Director of Operations & Chief Operating Officer Interview Questions & Answers

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About this NHS interview question bank

To prepare for a Director of Operations or Chief Operating Officer NHS interview, expect questions on urgent and emergency care flow, elective, cancer and diagnostic recovery, OPEL escalation, winter planning, your duties as Accountable Emergency Officer, financial recovery and how you hold divisions to account without losing sight of safety and quality. Panels also test how you behave as a member of a unitary board and with system partners, so prepare honest, specific examples of decisions you have led, including one you got wrong.

This bank contains 40 original practice questions with first-person model answers written for candidates applying for Band 9 Director of Operations and Deputy COO posts, with a selection pitched at executive Chief Operating Officer level on a trust board. It covers operational performance across urgent and elective care, patient flow and discharge, emergency preparedness and critical incidents, industrial action, productivity and cost improvement, partnership with social care and the ICB, and the safeguarding, information governance and patient safety responsibilities that sit with senior operational leaders. Every question explains what the panel is really assessing, the points you must hit, the mistakes to avoid and the frameworks worth reading, so you can rehearse answers that sound like a calm, credible operational leader rather than a briefing paper.

 

What this question bank covers

• Motivation for executive operational leadership
• Urgent and emergency care and OPEL escalation
• Elective, cancer and diagnostic recovery
• Patient flow and discharge
• Winter and surge planning
• EPRR and the Accountable Emergency Officer
• Critical incidents and business continuity
• Industrial action contingency
• Balancing performance with safety and quality
• Divisional accountability and the triumvirate
• Data, SPC and productivity
• Financial recovery and cost improvement
• Unitary board duties
• ICS and social care partnership
• Safeguarding in operational decisions
• Health inequalities and EDI
• Information governance and decision logs
• PSIRF and Duty of Candour
• Resilience, wellbeing and leadership values

 

40 NHS interview questions with full model answers. The first 8 are free to read below. Unlock the remaining 32 for £2.99 (12 months' access).

These are original practice questions written to reflect how NHS interviews are run. They are not leaked or official questions, and Healthcare Interview Prep is independent of the NHS.

 

 

Free NHS interview questions and model answers

 

 

Question 1: Why do you want to be our Director of Operations, and why now?

Motivation question  ·  Motivation

 

What the interview panel is assessing

The panel wants a genuine reason for stepping up that is about patients and the organisation, not status. They are listening for evidence that you understand what the role really carries, including the nights on call and the accountability, and that you have done your homework on this trust's position.

 

Model answer

I'll start with the honest version. For the last few years I've been a deputy, and I've loved it, but I've reached the point where I can see the decisions that make the biggest difference to patients being made one level above me. Whether a trust protects its elective beds through winter, how it sets up discharge with the council, how it treats a division that's struggling: those choices shape what happens at three in the morning in ED far more than anything I can fix on the day. I want to be accountable for them.

I've also had enough tough moments to know I'm ready rather than just keen. I was tactical commander through a long run of critical incidents last winter, I've led a division through a recovery plan, and I've stood in front of a board and said that a trajectory we'd promised wasn't going to land. None of that was comfortable, but I found I could stay steady and keep people focused.

Why here? I've read your board papers and your latest CQC report, and I've spent a morning with your site team, which was generous of them. What struck me was a front door with genuinely good clinical engagement, a same day emergency care service that's doing the right things, but a discharge picture that's still very dependent on goodwill and a few heroic people. That's a problem I know how to work on with partners. Your elective recovery is also further along in some specialties than others, and I think some honest productivity work could close that gap.

I'll be realistic. This job means being the person people ring when it's going wrong, and sometimes making decisions where every option carries risk. I'm not daunted by that. What I want is to do it in an organisation where performance and safety are talked about in the same breath, and from what I've seen, that's what you're trying to build.

 

Why this answer works

The answer is personal and specific without being sentimental. It shows readiness through real experience, evidence of research into this trust, and a clear-eyed view of the burden of the role, which is exactly what a board wants to hear before appointing someone to carry operational accountability.

