This book has been based on a decade-long set of experiments redesigning hospital and health service processes across Australia and other parts of the world. Over that period, the Flinders Medical Centre, where I was based, was caught up in a ceaseless vortex of health service restructuring. The health system that it is part of was substantially restructured five times. The Redesigning Care Program itself reported directly to at least six chief executives and general managers, and indirectly to a somewhat larger group of regional or supra-regional managers. Under those circumstances, it is just not possible to work to clear goals and strategic plans: they do not exist. That is not exceptional for public health services. On the contrary, it is the new normal. But what we discovered was that Process Redesign for Health Care using Lean Thinking is resilient. Whatever the broader organizational context, gains in Patient Flow and improvements in Safety and Quality of Care can be produced and maintained, provided the work of Process Redesign has the permission of the managers in place at the time, and, crucially, the permission and engagement of the staff who do the work.