**6. Conclusion**

After over three decades of the Quality and Safety movement two major themes are apparent. First, despite the best of efforts at an individual patient level, ward or department, hospital and organisation, the incidence of HAE has not substantively diminished. Second, the same mistakes are repeated. The traditional response to HAE has been the RCA and thence implementation of recommendations. This approach takes no or minimal account of the human factors involved or the socio, politico, fiscal and cultural circumstance that might be at play. At best this approach makes the assumption that such implementation will actually occur. At worst individual practitioners, usually junior, usually at the bedside, must take the responsibility and with it an unwieldy professional disciplinary process. There is rarely professional accountability for those further up the traditional hospital hierarchy despite their obvious engagement in setting the socio, political and fiscal arrangements for the organisation. Of greater concern they are often oblivious to particular sub optimal cultural practices that are often present when HAE's occur.

Clinical Futile Cycles gives an alternative framework to examine HAE, by directing focus at the futile clinical activity, and then trying to understand why such futile clinical activity occurred. With this understanding, interventions that target the early recognition of futile activity with the ultimate aim of learning clinical processes that are productive in circumventing clinical deterioration.
