The programme comprises a series of 40 surgical and medical workstreams and a number of other cross-cutting, system-wide projects. Each workstream or project is led by a prominent clinician who works with the GIRFT team to compile and review data analysis from across a range of agreed metrics. The work involves combining publicly available information, including Hospital Episode Statistics (HES), other relevant registry or professional body data, and the results of a questionnaire issued to the trusts where services or pathways are being reviewed. This then informs actions and recommendations for improvement.
Specialty reviews and national reports
The specialty reviews involve a local data pack being produced detailing the trust’s performance data across that specialty, followed by a meeting at the trust – known as a deep dive (see video below) – with medical staff and senior trust managers. At each deep-dive meeting the clinical leads review the findings from the data analysis with their peers, which provides more context to unwarranted variations and opens up a discussion around individual practice and any challenges the trusts face. It is also an opportunity to share best practice and any solutions that have already helped reduce variations. The review of a specialty and its services examines a wide range of factors, from length of stay to patient mortality, and individual service costs through to overall budgets.
Once the trust reviews have been completed, the clinical lead oversees the creation of a GIRFT national report into their specialty. The national report presents the original data, GIRFT’s findings, examples of best practice and recommendations for proposed changes and improvements to be delivered at both a national and local level.
Local improvement action plans
At trust level the recommendations found in each specialty are collated into an improvement plan with implementation supported by NHS England regional teams and the central GIRFT programme team. Trust data is uploaded to the Model Hospital portal, acting as the gateway for accessing benchmarking metrics and GIRFT information for all providers and commissioners.
GIRFT ‘gateways’ and top decile performance
GIRFT methodology is also used to drive change across national, regional and local pathways to achieve top decile performance within trusts and integrated care systems (ICS). GIRFT leads the clinical engagement to develop and agree, with the support of the Royal Colleges and professional societies, clinical pathways that will standardise care across a region or health system and deliver the best outcomes for patients as well as drive significant productivity improvements.
Central to this is the core principle of striving for ‘top decile’ performance against the GIRFT metric baseline. To support trusts with this, GIRFT has developed ‘gateway frameworks’ which include a range of metrics enabling trusts and integrated care systems to benchmark against these metrics in relation to top decile performance.
Led by the GIRFT national clinical lead with clinicians and operational colleagues from across the system, this follows the core GIRFT approach of clinician-to-clinician data-driven discussion, developing models of service to aspire to and the pathways to follow in order to achieve top decile performance as standard across the local healthcare system.