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Mark Britnell is correct in focussing on the key role of staff in ensuring quality of care. The KPMG report has some interesting international case studies especially those from Netherlands and Virgina Mason hospitals. Levels of staff engagement are closely correlated with patient care. There is widespread activity to improve staff engagement across the NHS including the excellent work at Salford highlighted in the report . For more examples see NHS Employers website and the recent article in HSJ about the Listening into Action programme.