Objectives An ethnographic enquiry aimed to understand issues relevant to clinical governance in relation to how health professionals and patients interacted in a system of referrals to orthopaedic services.Design A qualitative approach to description, analysis and interpretation was taken using ethnographic techniques to select and analyse data from four component studies of an orthopaedic services referrals management initiative.Results The network of referral routes reflected potential for a wide variation in decision making for patient care. A lack of important information transfer and feedback through the system was identified at critical points.Conclusions The findings of this study demonstrate benefits to be gained in taking a systematic wider look at the scope for supporting responsiveness to patients in an orthopaedic care system. Doing this identified a need to improve system communication in orthopaedic services, to underpin cultural change which can enhance patient care in the communityand support a continuum of delivery of lifelong care.
Fiona Poland, Barbara Richardson, Lucy O? Driscoll, Michael McCullagh