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A simple visual display that outlines and logically connects: An improvement aim that quantifies what better will look like, for who and by when. A small number of Primary drivers that focus on the key components of the system/main areas of influence that need to change to achieve the aim. These are often associated with process, infrastructure, norms (culture) and people. Secondary drivers that break primary drivers down in to natural subsections or processes. They provide more detail on where interventions to positively influence the primary drivers are required. Change ideas – these are the specific ideas that teams can test to see if they influence the secondary drivers and ultimately the aim.

What we did Sharon Mcloughlin, Ward Manager, Dott Ward: "The Innovation Agency gave us the dialogue to engage with staff and address concerns objectively, without staff taking anything personally. I was able to say this is an outside organisation, and with them we’re going to look at how our team could improve." “It’s been about empowering staff, and staff realising that change has to come from all of us. I’ve gained skills to help staff feel more empowered and get on board, and see it as their responsibility to improve things too." “Hopefully as a result we’ve improved safety for patients as well. I’m more confident now that I know everybody on the team knows which patients need turning, which patients are at risk of a fall, which patients are suffering from an infection – and if staff don’t know, they need to take some accountability for that now.” Kate Wallworth, Sister, Dott Ward: "After the Coaching Academy we've now got a structure in place – we’re organised, very organised. We introduced our Safety Huddle where all staff come in and listen while we run through all the main points on the ward. That’s before every shift. Going forward everyone is aware of what’s happening on the ward that day. If a visitor comes onto the ward, any member of staff would be able to answer their questions. We all know which patients are suffering from an infection, which patients are going into theatre. It just helps the running of the ward. It’s a more pleasant ward to work on.” Lisa Clark, Sister, Dott Ward: "We had to try and figure out a way to measure if teamwork was improving or not. We introduced a simple box where staff can post a smiley face or an unhappy face, or a comment card – it was just trying to make it as easy as possible. At the beginning we’d see a lot of sad faces going into the box and not many suggestions." “Now it takes me longer to type up because there’s so many suggestions. People mention staff who’ve really put themselves out to help out, just to say thank you. You can see a lot more positive feedback, and everyone who sees their name on the board gets a positive feeling." “I don’t think people realise how powerful and uplifting it is to hear how to be positive – that there is a way to think positively, and there are solutions to problems. That’s something we’ve tried here with the team – if things aren’t going in the right direction, why don’t you think of an idea? How could you fix it yourself?” The Coaching Academy The Innovation Agency’s Coaching Academy is a programme that enables health and care professionals to improve culture, quality and safety of health and care through structured, focused interactions. Coaching for a safe and continuously improving workplace culture is a one-year programme for clinical teams focused on developing safe, high-quality and compassionate services. The programme includes accredited coaching training for team leaders; a collaborative action learning programme with other teams, creating a community of practice; an accredited team culture diagnostic to identify key areas of focus; and quality improvement and innovation practical knowledge and skills.

Ward leader, Sarah King, had only been in post for 1 month when all of these concerns came to light and she was set an improvement action plan to improve the feel of the ward by developing the leadership team and creating a strong and supportive environment for a junior workforce. Following the inspection, Sarah developed an action plan that included setting the leadership team clear goals and objectives, improving record keeping, improving medicines management, addressing low moral on the ward and changing a chaotic feeling ward into a busy but controlled feeling ward.

Three NHS case studies (from acute care, primary care and commissioning) are described and reviewed in the light of evidence from successful organisational change in the US. Eight key features of successful leadership for patient and family centred care are outlined: Strong, committed senior leadership Active engagement of patients and families Clarity of goals Focus on the workforce Building staff capacity Adequate resourcing of care delivery redesign Performance measurement and feedback