Improving services is hard work. There are four key elements to carrying through any improvement which ‘sticks’:

• Convincing the staff the change is necessary: this means working through all the reasons why they haven'’t done it up to now. No permanent change ever happened just because a Chief Executive said it should happen.

• Understanding that if things are going to improve they have to be measured. Unless one has milestones and progress targets one can’t know if anything is getting better.

• Giving the people who will carry out the work the tools to do the job. This may require training or coaching. It also means fostering a culture without blame, a working environment which celebrates success and also sees ‘failure’ as a reason to learn the necessary lessons without rancour.

• Involving everyone -  if you’'ve got problems as an organisation it’s a sign of maturity to be open about them, and seek input from all your stakeholders on how to overcome them. But be clear about when discussion stops and implementation starts.