Why do processes need to be redesigned? This is a frequently asked question. Finding the answer will either help or hinder your change efforts. Within healthcare, as in many other public services, there is a political mandate to modernise. The problem about 'modernisation' is that staff can view it as just another initiative. In our own change efforts, we have observed that many staff try to improve their services irrespective of whether there is an external lever to do so. This is an important, if not critical, point to remember. The current agenda is about achieving radical change. When policy makers speak of radical change what they usually mean is radically improved results fast.