Published: 08/01/2004, Volume II4, No. 5886 Page 32 33

Instead of envying other people's success, why not applaud and emulate them? So preaches the TIN commandments. Lynne Greenwood reports

It all started with the seven deadly sins - and has now evolved into the TIN commandments. In 2000, greed, lust, sloth, anger, pride, envy and gluttony were the theme of an early presentation by the Service Improvement Network.

The concept is based on a USoriginated philosophy which uses collaborative professional peer projects to tackle service improvement issues.

The presentation, at a Modernisation Exchange event, suggested, for example, that instead of envying others' abilities and status, the audience should show a healthy desire to learn from them and emulate their success.

As a means of capturing the imagination, it was a success. Two years later, SIN evolved into TIN - the improvement network - now firmly based within Trent strategic health authority with more than 1,000 members.

The first official evaluation of TIN's success, which is being carried out by Nottingham primary care trust, provide much-needed evidence for a wider assessment of networks nationally, is underway. For although there has been a rapid growth in their number in recent years, there is little published evaluation of networks.

According to one of TIN's originators, Phil Glanfield, now performance development team programme director for the Modernisation Agency's clinical governance support team, it is 'the one piece of Trent modernisation infrastructure that has survived and thrived after shifting the balance of power'.

Although reluctant to describe it as unique, its exponents are adamant that the network has some special qualities. TIN's aim is the mantra 'to help frontline staff in the NHS and its partner organisations to improve services for the benefits of patients, users and carers'.

And although it uses workshops, conferences, mentoring, coaching and other learning events, one of its key tenets is sharing. 'When I think back to the start of TIN, I remember there were a few of us who thought that connecting people who were enthusiastic about improvement was important, ' says Mr Glanfield. 'It was also clear this was not just another project, but something more organic and emergent.'

He adds that, although it took some time for the network to take shape, what has now developed 'seems to have a clear form and considerable resilience'.

Underpinning the network is a website - acknowledged by many to be user friendly and accessible - which provides links to a range of information, including a directory of service improvement activity and a calendar detailing learning and sharing events, many hosted by TIN, contacts and other networks. This year the site was averaging 15,000 hits a month, until a reference in the National and Care Trust Development Programme newsletter to the site's 'jargonbusting' section sent hits rocketing to 25,000.

Virtual network manager Jacqui Fowler is known as 'the face behind the web' for her regular meetings with TIN members to gather feedback and make appropriate changes to the site.

'I start at a nuts and bolts, userfriendly level with every topic, ' she says. 'I give brief details and a reference to more in-depth information for those who are interested, because people are short of time.We all have good intentions to read everything that concerns us, but often do not get the time.'

Lincolnshire Ambulance and Health Transport Service trust chief executive Margaret Serna has been a member from the start.

'The network has now reached a level of maturity for sharing good practice where nobody assumes they have all the answers.

'It also operates regardless of internal hierarchies - I can spot something on the network and so can my frontline staff. It goes up and down.'

Nottingham City Hospital service improvement manager Ron Staff recruited TIN members to shadow and interview patients during a pilot study for the Modernisation Agency's Improvement Partnership for Hospitals programme.

'We advertised on the TIN network and the response was amazing, ' he says. 'We were able to use between 40 and 50 people from a wide area - managers, clinicians, non-NHS professionals - who helped us with the study but who also gained an insight into how a different organisation - our acute trust - operated.'

TIN member Dave Young is an independent service improvement consultant. 'I heard about the network in an unconventional way - when I bumped into someone involved in it in the supermarket, ' he says. 'But I immediately saw it as a useful resource for people in any organisation for picking up tools and techniques. I have recommended it to as many people outside the health service as in it.'

Although around two-thirds of TIN's members work within Trent health area, the remainder includes one member in Italy, one in Belfast and many throughout the UK.

Devon Partnership trust head of service improvement Leena Sudano says she discovered TIN in an information search on the internet: 'I value TIN because of its 'can do, will do' attitude. I have often asked network members for information or contacts, and if they haven't been able to help they have referred me to someone who can. TIN members have no interest in wheel reinvention - they are just keen to share and help others to benefit from their experience.'

The sharing aspect was not always an integral part of the NHS.Anne Clark, newly appointed associate director in the performance development team at the Modernisation Agency, working with no-star trusts, was in at the beginning of SIN and later responsible for TIN.

'I was conscious in the early days that there were a lot of people in the region working on similar agendas in different departments who could share good practice, ' she says. 'I am an optimist and I thought it would work. But it has taken time for some people to embrace the philosophy of sharing.'

But it is now second nature for the converts. Consultant emergency care adviser Tim New received over 20 requests from across the UK for more information on his diagnostic patient-tracking tool after details were posted on the TIN website.

'Stealing' ideas has gained legitimacy and TIN encourages members to 'steal with pride'.

Northumberland, Tyne and Wear SHA service improvement manager Sean Barnett has taken the idea one step further. He created a light-hearted version of TIN's 10 commandments.He writes: 'Thou shalt steal (and tell everyone where you stole it from).

Ideas that are shared (or stolen) should be used and acknowledged.'

He also ventures: 'Thou shalt commit adultery - if 'getting into bed'with a similar team doing similar work is adultery!

'Seriously, 'buddying up'with co-workers in another trust helps to share problems.'