10 principles of radical redesign of the healthcare system

When it was first revealed around the turn of the millennium that healthcare was actually a leading cause of death, a new era of regulation began to set in that has continued through today.

The current environment for clinicians is “a tough time” as a result, according to Donald Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement, who spoke at the annual RSNA conference in Chicago on Nov. 26. Under pressure to convert to a value-based care system with heightened regulation, clinicians can still be at the forefront of leading a radical redesign to meet the goals of the triple aim.

Healthcare eras

Two separate reports in 1999 and 2001 found that many people die as a result of receiving healthcare––not complications of a disease or condition, but errors in care. Slips and lapses in care lead to a “stunning estimate” that between 44,000 and 98,000 people die annually from their care––“more deaths than [caused by] breast cancer,” Berwick said.

At this point, a “chasm” was declared between what doctors were doing and what they could be doing. Since then, the government and regulatory authorities have stepped in to more closely monitor how doctors deliver care and how patients perceive services. This new phase in healthcare marked an era of skepticism, Berwick said during his speech.

“We had a deal––[doctors] will be the beneficence, but [they’re] killing 50,000 people per year?” Berwick said. … “So, the government said, ‘The deal is off. We need to review what you do and attach certainty.’”

What has emerged since then is the triple, or quadruple aim, to improve the experience of care, improve population health, lower the per capita cost and improve the job satisfaction for clinicians and healthcare professionals.


What has gotten lost in the fray of the goals of the triple or quadruple aim is the role of the clinician, particularly the feeling of joy in the work, according to Berwick. For example, physician burnout is an ever-present problem among healthcare institutions, and surveys have found that 70 percent of physicians would not recommend healthcare as a profession to others.

To meet the goals of the quadruple and triple aim, the era of skepticism won’t be enough, Berwick said. To get there, clinicians should be leading the way.

There are several ways to move the healthcare system along and enable clinicians to more freely enjoy their occupations, as well as encourage the next generation of healthcare professionals, according to Berwick, who spoke of 10 principles of this radical redesign.

10 principles of radical redesign:

  • Change the balance of power by giving more voice and power to the patient and provide the “perception that healthcare is co-produced in partnership with patients”
  • Standardize what makes sense
  • Customize to the individual and practice that “every patient is the only patient” by asking not “what’s the matter with you,” but “what matters to you?”
  • Promote wellbeing
  • Create joy in the work for clinicians
  • Make it easy and reduce waste in all forms
  • Move knowledge forward
  • Collaborate
  • Assume abundance
  • Return the money by lowering the cost of care

Many of these principles are already in action, but healthcare as a whole needs to adopt them for patients and clinicians alike to feel empowered.