Orthopaedic Rapid Improvement Programme

The journey –

The Orthopaedic Rapid Improvement Programme was set up to rapidly improve patient pathways for fractured neck of femur and hip and knee surgery. It was a national programme designed to embed best practice pathways and, in so doing, to make major improvements in patient experience, beds saved and clinical outcomes.


Nationally, the Rapid Improvement Programme was commissioned by the Department of Health and led by the NHS Institute for Innovation and Improvement. Each trust was supported by a clinical facilitator to embed the pathways. In NHS South West, the SHA built on the Rapid Improvement Programme pilots with a series of events to help spread the learning (see: Collaborative Commissioning events).



The impact of the programme has varied between the trusts but overall it has been very successful. Common outcomes include greater numbers of patients being admitted on the day of surgery and reduced length of stay. Trusts developed a better understanding of their actual performance, which helped them improve and there were also cultural changes, such as traditional role demarcations being broadened to foster a ‘can do’ attitude and better quality teamwork.


Patient setting

In-patient   X Out-patient   X Community based   X
Mental health Chronic illness Cross-systems    X


Clinical area

Staying healthy Maternity and newborn Children and young people Acute care
Plannedcare X Mental health Long-term conditions End of life


Information, tools and techniques used

The programme drew upon regional benchmarking evidence to support best practice in orthopaedic pathways. It used an evidence-based rapid work process developed by the NHS Institute, which included a range of tools, such as the observation tool ‘Through the eyes of’.



The programme was implemented in 20 acute trusts across England, two in NHS South West.



Each trust implemented the pathways in an intensive 12 week period. The programme as a whole ran for a year from 2008 to 2009. This included time to form direction, select trusts and work with these pilot sites.


Contact details and further information

Deborah Thompson deborah.thompson@institute.nhs.uk headed the orthopaedic Rapid Improvement Programme team. Further information on the programme can be found at: http://www.institute.nhs.uk/quality_and_value/high_volume_care/rapid_improvement_programme.html

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