In a sense, nothing seems to be have changed, nothing seems to be changing and nothing will perhaps

1
The challenge- e.g. Involving the doctors

• In a sense, nothing seems to be have changed,
  nothing seems to be changing and nothing will
  perhaps change unless carefully planned
  sophisticated health policy interventions are
  designed (after adequate consultations with the
  clinicians) that would engage clinicians, empower
  them and enable them to take full responsibility
  for the quality of clinical care.It seems
  clinical governance is something that doctors are
  putting up with for the time being, in the hope
  that it will slowly fade away like many other
  government initiatives. Som, 2005. (474)

2
Practitioner engagement

• Demystification of leadership and change
  management
• Getting to know what it is that we already know
  about change

3
The best approaches to change require that we

• are clear where we are going and why.
• promote personal investment in that future.
• respect and act on other peoples world view and
  particularly those that have most difficulty
  exercising power
• recognise that just trying out changes consumes
  time and resources

4
The best approaches to change require that we

• respect issues concerning the meaning and value
  that people attach to aspects of change and not
  changing
• recognise that enduring change takes a long time
  and will not be achieved without setbacks to
  learn from.
• use measurement to promote learning
• work with as much of the system as we can

5
The best approaches to change require that we

• ensure that enough people can participate fully
  and equitably in the process
• are not deflected by challenging behaviours that
  need to be put right but rather focus on
  meaningful longer term goals that build capacity
  to continue to improve in future
• build on the strengths and experience of all
  participants in the process.