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Over the last few decades advances in health careservices have allowed for the effective treatment ofmany illnesses. The only problem is that proven,effective treatments are not consistently applied inmost health care settings. The question is, if weknow better, why are we not doing better? This bookattempts to answer this question from multipleperspectives. Using a qualitative research design,clinicians from an acute care setting wereinterviewed about an integrated care pathway forcongestive heart failure, two yearspost-implementation. What follows is an explorationinto the impact of system design, organizationalculture, and individual will on the eventual disuseof the pathway. As patients begin to demand moreconsistent care, it will be up to health systemleaders to find ways to address these barriers tosustainable knowledge transfer.