Social and cultural factors have also been identified as a key determinant for whether QCI is achievable in different healthcare organizations. For example, research has shown that local decision making is dependent upon culture, social cues, and beliefs. It is important for healthcare professionals to set their personal ideals and beliefs aside when caring for patients. Government and health-care investment services coupled with advocation and training on part of nurse leaders and managers have helped ease social and cultural factors that could be detrimental to patient health. Advocacy and education provided by nurses in the field to their co-workers and employees is the best way to make changes where there is increased efficiency in the organization and employees, as well as patients, are satisfied with their care. Continuous quality improvement is important and without nurse leaders, it arguably wouldn’t be possible.