Problem: The General Manager of an NHS Trust was concerned that a perceived lack of team-working across functional boundaries was a potential source of a reduction in standards of patient care. He was also concerned that there was a lack of focus in the management team on identifying and fixing organisational problems, of which the 'team working' issue was but one example.
Result: It was established that there was a major lack of communication between Ward and Community-based Nurses about patients' care needs, caused by a small group of Consultants regarding information as a source of power. The two groups of nurses fixed the problem themselves, acting informally. The Clinical Director expressed surprise when the management team pointed out the evidence that he was not acting as a senior manager. He decided that his desire to be a researcher did not justify his Director's salary. He volunteered to change the focus of his attention, including sorting out the power issues involving the Consultants.
The two groups of Nurses, supported by other staff, rejected the Executive's strategy for change, on the basis that it was not radical enough. A re-worked and extended strategy got their unanimous support. Patient care was speeded up and better targeted.