I’ve chosen this article “Why we cannot learn a damn thing from Semco or Toyota” because I think that an awful lot of failed practice goes on in the NHS and wider health and care system. We think we can take the best practice or good practice of high performing organisations and directly replicate their achievements. This isn’t something that it is possible to do because each local context is unique. There are certain hospitals and other health and care organisations that get continuously quoted as examples of high performing systems. Lots of people visit these organisations and seek to learn from them. Yet the pool of high performing organisations with their own unique style in healthcare never seems to grow. The same, small numbers of organisations continue to be cited. So perhaps the time has come to think about best practice and replication in a different way. Rather than seeking to translate the operating systems of high performing organisations, we might choose to focus on building a local context for change where it can flourish.