Rotherham foundation trust chief executive Brian James has made significant changes since joining three years ago, and seen ratings of fair for quality and good for resources improve to double excellent, writes Dave West.

Most of the board also changed in 2005, just before the trust achieved foundation status. Mr James says the fundamental change was to give clinicians genuine management roles. In each specialty, doctors have been put in charge of all their staff and budgets and told they can reinvest a large chunk of any surplus.

Four of seven executive directors are now doctors, with posts representing clinical support services, the surgical division and quality and standards.

How did Mr James persuade clinicians to engage in this?

"Empower them. Give them real responsibility and the autonomy to use it," he says.

The trust aims to exceed national targets in line with regional priorities. It expects waiting times to be down to nine weeks by April and wants to eliminate hospital-acquired infections.

Mr James says the trust was also looking at patients' experience "before it became a buzzword". Electronic feedback boards allow patients to record comments, with results sent back to managers in real time.

"The important thing was to engage our staff as stakeholders in the organisation and get doctors fully involved."

Read more

Quality leap sees PCTs drag behind

Patient safety push fails to raise bar on hygiene

London's NHS trusts slide down rankings

Best and worst performers

Healthcare Commission head looks back on a turbulent era

Annual check finds trusts in rude health

Case study: Salford

Case study: Dorset healthcare foundation trust

Johnson thanks top performers