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Simple interventions are sometimes very effective. Providing parents of children attending a paediatric neurology clinic with a sheet inviting written questions encourages many to ask questions that otherwise may not have been articulated—at least not in the clinic.¹ The immediate benefits to parents, and children, whose worries were resolved are clear, but doctors also noted that parents seemed to take more initiative on subsequent visits. This approach to enabling patients to discuss questions and concerns has wide applicability. It is not a new idea—the authors refer to some of the background literature—and to an outsider it must seem staggering that the use of simple question sheets is not standard clinic practice throughout the NHS.

This story of the introduction of an intervention that does not cost much, has obvious benefit, and probably little potential for harm illustrates two important barriers to quality improvement. Firstly, the information gap: unless we know that there is a better way of doing things then change is unlikely. Secondly, the education gap: unless …