1. Improving practice is a process that should not be seen as a short term objective.
2. We often forget that changing practice includes important issues that are not easy to address:
   • changing culture,
   • reorganizing resources,
   • and finding the financial support to add resources where necessary,  amongst many other possible interventions that would eventually lead to measurable changes in practice.
3. Accountability should not depend on the members of the team. Too often team members change and the whole program is jeopardized.

It is important to follow-up on the implementation of the improvement process in a sustainable way. However, accountability is essential, and a continuous evaluation of the team's performance and quality indicators is mandatory.