Four clinical governance rabbit holes to avoid.

For deep clinical governance or quality governance, depending on where you're coming from and what sector you're in. Everyone has their own language, but essentially we're talking about the governance of the care and the services that you provide to the people that you serve. And I'm going to try and give you 30 years of lessons learned in 30 minutes. I'll do my best. We'll see how we go. Maybe a little bit more than 30 minutes, but essentially this is my take on where we are in terms of clinical governance and where we need to go, because we're a bit stuck. I work right across all of human services and everyone is just a bit stuck. And it's not just me saying that. There's plenty of research and literature that talks about this, that we sort of plateaued. And for all of your hard work and all of your effort, you're not really getting that return on investment that you should be at point of care and service delivery. So why is that? Well, we know what doesn't work, but we keep doing it anyway. And I'm going to talk about that as we go through. And my rabbit holes are common clinical governance traps, particularly that I've seen acute care fall into. And I'm going to make some suggestions as we go through for each of the four rabbit holes, for building a bridge over the top of those rabbit holes so you don't get sucked into them or wander into them or fall into them, because once you do, it generally takes quite a long time to find your way back out. Now, I'm not finger pointing, because I have fallen down every single rabbit hole at least once, if not more. I may also be responsible for digging some of those rabbit holes from the very early days of clinical governance. So it certainly is very much a lesson learned personally, but also from observing the acute sector and now more broadly, human services and their journey towards consistently high quality care and how we can so easily get waylaid. There is a clinical governance Rabbit Holes paper available which you can get from the Australian Institute of Clinical Governance website and that dives into this in a bit more depth than you'll get today. So if you're interested today, if this piqued your interest and you think it's relevant to you, hop on the AICG website and you can download that paper. So we don't need to talk too much about the fact that we still have problems with care and service quality and human services. Sometimes I wonder how many Royal commissions it's going to take, how many public inquiries before we actually get it before we realize that the core issues are the same over and over again. Of course you have service and sector specific issues, but at the core of every single public inquiry, every single royal commission into human services, there is a set of governance issues that is always the same. So we don't need to wonder what the issues are, we just need to get on and fix them. Now, a lot has happened since the acute sector had its kick in the backside, as I call it, way back in 1995 when the first large scale study of adverse events in health care was published at the Quality Australian Healthcare Study. And essentially that just gave everyone the biggest shock because it showed that we were harming 16% of patients. And that's no joke. First of all, everyone argued about the data, as you can imagine, exactly as what's happening in aged care now with the star ratings. Everyone argues about the data and then eventually you accept that, well, actually we do have some issues and we better get on and do something about it. And a lot of things have happened in healthcare since then. That's quite a long time. Big mindset shift. So learning a bit of humility that we're not perfect and we're not great and in fact we operate in complex systems and complex systems are quite difficult and challenging beings to work with and I'll talk about that in a minute. We've learned a little bit about how to create consistent quality care and services in complex systems. We've learned from lots of other industries to do that. We have implemented clinical governance, we have learnt new and better processes for analyzing what goes wrong and helping to make them go right. And we've endlessly trained. But despite this, suboptimal care still exists 25 years on. More. More nearly be nearly 30 years. Seven. Goodness, Kathy. Wow. Suboptimal care still exists and it's still cough. So, you know, there's some really interesting data around now about the impact on people who experience an adverse event. So this is quite new. I hadn't seen this up until recently. This is an OECD report and this is one study that said that in hospitals, if you experience what they call a safety lapse, we might call it an adverse event, a harm event during their admission. And if you experience that, you're likely to also experience a 15 to 20% reduction in quality of life. Can I just check that everyone's on mute, please, because I've just got a little bit of feedback. Thanks everybody. So that's, that's a lot. We knew it affects people badly, of course. To experience an adverse event, we know that, it makes sense, right? But to quantify the reduction in quality of life, that's interesting and that's probably more than I would have expected. We know there are costs to staff in lower job satisfaction, time wasting, the stress associated with creating suboptimal care. In fact, there's some great data now which talks about the stress and the dissatisfaction with people's roles related to providing suboptimal care, because they're stressed, because they're working with poor systems, because they're too busy to do things properly. So this has a significant impact both on the people we serve and on our staff. And of course, there's the financial cost and this OECD report of from last year, which comes up every couple of years, they have a look at the cost of unsafe care across developed countries and their latest figures are unsafe care costs about 5.4% in acute, 3.3% in primary and 3.9% in long term care. So poor care and poor services are not deep. People often say, oh, what's the cost of quality care, Cathy? And I say, well, what's the cost of suboptimal care? It's not good. It's costing you more than you think you might know. You might have done the maths. And that's great, that's