In the last five years quality and performance improvement have been articulated as central policy objectives for the NHS. Securing meaningful change in organisational culture, together with concomitant structural reforms, is seen to be critically important in achieving those objectives: “meaningful and sustainable quality improvements in the NHS require a fundamental shift in culture, to focus effort where it is needed and to enable and empower those who work in the NHS to improve quality locally” (A First Class Service – Quality in the New NHS …