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Can you change anaemia management in your transplant patients? Measure it! • How many patients are anaemic? • What is range, mean, median Hb? • Compare with national/local recommendations or local/national results • Present your results Centre protocol • If no written protocol/standard – write one with a nephrologist and get agreement. National/European guidelines are useful starting points • If protocol exists, who monitors deviation from target? Success usually depends on: • Spending time to understand the cues and clues • Accurate summary of issues raised, and control of direction of discussion • In-depth agreement to ensure an action is on a solid basis • Attention to the political processes of the organisation and the involvement of relevant people • Delivery of any promises on time to the required standard • The management of the project by establishing a structure or forum to highlight/resolve issues Reasons for failure • Not involving influential people early - the make or break people • Proposing solutions before problems are diagnosed • Presenting reports full of content without an equal regard for the process of discussion • Moving too quickly, causing surprises and creating defensive behaviour amongst others • Not recognising the effect of change in one part of the system on another part of the system Margerison CJ (1988) Managerial Consulting Skills - a practical guide; Gower