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The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

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

Fiona Aspinal¹, Jean Ledger², Sarah Jasim³

¹Department of Applied Health Research, University College London, London, UK f.aspinal@ucl.ac.uk.

|February 24, 2023

Summary

The national orthopaedic improvement programme (GIRFT) had limited direct impact on NHS Trusts, as implementation depended on team, Trust, and economic factors. Success required aligning interventions with existing priorities and contextual influences.

Keywords:

Adult orthopaedics Orthopaedic & trauma surgery QUALITATIVE RESEARCH Quality in health care

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Area of Science:

Healthcare Management
Health Services Research
Orthopaedic Surgery Improvement

Background:

The Getting it Right First Time (GIRFT) programme aims to enhance NHS elective orthopaedic surgery.
Understanding the implementation facilitators and barriers is crucial for large-scale health interventions.

Purpose of the Study:

To evaluate the implementation and impact of the GIRFT programme within individual National Health Service (NHS) Trusts.
To identify factors influencing the adoption of GIRFT recommendations at micro, meso, and macro levels.

Main Methods:

Qualitative case studies were conducted at six NHS Trusts.
A mixed-methods evaluation approach was employed.
Data were collected from 59 NHS staff involved in orthopaedic surgery.

Main Results:

While all studied Trusts improved care, few attributed changes directly to GIRFT.
Implementation success was influenced by team perceptions, Trust-level competition for resources, and broader health economy demands.
GIRFT data sometimes supported pre-existing plans but was less influential when competing with immediate pressures like financial and bed capacity issues.

Conclusions:

Contextual factors at multiple levels dynamically influence the effectiveness of large-scale improvement programmes like GIRFT.
Future improvement initiatives should consider these multi-level interactions for successful implementation and varied outcomes.