Footnotes

• X @McCullochP

• Contributors This article draws on experience of the challenges of implementing quality and safety changes in healthcare organisations in England and the US. Professor PM is a surgeon by background and has led multiple research groups focused on improving the safety of surgical care and quality of surgical research. He would like to acknowledge the assistance of Ms Olivia Lounsbury, a US quality and safety practitioner and researcher focused on removing barriers to implementation of safety changes in healthcare organisations. The piece was first conceptualised from discussions between PM and Ms Lounsbury, and both consulted a variety of international healthcare journals for evidence on the topic. Ms Lounsbury commented on and edited drafts, but declined to be an author. Professor PM is the article’s guarantor, and declares that the opinions expressed in it are his alone.

• Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests None declared.

• Provenance and peer review Not commissioned; externally peer reviewed.