 

Key points to include

• A clear reason for stepping up that is about influence over outcomes for patients
• Evidence of readiness from real experience, such as incident command or recovery work
• Specific knowledge of this trust from board papers, CQC reports or visits
• Realism about the pressure and accountability of the role
• A link between performance and safety in your motivation

 

Common mistakes to avoid

• Talking only about career progression or the title
• Generic praise for the trust that shows no research
• Criticising the current team or predecessor
• Overclaiming that you will fix everything quickly

 

NHS values and standards

Commitment to quality of care; Working together for patients; Improving lives; Everyone counts

 

Further reading

• NHS Constitution for England
• CQC Well-led framework
• NHS England Leadership competency framework for board members
• The trust's latest annual report, board papers and CQC inspection report

 

 

Question 2: It's 8am. The trust declared OPEL 4 overnight, the emergency department is full, there are ambulances waiting outside and no beds. You've just arrived. What do you do in the first two hours?

Operational Scenario question  ·  Urgent and emergency care

 

What the interview panel is assessing

The panel is testing whether you can lead calmly through a very high-risk morning, prioritise clinical risk over appearances and use the escalation framework properly. They want to see you working with clinical leaders, engaging the system and making clear, documented decisions rather than simply asking everyone to try harder.

 

Model answer

The first thing I'd do is not make it worse by adding noise. I'd go to the site office, get a proper handover from the overnight team and the on-call director, and understand three things: where the clinical risk is greatest right now, what's already been tried, and whether anything has changed in the last hour. I'd want to know which patients in the department and in the ambulance queue are sickest, how long people have been waiting, and whether anyone's waiting in the community for an ambulance that can't get to them because crews are stuck with us.

Then I'd walk down to ED with the site manager. I'd speak to the nurse in charge and the consultant, ask what they need and look for myself. I'd want to agree with them how we're managing the ambulance queue safely, with a clinician actively reviewing those patients alongside the ambulance service.

By about half eight I'd chair a focused huddle with the divisions, the director of nursing on duty and the medical lead. The question is simple: how many safe discharges can we make before midday and what's stopping each one? That means a senior review of every patient who might go home, the discharge lounge opened early, transport and medicines prioritised, and our full capacity protocol used so that suitable patients move to wards ahead of a bed being cleaned. I'd ask clinical colleagues to look hard at whether any non-urgent elective activity using inpatient beds should be stood down, while protecting cancer and urgent surgery.

I'd also escalate outward. I'd make sure the ICB knows our position, ask for a system call, and push community services and social care on the specific patients waiting for packages or beds.

If, having done all that, we still can't provide safe care, I'd talk to the chief executive about declaring a critical incident, because that unlocks support. Throughout, I'd keep a decision log, keep staff informed honestly, and be visible. People notice whether senior leaders show up on mornings like that.

 

Why this answer works

This answer starts with clinical risk rather than targets and follows a clear sequence: understand, see for yourself, mobilise internal flow, escalate externally and consider a critical incident declaration. It shows partnership with clinicians, use of recognised tools such as full capacity protocols and decision logs, and an awareness of risk to patients still in the community.

 

Key points to include

• Get a clear handover and identify where clinical risk is greatest, including patients waiting in the community
• See the department yourself and support the ED nurse in charge and consultant
• Drive safe early discharges through senior review, discharge lounge, transport and medicines
• Use the full capacity protocol and consider standing down non-urgent electives while protecting cancer and urgent cases
• Escalate to the ICB and system partners and consider a critical incident declaration
• Keep a decision log and communicate honestly with staff

 

Common mistakes to avoid

• Jumping straight to targets or the four-hour position rather than clinical risk
• Running the response from an office without visiting ED
• Forgetting patients waiting in the community for an ambulance
• Not documenting the rationale for decisions such as cancellations or boarding

 

NHS values and standards

Commitment to quality of care; Working together for patients; Compassion; Everyone counts

 

Further reading

• NHS England Operational Pressures Escalation Levels (OPEL) Framework
• NHS England Emergency Preparedness, Resilience and Response (EPRR) Framework
• The trust's full capacity protocol and escalation policy
• Royal College of Emergency Medicine guidance on crowding and corridor care

 

 

Question 3: How do you balance delivering operational performance targets with patient safety and quality of care?

NHS Values question  ·  Performance, safety and quality

 

What the interview panel is assessing

The panel wants to know that you do not see targets and safety as opposites, and that you understand why national standards exist. They are also checking that you would never let pressure to hit a number override a clinical safety concern, and that you can describe how you hold both together in practice.

