The penny dropped on audit meetings. The first presentations, on projects chosen by juniors, were done to an audience who asked some questions, made some suggestions, gave some applause, then moved on to the next presentation. Then medical director arrived. Next presentation. At the end, specific people were tasked with certain jobs and took responsibility for actioning. This is the first audit meeting in 4 years when this has happened. Now I see why things are so slow and same old audit and recommendations occur every few years with no action or progress. Whether these people will complete their tasks in order to implement the change remains to be seen.
It is also a given therefore that a senior person need to take on responsibility to oversee this process and have a long term vision.