One of the defining characteristics of human beings is held to be their capacity to learn from experience, yet how often is the response to delivery failure to increase the exhortation just to do better or work smarter, rather than think of another way of tackling the issue? Even the current fashion for scenario planning tends to reinforce this. It is customary to have three scenarios:

• business as usual

• smart working with performance management

• doing things differently

The problem is that, like circus animals trained to jump through hoops, health planners and managers don’t know what they don’t know, and may have a limited repertoire of response to complex problems. The only way to break new ground in to lateral problem solving is by creating environments that embrace diverse analysis, ideas, and experiences.