fantastic if you have, because we need more people to be looking at this, but if you haven't, it's a hidden cost in your organisation. So the rabbit holes that I'm looking at, activity without purpose, processed before people, prioritizing passivity and confusing fads with foundations. Now, we could probably, if we got together with a whiteboard, we could probably name 50 rabbit holes. These are those that I see over and over and over again. They're very easy to fall into and really hard to escape from. They also align with the literature and the public inquiry findings on clinical governance failures. They waste endless time and energy and dollars, and they're all avoidable through committed and focused board and executive leadership. And as I said, they're also my lived experience, so I can speak with some confidence about each of these. So activity without purpose. I think what happened in healthcare, and I will use healthcare as my main example because that's where we've had lots and lots of years to study the patterns and the good and the bad. Clinical governance at some point became all about following directions and we kind of forgot about the destination. And what happens when you turn clinical governance into a series of directions with no clear destination? You get a whole Lot of people in the organization saying, well, what is the point of all this? And some research I did with Professor Sandy Leggett a few years ago, looking at eight health services and what was happening in those health services in terms of their quality and clinical governance system. We saw over and over the same comments coming back from clinical leaders, from frontline staff, from everyone in between, middle managers. A lot of what we seem to be do in the name equality seems to just be done for the doing. Can't see the point. Or I'm so busy trying to meet compliance requirements, I question if what I'm doing is actually improving care delivery. And if I had a dollar for every time I heard one or both of these quotes, I'd be somewhere on a very warm beach now, probably. So activity without clear purpose is kind of like wanting to make a beautiful Nigella Lawson cake. You know, let's say that we want to make a. We want to make a beautiful quality experience for our clients, for the people we serve, just like a beautiful Nigella Lawson cake. And how we go about that is a bit like this. Instead of giving the cake to the people we want to make it and saying, look, here it is, look at it, eat it, touch it, smell it, chew on it, think about it. We don't actually give them the cake. We don't give them anything. We just give them a very long recipe, very small font, lots of pages, and we say, here, here's the beautiful quality cake. Go away and make this. And so our staff have all these instructions and directions. So a lot of that is in the form of standards, policies and procedures. However, we tell people how to do their work, essentially. And so what will happen if you give people a very long recipe but they don't know what they're making? Well, your superstars will probably end up making something great anyway, because they're superstars. But your average mortal human being in your organization is probably going to end up with something like that. So it's probably quite serviceable, but it's not great. And that's where I see so many human services. They want the Nigella Lawson version of a great cake, but they end up with a very mediocre cake and they're not sure why. But that is the why is that we're giving people way too much process and not enough purpose. And if you think about your strategic plan, somewhere in your strap plan you'll have something about how great you want your organization to be, whether it's the great services you're going to provide, the Great care. You want to be known for great leadership in quality care and services. Whatever it is, there'll be something. But unless that vision is properly operationalized so that your managers and staff are making decisions and taking action every single day to make that a reality, it will not happen. It's impossible. And I've seen many a beautiful strategic vision that probably cost quite a lot to craft just completely fall flat on its face and not be realized. Because that bridge has not been built. And that bridge is a strategic clinical or quality governance system that takes what you want and turns it into something that you have. But that requires clear purpose. Not just a bunch of instructions or directions, but clear purpose first. And then we work out the directions to get there. And we know the importance of setting goals for quality services. We know, you know, it's all over the literature, it's all over the research. You know, there's some much greater minds than mine, I can assure you have absolutely categorically stated that a positive relationship exists between strategic goal setting and organizational performance and that organizational and individual goals for quality services are found in high performing health services. We know it. Yeah. So why don't we do it? Because it doesn't cost you a thing. And I think in human services, the rabbit hole here is getting so caught up in process that we forget that all that process is a means to an end and it becomes an end in itself and it's a trap. But in a human service which is a complex system, we all, every single person on this call here works in a complex. We don't work on a production line where we pop inputs in and then it goes along the line and then we get great care and services out the other end. It just doesn't work like that. And you know that, right? What happens is we get our inputs, our people and our systems and our resources with the best will in the world. And all of that goes into what I call a maze of complexity. So your PNP and your standards and your training and your governance, your leadership and your planning and your implementation, all your good stuff, all the stuff you're doing to try to get good, consistent quality care and services, that's all great, but the reality is that that collides head on with the reality of a complex system. All of the interactions that happen in your services every day so that no two days are ever alike. There's a lot of risk and stress, there's a lot of natural erosion in a complex