In the first part of this 2-part explanation of the importance of chronology in transformation, we examined transformation first by splitting it into 3 distinct forms, so that we could understand the chronological relationship of those forms. On closer examination, it becomes patently obvious why Trusts are constantly fire-fighting when they have not undertaken the part of transformation that protects against fires starting i.e. type 1 transformation. The necessity for this has arisen largely out of very changed conditions but a necessity it is i.e. it isn’t optional, if you want to survive. The defined output seems simple enough – a strategy aligned with the system and locality in which you operate, an organisational design model that serves adaptability, a mental model of critical success factors and robust performance management. However, our challenge now is to understand that, simple though these look, they too have a chronology that holds within its ‘power’ the balance of success versus failure. The complication is that the chronology is complicated and although it is chronological, it has a degree of iterativity about it that makes success frustratingly elusive. It is this that we must now understand.