In the end, six months of work came down to one meeting. Anyone who has ever done an exam, driving test or job interview will know how I felt before the business case approval panel.
 
One little moment in front of the ‘powers that be’ would decide whether the redesign of the stroke pathway went ahead. It didn’t matter that my secondment was nearly over and it won’t be me who implements the project. All I could think about was how much I wanted this to happen and the hopes and expectations of the stroke survivors, carers and clinicians who supported every step of this process.
 
The decision on my business case was in the hands of NHS Leicester City’s commissioning executive, a heavyweight group of senior managers and practice-based commissioning clinicians.
 
I’ve spent many years on their side of the decision table. I was good at listening and had a nice line in challenging interjections like, ‘so what?’ and ‘but what if?’ Perhaps that’s why I spent hours thinking about the questions I might get as well as worrying about the answers.
 
I confess being on the other side is, well, scary. Sleep didn’t come easy during the nights leading up to my 20 minute slot. Then, when the day came and I was finally in that room all I wanted to do initially was take the director of finance’s cosy seat opposite mine.
 
Instead, I took a deep breath and relayed my prepared speech. I even got up and drew on the flip chart to illustrate my points, a bit of a trademark for me. Then I reasserted the caveats I believe are essential to this project. Those caveats are that we properly resource the implementation phase; reduce cost at the same time as building better quality; and work across organisational boundaries. I outlined how the next bit of the redesign will happen and asked if there were any questions (I’m always so polite). Then I waited.
 
I held my breath until they said ‘yes’ and I replied “Yeesssssss!”. It was a ‘yes’ to moving on from my secondment, knowing the project can continue. It was a ‘yes’ on behalf of more than 50 patients, carers and clinicians who formed my project group. And today, most of all, that` ‘yes’ was an endorsement to leaving my comfortable executive chair (and comfort zone) and putting myself in the do-er’s shoes. I slept like a baby that night.

I have just had a lesson in finding the right pace. I scheduled an extra event so I could work with our stakeholder group on some of the finer detail of the redesign – at a speed to suit them. It was worth changing my plans and boy, what an event it turned out to be.

We spent the day looking at the option appraisal for the redesigned stroke service that will be implemented across Leicester. There was an exceptional turnout (this was the fourth day we have spent together) reflecting a really good mix of stroke survivors, their carers and health and social care staff.

I can honestly say that the day was a complete inspiration to me. It was definitely one of the best days of the whole project so far. It was stakeholder involvement at its best and I ended the day thinking just how robust the option appraisal for this redesign is as a result. So, what was it that made it so special?

At the heart of its success was its simplicity. We went through evaluation criteria, weighting the criteria, and got that all agreed. We described options, compared and contrasted them so that everyone was clear what the similarities and differences were between them. We scored the options using the criteria and we covered the risks associated with our options. We had a clear winner in terms of benefits score.

Maybe the agenda doesn't sound all that simple, but the other critical success factor for me was that we spent the whole day on it. We took plenty of time to get it right. We applied a very methodical approach to what can be quite a tricky concept and when someone on the stroke survivors' table said to me ‘Oh, so that's why...’ and a second person then added  ‘Aah right, I can see now why you ....’ I knew we were taking everyone along with us.

Not only have I learned a big lesson from this project, but I have seen it in action. Take the time to think things through, give others the time to catch up and then together you can find the best solution.