What a strange week. I’m sure you have them. My initial reaction was that it had been a pretty unsuccessful one, but on second thoughts perhaps a little reflection is in order?

I have been holding staff ‘focus sessions’ to help me understand what works well along our care pathway and where we have issues that need sorting out. My first group was small but beautifully formed. The second we changed from a focus group to more of a one-to-one and the third, I have to admit this, made me rethink the phrase small but beautifully formed from earlier in the week. In a nutshell, very few attendees came along. Lots of apologies right at the last minute and absolute commitment to attend the next all-day event (coming up soon!) when I will replay this diagnostic material back to my stakeholders.

So what went wrong? Are staff really engaged? I’ll ask on the day to see if we can get underneath this dilemma. Future involvement is critical to the success of both the project itself and the sustained implementation of any service changes we make. So, is it my method of involvement that does not suit? Was the time or the location wrong? Is it that people want to be given the chance to comment but don’t really want to spend the time it takes to do the research? Are there more important things for staff to be doing?

Or is it just that our frontline staff don’t get the opportunity to sit down, away from the day-to-day operational tasks, and reflect? Is it difficult for them to find time to develop ideas and change the way they work as a result – you know, that system of continuous improvement? This could be a significant strategic issue for us. How can we expect to get the group of people who play a major role in the delivery of our services involved in thorough review and redesign unless we find ways to release them from their jobs to have the input that such a programme as this demands?

Redrawing this pathway will take a huge amount of people hours over a number of weeks. The optimum solution will elude us if those best placed to understand the issues and come up with the solutions are only able to contribute a little here and there when they can. We already know that things will be very challenging for us over the next few years. Resourcing frontline involvement will be critical if we intend to improve quality and productivity to maximum effect.

I cannot contain it any longer – the deep-rooted accountant’s need to share numbers and costings with my new found colleagues.

Two things have stopped me doing it before now. First, I have been trying to work out the best way to share this exciting stuff with the clinicians and patients I have met so far. Most of them really can’t understand how an accountant gets their kicks. So I need to give some serious thought to how I can best deliver the big impact messages that will make them ‘wow’ quietly and then want to seize the power and opportunity these figures will give us in our redesign.

Second, and perhaps more interesting, is the time it is taking us to collect the figures. The cost of the acute stay in hospital is easy – well for commissioners it is – national tariff x volume of activity.

But then adding the cost of community nursing and therapists’ input, the cost of individually designed social care packages, preventative programmes across health and social care and prescribing to those who might be at risk of having a stroke and those who have already suffered one, you can see it’s going to be a bit more tricky.

Our local patient activity systems just don’t collect the data we need to make these costs pathway specific. The residual presence of block, and the emerging cost and volume, contracts for intermediate care and community services make it difficult to break down expenditure beyond these high level categories.

So, with the aid of some very smart and committed financial support from both health and social services, we are developing a ‘bottom-up’ model. This is the only way we will objectively prove what impact our redesign is having on the relationship between patient flows and costs. It will prove if we are providing better value for money and if we are truly targeting financial investment where it is needed. This is another area where I am keen to know if any of you have experiences you can share with Leicester.

The big event – that thing that kept me awake for several nights worrying about it has come and gone.

Overall I believe my first stakeholder event on stroke went well. A bit to improve on at the second event but we achieved the objectives for the day. Someone even said it was well organised and there are plenty of stakeholders who wanted to join me at the next one later this month.

For me, the day was great, lots of people there – patients, carers, patient groups, acute professionals, community teams, social care representatives, commissioners and my GP champion. And even better, they were all still there at 4.30pm. There was a friendly atmosphere, lots of completed flipcharts on the huge amount of wall space and such a feeling of wanting to be a part of this initiative.

We did the ‘What will stop us changing things?’ session. This was one of the areas where I would want to do it differently next time. On the downside, we did miss the skills of an experienced facilitator. My guide book provides tips for this type of work and it suggests that you might need one. A note for the future – pay attention to tips.

Subsequently, my example fell a little flat and also I was time pressured so ended up cutting it short as we rapidly approached the end of the event. On the upside – perhaps in support of understanding where I was trying to go with all of this, even if I wasn’t doing it very well – I felt the audience’s underlying agreement that we need to work on this area over the coming weeks. I felt there wasn’t a sceptic in the room and we all believed we could improve these services for the better.

As I go off to try and find out how I can tackle this hearts and minds stuff, I reckon this isn’t just about pathway redesign, it’s about all we do in the NHS and wider life. So having determined this question applies to you all out there, perhaps readers of my blog will have some good ideas/experiences on winning hearts and minds that they can share with me?

My holiday was fantastic. Switzerland’s scenery was breathtaking and the mountain air refreshed me for my next challenge – engagement.

I am just about to hold the first of three all-day events with a variety of stakeholders. The aim of the first day will be to agree the current stroke pathway across the city.

I’m quite anxious about it, in a positive way. I desperately want it to go well – for everyone to be keen to work together and as enthused as I am about the project. I hope we will also find a shared motivation to see us through any potential hurdles.

I have been thinking about whether I should do some hearts and minds stuff on the day. Those who work in service improvement are always telling us that it doesn’t matter how good the solution is. If the people who are asked to work with the new solution aren’t behind it conceptually, and they haven’t thoroughly bought into the process of change, then the redesign will not be successful over a sustained period of time.

Often great projects fail after implementation because the enthusiastic project leader leaves the project and along with them goes the momentum, the spotlight and the determination to make it last.

Hmm…so, on the basis that I buy into this theory myself, what to do? I don’t want to insult the intelligent people who will be there with a load of management speak that might suggest that they are not there for all the right reasons. But I do want to challenge them so that any doubts they may have, or reluctance they feel, comes out into the open and is addressed.

I decide to spend a little time during the day on ‘What will stop us changing things for the better?’ This may help to uncover some of the people issues as well as the more easily identifiable tangibles. Hopefully, the output of that session will assist me in working out how to tackle potential problems, as well as giving me a little time to find a change agent-type professional to help me over the coming months. Any volunteers?