Getting it right first time (GIRFT)
Date: Friday, June 08, 2018
Venue: Haydock Park Racecourse (Lancaster Suite)
Speakers: Ruth Tyrell, GIRFT North West Hub Director Neil Haslam, Consultant Endoscopist and Gastroenterologist at Royal Liverpool University Hospital. Dr Maire Morton, Divisional Director for Surgery and Anaesthetic Services, East Lancashire Hospitals NHS Trust, National GIRFT Clinical lead for Oral and Maxillofacial surgery
Ruth Tyrell, GIRFT North West Hub Director
Neil Haslam, Consultant Endoscopist and Gastroenterologist at Royal Liverpool University Hospital.
Dr Maire Morton, Divisional Director for Surgery and Anaesthetic Services, East Lancashire Hospitals NHS Trust, National GIRFT Clinical lead for Oral and Maxillofacial surgery
Tim Crowley, Managing Director, MIAA welcomed everyone to the Getting it Right First Time (GIRFT) event which was run in collaboration with AQuA. The purpose of the GIRFT programme is designed to improve care by reducing unwarranted variations.
Tim introduced Ruth Tyrell, the GIRFT NW Hub Director and the NW lead on the GIRFT programme. Ruth set the scene. GIRFT is the brainchild of Tim Briggs, a leading orthopaedic surgeon who saw the variation in orthopaedic practice across the UK as he found himself doing a lot of revision surgery for procedures that had been undertaken elsewhere. He obtained funding of 200K for a pilot and he started to collect activity and outcome data for every NHS provider on their orthopaedic practice. The key findings from the pilot were that there was variation in prosthetic kits and variations in hip implants. Low volume work did not have the best outcomes and there was a failure to follow national joint register recommendations. There was a need to address theatre scheduling and ring fenced beds and variations in staffing. There was a lack of emphasis on rehabilitation and seven day physio service which had an impact on length of stay and differences in surgical site infection rates. This all was combined with a paucity of data and inaccurate coding. There was therefore a big difference between the patients that did well and the patients that didn’t, with significant unwarranted variation seen in practice and outcomes.
From the initial pilot of 200K the GIRFT Orthopaedic programme has had a massive impact with estimated savings of between 60 – 90 million over time. The programme has now been set up to expand to 35 different specialities and the GIRFT methodology was developed to ensure the work was replicable.
Phase 1: preparation – look for leaders
Phase 2: data pack production
Phase 3: National clinical lead – deep dive site
Phase 4: National report
Phase 5: review
Phase 6: move to business as usual
Ruth concluded her talk by saying unwarranted variation is no longer acceptable in the NHS. It shouldn’t be a postcode lottery from a clinical perspective. GIRFT will be funded for another four-six years supporting clinicians nationwide to adopt continuous quality improvement for the benefit of patients.
Tim introduced Dr Maire Morton who is the National GIRFT Clinical lead for Maxillo-facial surgery. The GIRFT work in this speciality started in summer 2016. So far there has been over 60 deep dive visits using the data pack but there are 127 units across England. Maire has noted that the best data has been where the consultants have the best relationship with their coder. She has also noted the complexity of service provision within this speciality with many adopting a hub and spoke model. Some of the key findings from the work to date include:
Poor basic data ( HR/Staffing and activity etc) – Some managers unaware how many staff are employed in their area.
Differences in operational practice – daycase v outpatients
Poor coding ( especially in head and neck cancers)
No awareness of Litigation (cases and learning)
A number of recommendations will be made through the national report in this area including
Smaller units should form hub and spoke arrangements with neighbours or larger units
The speciality coding needs to be corrected
Urgent need to have mandatory quality outcome audit in head and neck cancer
Develop consistent coding in head & neck cancer
The final speaker Neil Haslam is a Consultant in Endoscopist and Gastroenterologist and a Clinical Ambassador for the GIRFT programme. His presentation focused upon how we can maximise the effects of GIRFT and sustain the activity going forward. There remains unwarranted variation across Trusts and he believes we should be moving everyone to the top quartile. One of his recommendations was to propose a GIRFT oversight committee within every Trust to drive forward GIRFT activity with support from the Exec team using model hospital data and self-monitoring to improve performance https://improvement.nhs.uk/resources/model-hospital/
Neil invited everyone across the NW to do this. He believes a lot of clinicians come to work not knowing whether they do a good job or a bad job. Give them the data and they get it.
Tim finished the event by inviting everyone to challenge variation, familiarise themselves with their data and monitor to drive improvements locally.
Our next event features Jeremey Scrivens, Director at The Emotional Economy at Work and a global thought leader on 6th July 2018 at The Hive, Manchester. Bookings can be made via www.miaa.nhs.uk and click on events.
Updated by: Administrator on 26, Feb 26, 2018