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From the President: Emerging Issues

 Finding the Root Cause to Improve Timeliness in Newborn Screening

By Yvonne Kellar-Guenther, PhD
Colorado School of Public Health, NewSTEPs 360

​​Sikha Singh, MHS, PMP
Association of Public Health Laboratories, NewSTEPs

Marci Sontag, PhD
Colorado School of Public Health, NewSTEPs 360

Sarah McKasson, MPH
Colorado School of Public Health

​NewSTEPs 360, a collaboration between the Colorado School of Public Health and the Association of Public Health Laboratories, supports improvements in timeliness of pre-analytic, analytic and post-analytic components of newborn screening (NBS) programs across the U.S. through continuous quality improvement (CQI) initiatives. The CQI approach has benefited many health agencies and organizations by promoting impactful and sustainable change in health care systems.

In June 2016, NewSTEPs 360 – in partnership with the Cystic Fibrosis (CF) Foundation – convened NBS program staff (laboratory and follow-up) and clinicians to identify barriers and solutions to assure timely newborn screening for cystic fibrosis. Participants received training on the 5 Whys approach, conducting root cause analyses and applying this methodology within their multidisciplinary teams to identify underlying barriers to meeting the NBS timeliness recommendations issued by The Advisory Committee on Heritable Disorders in Newborns and Children. The overarching goal of the meeting was to equip NBS programs with tools to improve timeliness in newborn screening for all infants, as well as to identify specific solutions for improving timeliness in CF newborn screening. CF clinicians were engaged in all aspects of the process with the understanding that identification of solutions to improve the overarching system would also benefit newborns identified with CF.  

In small groups, teams discussed the barriers and proposed solutions. Facilitators prompted discussions to identify root causes. For example, one barrier discussed[PB1]  was that midwives have a lower percentage of specimens collected in the recommended time frame (prior to 48 hours of life) than do hospitals. This barrier was not the "root cause," though; it was the problem statement. As a result, the facilitator walked the group through the 5 Whys approach to identify the true root cause. After three whys, the group identified the root cause.

Through a facilitated discussion, the group identified challenges in locating midwives as the root cause and discussed solutions to reaching midwives. These included finding professional midwifery groups and working with naturopath providers to assist in outreach efforts to find other midwives in their state.

Another group discussed the challenge of increasing operating hours of the newborn screening laboratory to include weekends. Challenges identified included lack of dedicated funding, limited technical support on weekends and staffing shortages for weekend shifts. Using the 5 Whys approach, the group explored the staffing shortage challenge, and a root cause was determined to be a shift in expectations for laboratory staff. Laboratory technicians might have been hired with the expectation of a five-day work week and might feel their job duties have changed if they are shifted to weekend hours. Potential solutions proposed were to offer compensatory days for staff working Saturdays and to consider alternate work schedules.

This was the first NBS meeting of its kind, bringing together clinical specialists and public health laboratory and follow-up directors to identify opportunities for improving timeliness for condition-specific newborn screening. The application of CQI techniques in multidisciplinary teams provides opportunities for implementing cross-discipline solutions and for developing partnerships with dedicated personnel working toward a common goal.  

For more information about NewSTEPs 360, visit  its website.

NewSTEPs 360 is supported by the Health Resources and Services Administration (HRSA) under grant UG8MC28554. The contents of this publication are solely the responsibility of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.