system. So just like the road system, the road system is a complex system. So if you think about roads, and up here, since we had the floods a couple of years ago, the roads in many cases are still a mess. And those roads are not just sitting there the same as they were two years ago, waiting to be fixed, they're getting worse. So if you don't move forward in a complex system towards something better, you're not just standing still, you're probably eroding your standards, your standard of care quality and service quality is eroding, unless you're making it better. And human nature, of course, a massive part of complex systems in human services is human nature, which ain't perfect. So until we're all robots or androids, that's always going to be an issue. And even when we are robots and androids, there'll be other issues that come with that. We have systems breakdown, our systems, let our staff down consistently, a lot of human error, a lot of unexpected events. And I could go on, but you get the gist. Yeah. The reality that your staff are working with every day is not neat and clean. They're trying to do their best every single day. Excuse me, in a very challenging environment. And of course, we have massive external forces, funding policy, policies and procedures, compliance, legislation, all the things that we have to deal with that come in from the outside that we just have to make the best of. So it ain't easy. To create something consistently good in human services is not an easy thing, but it can be done. If that's your only approach, that you throw a whole lot of things into your organization and you hope that you're going to get something good, where you are going to end up in what I call the swamp of inconsistency. And the swamp of inconsistency lies, unfortunately, at the heart of the maze of complexity. So unless you're very specifically and deliberately heading away from the swamp, you are going to end up in the swamp. And this is where a lot of places are that I see and I work with. So you recognize it. Yeah, good days, bad days, some harm. Some amazing, brilliant, incredible things happening, some not so great things happening, some high satisfaction, some low satisfaction, quite a lot of mediocrity. So as a human service, if this isn't where you want to be, you've got to do something quite deliberate. And this is the rabbit hole that people end up in unless they do this deliberate thing. And the deliberate thing is you've got to plant a flag on the, on the hill that says, this is how good we want to be. And so everyone can follow the flag out of the maze, out of the swamp, out of the maze and up the hill towards consistently good. So avoid that activity without purpose rabbit hole by defining that high quality experience and make it a board and executive priority because your flag on the hill is a defined great experience with and for your clients. And I've done this with literally thousands of people in the last 10 years. I have run definitional work about what good is right across all of human services. Anything you can think of, I've probably done it with and at every level of organizations and it turns out what human beings want from human service. So if you think about someone you love in the service that you provide, but on the other side of the world, so not in your service, but it might be a mental health service, it might be an employment service, it might be a home care service, might be an aged care service, might be a community service of some sort. But think of that with someone you love availing themselves of a service just like yours. But let's say in Uruguay, let's take it far away and you think about, gee, what would I hope is happening for the person I love or not happening for the person I love in that service on the other side of the world? Generally speaking, this is what people want from a human service. Please treat me or the person I love like a dignified, respected individual supporting their goals and needs. So our definition there of good is to provide individual care and services. Please don't harm them or make them worse or make things worse. So please provide safe care and services, do the right thing by them and with them that gets the best possible result. So provide effective care and services and please don't let them fall through the cracks. And that's something that consumers tell me all the time and it's one of the first things that they raised when I, when I run this definitional exercise with a group of consumers, don't let them fall through the cracks, for heaven's sake. Please let it all hang together and make sense and let us all be on the same page. Please provide connected care and services. Some people like to call this integrated doesn't matter. As long as you're using a descriptor that describes something that hangs together and turns out that doesn't matter who I do this with. That is what human beings want from human service. So if you make that your flag on the hill that this is good in our neck of the woods, this is what we're striving for. This is how we're going to get out of the swamp of inconsistencies towards something consistently good. That is your get out of rabbit hole one pre card now, process before people. Rabbit hole number two. I can always tell when this is happening in an organization. It becomes obvious extremely quickly. So this is your staff in the middle, and they think that the purpose of the quality system that they're working with is to do a lot of stuff. So all of the compliance stuff that they have to do, all the improvement stuff they're involved with, they will often use terms like do quality. They'll say, oh, Cathy, we do quality on Tuesdays. And they think, I'll be excited about that. But then I'm sad, and then they're sad and it all goes horribly wrong. Because if people are talking to me about doing quality, I know that to them it is a series of tasks. What about if we said to people, you know what we really want you to do? We want you to create something great at point of care. We want you to create something great between you and the people you serve. We want to create great experiences, great services, great care. And this is how we'll define it together. This is our flag on the hill. This is what good is individual or personal, safe, effective, connected