The notion that health care systems in Australia and, indeed, worldwide, are straining under the increasing age of our patients, the complexity of disease in the ageing population, and the technical intricacies of new technologies has only served to hasten the need for effective and sustainable change. The traditional approach was, of course, to restructure the whole organisation. The failure of restructure to drive change has led to the mantra of health — you cannot get the leopard to change its spots — which, interpreted, reads “why bother!”. It has been shown that restructure just serves to delay progress, dislocate staff and produce an unsettled climate of fear, distrust and apprehension, with little gain in confidence.1