thing we don’t argue is that we need screening of some type for colon cancer. Everyone knows the old adage is that any screen is better than no screening. So we all agree that we need to get there to screen the population. And we’ve got to decide what’s the best way to do it for our population.” —GI specialist

Internal success at raising screening rates for other health issues (e.g., mammography for breast cancer screening) using a centralized outreach reminder approach

“Clearly, we had great results with breast cancer screening, and we had some good results with cervical cancer too… So that was part of what we wanted to test, does IVR calling work as well [for CRC]?” —HP leader

Quality performance numbers for CRC screening were not as good as other comparable health care organizations

“We saw what our screening rates were… and we looked around at other regions to see what they were doing successfully. Mid-Atlantic had used [interactive voice recognition]. And so I worked really closely with Mid-Atlantic to find out which IVR they used and what their success rate was with CRC screening… ” —HP leader

Trust in the structure of the integrated health system to enable alignment of evidence-based CRC screening approaches with available resources and department roles

“And I know that, you know, we had a very strong analyst. We had a very strong negotiator. We had a strong physician lead who was very interested and extremely engaged. And then we had a project manager, I mean, that could just kind of manage all the pieces and make sure that everybody shows up and things are done in a timeline.” —HP leader

Strong trust in the skill level, training, and recommendations of endoscopy specialists

“I think that the GI doctors are just so dang ethical and skilled… they’re not going to recommend something just to save the organization money, and they’re still going to have the patient’s best interest in mind.” —PCP

Use of support staff (medical assistants) trained in educating and motivating patients on screening and follow-up

“We have our own MAs and own staff and we can say, okay, when a patient checks in and they’re due for one of these, you hand them this. If there’s no need, not involving the physician just speeds up things. If you have a nice handout and your staff is knowledgeable about the task and can explain it to somebody, like an MA, there’s no reason for taking time out of an appointment for the physician to go over the test, when the patient is there for something else. So finding the earliest person who is able to deliver the message early on is better.” —HP leader

Presence of PCP champions to assist other providers in navigating and integrating latest research with organizational goals and patient demand

“Presentations and talks [with clinician champion] have really been helpful. They have helped me kind of frame my conversations about everything… having a clinician who has looked at the research is really powerful.” —PCP

Access and utilization to EMR tools that help identify screening gap or indicate prior completed screening. Recent emphasis on increasing access to colonoscopy

“Systematically we are pretty good at reaching out to people and [we] have pretty good tools to identify them. We know who they are. We know what they need. And, we have a pretty good process to tell them what they need and to try to connect the dots for them.” —HP leader

General surgeons and other staff trained in colonoscopies alleviated some resource/access constraints

“Fortunately, the backlog in GI is down quite a bit from what it used to be. When I first got here, it was a two year wait, and now it’s maybe three months. So it’s totally manageable since they have obtained enough manpower to actually do the testing, which is great.” —PCP

Organizational shift allowed more flexibility and support for referring patients’ to a screening colonoscopy, especially if patient requested

“Now I can refer them to colonoscopy. And with the FIT I can have these easier conversations. So I’m promoting FIT, but if they still want the colonoscopy, I’m going to refer for it.” —HP leader/PCP

Overall improvement in organizational CRC guidelines to make them more in line with national standards and emphasis on colonoscopy

“Until recently, the organizational recommendation was hemoccult testing and flex sig [sic]. And, that probably was not the community standard or the national standard… More recently, the GI Department has made colonoscopy more available. And I think that’s been a real advantage in my patient population and getting them screened.” —PCP