for every person. And of course, we have to do all those things that you were talking about before when you were doing quality. Of course we do. But those things are only as good as they support you to create that greatness at point of care. So what we need to do to be able to get up to that flag on the hill is to understand that the clinical or quality governance support system is only as good as it's supporting staff to create something great, a quality experience at point of care and service delivery. And what we need is for those clinical governance systems not just to be just a series of sort of random stuff that we're doing because we have to, but to be embedded in the things that guide how people work every day. So, for example, I know in some organizations, your journey towards the flag on the hill as an employee of that organization will start at your interview. If you go for an interview at one of these organizations, you'll be sent some information on their definition of good, their flag on the hill, and be told you'll be asked about what your contribution would be to that if you got the job. And then, of course, that leads onto your induction, where the CEO will tell you all about how important your role is in creating that flag on the hill for every single person. It'll be discussed in your meetings with your manager and Your team consistently. It'll be in your pd. Your specific role in that will be in your pd. So that you know if you're frontline staff member, a manager, a senior person, a support service person versus a direct care person. You'll be very clear on what your role is in supporting or providing something great at point of care. It'll be in your training, in your policies, your procedures, your protocols, your standards. All of these things will be directed at supporting you to play your role. It'll be in your workflows, your it, your support systems design all the things that help people do their work every day. Those goals that flag on the hill, those goals for great care and great services will be embedded in all of them so that you can't ignore them. It'll be in your measures, your risk management, your improvement and in your reward, your recognition, your fun, your conversation. So some organisations are just great at wrapping around staff to say, this is why we're here, to provide safe, personal, effective and connected care and services. And everything that you work with every day will support you to do that. In return, we need you to play your role. There's also, I think, something that we've missed, completely missed, and I missed it as well, totally in my early days. I wish I could go back now and do a whole lot of things differently. But we can support staff with systems that build their satisfaction as they pursue the flag on the hill to build client satisfaction. We know what the key components are of great care and services. We know what the key components are of staff satisfaction. How do we bring them together? And turns out it's not that hard and it's not going to cost you any more money. It's really about how you think about your staff and how you manage your staff. Because if we take, and I've just kind of cobbled together some of the core components of staff satisfaction here, but, you know, let's start with meaning. Staff need meaning in their work to give them satisfaction. How can we make pursuing those quality goals, those four goals, the flag on the hill, meaningful to staff in their daily work? How can we relate it to what they come to work to do? And turns out that's not that difficult because most staff, not necessarily 100%, I get that, but most staff in human services come to work to make someone's life better, to help someone have a better day or a better life mastery. How can we show off staff skills and knowledge as they pursue those quality goals that flag on the hill. How can we help them develop more skills and knowledge to do that? How can we make sure that we show appreciative acknowledgement when we see staff striving for those goals in their everyday work? How can we bring in individual and team judgment and decision making to help achieve the goals? Because autonomy is a significant factor in job satisfaction. And how can we foster that camaraderie and that teamwork and that shared purpose so that everyone knows we're on the journey up the hill towards that flag on the hill of consistently good quality care and services. So I think this is an unmind treasure. I really believe that this is the next phase of pursuing consistently good quality care is bringing staff satisfaction and consumer satisfaction together so that in the pursuit of one we achieve the other. All right, rabbit hole number three, prioritizing passivity. Well, I see an awful lot of this, unfortunately. I see a lot of passive clinical governance. And obviously all of this flow, all the rabbit holes are interdependent and they probably all join up, you know, 10 meters below the surface. But passive, or what I could also call trickle down clinical governance, doesn't work very well at all in complex systems, in the complexity of our human services. So what do I mean by trickle down? Well, everything looks great at the top. You might have a beautiful framework, you might have beautiful policies and procedures, you might have a lot of things that just look fantastic. But by the time they actually reach point of care where people are meant to be working with them to provide good care, they've become so diluted that they're just not working very well anymore. And in some cases it's just extra work for absolutely no gain whatsoever. So trickle down we could call it. Another great thing that I've seen is in an article about the research to practice pipeline, as they call it, and this article said the research to practice pipeline is leaky. And and I would say that the strategy to practice pipeline is also leaky. So we might have something beautiful in our strategic plan about how great we want to be and how great we want our care and services to be and our staff to be. But by the time it hits point of care and services, it's unrecognisable because it's leaked all the way through. And unless you are absolutely laser focused on your purpose on your flag on the hill, that is what's going to happen, unfortunately. And when