THE FEATURE ARTICLES included in this issue of Frontiers of Health Services Management, authored by John Toussaint and Gary Kaplan, have much in common. Both address one of the most critical mandates in healthcare delivery: the need for transformational change. Both share essential guidance-which leaders may find difficult to accept-on how to be successful in adapting to today's healthcare market. And both have documented measurable outcomes that demonstrate marked improvements in their respective organizations, allowing them to verify the effectiveness of the improvement process and promote its continued use.
I can attest to the importance of the authors' suggested improvement approaches because I and other senior leaders implemented similar principles and practices at two healthcare organizations. In my 12 years as CEO of CHRISTUS Health, in Irving, Texas, and during my nine-month tenure as the interim CEO at Parkland Health & Hospital System, in Dallas, I witnessed gains at both organizations as they developed verifiable and measurable improvements in the quality and safety of the clinical services they provided at their numerous hospitals and clinics.
THE PRESENT UNSUSTAINABLE HEALTHCARE ENVIRONMENT
Both Toussaint and Kaplan define in their opening paragraphs the operational characteristics of most healthcare delivery today, which industry leaders generally accept as valid. I attribute the poor performance outcomes they note to four drivers of the need for transformational change, a critical factor for future success that both authors mention in their articles.
The first driver is the lack of consistency and coordination of services among providers that results in much of the poor quality of care delivered today. Toussaint highlights this problem by noting the excessive levels of medical errors, readmissions within 30 days of discharge, and unnecessary deaths.
The second driver is the high cost of care in the United States, where prices and charges bear no relationship to actual cost structures. Exacerbating the high cost of poor outcomes is the unnecessary duplication of services and tests caused by the aforementioned absence of care coordination among providers.
The third driver is increased physician dissatisfaction, often triggered by physicians' realization that they are being asked to relinquish their independent practice style. Although Toussaint knows firsthand that doctors in training are taught that individual judgment is more important than best-practice protocols and independence is more important than group critical thinking, he understands that this mind-set no longer has a place in today's healthcare marketplace.
The fourth driver is a misaligned vision of leadership teams that results in a focus on illness rather than wellness and on volume rather than value. Kaplan and the leadership team at Virginia Mason Medical Center confront this driver by working "to avoid the mentality that bigger is inherently better" (page 24).
When considering these four drivers of change, it appears that the only health systems that will survive in the future are those that can prove by their outcome metrics that they are providing consistent, high-quality, and safe services at accessible sites and times and at affordable costs.
THE KEY QUESTION AND KEY ANSWERS
Both authors ask this critical question: What must we do to ignite the enthusiasm and will in our organization - at the front lines, in the leadership and management teams, and in the board and governance processes - to create not only a sustainable but a thriving healthcare industry for all who enter our doors?
Not surprisingly, Toussaint and Kaplan provide similar answers. Each repeatedly stresses that transformational change throughout all levels of the delivery system is essential, noting that changing the way the people in the organization think and perform is the most important step toward ensuring success in the future marketplace. …