Policies, politics and micro-politics are power-based forces that shape healthcare workplaces, influencing team dynamics, learning and improvement. Power here refers to the ability to influence or control outcomes, and political power is key to understanding how workplace politics affect decision-making. This chapter explores both explicit and implicit power structures that shape healthcare processes and culture. Examples highlight how policy and compliance-driven cultures can overshadow principle-based care and learning. Challenges like inefficient electronic medical records show how policies can hinder clinical decision-making. Policy development is presented as dynamic and interpretive, with individuals capable of driving change. Martha’s Rule illustrates how one incident can lead to national policy reform. Reflective tasks prompt consideration of how policy language and structure can have unintended consequences, drawing on a case from The Lancet. The chapter also examines micro-politics and its impact on safety and learning, using aviation literature and the Nimrod Review to explore how cultural principles offer deeper insights into incidents than compliance metrics. Throughout, the chapter contrasts local-level implicit politics with broader policy formation, encouraging critical reflection on how both constrain or enable practice and how individuals can contribute to meaningful change.