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This is a recently published case study that describes the application of systems engineering for improving safety, flow and quality in the ambulatory stream of a large tertiary centre ED in the north midlands.  The authors are Alex (an ED consultant), Jayne (a member of the Transformation team) and Simon (their SE trainer/coach).  It is a warts-and-all story told as a narrative and supported by objective data that describes what they did, how they did it and what happened next.  In June 2019 the team were scooped a hospital award for the transformation of the improvement culture in their ED department.