“…5 More optimistically, however, there is emerging evidence to suggest successful change management following a renewed emphasis on PPIE: McLaughlin et al observed the importance of coproduction in improving chronic kidney disease care pathways in the NHS, while O'Flaherty et al also advocate for stakeholder engagement in evaluating the effectiveness of the NHS Health Check programme. 6,7 The implementation gap A key limitation when applying a systems approach to QI in healthcare has been to transition from a purely theoretical exercise towards real-world applicability. Despite being comprehensive in its scope, the approach is grounded in complexity and poses questions of resources, training and appetite.…”