Using a longitudinal, critical ethnographic approach this book explored how a change process was managed over a five-year period at a large Australian hospital. It aimed to explain how power dynamics that operate in the health system actively generate systemic inertia making organisational change difficult and complex. The book questions the efficacy of the rise of the new public management agenda and clinical management as valorised practice among clinicians.The most important contributions of this book are findings that reveal how new public management infiltrated political, professional and bureaucratic fields of power strengthening pre-existing power structures that underpin a dominant discourse, which is reproduced through systemic inertia. The findings suggest the current top down approach to planning needs to be reversed if a more integrated Australian health system is to be established. To hear and act upon the muted voices of patients and the wider community it is necessary to unmask and disrupt the power of dominant groups such as clinicians and clinical managers.