Objective. The purpose of this study was to investigate the characteristics of the Residential Aged Care Coronial Communiqué that have promoted previously reported professional practice change, and to explore the circumstances of these changes. Methods. This was an exploratory, qualitative study for which data was collected through semi-structured interview of 15 subscribers to the Residential Aged Care Coronial Communiqué. Results. The Residential Aged Care Coronial Communiqué was reported to promote self-reported practice change though the inclusion of case studies, by being associated with the Coroner, and by providing evidence to justify change. The combination of existing concerns about risk and staff awareness, in conjunction with reading the Residential Aged Care Coronial Communiqué was also reported to promote practice change, as was having the support of senior staff and the authority to implement change. Conclusions. The combination of narrative case studies in the context of an educational publication associated with the Coroner’s Office has been reported to provided evidence and incentive to promote professional practice change in an aged care setting. However the relative influence of the Residential Aged Care Coronial Communiqué, and other background circumstance and facilitating factors on practice change cannot be determined from this study. What is known about the topic? Passive dissemination of written educational material has little or no impact on altering clinical practice. What does this paper add? Exploratory research findings published in this paper provide insight into characteristics of an electronic, educational publication for a health professional audience reported to have promoted practice change in a residential aged care setting. What are the implications for practitioners? The inclusion of short, clearly written case studies that describe real situations that have been investigated by the Coroner, in the context of a publication associated with the Coroner’s Office, has been reported to motivate staff to change professional practice to improve safety in a residential aged care setting.