This paper develops a hypothesis that the ‘normal’ mode of operation for many organisations is well beyond their safe design capacity and that many health and social care organisations in the UK are in this position. This situation arises from having to cope with demand, irrespective of their supply capability.

The irony is that such organisations can appear to cope at the strategic level. This is because operational managers employ a variety of well-intended, informal, survival techniques to meet performance targets. However, such practices can perpetually mask the underlying reality and have serious unintended consequences .

Evidence for the hypothesis has emerged from a number of studies carried out using system dynamics to identify and promote systemic practice in local health communities in the UK. The rigour of quantitative simulation model construction has identified mismatches between how managers claim their organisations work and the observed data and behaviour. The discrepancies can only be explained by surfacing informal coping strategies. Indeed, the data itself becomes questionable as it reflects more the actions of managers than the true characteristics of patient pathways.

If proved wholly or even partially correct there are some important messages in the paper for Health and Social Care management, the meaning of data and for modelling.