Evaluating societal outcomes of orthognathic surgery: an innovative application of the Social Return on Investment methodology to patients after orthognathic treatment.

Outcomes after orthognathic treatment are complex, and include improvements to mental and physical health, and psychosocial adjustments. The Social Return on Investment (SROI), a framework that is recognised by the government, explores the wider social value of interventions, but has not yet, to our knowledge, been used to measure the value of surgical procedures. To test its feasibility in a surgical setting and to begin to understand the wider nature of the changes experienced by patients after orthognathic surgery, we designed a pilot study that focused on the first two stages of the six-stage model. We collected data from 16 participants about their perceptions and experiences of the short, medium, and longer term outcomes of their treatment during two qualitative storyboard workshops. A grounded theory-SROI method was used to explore their experiences through a process of constant comparison by which data were analysed for concepts and organised into distinct themes. This produced a theory of change that clearly expressed the short to medium-term and longer term outcomes of orthognathic treatment, and provided an initial framework for the approach. The theory captured several outcomes and showed that the framework can be used effectively to investigate the wider psychosocial changes after orthognathic treatment. It therefore provides a basis on which to develop potential indicators for the assessment and valuation of these outcomes over time. The application of these findings to the selection of patients, engagement, and postoperative care, is briefly discussed.