This document summarizes a presentation on the Getting It Right First Time (GIRFT) program and its workstream focused on pathology. GIRFT aims to reduce unwarranted variation in clinical care through data collection, identifying best practices, and promoting changes. The pathology workstream is led by four clinical leads and aims to measure current variability in pathology services, create a vision for the future, and test changes. Key activities will include collecting data through questionnaires and site visits to understand variations and identify opportunities for improvement.

1. Getting it right for
pathology
Tom Lewis
Consultant Microbiologist

2. “Our approach is to deliver
clinically-led improvement
and put the patient in the
heart of the system.
We deliver this through an
approach called Getting It
Right First Time (GIRFT).”

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David Hunter – BMJ 14th March 2015
• Health systems have always been complex, messy, hard
to comprehend and even harder to change.
• Meeting these challenges has not been helped by the
endless meddling in health systems by politicians.
• In this endeavour they have been assisted by numerous
snake oil merchants, peddling the latest fads and
fashions.

4. Getting It Right First Time
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Started in orthopaedics, aiming to reduce
unwarranted variation in clinical care
Now rolled out to over 30 specialties in
England
Budget of £60M from NHSI
Led by senior consultants
Pathology workstream – 4 clinical leads
6+ months old
Independent of the NHSI NPIODG
Professor Tim Briggs CBE

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Kingdon’s “organised anarchy”
PROBLEM
POLICY
POLITICS
WINDOW
OF
OPPORTUNITY

6. Perfect storm or fab opportunity
• Primary care meltdown and consolidation
• Personalised health
• POCT and changing technical delivery
• Demand and demographics
• ICOs and care closer to home

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10. Working at the edge of Chaos
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complexity
wisdom
science
art

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• The Science of Measurement
• The Art of Leadership
• The Wisdom of Politics*wisdom
art
science
Working at the edge of Chaos

12. Our intention
• To improve the value of pathology
• For patients & families
• For communities & society
• To measure the current variability of pathology
• by geography, service, specialty, demographic
• By clinical team (?)
• To create a vision for the future of pathology
• as a template on which to plan and execute tests of
change

13. The GIRFT process
• Data Collection
• Central
• Questionnaire
• Deep Dive
• Spirited dialog
• Follow-up
• National Report
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14. Pathology providers are considered productive if the cost
of pathology to the trust is less than 1.6% of operating
expenditure.
Carter Review 2016
If economists could manage to get themselves thought
of as humble, competent people on a level with dentists,
that would be splendid.
John Maynard Keynes
Economics:

15. We are not focused on economics
We are focused on value
Value = benefit/cost

16. In other words …
• We are not directly concerned with laboratory
efficiency (cost per test; cost per FTE etc)
Unless it impacts on quality and/or care
• We are not directly concerned with laboratory system
& structure (hub, spoke or federation)
Unless it impacts on quality and/or care

17. In other words …
We are concerned with starting a conversation that
• will help laboratory services make rational
decisions about their future
• So they can deliver better value to patients,
clinicians, communities and to their staff
So where do we start? …

18. Next steps
• Create the “Datapack”
use HES & other readily accessible data
A long questionnaire
• “Deep Dive” visits
• National report and recommendations
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19. GIRFT and IDPS

20. Turn around data for antenatal serology
• Does it mean something for IDPS?
• Does it tell us something more general about
laboratory performance?
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