Implementation of the national Getting it Right First Time orthopaedic programme in England: a qualitative case study analysis

Aspinal, Fiona, Ledger, Jean, Jasim, Sarah ORCID: 0000-0003-3940-6350, Mehta, Raj, Raine, Rosalind, Fulop, Naomi J. and Barratt, Helen (2023) Implementation of the national Getting it Right First Time orthopaedic programme in England: a qualitative case study analysis. BMJ Open, 13 (2). ISSN 2044-6055

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Abstract

Objective To describe the implementation and impact of the Getting it Right First Time (GIRFT) national orthopaedic improvement programme at the level of individual National Health Service (NHS) Trusts. Design Qualitative case studies conducted at six NHS Trusts, as part of a mixed-methods evaluation of GIRFT. Setting NHS elective orthopaedic surgery in England. Participants 59 NHS staff. Intervention Improvement bundle, including bespoke routine performance data and improvement recommendations for each organisation, delivered via 'deep-dive' visits to NHS Trusts by a senior orthopaedic clinician. Results Although all case study sites had made improvements to care, very few of these were reportedly a direct consequence of GIRFT. A range of factors, operating at three different levels, influenced their ability to implement GIRFT recommendations: at the level of the orthopaedic team (micro - eg, how individuals perceived the intervention); the wider Trust (meso - eg, competition for theatre/bed space) and the health economy more broadly (macro - eg, requirements to form local networks). Some sites used GIRFT evidence to support arguments for change which helped cement and formalise existing plans. However, where GIRFT measures were not a Trust priority because of more immediate demands - for example, financial and bed pressures - it was less likely to influence change. Conclusion Dynamic relationships between the different contextual factors, within and between the three levels, can impact the effectiveness of a large-scale improvement intervention and may account for variations in implementation outcomes in different settings. When designing an intervention, those leading future improvement programmes should consider how it sits in relation to these three contextual levels and the interactions that may occur between them.

Item Type:	Article
Additional Information:	© 2023 Author(s) (or their employer(s)).
Divisions:	Care Policy and Evaluation Centre
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine
Date Deposited:	14 Mar 2023 15:21
Last Modified:	18 Nov 2024 21:24
URI:	http://eprints.lse.ac.uk/id/eprint/118411

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