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I think there is possibly a third way.

I’m currently working with the NHS in a Quality Improvement role in a hospital. The team exists to give grass-roots folks the tools they need to make change happen when they spot something in the system which is less than ideal. We offer training, help with setting aims, running projects, finding stakeholders, analysing data etc. These aren’t huge system transformation projects, in fact some of them can be quite small - but as a way of working it feels quite effective.



> in fact some of them can be quite small

The biggest changes always start with someone taking one small step towards their goal.

Some of the biggest software (used by billions of people) I've ever worked on started as a simple script made by a teenager.




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