title: Mixed methods evaluation of the Getting it Right First Time programme - improvements to NHS orthopaedic care in England: study protocol.
abstract: Orthopaedic procedures, such as total hip replacement and total knee replacement, are among the commonest surgical procedures in England. The Getting it Right First Time project (GIRFT) aims to deliver improvements in quality and reductions in the cost of NHS orthopaedic care across the country. We will examine whether the planned changes have delivered improvements in the quality of care and patient outcomes. We will also study the processes involved in developing and implementing changes to care, and professional and organisational factors influencing these processes. In doing so, we will identify lessons to guide future improvement work in other services.
  
  
  
  We will evaluate the implementation of the GIRFT programme, and its impact on outcomes and cost, using a mixed methods design. Qualitative methods will be used to understand the programme theory underlying the approach and study the effect of the intervention on practice, using a case study approach. This will include an analysis of the central GIRFT programme and local provider responses. Data will be collected via semi-structured interviews, non-participant observation, and documentary analysis. Quantitative methods will be used to examine 'what works and at what cost?' We will also conduct focus groups with patients and members of the public to explore their perceptions of the GIRFT programme. The research will draw on theories of adoption, diffusion, and sustainability of innovation; its characteristics; and contextual factors at provider-level that influence implementation.
  
  
  
  We will identify generalisable lessons to inform the organisation and delivery of future improvement programmes, to optimise their implementation and impact, both within the UK and internationally. Potential challenges involved in conducting the evaluation include the phased implementation of the intervention in different provider organisations; the inclusion of both retrospective and prospective components; and the effects of ongoing organisational turbulence in the English NHS. However, these issues reflect the realities of service change and its evaluation.
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. h.barratt@ucl.ac.uk.
authors.forename: Helen
authors.identifier: 0000-0002-1387-137X
authors.initials: H
authors.lastname: Barratt
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Turner
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Pizzo
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Hudson
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Hurd
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Day
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Yates
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gikas
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Fulop
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D004739:England / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D009936:Organizational Innovation; D009985:Orthopedics / Q000191:economics / Q000379:methods* / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000592:standards*
keywords: Cost effectiveness; Health services research; Implementation; Organisational change; Orthopaedic surgery; Outcomes; Service reorganisation