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Want to spend a long time training for a job? Become a doctor - or an architect. I became a doctor, yet my job recently has involved quite a lot to do with buildings, and talking about buildings. So, what's that got to do with the day job?

Strategy is rarely a word that inspires enthusiasm. It should. But too often it’s an arduous process to produce a long list of hopes and aspirations, with no plan for action or evaluation. The result is something that no one looks at or believes in. What is going wrong?

Rich Taunt argues that we all think the same, and that's a problem. To succeed as a health service we need more 'cognitive diversity', seeking different ways of thinking and opening ourselves up to challenge.

As the NHS has restructured over the years we have taken professional tribes and overlaid them with organizational tribes – commissioner and provider, hospital and community, physical and mental health, health and social care. Sometimes we recognize this, and we learn to speak each other’s dialect – but all too often we simply adopt a new jargon – the “special words used by a profession or group that are difficult for others to understand.” And we hold on to our positional power.