The title was perhaps a bit grandiose but it seems clear that Gerry has made a difference in Rotherham General Hospital. He has stuck with a simple prescription: recognise the ideas and talent you have in an organisation, recognise what will and what won't work, support the good ideas, and give people the help they need to make things happen.

Surely if it were so simple, waiting lists would be a thing of the past?

Well as the three programmes come to an end, I think we are left with some interesting questions:

• Will the projects Gerry supported wither and die now he has gone?
• Will key managers adopt Gerry's approach and keep bringing staff together in similar projects?
• Gerry focussed a great deal on making change happen despite the wider system. What changes to the way hospitals and the NHS are structured might make effective management more possible?

"So what will it take to make change stick?"

So what will it take to make change stick? Certainly, Gerry's call for more active management would need to be part of it. However, as we saw in the programmes, there are some more systemic issues. Two key issues that I would identify are:

First, the way responsibility and decision making runs through narrow professional silos clearly creates an impediment to the kind of cross-professional working needed to foster improved performance, especially the kind of bottom-up change Gerry espouses.

Second, the new financial regime, while having some benefits also provides disincentives to improved efficiency. So long as hospitals are stuck with a system of fixed charges, they are unable to share efficiency gains with their main customer, the Primary Care Trust (PCT). This means that the most likely outcome of massive reductions in the waiting lists is a surplus in the hospital budget which is matched by a deficit in the PCT.

What are the chances that the government will act to allow flexible pricing? Since a likely consequence is that more efficient hospitals would win business from the less efficient and that would lead to closures it would take some political courage.

That's my perspective on the series. Why not share yours and join the discussion in our forum.

Content last updated: 03/01/2007

About our columnist

Mark Fenton-O’Creevy is Professor of Organisational Behaviour and Director of Programmes and Curriculum at the OU Business School. His published research includes investigations into the performance of traders in financial markets, barriers to the international transfer of management practices, and the reasons for resistance to change in middle management.

Mark has acted as an adviser to a range of large organisations across the public and private sector. Since October 2005 he has also been Director of the Centre for Practice Based Professional Learning: one of four national centres for excellence in teaching and learning at the Open University

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