1. Introduction to group work. Developing a strategy to improve SNOD involvement in the ‘Approach’ in the Midlands Region.

2. Aim. Increase rate of SNOD involvement in the ‘Approach’. Benefits to recipients Benefits to family (time, quality of approach, consent rates if right) Benefits to hospital/local team

3. Goal. Improve SNOD involvement from 61% (red) to 78% (green) in 2 years.

4. Improvement strategy (driver diagram). Education and training Internal processes (within your hospital) External processes (regional organisation)

5. Improvement strategy (driver diagram). Education and training 1.All consultants to watch DVD/best practice training 2.? Difficult communication course Internal processes (within your hospital) 1.Adopt regional pathway 2.Adopt 1 new approach to encourage early referral 3.Increase the practice of ‘admit to prognosticate’ 4.RCA for every case where no SNOD involvement External processes (regional organisation) 1.Effective and early DCD triage 2.? Changes to regional SNOD deployment

6. Monitoring progress. Feedback at future Collaboratives of progress towards - headline goal (% SNOD involvement in Midlands) - % SNOD involvement by hospital - achievement of agreed objectives (primary and secondary drivers)