Box 1.

Improving the delivery of thrombolytic therapy in patients with acute coronary syndromes

• Administer thrombolytic drugs within 60 minutes of the onset of chest pain (direction pointing)
• Administration can occur in any safe environment and be done by any properly trained medical staff (direction pointing, boundaries, permission)
• Remain within the overall project budget and do not add new acute care beds (boundaries)
• Any group can access the pooled budget, but . . . (resources)
• The proposal must reflect active participation from at least three stakeholder groups; for example, a team of cardiologists, accident and emergency department nurses, and ambulance service personnel (direction pointing)
• All proposals, expenditures, and results of pilots will be shared openly to stimulate comment and assessment (resources, in this case, knowledge resources)
• Source: Product of a group on the NHS leadership programme for chief executives organised by the Health Services Management Centre, University of Birmingham, May 2001