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Evidence base: The assessment of patients for dementia and delirium in the acute hospital setting is a national CQUIN. In many hospitals this assessment is performed by the junior doctors but imposed and led in a top down manner. This can lead to a sense of deprofessionalisation of the junior medical doctors who feel they have little control over the system they work in and it may not encourage their active participation. Observed activist professional movements allow the focus shift from an individual's actions to those of the group as a whole; harnessing trust, obligation and solidarity.

Change strategies:

(1) Creation of a Dementia and Delirium(DaD) team prompted junior doctors (mostly FY1) to volunteer to be 'dementia champions'.

(2) Monthly audit and review meetings were performed and results emailed to each team.

(3) As the dementia champions rotated around the hospital new champions were recruited by them to continue their work.

(4) Junior doctors implemented a 'forget-me-not' dementia awareness scheme in all the wards.

Change effects: AMTS recorded in the first 72 hours: July 2012 68%, October 2012 85%, April 2013 99% Screening Question asked: October 2012 64%, April 2013 98% Referral to memory services (via GP): October 2012 59%, April 2013 100% The junior doctors felt that they had championed a change in the culture of the hospital likely to give lasting changes affecting the care of patients. Feedback from relatives was very positive.

Conclusions: Allowing a group of junior doctors ownership and active involvement in the project has fostered a sense of activist professionalism where the driver for change is now from the bottom up to improve care for this vulnerable group of patients. This is much more likely to produce the needed culture change than a more traditional top down approach to management.

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