This week’s item is more sad than funny.  It is an unfortunate truth that as consultants we experience too often that institutions have continued for a while with poor practice, resisted research and resisted change.  It is also unfortunately true that often someone within the institution has advocated for change and senior management will only consider making that change if an external consultant says exactly the same thing to them.  We are aware that us making this observation probably undercuts our own income stream but institutions should definitely collect and analyse data and comments about their own practice and be welcoming of internal suggestions for change.