| Achieving organisational readiness for change | NHS England money available to pump-prime project funding Resources, ie staffing in place Clinical and implementation expertise on-hand from GSTFT Chief executive with belief in benefit of service: ‘the right thing to do’ Success in National awards, ie shortlisting for BMJ and HSJ awards, raising trust profile
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| Achieving individuals’ readiness for change | Some staff perceived current service as not adequately addressing needs of older patients, generating desire/tension for change. More pronounced among nurses and AHPs Sessions for clinical and management staff demonstrated purpose of service and potential improvements, setting a shared vision Proactive engagement of staff throughout implementation process (through conception, introduction, and improvement work) facilitated ‘buy-in’ Individuals with prior experience of working with similar models of care in other centres were early acceptors and advocates of service
| Some staff perceived current service as working adequately, generating limited desire for change. More pronounced among doctors. Example comment ‘We managed before you’ Some individuals described introducing change as synonymous with introducing more work, leading to reluctance to engage Service implementation encountered individuals resistant to change throughout. The reasons could not always be understood or defined. Commitment to consistently delivering quality clinical work proved more powerful than other methods of persuasion for this group
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| Ensuring acceptability of intervention | The intervention being introduced appealed to clinical staff – ‘common sense’ service with strong patient focus Active process of engaging clinical staff in implementation process demonstrated desire to adapt service to new context Early and frequent sharing of outcome data demonstrated efficacy of service
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| Achieving multi-disciplinary working over silo working | Close interdepartmental relationships were already in existence within the DGH setting, ie anaesthesia/general surgery AHPs and nurses were familiar with MDT meeting model and enthusiastic to introduce it into general surgery Education and training sessions for junior doctors and nurses encouraged understanding of and engagement with the service Regular presentations at departmental meetings (surgery, anaesthesia, medicine) maintained high service profile and led to new opportunities to collaborate with improvement projects
| Achieving buy-in from junior surgical doctors was challenging with a ‘surgery vs medicine’ culture. Initially ‘medical’ jobs were perceived as lower priority than ‘surgical’ jobs Different working patterns hindered streamlined communication between teams, ie different handover times / consultant ward round times. Challenging traditional role definition, – ie geriatricians offering preoperative assessment provoked mixed opinions, especially from anaesthetists
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