Having a mechanism to work through when trying to bring about change is extremely useful. I have found this particular framework of setting and monitoring standards to be successful and rewarding. But a framework on its own cannot make changes — success is dependent upon taking on board the whole philosophy of participation, education, involvement and facilitation as well as the mechanics. It also helps to have a high level of personal commitment, a vision of what might be achieved, and a clear understanding that in order to change practice one needs to change people — that is the most challenging aspect of all. In order to bring about change you have to believe that change is possible — and you have to be able to make others believe that change is possible too. Being able to offer practical ways of tackling changes is a useful skill to have.