Canadian healthcare has learned a lot about failure; it is less clear that it has learned from it. Our system performs poorly on most indicators compared to our international peers. We continue to define failure narrowly and hence as a relatively rare phenomenon, which both comforts the status quo and douses the burning platform essential to large scale improvement. We cannot simultaneously tell ourselves that by and large Canadians are well-served by the system and at the same time call for transformation change. Success requires both that we recognize that the middle of the performance curve is riddled with failure, and that failure to produce achievable benefits is no less a failure than failure to avoid harm. The challenges are both conceptual and cognitive, and the first step is to determine how much truth we're prepared to face.