Evaluation >> Assessing the system impact It is important for the core team to periodically evaluate the project’s impact within the care system. Key questions to ask will include: Who do you have on board now that you did not have at the beginning of the project, i.e. to what extent have you enlarged the circle of involvement? How do you rate the level of morale, commitment, enthusiasm, innovation and cohesion shown by project participants? To what extent are the clinicians and non-clinicians who were initially opposed, disinterested or neutral towards your project now accepting or even supportive of the project? Are project insights and results being sought from other groups with an interest in extending or adapting your project’s methods into other clinical areas? Are the project and its participants gaining public recognition in the eyes of patients, administrators, and those with political influence? Are you enhancing the skills, productivity and job satisfaction of those directly involved in the project as a result of project activities? If your answers to two or more of these questions are not positive, then the long-term sustainability of your project is questionable, even if you are seeing pleasing results in relation to clinical indicators or other seemingly objective end points.