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We joined the LIA journey on the back of a tumble in our staff engagement ratings. There was an understandable sigh of cynicism from staff about what they initially saw as yet another initiative. However from the first of our "Big Conversations" some four months ago to now when the first ten teams are beginning to demonstrate some real excitement in developing their local schemes, that has changed beyond all recognition. Teams are led by Consultants, middle managers, ward sisters, one by a ward assistant. The work they are doing will I am confident reestablish the concept of quality improvement being driven from within clinical and non-clinical teams, supported by the Executive and the Board