|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|
|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