This article highlights structural barriers in our current health research infrastructure which inhibit the formation of a community of researchers who could provide a more structured and sound approach to evolving and sharing methods of care delivery that could benefit countless people in many jurisdictions. The way that health services are structured inhibits the uptake of best clinical and process practices yet examining examples and methods of successfully restructuring to improve this are often not seen as legitimate, publishable science. By increasing the rigor with which we examine our health services and our methods of altering them we will assist a great number of people with receiving more timely, appropriate, safe and effective health care. The current health research infrastructure could be of great benefit in contributing to this rigor by more fully recognizing the benefit of, and contributing to the emerging work in, health system improvement. Berwick states that the current 'intellectual hegemony' fails to 'accommodate the kind of discovery that drives most improvement in healthcare'. Given that most people in the academic world would like to see healthcare improve I would suggest that such a statement invites controversy.