 

Model answer

I don't really see them as a trade-off most of the time. The four-hour standard, eighteen weeks and the cancer standards exist because waiting harms people. A frail man who spends a night on a trolley is more likely to become delirious or develop a pressure ulcer. A woman waiting too long for a diagnostic test may be diagnosed at a later stage. So when I talk to divisions about performance, I talk about it as a safety issue first.

Where it gets harder is when a target creates pressure to do something that looks good on the dashboard but isn't right for the patient. I saw this when I was a divisional director. At the end of a difficult month there was pressure to move patients out of ED to an assessment area just before their four-hour point, where they'd simply wait again with fewer staff. On paper it helped. In reality it moved the risk somewhere less visible. I stopped it, explained why to the team and to my COO, and we took a hit on that month's figures. What we did instead was work with the acute physicians on getting senior decisions earlier, which helped properly over the following months.

In practice I hold the two together in a few ways. Every performance conversation I chair has quality data alongside it: falls, pressure ulcers, complaints, incidents, staffing. I ask the head of nursing and clinical director what they're seeing, not just the general manager. Any cost improvement or service change goes through a quality impact assessment signed off by the medical director and chief nurse. And I try to make it completely safe for anyone to tell me a plan isn't safe.

If I'm ever in a genuine conflict, safety wins, and I'd go to the board and explain the performance consequence openly. That's what being accountable means.

 

Why this answer works

The answer reframes targets as patient safety measures, then gives an honest example of a target driving the wrong behaviour and how it was stopped. It finishes with concrete mechanisms, such as quality data at performance reviews and quality impact assessments, and a clear statement that safety comes first.

 

Key points to include

• Waiting is itself a source of harm, so performance standards are safety standards
• A real example where a target risked distorting behaviour, and what you did
• Quality and safety data reviewed alongside performance
• Quality impact assessments signed off by the medical director and chief nurse
• Willingness to accept a worse figure and explain it openly rather than compromise safety

 

Common mistakes to avoid

• Implying targets matter more than safety, or that targets are just politics
• Giving no example of a real tension
• Describing gaming of figures without recognising it as wrong
• Leaving clinical leaders out of the decision-making

 

NHS values and standards

Commitment to quality of care; Everyone counts; Respect and dignity; Working together for patients

 

Further reading

• NHS Constitution for England
• NHS Oversight Framework
• CQC Well-led framework
• National Quality Board guidance on quality and safety

 

 

Question 4: How do you hold divisions to account for performance while staying compassionate?

Leadership question  ·  Divisional accountability

 

What the interview panel is assessing

The panel wants to see that you can be clear and demanding about delivery without creating a culture of fear. They are looking for structure, such as an accountability framework and regular reviews, combined with genuine curiosity about why a division is struggling and willingness to give real support.

 

Model answer

I think of it as high support and high challenge, and I try hard to make sure people experience both. Accountability without support turns into fear, and people start hiding problems. Support without accountability means nothing changes and patients keep waiting.

The structure matters. I'd want a clear accountability framework where each division knows what it's responsible for, what good looks like, and what happens if things slip, with escalating levels of support rather than escalating levels of shouting. Monthly performance reviews with the triumvirate cover performance, quality, workforce and finance together, and I try to look at trends rather than reacting to one bad week.

Let me give you a real example. As a deputy COO I had a surgical division whose long waits were growing month on month. The easy thing would have been to keep asking for a recovery plan and getting cross when it didn't deliver. Instead I asked to spend a day with them. I sat in theatre scheduling, went to the pre-op assessment clinic and talked to the clinical director over coffee. What I found was a team that was exhausted, two consultant vacancies, and a pre-assessment service so short-staffed that lists were being lost late. They weren't failing through lack of effort.

So the conversation changed. We agreed a small number of specific actions: some temporary pre-assessment capacity, a fresh look at the theatre timetable, and help with consultant recruitment. I was still clear about the trajectory and we reviewed it every fortnight. When one action stalled, I said so plainly. But they knew I was on their side.

Over the next couple of quarters the position steadily improved. What I learned is that people will accept hard challenge from someone they believe understands their reality and will help. I also try to watch my own behaviour on the bad days, because tone at the top of an operational team travels fast.

