The value of the GIRFT programme
Our engagement with trusts has indicated that trusts recognise there is significant potential for GIRFT to enable both clinical quality and operational productivity improvements.
"The GIRFT programme is a major advance in clinically-led, clinically interpreted benchmarking. It is delivered in a non-partisan manner by experienced clinicians who do know the breadth and depth of the work that is being discussed and can bring a wealth of information gained from visiting all the other sites in England delivering that same service."
Chief Executive, teaching hospital
Trusts have seen benefits from the GIRFT approach in terms of reinforcing arguments locally, supporting their case for change.
"GIRFT has been useful in supporting our orthopaedic argument, for example, that protected beds for those recovering from orthopaedic surgery need to be protected and not released back in to general use. GIRFT data highlighted the potential costs involved of not doing this."
Deputy chief operating officer, acute hospital
Some early beneficial impacts reported by trusts included:
- centralisation of surgical activity, creating centres of excellence
- more uniformity in purchasing of goods and supplies
- positive impact on orthopaedics waiting list management
- encouraging and supporting clinicians to improve the delivery rate of certain procedures, on the basis of benchmark performance data
- improving coding and facilitating better conversations between clinicians and coders, and therefore helping to develop a more solid evidence base for the relevant clinical pathways.
Engagement with the GIRFT team
Trusts generally felt that that their involvement with the GIRFT programme so far has been a helpful enabler of clinical engagement, and was therefore supporting them to make progress on operational productivity improvements.
The credibility of the programme’s clinical leads is vital to securing engagement and challenging longstanding clinical variation. It is important to stress that trusts recognised a strong desire in their senior clinical workforce to improve their practice and deliver gains in quality and cost. However, the GIRFT programme’s data must be matched with sound and authoritative clinical judgment which clinicians can engage with, question, and debate.
Early feedback on the effectiveness of the specialty leads is positive, but continued attention should be given to the recruitment, retention and support of what will be, at times, a very challenging role. Alongside the usefulness of visits from the clinical lead, the wider engagement of the GIRFT programme with the relevant professional associations and medical royal colleges is a vital driver of successful clinical engagement. Trusts have frequently reported that the breadth and depth of support from clinical communities for the GIRFT programme has been indispensable for engaging their local workforce in the programme.
Given the importance of GIRFT to the aggregate operational productivity savings identified by NHS Improvement, it is critical the programme is also an iterative process, focusing on the ongoing lessons learnt from the individual reviews, as more specialties are reviewed and move into the implementation phase.
Building and sustaining strong clinical engagement
Clinical engagement was helped by two distinct features of the GIRFT programme. Firstly, the degree of organisational independence the programme appears to have from NHS Improvement and other national operational productivity initiatives.
"The peer-to-peer element provides clinical engagement which is very valuable and in conjunction with benchmarking can generate a real spur to change from the clinical body itself, often otherwise hard to achieve."
Medical director, district general hospital
It was also frequently reported that previous engagement with NHS Improvement and other bodies under the auspices of the Carter programme of work was driven by a narrative of cost savings. The GIRFT programme’s approach of focusing on quality first was significantly more effective in engaging clinicians than focusing on cost savings.
Realising the benefits of the programme is contingent first and foremost on maintaining the prioritisation of clinical leadership and engagement. This is based in confidence from and in the GIRFT programme team and the wider system that there is genuine willingness on the part of trusts and their clinicians to improve when the evidence indicates that there is scope for improvement.
In addition, while the clinical leadership of the GIRFT process is essential, for it to embed across the trust culturally and operationally, early and sustained communication between the GIRFT team and relevant trust directors is essential. Trusts are keen to work with NHS Improvement and the GIRFT programme to ensure that vital clinical improvements are embedded and sustained beyond the duration of the formal GIRFT programme to March 2021.