that does happen, this cartoon on the right is kind of what clinical governance with the best will in the world. It's kind of how it ends up playing out. So the boss has these great goals in Mind, oh, we're going to implement all this great stuff and we're going to have great quality care and we're going to be the best and everyone's going to think we're great. That's what they're hoping for. And a lot of boards tell me this, that's what they're hoping for. But in reality, how it gets executed out there, in reality is that it just turns into a series of tasks. And in the end, you know, as we've got the. Got the little person there wanting to climb out of the box saying, this job sucks, right, because it's just a series of tasks and I have no idea why. And we're just going sort of round and round and round, doing the same things and hoping for a different resolved that you can't be passive when you're implementing clinical governance. It just doesn't work. It just doesn't get you anywhere and you'll be stuck in the swamp forever. So we certainly got lost as part of this passivity, I think, in the quality control, quality improvement loop, where improvement became all about meeting standards and meeting compliance requirements, instead of improvement being all about creating something greater. Point of care. Now, of course we have to meet our compliance requirements, of course we do. Of course we have to meet standards, but we should be using those as our foundation for working towards our flag on the hill, our consistently great care. And this is, you know, Duran, some of you will know Duran's quality trilogy, and he was pretty clear. He said, yep, quality control is the base. Quality improvement is your next level up. But quality improvement should not only be to meet those standards and those policies. Oops. Quality improvement and quality control, also about transformation. Both of those together should be taking you closer to consistently high quality services for every person every time. But that, that bit, I, I just don't see it enough. I see maintenance, I see improvement, but I'm not seeing that we're using our maintenance and our improvement to create something great. And so where I'm just seeing the maintenance improvement loop, that's a very passive approach to trying to create something great when we're talking about the complexity that we work in and where. I often see this first. If I go into an organization, I'll see it in committees, I'll see it in committee minutes, I'll see it in committees. If I sit in on a committee, lots of looking back, endless monitoring where people have forgotten why they're monitoring what they're monitoring. Confusing activity with achievement. Oh, but we did, and we did and we did. And we did. Yeah. But did it actually make a difference? Oh, gee, I don't know, you know, but we did a lot of stuff. And that lack of bold decision making for greatness, that lack of bold decision making for what's our next step up the hill towards consistently great. So if you've ever been in a quality committee feeling like you're losing the will to live, you might be, you might be the. Well, I'm glad that that's. That someone thought that was funny. That's great. If you could just go on mute though, for me that would be great too, just because I'm getting a little bit of feedback. But I certainly have and I have. You'd be surprised. I've talked to some very senior people about this who have nodded when I have said that, who shouldn't have nodded. They couldn't help themselves because how many times have you sat in the quality committee and thought, what am I doing here? What are we doing here? Quality committee should be the engine room driving towards something great, providing guidance and making great decisions to get further up that hill. But so often they're just caught up in this sort of passive clinical governance, control improvement loop. The other thing about passive clinical governance is that unfortunately, and this happened definitely with acute care years ago, but I, and I was party to that, unfortunately, but I see it everywhere, right? Where we start well and then it kind of all falls apart and this contributes to the leaky pipeline as well. Where you've got, you might have a great clinical governance system, you might have adopted a state based system or developed your own or found something from somewhere else and you know, you think it's great and you've got all the good stuff in there that you need to do to create consistently good care. And the board says the executive go forth and implement this framework and what happens is that that loses something in the translation and instead of it being implemented through line management, it gets what I call outsourced to the quality manager or the quality team. Now that is just never going to work, I can tell you, because I did it myself for years and it didn't work very well then. And as I said, I still see it a lot now because the quality manager really, A isn't responsible for what happens at point of care, that is not their job and B, they generally don't have any authority over the people they're trying to persuade, beg, plead, whatever it is to do certain things like meet standards so that we can try and get closer to something, you know, like consistently good care. It's just, it's a setup that we've stuck with, expecting a different result year after year, and then we don't get a different result. So how could we do this differently? So avoid that prioritising passivity by implementing clinical governance with that purpose through line management. Because it is line managers that have the responsibility to provide a consistently good service. As a middle manager, as a senior manager, your job is not just to get through the day, although some days, fair enough, but generally speaking, your job is to create not just a service, but a good service and a consistently good service. It shouldn't be okay for every third person to have a great experience. It shouldn't be okay for resident A in this aged care home to have a much better experience than resident B in that aged care home or that home care service or that community service. It's just not what we're about as human service providers. And I know that we would never set out to design our quality and