Within a hospital, the process often starts with representatives from each clinical area and discipline getting together to form a steering group that reviews the whole pathway for elderly fracture patients. Once the collaborative arrangements have been agreed and disseminated among all the relevant colleagues, it is important that the steering group continue to have regular meetings, which combine discussion of strategy, quality improvement work and clinical governance.

In practice, the initiation and leadership of such a steering group requires the existence of just a few champions – people who have realised how much better and more cost-effective the multidisciplinary approach can be, especially for hip fracture patients, which are the most numerous and costly patient group. They may be orthopaedic surgeons, geriatricians, anaesthetists, nurses – anyone involved in hip fracture care in fact – who are activists, determined to change the way things are done in their hospital. The Fragility Fracture Network exists precisely to generate and develop such champions, by linking them with like-minded people from all over the world.

Although the steering group itself needs to be kept to a manageable size in order to have efficient meetings, it is important that wider audiences be engaged on an occasional basis, to raise the general level of knowledge and commitment among all the healthcare workers involved in fragility fracture care. If the fracture unit opts to take part in a hip fracture database, as described in Chap. 1, then discussion of the data in regular unit meetings (clinical audit, mortality and morbidity reviews etc.) is the ideal way to achieve this.