The starting point for this case is the rationalization process which happened in the Eastern Cape Department of Health in 2002. This process was a top down approach with no consultation with stakeholders. This resulted in a structure which was bureaucratic, with strategic units that negated the functional reporting structures. This new age movement from structure to process was not preceded by training of managers, who were still stuck in the old industrial age focusing on control and hierarchy. Two significant events, the first being the 2006 ICU baby deaths at Cecilia Makiwane hospital and...