As shown in this figure hospitals and clinics are faced with a huge number of systems issues. Administrators will be managing the larger systems wide problems represented by the medium and large dots, but those of us on the front lines need to manage the smaller, but very important problems represented by the small dots. Medication administration, proper orchestration of diagnostic procedures, problems with falls, overuse of tests to name a few. They require interventions at the front lines and require everyone working in the clinics and hospital wards to pitch in and help to correct these problems. When it comes to improving the delivery of health care we all need to become leaders. 