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Road map for a better healthcare system: Creating new standards of excellence

In my newest book, Healthcare’s Path Forward: How Ongoing Crises Are Creating New Standards of Excellence I highlight some of the challenges of recent years that have transformed the way we think about healthcare: the COVID-19 pandemic, the “great resignation” of thousands of healthcare workers, and conversations about racial inequality in both healthcare and society at large. These challenges have shown us that healthcare isn’t as reliable as it must be. Even in the best of circumstances, delivering care that is safe, effective, efficient, and empathetic can be difficult.

It requires clearly defined strategic goals, supported by essential activities and critical skills.

High reliability—no matter what

No one can anticipate the next challenge, but what we do know is that healthcare organizations must be resilient and able to adapt. What’s more, they must be able to assess how well prepared they are for a crisis. Organizations must go beyond sheer high reliability to becoming an HRO-NMW (high reliability organization (HRO), no matter what). But how do you do that?

For starters, each organization must clarify its strategic goals to improve healthcare. What is your organization trying to accomplish, and for whom? In healthcare, the goal is to alleviate not just physical pain, but also fear, confusion, and anxiety.

Next, organizations must define the value chain of activities. This constitutes the key activities that must be performed in order to improve patients’ well-being.

I am using the phrase “value chain” as taught by my friend and colleague Michael Porter of Harvard Business School. Michael helped define modern concepts of “strategy,” boiling its meaning down to two key questions: What are you doing for whom, and how are you going to be different? The concept of value chains is useful because it helps leaders and managers focus on essential activities and helps them not pay attention to activities that don’t further the strategic goal a better healthcare system.

As healthcare organizations continue on the path forward, they must consider other goals, like:

  1. Deserving, earning, and building the trust of patients
  2. Deserving, earning, and building the trust of the healthcare workforce
  3. Building a high reliability culture with a broadened concept of safety
  4. Building an inclusive culture that treats every patient and employee with respect
  5. Extending patient-centeredness to embrace consumerism, and working relentlessly to remove friction from the experience of consumers/patients

To achieve these goals, employees at different levels of the organization must master specific critical skills. In the final chapter of the book, I explain these skills in detail. I hope this framework helps make the path forward feel more manageable by highlighting three action items for each employee group.

Leaders and boards

  1. Articulate core values. How well do your leaders understand what is important to patients and employees, and how well can they articulate those values?
  2. Develop strategy. Do your leaders have a clear idea of who your organization’s key customer is and of the value you create for that customer?
  3. Understand the chain of activities needed to create value. Do your leaders and board know what is important to focus efforts on?


  1. Create social capital. Do your managers set the tone of the workplace, ensure a culture of trust and respect, and create a growth mindset?
  2. Bring principles of high reliability organizations to life. Are managers primed to recognize when mistakes have occurred? Are they studying mistakes and learning from them to ensure they don’t happen again?
  3. Eliminate waste—including waste of time for patients and employees. Are your organization’s managers looking for ways to eliminate wasted resources that increase costs and wasted time for patients and employees, causing annoyance and dysfunction in patient care?

Front-line caregivers

  1. Create a culture of respect. Do your front-line caregivers ensure that every patient and caregiver feel respected and that their problems matter?
  2. Participate fully in great teams. Do caregivers work well together and as a team where there is mutual respect?
  3. Shape the stories and memories of patients. Do your organization’s front-line caregivers understand that their roles help shape a patient’s experience with the organization?

A road map for learning and improvement

Our work is cut out for us. But for those of you in healthcare, I hope this book provides a road map for the process of learning and improving the quality of care to ensure greater success for our industry. 

This is the sixth book I’ve written, and each time I feel like I’ve captured everything I know about everything important. That pattern would suggest that, in a few years, I’ll be writing about all the things I just did not grasp back in 2023. Until then, I hope this book will help people in healthcare improve the great work we do—and not feel overwhelmed by the challenges.

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About the author

As Chief Medical Officer, Tom is responsible for developing clinical and operational strategies to help providers measure and improve the patient experience, with the overarching goals of reducing patient suffering and improving the value of care. Tom has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, researcher, and health policy expert. An internist and cardiologist, Tom continues to practice primary care at Brigham and Women’s Hospital in Boston.

Profile Photo of Thomas H. Lee, MD