Table 2 Diagnostic findings: implications

Communication problems, lack of staff consultation, preparation and ownership associated with past history of poorly managed change

Good communication, planning and training provision associated with past history of well managed change.

Build on previous success. Clarify lines of communication; establish local ownership; use training intervention to benefit staff skills related to changes.

Uncertainty relating to a potential Trust merger; possible negative impact on management, staff capacity and work environment

Positive staff views of the work environment and management structure.

Local project support explicit.

Strengthen teamwork; set up project steering group with influential support; work across organisational boundaries.

Nursing workforce shortages; use of agency staff leading to potential discontinuity in assessment and care planning.

Core of stable senior staff: median service of interviewees 10 years.

Ensure agency staff included in outreach training to implement assessments; flexible scheduling of training to maximise attendance.

Processes for implementing innovations not clear in organisational strategy.

Strategic commitment to clinical effectiveness, multidisciplinary working, evidence-based medicine, education of staff.

Develop strategy using recognised clinical effectiveness methods, education/training, multidisciplinary approaches

Teamwork Factors

Team work less well developed in medicine and some areas of nursing

Team work strongly developed in therapies and some areas of nursing; positive role models exist.

Create positive focus and environment for team work within strategy eg shared training; outreach necessary in areas of weak team work and staff shortages.

Team concept; unidisciplinary Negative views of multidisciplinary ward meetings and efficacy of liaison.

Service teams and ward meetings largely medically led.

Positive views of multidisciplinary ward meetings and efficacy of liaison.

Leadership potential evident within therapy and some nursing teams

Professional representatives/champions needed to provide leadership on equal basis to drive change

Stroke Assessment Factors

Assessments unidisciplinary, fragmented, variable evidence-base, and using separate recording systems.

Negative experiences of patients on discharge information provided

Local commitment to developing evidence-based practice. Need for assessment project supported by Trust.

Positive views of patients on assessment and care provided

Utilise evidence-based guidelines for assessment and recording.

Mechanisms for critical appraisal to be set up.

Guidelines for discharge information needed