 

Why this answer works

The answer combines a structured accountability framework with a concrete example of curiosity and support changing the outcome. It is honest that challenge continued, and it shows self-awareness about the leader's own behaviour under pressure, which panels value at director level.

 

Key points to include

• Clear accountability framework with defined expectations and escalating support
• Reviews that look at performance, quality, workforce and finance together
• Curiosity about root causes, including going to see the work
• Specific support matched to the real problem
• Continued clarity and challenge on the trajectory
• Awareness of your own behaviour and its effect on culture

 

Common mistakes to avoid

• Describing accountability only as pressure and escalation
• Being so supportive that there is no clear expectation or follow-up
• Blaming a division or individual managers in the answer
• Talking in theory without a real example

 

NHS values and standards

Respect and dignity; Compassion; Working together for patients; Commitment to quality of care

 

Further reading

• NHS Oversight Framework
• The King's Fund work on compassionate and inclusive leadership
• NHS People Promise
• NHS England Leadership competency framework for board members

 

 

Question 5: As Director of Operations, what is your responsibility for safeguarding patients who are waiting a long time in the emergency department or being cared for in corridors?

Safeguarding question  ·  Safeguarding adults in escalation areas

 

What the interview panel is assessing

The panel is checking that you understand safeguarding is not just the chief nurse's job, and that operational decisions about escalation spaces can put vulnerable people at risk. They want to hear about minimum standards, clear exclusions for the most vulnerable, use of the Mental Capacity Act and a culture where staff can raise concerns.

 

Model answer

I think operational leaders have to own this directly, because we're the people making the decisions that put patients in those spaces. The executive lead for safeguarding is usually the chief nurse, but if I sign off an escalation plan that means a frail woman with dementia spends fourteen hours on a trolley in a corridor, I've created the risk. I can't hand that off.

So the first part of my responsibility is the design of our escalation arrangements. Any temporary escalation space should have clear minimum standards: named nursing staff, access to a toilet, regular observations, food and fluids, pressure area care, privacy for personal care and a call bell or equivalent. There should also be clear guidance about who shouldn't be placed there, such as people at the end of life, people with significant cognitive impairment unless they can be properly supervised, or people needing isolation. I'd want the chief nurse and safeguarding lead to have shaped that guidance, not just reviewed it.

The second part is visibility. I'd want regular data on long waits, broken down so we can see whether people with dementia, learning disabilities or mental health needs are disproportionately affected, and I'd go and look for myself. When I've walked through ED at night as on-call director, I've found things no dashboard would tell you, like a man with a learning disability whose carer had gone home and who hadn't eaten all day.

Third, it's making sure staff know what a safeguarding concern looks like in these settings. Neglect can be caused by a system as well as by individuals. If a patient comes to harm because of how we've organised care, that may need a safeguarding referral and an incident report, and the Mental Capacity Act still applies to decisions about where and how people are cared for.

Finally, I'd report it honestly to the board. Corridor care shouldn't become normal just because it's frequent.

 

Why this answer works

The answer accepts direct operational ownership of safeguarding risk, sets out practical minimum standards and exclusions, and links data, visible leadership and staff awareness. It recognises organisational neglect and the Mental Capacity Act, and ends with honest board reporting.

 

Key points to include

• Operational decisions create safeguarding risk, so operational leaders share accountability
• Minimum standards and exclusion criteria for escalation spaces, designed with nursing and safeguarding leads
• Data on long waits broken down for vulnerable groups, plus visible leadership
• Recognising organisational or system neglect and making referrals where needed
• The Mental Capacity Act applies to decisions in these settings
• Honest reporting to the board so corridor care is not normalised

 

Common mistakes to avoid

• Saying safeguarding is the chief nurse's responsibility
• Treating corridor care as purely a capacity issue
• Forgetting people with dementia, learning disabilities or mental health needs
• Offering reassurance without data or first-hand observation

 

NHS values and standards

Respect and dignity; Compassion; Everyone counts; Commitment to quality of care

 

Further reading

• Care Act 2014 and statutory guidance on safeguarding adults
• Mental Capacity Act 2005 and Code of Practice
• Royal College of Emergency Medicine and Royal College of Nursing guidance on corridor care
• NHS England guidance on temporary escalation spaces
• Learning from Lives and Deaths (LeDeR) programme

 

 

Question 6: Performance has deteriorated for three months in a row. How would you report this to the board?

