Making ideas reality

Authors: Mona Stokes, Yasmin Ahmed-Little, Deborah Kendall, Jennifer Harrop, Joseph Collum 

Publication date:  19 May 2010

Mona Stokes and colleagues look at a Dragons’ Den initiative that has converted junior doctors’ ideas into practice

Have you ever had a great idea to make things better? Something that would streamline service, improve training, or just improve junior doctors’ working lives? Nine projects are now up and running in the northwest of England that do just that. These projects were designed and are led by the region’s junior doctors after winning funding from the “Junior Doctor Dragons’ Den.” The junior doctor advisory team at NHS North West, along with our colleagues from BAMMbino, the junior doctors’ arm of the British Association of Medical Managers (BAMM), set up a panel of senior health service “dragons” so that junior doctors could get their great ideas heard.

Frontline junior doctors are often an untapped resource in the NHS when it comes to leading innovative projects. Perhaps this is owing to the short, rotational nature of their posts: they’re never in one place long enough to do anything more than an audit. But maybe rotation gives them the edge: they can see how different systems and processes lead to different results between trusts, wards, and departments. Even though many of us have been party to coffee room conversations about how to improve things, few junior staff members feel comfortable in developing these ideas and arguing their corner with senior colleagues. This year the junior doctor advisory team sponsored and supported junior doctors to do just that—to be agents for change at their local trusts.

The dragons held the purse strings of a £50 000 prize pot to be divided between projects in three categories—service improvement; education and training; and improving junior doctors’ working lives. The proposals were judged on merit in terms of originality, innovation, cost effectiveness, and their contribution to improving patient safety. The proposals were presented to the dragons at an evening event with an audience in February this year. And in true BBC style there were opportunities to cross examine and question. The winning projects include “online consent for gastroscopy,” “Balint reflective-practice groups in foundation training,” and “lessons learnt,” a teaching and learning tool to report patient safety infractions.

How to set up your own Dragons’ Den

The money

You don’t need a vast sum of money to plan an event like ours. It is easy to run something similar at your trust for free; you may just need to be creative. You could suggest it to your management team as an engagement exercise to improve relations between trust management and junior doctors. Indeed, you may find that you plan a zero cost affair only to find that some enlightened budget holder thinks your idea is fantastic and is willing to divert funds to a winning project that can save costs. You can clearly set out whether there are funds to bid for, and how much, in your proposal criteria. Your hitlist of potential forward thinkers could include the director of operations, the director of finance, or the medical director.

Maybe you have the management on board, but given the financial climate there’s no spare cash. There may be other organisations that you could approach for sponsorship, such as charities. Be bold, but don’t be greedy.

Choosing your dragons

The key to choosing the dragons is to pick a group of individuals who have the experience and knowledge to identify an exceptional proposal and appraise it critically. They may hold some local knowledge of the service or of the organisation. You may wish to use an outsider from local industry, as we did, or include a stakeholder (patient) representative. Remember that in order to implement change there must be hand in glove cooperation between clinicians—medical or nursing—and management, and you should seek patient approval.

A cautionary note—don’t pick a dragon who is likely to say yes to everything, and equally don’t pick one who only says no. You should pick your dragons on the basis that they are the ones with access to funding, or because they have the clout to make things happen (for example, the chief executive officer).

Set the criteria

This is where you can offer some guidance on the kind of projects that you expect—it’s no good someone proposing a new technique to save the world when there isn’t the infrastructure or financial backing to support it. We requested that proposals were accompanied by a commitment from the trust that if successful, they would be implemented. This was done by providing a form to be signed by the finance director and the chief executive. Without this sort of local support, projects will probably never get off the ground. A useful by product of this process is that projects may gain a “champion” or “critical friend” who can help refine the idea.

Advertise, advertise, advertise

If no one knows about this great opportunity, the whole thing falls at the first hurdle. Publicising needn’t cost a fortune. It sounds obvious, but:

  • Identify your audience (for example, junior doctors in your trust)

  • Source a budget for publicising the event. Print out posters and put up around the site(s) at key locations—postgraduate centre, library, mess, theatre coffee room

  • Use a mailshot to contact potential candidates. Medical staffing or the postgraduate centre will have a mailing list of all the doctors in your trust

  • Nominate a key contact, set a closing date, and sit back and wait for the project proposals to come through.


You may well find that you are inundated with ideas from keen junior doctors. Assemble your shortlisting panel. Using the criteria, examine the proposals and select those that you want to hear about at the event.

Don’t be afraid to ask for extra information from applicants. This will allow the best proposals to shine on the night and make overall success more likely.

There will always be applicants who aren’t successful. Give feedback. Whether it was the style of the proposal or the idea behind it, commenting on the reasons they weren’t picked will raise their future application standard.


You’ve got the dragons, you’ve got the candidates, and now you need a place to get them together. The postgraduate centre will often be able to support internal events. To arrange this, contact your postgraduate clinical tutor or postgraduate centre manager. You may be able to co-opt an established forum where you are guaranteed attendance; for example, the grand round or an alternative to audit afternoon. It may be a cheap way to keep the dragons, candidates, and attendees fed and watered too.

