Published: 07/04/2005, Volume II5, No. 5949 Page 33

On a management course three years ago, a long day of thinking and self-analysis was finished off, in good health improvement fashion, with several yards of ale in the hotel bar. Operational colleagues turned on strategists, whom they saw as overpaid, underworked and gloriously isolated from the realities of service delivery. 'If someone says they do strategy in our trust, ' slurred one manager, 'they do nothing'.

Tasked recently to write a health inequalities strategy, my colleagues and I were clear: we wanted a distinctive document, brimming with fantastic ideas and the latest evidence. It took a long time and it was hard work, but we succeeded.

Expertly crafted, and eagerly downloaded, copies steamed as they spewed out of printers across the city. Readers soaked up its contents.

We were praised for our bravery and vision. Phones rang incessantly.

Computers groaned with the weight of congratulatory e-mails. Senior colleagues commended our work.

We feigned humility. And we waited for the world to change.

But not much happened. We had hit a brick wall. The accolades stopped. We needed action. We chewed our bottom lips. 'Should we write another strategy?' I asked. We stared out of my office at the hills of Oldham, searching for inspiration.

Suddenly, a black dot appeared on the horizon. Slowly, it grew. It was a woman with an umbrella floating through the skies of Greater Manchester. As she got closer, her face became clearer. It wasn't Mary Poppins. It was our deputy director of nursing.

I defy you to find anybody with greater vim and vigour. She was supercalifragilisticexpialidocious.

She made things happen. She took my breath away. I felt daunted by the relentless focus of her work.

And she tired of my endless talk of evidence and analysis. When we wrote implementation plans, mine began: 'Take six months to critically reflect ...' Hers read: 'Get 300 nurses in the boardroom by 3pm today'.

Together we had something special.

First, she made a simple truth very plain. Dedicated health improvement staff were crucial, and ours were gifted, but they would not have a significant impact on their own. It would take the efforts of each and every doctor, nurse, health visitor and allied health professional.

And she understood their worlds.

I asked her to help us deliver because she could bridge strategy and practice. And her help is paying dividends. It is still a struggle, but we are making progress.

Strategy is often disconnected from the realities of delivery. To succeed it depends on the vision and know-how of operational managers and the quality of their relationships.

Criticising strategy might be a veiled, perhaps unconscious, fear of its implications: a fundamental challenge to the way we have always done our business.

In turn, strategists who feel exposed and undervalued are likely to relish the complexity of their worlds at the expense of building relationships with our greatest resource: frontline staff.

Strategy will not change the world. Understanding what motivates colleagues, and harnessing their diverse energies, will get us a long way. We all have a responsibility to improve health, and reasoned documents provide frameworks to succeed.

But strategy - a process that encompasses planning and authoring statements of intent right through to implementation and monitoring - is all of our business.

It is not just the rarefied activity of a chosen few. That is our challenge. A spoonful of sugar, anyone?

David Woodhead is deputy director of public health at Salford primary care trust and Salford city council.

He writes in a personal capacity.