There is currently widespread concern in the British National Health Service with the problems of improving hospital care, particularly in the long‐stay sector, at a time of economic constraint. In the light of two recent reports providing guidance on good practices of patient care, an analysis is presented of how change in existing attitudes and practices can be encouraged. The real difficulties of this process are recognized but a case study of one hospital over several years, when combined with insights from other social scientific research, suggests a set of principles which may be of assistance to hospital staff with potential leadership roles in innovation. Attention is directed to the variety of channels through which patient care may be influenced, the importance of harnessing the motivation of care staff, the need to provide support in working through emotional barriers to change, the complementary roles of staff at different levels and in different professions, and the scope for mutual exchanges of experience between different units. Finally some ways in which these principles might be applied in particular initiatives are suggested in outlin
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