Some very interesting metaphors - the balcony one may possibly accurately describe how some healthcare leaders feel and act. And the dance floor metaphor is an interesting way to introduce the concept of complexity. But then the important points are lost - when you say "healthcare is large and complex" you are bang on in your description. Unfortunately you then add that healthcare is "inherently prone to inertia". In fact the opposite is true. Most complex adaptive systems are constantly adapting and changing as the external environment changes. This is happening whether we acknowledge it or not and complex systems self-organize whether we understand or attempt to understand and influence the processes that lead to the emergence of new patterns and relationships within a complex adaptive system. Our "rules" cannot be imposed on the self-organization processes - it doesn't matter how many dance instructors there are or how well prepared they are if the processes they are "teaching" are imposed from the "balcony". To explore this further visit One final extremely important point - the "music is [definitely not] controlled by the customers". You are probably right that "politicians are playing the music" but when it comes to patients, we have all been spectacularly tone-deaf for decades. For the few courageous patients who try to compose music we definitely cannot hear the tunes or understand the stories they contain.