Participation, high case ascertainment and near complete data are essential for high quality Clinical Quality Registries (CQR). Many counties now mandate participation in priority CQRs. The Commission’s Framework for Australian CQRs demands that quality data be reported. There are many long-standing barriers to participation in Australian CQRs and participation is poor. Only 2 surgical CQRs on the Commission’s website achieve the recommended 95% participation rate. This is unsatisfactory level of engagement will only improve if a culture of participation is established. The culture of any organisation is set by its leadership. The Commission has indicated it will explore linking CQR participation to hospital accreditation and Continuous Professional Development (CPD). This provides the College with an opportunity to demonstrate its commitment to surgical CQRs. Both the College and its Fellows have an ethical and professional responsibility to benchmark the quality of their care. Neither the College nor its Fellows can defend or justify their on-going failure to advocate and act where they can. The College should commit to linking CQR participation to hospital accreditation and individual CPD and so establish the culture of participation that others have not provided. The starting point would be to formalise mortality and morbidity meetings. This would include a minimum consultant attendance and formal reporting of relevant specialty CQR participation and compliance, including the College’s mortality audit. Hospital participation in CQRs should be openly published. The risk of being disaccredited would have meaningful consequences for both practitioners and hospitals and so provide a powerful incentive to participate.