clinical governance system to provide inconsistent care and services, would we? I mean, just ridiculous. But that's kind of what we've got if we're stuck in the swamp of inconsistency. Yeah. So what we need to do is to make sure that our frontline staff and our consumers clients are on the same page about what is good. Because they both had input into that discussion, into that definition. And as I said, generally speaking, it'll be something around individual, safe, connected and effective. Why do I choose four goals? You might be thinking, well, Kathy, I've done my study and my management study, and I know this five dimensions of quality, or six or seven or eight. I've even seen nine. And that's absolutely right. But what I do is roll all that up into four. Because people can walk around with four things in their head. Like when you get into five, six, seven, it's all a bit much. So anything that is a dimension of quality in any model, you can fit into these four goals. So for example, you might be saying, well, where's access, Kathy? I pop access under connected care because good access is part of a logical, streamlined connection of care for people. So that's just my very pragmatic approach. But frontline staff had to be crystal clear about what good is because they've been engaged with it, because we've helped them develop meaning around it, which is then getting into our staff satisfaction. This has meaning for me. I come to work every day to do this. I'm very clear about this. I'm very clear about my role. I feel very Supported, I feel very supported by my manager in that because it's also their job to help me to create this great flag on the hill with every client and it's their senior leaders or their manager's job to help them to help me to do that. Because this is where the responsibility lies for what happens at point of care. And so our board and execration say, go forth and implement clinical governance systems because we know that's going to help us do something great. And this gets implemented through line management to support line management. All these systems that we have in our framework, all these systems that we have to comply with are implemented to wrap around, as I showed you before, all of these people so that they play their role in supporting and helping people at point of care and service delivery, who are the, the ultimate arbiters of where the people get a good experience or not, as you know, they are supporting through their role and the people that they then manage and the people that they then manage to create that greatness at point of care consistently. And of course, you've got your committees, your support services, your quality team, all should be providing technical support, playing their role in supporting line managers to do this. But they can't take away the responsibility of line managers to create a good service. What committee, support services, quality team are there to do is to help them to know how to do that. And this is how we turn our clinical governance system into something purposeful and dynamic rather than a passive, oh, let's put a whole bunch of things in place and hope we get something good. All right? On the home stretch. Fades before foundations. This is one of my favorites because it is such an easy trap to fall into. And every single organization I know has fallen into it at least once. So fads before into foundations, basically, very short, very quick. You just need to be sure when you're grabbing a framework or a tool or someone's trying to sell you something to improve the quality of your care, you just have to be super, super clear about what you're trying to achieve so that you can choose the right tool for the job. And don't just grab a random tool and say, oh, this will fix everything. Because I can assure you that nothing fixes everything. No single approach ensures quality care. Even though people tell me that all the time and I know it's a very, it's a very convenient untruth to say that, oh, if I grab this, that will ensure quality care. Because life's just not that simple, right? So you can end up with the best will in the world thinking that, oh, I'm going to be able to fit more tennis balls in my container if I. If I grab this tool or this fad, that you actually might end up with more tennis balls in your container but not being able to play tennis? Yep. So a very simple way of avoiding fads that aren't going to help you is to know what you're trying to achieve. And so this just draws everything we've been talking about together. You need to ask, will this tool, this method, this bit of software, this training, whatever it is that I'm about to grab, will it help me set goals, set our goals, our flag on the hill. Will it help us create the right mindset and culture? Will it clarify staff roles and responsibilities and will it support them to enact those roles? Will it support partnering with consumers and clients? Will it help us develop our line manager capability to lead their staff to achieving those goals? Will it develop our quality managers and leaders and teams to support line managers? Will it identify and implement the infrastructure that we need to wrap around people to support quality goal achievement to get to that flag on the hill? Will it develop both responsive and proactive methods for managing risk and creating quality service? Will it help staff to make positive changes that stick and scale? And will it help you tell the story of your care and service quality through great data? So a tool should do at least one of these things if it's going to be useful in your pursuit of that flag on the hill. All right, so I'm going to finish up, but just before I do, there is the QR code to download the article, as I mentioned earlier. And please jump on my website. I've got lots of free resources around this. You can grab a free quality system assessment checklist that will tell you whether or not your quality system is currently dynamic and helping you get up the hill towards the flag on the hill. And also the no Harm Done podcast that I do with Kathy Jones, where we kick quality and clinical governance around. We unpack it, we have a lot of laughs, believe it or not. And it's kind of a fun way to think about how quality and clinical governance is going at your place.