An academic poster from the 2017 British Association of Oral and Maxillofacial Surgeons Annual Conference. We outline that patient outcomes of orthognathic surgery are complex and include physical changes, mental and physical health improvements, and psychosocial adjustments1,2. To our knowledge, investigations of the personal and societal impact of orthognathic surgery using the government recognised SROI framework have not been published before. This study represents a collaboration between the University of Gloucestershire, and Gloucestershire Hospitals NHS Trust, involving patients following orthognathic surgery at Gloucester Royal Hospital (GRH).

1. Social Return On Investment (SROI) methodology
applied to patients following orthognathic surgery
BAKER, C1., COURTNEY, P. 1, and KNEPIL, G 2.
1 University of Gloucestershire
2 Gloucestershire Hospitals NHS Foundation Trust
INTRODUCTION
Patient outcomes of orthognathic surgery are complex and include
physical changes, mental and physical health improvements, and
psychosocial adjustments1,2. To our knowledge, investigations of the
personal and societal impact of orthognathic surgery using the
government recognised SROI framework have not been published
before.
This study represents a collaboration between the University of
Gloucestershire, and Gloucestershire Hospitals NHS Trust, involving
patients following orthognathic surgery at Gloucester Royal Hospital
(GRH).
CONCLUSIONS
Findings underpinned by stories of outcome change experienced by
orthognathic patients demonstrate the utility of using an SROI approach
to investigate the wider psycho-social value of changes associated with
orthognathic surgery and to develop potential indicators of change over
time. This represents an innovative approach that provides a basis on
which to understand and value outcomes that post-operative patients
experience.
The next stage in the research is to develop indicators of change for the
identified outcomes, and to pilot these across a wider cohort of
orthognathic patients. Collection of measurable data can be combined
with further qualitative enquiry and stories to triangulate findings, and to
follow the journeys of patients to help explore the nuances of surgery
context and post-operative care.
In conjunction with the SROI, patient case studies can also be used
help assess the economic benefits of orthognathic surgery, both through
cost savings to the state for example, through avoided medical
consultation costs, and the wider social value generated for example,
through improved well-being and self-confidence. This information
should be of interest to surgeons and health care commissioners alike
through recognition of the wider societal value of orthognathic surgery,
and ways of engaging patients at the start and throughout the process
of surgery and post-operative care.
RESULTS
METHOD
Social Return on Investment (SROI) is a government-recognised
outcome-focused methodology that measures and accounts for the
broader concept of value and measures change in ways that are
relevant to the people or organizations that experience or contribute to
it.3,4
This study focused on the first two stages of the six-stage SROI model
(Figure 1) as a means of establishing a basis on which to quantify the
value of impacts and translate them into monetary values.
Data collection took place via two qualitative workshops, lasting
approximately 90 minutes, whereby each participant completed a
standardised theory of change that captured data concerning the short,
medium and long term outcomes of orthognathic surgery.
A grounded theory-SROI methodology was used to explore the data
via a process of constant comparison whereby data were analysed for
concepts and organised into distinct themes5.
The product of this process was a theory of change which articulated
the short to medium and long term outcomes of orthognathic surgery.
Research ethics were approved by the Health Research Authority
(South West) Research Ethics Committee
Figure 1: Six stages of SROI
ACKNOWLEDGEMENTS
The authors are grateful to all the participants who took part in the data
collection process and shared their experiences.
AIM
To understand the wider nature of changes associated with
orthognathic surgery that are experienced by patients.
REFERENCES
1. Ryan, FS et al. What Are Orthognathic Patients' Expectations of Treatment
Outcome—A Qualitative Study. J Oral Maxillofac Surg 2012; 70;: 2648–2655
2. Lazaridou-Terzoudi T et al. Long-term assessment of psychologic outcomes of
orthognathic surgery. J Oral Maxillofac Surg 2003, 61;: 545-52
3. Aeron-Thomas D et al. Social Return on Investment: Valuing what matters.
London: New Economics Foundation, 2004
4. Nicholls J et al. A Guide to Social Return on Investment (2nd ed). London: The
Cabinet Office, 2012
5. Bringer et al. Maximizing transparency in a Doctoral research thesis: the
complexities of writing about the use of QSR*NVIVO within a grounded theory study.
Qual R 2004, 4, 247-265
Two overlapping and interrelated conceptual pathways along which the short to medium term and longer term outcomes emerged through the
analysis of data.
1. Physical functioning related to the impact of the surgery with respect to participants’ ability to lead to healthier and more active lives.
2. Mental health related the impact of surgery on participants’ personal resilience, vitality and self-esteem with respect to feeling less anxious,
more confident and better able to deal with challenges.
These pathways were characterised by a number of themes and related dimensions (Figure 2) which helped unpack the data and explain
participant experiences. Quotations are provided to give participants a voice and to link the data with the conceptual representation of the
findings.
Figure 2: Theory of Change
CONTACT INFORMATION
Dr Colin Baker, University of Gloucestershire. cmbaker@glos.ac.uk
1. Identify key stakeholders
2. Map
outcomes
3. Measure
& value
outcomes
4.
Establish
impact
5.
Calculate
SROI
6.
Reporting
‘Growing up, you
associate your
appearance with your
identity, so when that
changes suddenly you
have to step back and
readjust, so for me it was
about adjusting to that
change, which is a slow
process. You realize
you’re the same person
but that you look a bit
different’ [BB, W2].
‘…because I can breathe
better at night it’s
improved things, I feel
less tired, I have more
energy during the day, I
can do more things and
get out more. I’m more
focused now, and less
grumpy, and I think
generally better at my job’
[NT, W1].
‘you just want to walk
down the street and not
feel that people are
judging you. To just be
like everybody else, be
mainstream like
everybody else. Not be
different, not categorised
as something else’ [MU,
W1].
‘I was in the same job for
ages where everyone knew
me and I felt really
comfortable. But, obviously,
I was really conscious about
my jaw, but after the
surgery I was really
confident. Literally, weeks
after I was changed
drastically, and I wanted a
new job, I wanted a change
and I had the confidence to
go for the interviews’ [IW,
W2].