As with many other health and care systems, healthcare in Ireland is a complex adaptive system and mechanistic linear reductionist thinking is insufficient for systemic change. Creating the conditions for change, an adaptive space and some simple rules or enabling constraints have been successful in our experience. At the end of the day, all integration is local and attending to relationships and local context which understanding system context is important to be successful. Cultivating highly networked connections is vital for success. Improvement is iterative, dynamic, and organic, and it takes time to build trust and confidence so that policymakers and executive decision-makers are on board. While restructuring within the Irish healthcare system has made implementation challenging, the introduction of Regional Health Areas (and associated integrated healthcare) under the Sláintecare policy provides a strategic opportunity to enable adaptation of integrated care at scale and pace.