Communication question  ·  Board reporting

 

What the interview panel is assessing

The panel wants to see honesty, clarity and ownership. They are looking for someone who gives the board assurance rather than reassurance, explains causes with evidence, sets out a credible plan and is clear about risk to patients, rather than burying bad news in a long paper.

 

Model answer

I'd tell them early and plainly. The worst thing an operational director can do is let the board discover a problem in the integrated performance report with a paragraph of explanation that sounds like an excuse. If I could see it coming, I'd have flagged it at the previous meeting and talked to the chair of the relevant committee beforehand so there were no surprises.

In the paper and in the room I'd want to do four things. First, say what's happened in one or two sentences, using statistical process control charts so the board can see whether this is a genuine shift or normal variation. Second, explain why, with evidence. If it's a rise in emergency demand, a loss of theatre staff, or a change in discharge capacity in the community, I'd show the data and be honest about which parts are within our control. Third, describe what it means for patients, because that's what the board is really there for. How many more people are waiting over a year? Has harm review picked up any harm? Fourth, set out the plan, with named owners, a realistic trajectory and the risks to delivering it.

I'd be careful about the trajectory. I've learned the hard way that promising a recovery by a date you don't believe in damages trust more than the original problem. I'd rather say we expect to stabilise by a certain point and improve after that, and explain the assumptions.

In the room, I'd keep it short and leave time for questions. I'd welcome challenge from the non-executives, because that's their job, and if I don't know an answer I'd say so and come back. I'd also be clear about what I need from the board, whether that's a decision on investment, support with the system, or simply their understanding that we're choosing safety over a faster number in one area.

 

Why this answer works

The answer shows early warning, use of SPC to separate signal from noise, evidence-based explanation, a patient-focused view of impact and a realistic plan. It also shows maturity about trajectories and welcomes non-executive challenge, which is central to good governance.

 

Key points to include

• No surprises: flag early and brief committee chairs
• Use SPC charts to show whether the change is real
• Explain causes with evidence and distinguish what is within your control
• Describe the impact on patients, including harm review findings
• Realistic plan with owners, trajectory, assumptions and risks
• Be clear what you need from the board

 

Common mistakes to avoid

• Burying bad news in a long narrative
• Making excuses or blaming external factors only
• Promising a recovery date you do not believe
• Being defensive when non-executives challenge

 

NHS values and standards

Commitment to quality of care; Everyone counts; Working together for patients

 

Further reading

• NHS England Making Data Count guidance
• CQC Well-led framework
• NHS Oversight Framework
• The Seven Principles of Public Life (Nolan Principles)

 

 

Question 7: How would you make sure patients waiting a long time for planned care are not coming to harm while they wait?

Patient Safety question  ·  Elective waiting list harm

 

What the interview panel is assessing

The panel wants to know you see the waiting list as a list of people with clinical risk, not just a number to reduce. They are looking for clinical prioritisation, validation, harm review processes and communication with patients, all linked to the patient safety and incident framework.

 

Model answer

The starting point for me is that every entry on that list is a person whose condition may be changing. When I first took on responsibility for elective recovery in a division, I asked to see not just the number of long waiters but how we knew whether any of them were getting worse. The honest answer was that we didn't have a reliable way of knowing, so that's where I started.

There are a few layers. The first is clinical prioritisation. Patients on surgical lists should be given a clinical priority by a clinician, and those priorities need reviewing over time, because someone who was routine six months ago may not be now. The second is validation. Administrative validation removes people who've already been treated or moved, and clinical validation checks the pathway is still right. Contacting patients directly to ask whether they still need treatment and whether anything has changed is valuable, as long as it's done carefully and isn't used to pressure people off the list.

The third is a structured harm review. For patients who've waited beyond a set threshold, or who've breached a cancer standard, a clinician reviews whether the delay caused harm. If it did, that goes through our incident processes under PSIRF, and Duty of Candour applies where the harm meets the threshold. The findings should come back to the division and to the quality committee, so we learn whether there are particular pathways where delay is dangerous.

