This resurgence coincided with the abovementioned realisation that improvement efforts centred on human factors engineering and techniques imported from 'high reliability' industries such as aviation and nuclear power were having only modest impacts.
The drive to improve the quality of patient care puts 'lifelong learning' and 'continuing professional development' centre stage in the UK, but, as in other countries, there is an increasing realisation that 'real improvement comes from changing systems, not changing within systems' [ 1].
The key to this new realisation must be an improvement in governance.
The important thing is that success of the reform will surely bring about enormous benefits to the realisation of national development goals and the improvement of the people's lives.
Consistent, credible data about children, their families and their communities are critical to the improvement of children's lives and indispensable to the realisation of their rights.
The developed countries came to a more gradual realisation of the need to re-think their approach to seeking health improvement.
Running alongside this improvement in breast-cancer-specific survival has been an increasing realisation that preservation of the breast, without compromise on rates of local control, is important for quality of life.
But these have come with their own problems: despite the improvements in individual living conditions, there is a growing realisation that the RDP housing programme has reinforced apartheid era segregation, continuing to consign the poor to ghettos at the furthest edges of the city.
It began at the same time in Paris Roubaix and the Tour of Flanders, when widespread improvements to roads after the second world war brought realisation that the character of both races were changing.
These realisations can help to further motivate the clinical and managerial engagement with improvement efforts, and appropriate investment and improvement actions to address disparities in patient experience reported by patients with cancer treated by London hospitals.
