In reply: I thank Arah for pointing out the importance of the "context" into which any quality and safety program will be deployed. Success or failure of innovative pilot programs will always depend upon the willingness of the end-user to embrace change.

In the case of performance monitoring using electronic logbooks, this will first require an easily workable and reliable tool, not just for the technologically proficient few, but for all users. In addition, users must also be motivated to monitor their professional performance. In today's world, where medicolegal issues are increasingly significant, there is pressure to prove accountability and reduce one's risk exposure. In carrying out a pilot project only, we aimed to demonstrate the technological feasibility of such a tool. We believe that this has been successful, and that now is the time to embrace the use of such tools.

Ultimately, cultural change will only occur when the "early adopters" and enthusiasts demonstrate the usefulness of a concept, leading the way and pulling the rest of the population behind them.