Engaging staff and creating  shared ownership of improvement efforts  are two of the biggest challenges facing any trust that is serious about improvement. Whilst colleagues might agree that improvement is needed, there can often be a challenge in getting to a shared view of what needs to be done. Resistance can be created if a drive  for improvement is seen as  a management project imposed on already hard-pressed front-line staff and middle managers. In these challenging conditions leadership needs more than a knowledge of the mechanics of quality improvement. A facilitative approach which builds engagement and consensus towards action has proven to be more effective.

Greengage can help you build the skills you need to create shared ownership and get people into action. Whether you need help with a single project that has got stuck or want to build the skills of your staff to work together to improve we can help you.

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"Makes what seems impossible, practical and achievable." 
Mike Culshaw, CHFT
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The Work Together to Improve (WTTI) programme has been developed to give people the skills they need to engage colleagues and build ownership of improvement measures. The programme has been delivered to hundreds of clinical and managerial staff and received rave reviews. Below are some examples of the impact it has made.

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The WTTI approach has been used to make improvements across a very wide range of disciplines. These include:

Improving the delivery of medicines on time

Improving stroke SHMI scores

Improving bariatric services

Improving dermatology services

Improving midwifery services

Building engagement with a GiRFT programme

Integrating stroke services across two trusts

Improving general surgery

Improving radiology services

Improving collaboration between acute trusts

Improving primary care delivery

Read more detail about a few of these improvements below

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Neeraj Bhasin, Associate Medical Director

Improving General Surgery

A WTTI approach was used to make a breakthrough in general surgery. Whilst there had been a commitment to make improvements from all sides, there were different perspectives on what the needed to change and how to go about making improvements. This had led to frustration and it was perceived that, in certain areas, progress had stalled. The key to making progress was understanding that the perspectives of those that work in the general surgery team and those of the executive team were different and may have created barriers to developed a shared approach. 


The WTTI approach was used to bring everyone together in a conversation to create a common understanding of where things were working well in general surgery and where there were opportunities to improve. This process allowed the different perspectives to be explored and for people with different views to understand each other without blame or judgement. 


“Using the WTTI approach helped us create an environment where people could listen to and understand each other without judgement or blame. This created a good deal of trust so we could have the honest, open and productive conversation we needed to move things on. We are now making progress with our plan for how we develop the service collaboratively. The plan has the backing of both the general surgery team and the executive team. The actions we are now taking are having a positive impact on patient quality and improving efficiency.”


 Sayma Mirza, Head of collaboration for stroke services

Improving stroke services

Greengage were asked by Bradford Teaching Hospitals and Airedale NHS Foundation Trusts to support them to achieve their commitment to develop a single stroke service for the whole area. 

“ The way Greengage work really supported clinicians to see past the many challenges and focus on solutions ”

"We have made an amazing amount of progress on the collaboration project in a short space of time. Using organisational development tools and methodologies, helped strengthen relationships to work collaboratively to achieve a single stroke service. Stroke performance (SNAAP) scores also improved due to using a collaborative approach to improvement. The way Greengage work really supported clinicians to see past the many challenges and focus on solutions – what they can do rather than what they can’t do. This has given people confidence that we can make progress and unblock some of the most difficult issues."

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Catherine Riley, Assistant Director

Improving Radiology service

A WTTI approach was used to identify improvements in radiology. Radiology colleagues were frustrated with lack of progress on a number of issues that they saw as needing addressing to improve the radiology service. Colleagues felt that their concerns were not being heard and not enough progress was being made.


An initial meeting was held with the radiology team to clear the air. Members of the team were invited to present their views on what needed to change and also to identify positive examples of where things are working well. The meeting gave an opportunity for the team to air their concerns and ensure that there was a common understanding of the challenges faced by radiology as well as an appreciation of the many good things already in place. This was followed up by a second meeting to create a clear action plan to address some of the key challenges. 


“Having the clear process provided by WTTI has helped create clear actions with shared ownership of solutions and the led to the team feeling more empowered to take action.”

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