Doctors have a responsibility to ensure that patients receive a good standard of care and treatment, in a safe, supportive environment. Given the many influences on doctors' day to day practice, we need to increase our understanding of what factors may act as incentives or barriers to doctors meeting these standards in different healthcare settings. The question of why doctors adhere or do not adhere to good practice is the focus of this study, in order to improve understanding of the factors that may contribute to the failures in service provision that lead to poor standards of care. Investigations of recent service failures have shown that poor practice can arise at all levels – individual doctors making a poor decision, inadequate local systems and processes for managing aspects of health care or at a strategic level where the effects of policy decisions (such as the development of performance targets) can create an unintended negative impact.