The fourth is giving patients a way back in. If someone's symptoms get worse, they need to know who to contact and that it will be acted on. I've seen a simple letter with a named contact make a real difference, especially for older patients waiting for hip or knee surgery who were struggling at home.

And finally it's honest reporting. I'd want the board to see harm review findings alongside the waiting list numbers, not separately.

 

Why this answer works

This answer shows layered safety thinking: clinical prioritisation, validation, structured harm review, a route back in for patients, and honest reporting. It correctly links harm to PSIRF and Duty of Candour and avoids treating validation as a way to shrink the list artificially.

 

Key points to include

• Treat the waiting list as people with changing clinical risk
• Clinical prioritisation with regular review
• Administrative and clinical validation done ethically
• Structured clinical harm review linked to PSIRF and Duty of Candour
• A clear route for patients whose condition deteriorates
• Harm findings reported to the board alongside numbers

 

Common mistakes to avoid

• Talking only about reducing numbers or hitting long-wait milestones
• Using validation to pressure patients off the list
• Having no process to detect deterioration while waiting
• Keeping harm review separate from board-level reporting

 

NHS values and standards

Everyone counts; Commitment to quality of care; Compassion; Improving lives

 

Further reading

• NHS England Recording and reporting referral to treatment (RTT) waiting times guidance
• Patient Safety Incident Response Framework (PSIRF)
• Statutory Duty of Candour, Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Federation of Surgical Specialty Associations clinical prioritisation guidance

 

 

Question 8: Tell us about a time you disagreed with a system partner or a senior colleague about an operational decision. How did you handle it?

Conflict question  ·  Constructive challenge

 

What the interview panel is assessing

The panel wants to see that you can disagree professionally, based on evidence and patient risk, and still reach a workable outcome. At this level they are also looking for system thinking: understanding that a decision that is uncomfortable for your organisation may be right for patients across the area.

 

Model answer

A good example is when our ambulance service and the ICB asked all acute trusts to release ambulance crews within a fixed time of arrival, so that they could get back out to calls in the community. Our ED consultants were strongly against it. Their worry was that we'd simply be moving very unwell patients from the back of an ambulance, where they had a paramedic with them, into a crowded department or corridor with fewer staff.

My first instinct was to sympathise with my own clinicians, and I'll admit that. But I made myself look at the whole picture. I asked the ambulance trust for data on what was happening to people waiting in the community during our worst handover delays, and it was sobering. There were people waiting a very long time for a response after falls and strokes. That shifted my view. The risk didn't disappear if we held crews outside. It just sat somewhere we couldn't see.

So I didn't argue against the policy. What I did disagree with was implementing it without the right conditions. I took that to the ICB call and said we'd support it, but we needed agreement on a clinical safety process for the handover, some flexibility for genuinely exceptional cases agreed between senior clinicians, and a commitment from the system on discharge support so we weren't just moving the queue inside.

Internally, I sat down with the ED consultants and nursing leads, shared the community data and asked them to design the receiving process. That made a big difference. They produced a rapid handover area with a named nurse and clear escalation.

It wasn't perfect, and there were still hard days. But the relationship with the ambulance trust improved and our clinicians felt heard. What I took away is that disagreeing well means being clear about which part you disagree with, and being willing to change your mind when the evidence shows the risk is bigger elsewhere.

 

Why this answer works

The answer shows professional disagreement grounded in evidence, a willingness to change position when shown system-wide risk, and a constructive route forward that involved clinicians. It demonstrates the system leadership expected of a director of operations working within an integrated care system.

 

Key points to include

• A specific disagreement with real stakes for patients
• Looking at risk across the whole system, not just your organisation
• Separating the principle from how it is implemented
• Using data to inform your position
• Involving clinicians in designing the solution
• Reflection on what you learned about disagreeing well

 

Common mistakes to avoid

• Choosing a trivial example
• Presenting yourself as simply right and the other party as wrong
• Showing loyalty to your organisation at the expense of patients elsewhere
• Not describing how the relationship was maintained

 

NHS values and standards

Working together for patients; Everyone counts; Commitment to quality of care; Respect and dignity

 

Further reading

• NHS England guidance on ambulance handover and release to respond
• NHS Constitution for England
• Health and Care Act 2022 and the role of integrated care boards
• Royal College of Emergency Medicine guidance on crowding

 

 

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