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Over the past 100 years, the interview has received much attention. It is generally agreed that the interview is modest in terms of reliability or validity. In spite of this, it will continue to be used as a selection tool. Research has shown that structured interviews are more reliable than unstructured interviews. It has also been suggested that group interviews and extensive interviewer training modestly improve interview validity. Little theoretical development has occurred since these ideas were presented in the 1940s. At the risk of denigrating research contributions on the interview process, the past 20 years of interview research have lacked substantial theoretical contributions and the creativity necessary to make the interview perform the function it is designed to perform – identify the best person for the job.

Health services continue to face economic and capacity challenges. Quality improvement (QI) methods that can improve clinical care processes are therefore needed. However, the successful use of current QI methods within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.

A model to manage variability was adapted for use as a QI method and deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases, was used to assess its effectiveness.

Following the use of the novel QI method and the subsequent changes to care processes, the length of hospital stay was reduced by 18%. However, the interventions to improve care process highlighted by the QI method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the model to manage variability) was simple, effective, offered advantages over other QI methods and had highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing and organisational issues had prevented changes being implemented and a greater improvement being made.

The quality of QI reporting in surgery has previously been highlighted as poor and lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not only describes and presents the results of using a novel QI method but also provides new insights in regard to important contextual factors that may influence the success of QI methods and efforts.