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Authors: Steve Combe, Independent Governance Consultant, Jan Williams, Chair of Public Health Wales


Formal governance architecture such as processes, policies and procedures are relied on at the expense of examining how people actually behave and act, in effect the prevailing culture within which the formal governance processes are operating.

The two authors in this opinion piece are clear that the most immaculate system architecture will be ineffectual if people behave in a way that puts safe and quality services at risk and call for radical change in Wales’ approach to governance. The points made reinforce those made in The Bevan Commission’s recent paper Achieving Profound and Sustainable Improvement in Quality in Wales: An update and call for urgent action.