Clinicians and researchers aiming to improve congestive heart failure (CHF) services need to invest in quality assurance research. In this regard standards of accountability can be met for the goals set within any particular programme. Part of this process involves gathering evidence, which is the basis for audit and observational research. Implementing these findings can be straight forward when the issues are limited to resources. In all cases the responses can be negative, positive or somewhat positive where certain measures are taken within the constraints of that system. These issues becomes more difficult when findings involve implementing a new strategy or if there are more than one choice available. We have previously discussed some of these challenges and potential solutions for the NT [1-5]. In this short commentary, we discuss briefly some issues on the implementation strategies for CHF best practice in the Northern Territory (NT) of Australia and why it remains difficult for the cardiologists who are held to account to also maintain a degree of control on the process.