[This paper is a commentary on Operational Review: The London Health Sciences Centre Experience by Tony Dagnone and Barbara Willis.]

The decision to proceed with an operational review is important to all levels of staff within an organization and to all of its key stakeholders. No matter what you call a major review, or how you define it, the fact that it is being done is a big deal. Who makes the decision to proceed with an operational review and the reasons for doing so are fundamental issues in the design of the process, the opportunity to participate, and, ultimately, the outcomes achieved.