Discussion over the issue of failure demand has broadened our understanding of the relationship between organisational culture and performance. The link between the ways in which public sector organisations function and their failure to understand user-demand, generating significant resource waste, has generated a powerful narrative around the need for reform with the waste generated by outmoded organisational structures viewed as ‘low-hanging fruit’ in the demand for reform. Applying the notion to the Finnish primary care system however suggests that administrative change generating organisational reform or the implementation of industrial management tools such as Lean is not enough to alter deep-seated practices while complete systemic change remains impractical. What is required is a more holistic approach, including the adoption of the ‘continuity of care’ model, which involves system users and implementers engaging in a continuous process of social learning to (re)produce the most appropriate approach to system-user’s care needs as possible. The Pohde case detailing developments from Northern Ostrobothnia’s Wellbeing Service Country highlights the possibilities around such an approach while acknowledging that perfectly efficient human-based systems, where waste has been eradicated, remain elusive.