Titcombe identifies the need for change in the way patient safety failures and clinical negligence claims are dealt with in the NHS. The author feels partly responsible as a whistleblower for the failures of pediatric cardiac surgery at Bristol Royal Infirmary in the 1980s and 1990s. The unintended consequence of the Bristol incident was severe and punitive shaming of doctors by healthcare management, which damages the concept of clinical governance. Evaluations 10 years after the adoption of clinical governance and patient safety initiatives have shown that adverse events that were set out to be eliminated have not been affected. Legal costs continued to rise. The 'physician engagement' concept proposed for Victoria, Australia following the rural hospital maternity scandal focused on agenda-setting, informing, engaging and empowering ideas for clinicians to develop clinical practice from failure to excellence.