The programme was first conceived and developed by Professor Tim Briggs to review elective orthopaedic surgery to address a range of observed and undesirable variations in orthopaedics. In the 12 months after the pilot programme, it delivered an estimated £30m-£50m savings in orthopaedic care – predominantly through changes that reduced average length of stay and improved procurement.

The same model has been applied across 40 surgical and medical specialties and other cross-cutting themes (see Workstream section). It consists of five key strands:

• a broad data gathering and analysis exercise, performed by health data analysts, which generates a detailed picture of current national practice, outcomes and other related factors;
• direct clinical engagement via visits or virtual meetings between clinical specialists and individual hospital trusts, which are based on the data – providing an unprecedented opportunity to examine individual trust behaviour and performance in the relevant area of practice, in the context of the national picture. This then enables the trust to understand where it is performing well and what it could do better – drawing on the input of senior clinicians;
• a national report, that draws on both the data analysis and the discussions with the hospital trusts to identify opportunities  for improvement across the relevant services; 
• an implementation phase where the GIRFT team supports trusts, commissioners, and integrated care systems to deliver the improvements recommended; and
• best practice guidance and support for standardised/integrated patient pathways and elective recovery work in ‘high volume/ low complexity’ specialties.

See GIRFT:

• Workstreams
• Best Practice Library
• Reports

It is written for a general health care audience and will be most useful for those new to the field of quality improvement, or those wanting to be reminded of the key points.

When people use SBAR, they conclude by making specific recommendations that help to ensure the reason for the communication is clear. This is particularly important in situations where people may be uncomfortable about making a recommendation, eg those who are inexperienced or who need to communicate with someone who is more senior than them in an organisation.

The use of SBAR provides clarity to communication and prevents the unreliable process of ‘hinting and hoping’ that the other person/target audience understands.

1. Knowing why there is a need to improve.
2. Being able to interpret if improvement is happening through measurement.
3. Developing an effective change theory which will result in improvement.
4. Testing a change before moving to implementation.
5. Knowing when and how to implement a change.

• What the team wants to achieve from their improvement efforts, described as an improvement aim. Include how much improvement will be achieved, who the improvement is for and when the improvement will be achieved by.
• Why the work is important – the rationale or business case for the work. This should outline; the problem the work will address, how this links to strategic objectives, how you know this is a problem, who is affected, the impact of doing nothing and the benefits to be derived from improvement e.g. outcomes and costs.
• The scope of the project - what is included in the work.
• How the team intend to achieve the improvement aim – this should include initial ideas for change and the supporting activities to make the work happen.
• How the team will measure the impact of the work.
• Who will be involved the work and their role. Key people should include; subject matter experts, process owners who can make changes, representatives of those impacted by your project (families, young people, patients, customers etc), finance representative (where needed), and a sponsor linked to executive level for leadership support.
• Any risks to the delivery of the project, so that decisions can be made on how these should be addressed. 

• To allow a team to explore the possible reasons, root causes and possible solutions for a problem
• To visually represent the reasons, root causes and possible solutions for a problem
• To help identify change ideas and develop an improvement plan
• To enable team to focus on content of the problem, not on the history or differing personal interests. 

• An improvement aim that quantifies what better will look like, for who and by when.
• A small number of Primary drivers that focus on the key components of the system/main areas of influence that need to change to achieve the aim. These are often associated with process, infrastructure, norms (culture) and people.
• Secondary drivers that break primary drivers down in to natural subsections or processes. They provide more detail on where interventions to positively influence the primary drivers are required.
• Change ideas – these are the specific ideas that teams can test to see if they influence the secondary drivers and ultimately the aim.

• Identify who your stakeholders are; this is anyone who has interest in the improvement project or will be impacted by any changes.
• Use the opinions of your stakeholders to help define your improvement work at an early stage and gain their support.
• Guide the development of a communication plan for stakeholders to help them understand what the improvement work is about, to maintain and build further support for it where possible.
• Identify potential issues which could arise as the project develops, identifying ways to manage negative impacts.

• Use a measurement plan in order to clearly set out your family of around 3-8 measures that you will be using to track progress in your improvement project. 
• The template will prompt you to think through your measures thoroughly, and when complete it will be an essential communication and reference document for your project team.
• This will help ensure consistency of measurement over time and between team members, so minimising the potential for adding in variation to your data that could make it harder to see what’s actually happening.

For example you might want to look at:

• type of safety incidents that occur
• causes of a specific type of problem
• reasons for cancellation.

They are a useful tool not only when identifying opportunities for improvement, but also in drilling down to understand the reasons for special causes on graphs showing counts, percentages and rates.