Tackling variations in clinical care: assessing the Getting It Right First Time (GIRFT) programme

The Getting It Right First Time (GIRFT) programme aims to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices.

It uses national data to identify the variations and outcomes, shares that data with all those concerned with a service – not only clinicians, but also clinical and medical directors, managers and chief executives – and monitors the changes that are implemented.

The programme began with orthopaedics and is now being rolled out to 32 different surgical and medical specialisms across the English NHS. Through an informal assessment of the programme, this paper sets out what the programme is, why it is needed, what is different about it, what it has achieved, what challenges it faces and what potential it has. It also contains vignettes illustrating hospitals’ experiences of the programme.

Key findings

GIRFT is a clinically led programme, which brings together the clinical, performance and financial data for each specialist unit, making it easier to see the relationship between outcomes and cost.
On the limited evidence to date, it is producing real gains in procurement, productivity and quality. For example, in January 2016, 71 of the 142 orthopaedic units in England identified savings of between £20 million and £30 million after an initial GIRFT visit, with an additional £15 million to £20 million forecast for the succeeding 12 months.
The data is presented by leading clinicians in the given specialty, who are supportive and encourage change in behaviour and practice.
Some of the issues that need to be debated are directly in the control of clinicians, but without management, there is a limit to what the programme can achieve. It is important that clinicians and managers work together to seek solutions.

Policy implications

The evidence to date suggests that the GIRFT programme is achieving what it has set out to achieve – higher-quality care in hospitals at lower cost – with the engagement of both clinicians and management in the process. However, buy-in varied, and sustained success will depend on engagement of both clinicians and managers and commitment to taking action.

Comments

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How many times have we heard before that the success of these (often regurgitated) initiatives depends on:
1) buy-in
2)The commitment of managers and clinicians
During the 40 years I have been watching this stuff I have not seen one that stood the test of time! Hopefully this will be an exception but somehow I doubt it.

If GIRFT is to be clinically led with manager support, should there also be GIRFM (getting it right for me) patient/ carer level data with support from charities and GIRET (getting it right every time) which is at the commissioner level analysis to ensure that local policies and levers align with GIRFT. And Getting It Right for NHS - database of case studies with examples of how GIRFM - GIRFT - GIRET data driven initiatives reduce unwarranted variation. Isn't the idea that STP is about getting past initiatives in a silo?