If booking an external venue keep track of attendees by starting a database with contact details. Your expanding database will offer you a guide about what size room you should book. Most hotels have conference facilities and you may be able to negotiate a favourable rate. Make sure you have technological and audiovisual support if you and your team are not skilled in these areas.

Good attendance will make your den even more successful as the story of the event will spread.

On the night

Arrange for the dragons and candidates to arrive before the scheduled start times. Give plenty of notice of these times and arrangements. Brief all parties about how the event will run, then sit back and watch it all unfold.

To facilitate smooth running, we nominated a chair for the evening and kept the presentations to a brief five minutes with a further five minutes for questioning by the dragons. The dragons were provided with scoresheets that had judging guidelines. Marks were allocated for presentation style, clarity of vision, and appropriate use of visual aids, and the winning projects were the ones that had the most original ideas for improvement that were workable in the trusts.

After the event

After thanking the dragons and providing detailed feedback for all of the candidates, we set about drawing up service level agreements for countersignature by the winning proposer and their trust officials. In these agreements, we asked for evaluation projects to be designed and for clear timescales for project implementation, reporting, project end, and exit reporting. We will be following our winners for the next few years and hope that our Junior Doctor Dragons’ Den makes real, quantifiable improvements to the service for the patients and doctors of our region.

How to develop an idea for the board

We aim to show you how to take your vision and make it watertight. In other words how to turn your concept into a plan.

Know your audience

The first thing when preparing for any presentation is to know your audience. Your “board” may not be the board of directors at your trust or primary care trust, but the consultants and manager of your directorate, the partners at your general practice, or even the ward manager and consultants. Knowing your audience, what their aims are, or the jargon they value will give the proposal a better chance of being understood.

Get a critical friend

We can all think of examples of when we have come up with an idea just to have it shot down by the first person we told about it. Maybe we left it there, or maybe we learnt, modified, and tried again. Having a critical friend goes even further and requires a dose of courage. You could choose someone who is likely to be the biggest critic and get them to pull your plan apart so you can see all the challenges or, possibly more helpful, choose someone who has experience in this field and is likely to be objective. It could be a senior colleague, a member of the nursing staff, or maybe even the director of operations at your trust. Having your idea picked apart by a trusted colleague while you still have the freedom to modify it is far preferable to dismissal out of hand by the board.

Write a business case

The purpose of your business case is to get your foot in the door. It shows that you haven’t just plucked this idea out of thin air, but have considered and chosen it from all other possibilities. There are many resources online and elsewhere to tell you how to write a business case, but here are our top tips.

  • Make your executive summary compelling. Many readers will not get past the first paragraph unless they are drawn in by cost savings, tangible service improvement, or revenue potential. If not, you risk not even getting in the room to make your pitch.

  • Make it easy to read. Use some lists, numbers, or bullet points so the reader can pick up salient information easily without sifting through extensive longhand prose.

  • Outline the costs clearly, preferably in table form and provide a similar breakdown of the costs of continuing the status quo and other possible solutions for comparison. This is a vote winner and shows that you have put some real thought behind choosing this as the best solution. Remember, costs may not be purely financial—we work in a public service and improving the safety and quality of service are important considerations.

  • Include a risk assessment. Show that you have thought about the potential pitfalls and planned against them.

  • Show your timeline and evaluation reporting deadlines. This shows that the board can expect you to be accountable for the changes that you propose and their timely implementation.

Anticipate resistance

Few people like change. Most people carry on the way they always have and may continue to do so, even if it is doing harm. However, if you are able to convince the board and the stakeholders (shopfloor colleagues in this case) that by implementing your project things will be run better, faster, or smoother, then they may be willing to risk changes to achieve these goals.

Evidence based practice and clinical governance push us to exhibit best practice principles in all aspects of the health service. Including such standards as benchmarks or goals will add credibility to your proposal, but if your proposal generates more work in the long term, or if it doesn’t save time, money, or staffing, you will need to have some pretty compelling arguments for why it should be implemented.

Don’t be disheartened

If you were not successful, don’t be put off. You may not be presenting to the right people at the right time or worse still, it might not be the right idea. Sometimes even if an initial proposal is not suitable, by seeking feedback you may be able to salvage a potentially lost opportunity. Ask whether they would reconsider if amendments were made. If the answer is still no, you might have to chalk it up to experience, or shelve it for another day.

It is important to remember that the work you have done has not been a waste; it was a learning opportunity. Next time you will do it better, faster, smoother, and with fewer problems. You may now be more discerning and come up with ideas that are more likely to be put into practice, and all the challenges that brings are a matter for another discussion.

If you were successful, well done. The hard work starts here.

Competing interests: None declared.

Mona Stokes GP traineemedical adviser  NHS North West, Manchester
Yasmin Ahmed-Little specialty registrar public healthvice chair  NHS North West, Manchester
Deborah Kendall paediatric traineeproject director  NHS North West, Manchester
Jennifer Harrop deputy project  Junior Doctor Advisory Team, NHS North West, Manchester
Joseph Collum gastroenterology traineemedical adviser  NHS North West, Manchester

Correspondence to: M Stokes

Cite this as BMJ Careers ; doi: