Neo-endogenous rural development depends on 'bottom-up' activities that integrate external influences to increase local potential. This local focus calls for local knowledge, local resources and the engagement of local people to be central to development processes. Based on data from an evaluation of LEADER in England, we explore the scope for local control and the effective means of creating local empowerment within the neo-endogenous model. Interviews were held with policy actors and beneficiaries of funding across 20 of the 64 Local Action Groups in England. These highlighted a great diversity of projects generating an equally diverse range of outcomes. However, capturing their full value was problematic, suggesting that new approaches to evaluation should be explored to increase local control of the development process. Findings also indicate that the negotiation between top-down and bottom-up, and local and external influences is an ongoing process. Through this process, local learning has empowered local actors to develop flexible approaches tailored to their localities, but local empowerment is more effective when top-down parameters are clearly established.

Quality improvement initiatives targeting emergency airway management may be successfully implemented in the emergency department and are associated with a reduction in adverse intubation-related events.

Objective In 2013, our intubations highlighted a safety gap – only 49% achieved first‐pass success without hypoxia or hypotension. NAP4 recommended debriefing after intubation, but limited published methods existed. Primary aim is to implement a feasible process for immediate debriefing and feedback for emergency airway management. Secondary aims are to contribute to reduced frequency of adverse intubation‐related events and implement qualitative improvements in patient safety through team reflection and feedback. Methods A component of a prospective quality improvement (QI) study over 4 years in the ED of the Royal Children's Hospital, Melbourne, Australia. Debrief and feedback after intubation was one of seven study interventions. Targeted staff training and involvement of departmental leaders occurred. A post‐intervention cohort was audited in 2016. Analysis included the Team Emergency Assessment Measure. Results Immediate post‐event debriefing occurred in 39 (85%) of 46 intubations. Debriefing was short (median duration 5 min, interquartile range [IQR] 5–10) and soon after (median time 20 min, IQR 5–60). Commonest location was the resuscitation room (92%), led by the team leader (97%). Commonest barrier preventing immediate debriefing was excessive workload. Two QI process measures were assessed during debriefing (adequate resuscitation, airway plan) and case summaries distributed for 100% of intubations. Performance outcomes included contribution to 78% first‐pass success without hypoxia or hypotension. Team reflection prompted changes to environment (signage, stickers), training (skill drills), teamwork and process (communication, clinical event debriefing). Conclusion Structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety.