The document discusses emerging challenges related to ICH Q8 and Q10 implementation, including increased risk and non-compliance due to process variability. It also discusses how quality inspectors and assessors can evaluate product control strategy, quality by design, manufacturing processes, and change management systems. The rest of the document focuses on knowledge management, data integrity, and quality metrics as indicators of operational reliability and quality culture. Key quality metrics discussed include lot acceptance rate, product quality complaint rate, right first time rate, invalidated OOS rate, APR/PQR on time rate, CAPA rate, and ability to initiate voluntary CAPA.