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The problem with medicine, the author writes, is people like him: Fifty-something doctors trained in an era of autonomous hero-practitioners. These lone cowboy physicians may work hard, but they don't provide the best possible care, because they're embedded in a fragmented, chaotic, performance-blind system. Fixing this will require a new kind of leader who can organize doctors into teams, measure their performance not by how much they do but by how their patients fare, deftly apply financial and behavioral incentives, improve processes, and dismantle dysfunctional cultures. Drawing on examples from best-practice institutions such as the Cleveland Clinic, Seattle's Virginia Mason Medical Center, Intermountain Healthcare in Utah, and his own organization, Partners HealthCare System of Boston, Lee shows how a "new breed of leader" is orienting strategy around patients' needs (a more radical idea than it might sound) and raising the quality, efficiency, and value of care. A sidebar written by Partners strategy director Kelly W. Hall looks at how peer pressure can drive improved performance.

The surgeon and best-selling author readily concedes his own limitations as he explains how doctors-and health care generally-could do better. In his latest book, The Checklist Manifesto, Atul Gawande describes how asking a set of simple questions before the surgery starts-things like "Did we give the patient her antibiotic?" and even "Did we introduce ourselves to one another?"-can reduce infections and deaths by nearly half. As simple as this exercise is, it's often met with hostility, because it challenges beloved notions about doctors' status, autonomy, and expertise. In this edited interview Gawande discusses what checklists reveal about the culture of medicine and how its dysfunctions might be fixed.

In the United States and around the world, there have been plenty of proposals for curing what ails health care. All of them-new organizational forms, alternative payment systems, and free-market competition-aim to tackle a universal challenge: improving the quality of care and reducing, or at least curbing, its cost. But the reality is that regardless of what happens to the many experiments and reform efforts, including the one in Washington, the basic structure of the health care system in the United States and most other countries will remain in place for the foreseeable future. The only realistic hope for substantially improving care delivery is for the old guard to launch a revolution from within. Existing providers must redesign themselves. They must revamp core clinical processes and the organizational structures, management systems, and cultures supporting them so that they excel at performing three discrete tasks simultaneously: rigorously applying scientifically established best practices for diagnosing and treating diseases that are well understood; employing a trial-and-error process to deal with complicated or poorly understood conditions; and capturing and applying knowledge generated by day-to-day care. Some organizations - such as Intermountain Healthcare, the Cleveland Clinic, and Istituto Clinico Humanitas - have already redesigned themselves in ways that improve quality and lower costs. But no single dominant design exists; each organization has its own environment, structure, and history. More important than the specific designs are the four principles on which they are based: focus on the decisions, tasks, and workflows crucial to optimizing patient care; separate high- and low-variability care; reconfigure the supporting infrastructure and practices to match redesigned clinical processes; and design structure and processes to help organizations learn from their daily work.

This infographic offers a data-driven look at five reasons U.S. health care is so expensive-out-of-control pricing; payment schemes that reward excess; too many specialists; a few people cost a lot; and small practices, fractured care-and suggests some remedies.

A graphic look at how the United States stacks up against other countries in the Organisation for Economic Cooperation and Development on health care expenditures and life expectancy.

Don't pin your hopes on the rising savings rate. Consumers aren't going to spend the cash and reinvigorate the economy; instead, they're using it to pay off their enormous debts.

Protegra is a small company established in 1998 in Winnipeg, Manitoba. The company specializes in the area of computer software development and business performance consulting. Protegra features a unique organizational design, characterized by a lack of hierarchy and a collegial, professional culture centered on employee and customer values. Various information systems support Protegra's design. In the process of expanding into foreign markets and enlarging staff, Protegra has been concerned with preserving its way.

A newly promoted assistant deputy minister of business and trade must decide which of two candidates to recommend for her previous role as executive director, business and consumer regulation. One candidate is creative, innovative, client focused and an inspirational and charismatic leader with a history of "ruffling some feathers" with other departments within the government. The other candidate seems to lack drive and innovativeness but has earned the respect of his team and others within various government departments with whom he has interacted. This appointment is being made at a time of change within the government as it faces severe budgetary pressures and believes that there are opportunities to do many of its traditional functions in new, more cost-effective ways.

New research shows that female managers continue to lag behind men at every career stage, right from their first professional jobs-and that's among graduates from elite MBA programs. The aggressive efforts this past decade to create opportunities for women weren't nearly as fruitful as we'd thought. To achieve anything close to gender equality, organizations have a lot of work to do.

If you classify your employees into four types (Grand Prix Drivers, Pole Vaulters, Long-Distance Runners, and Flatliners) and customize engagement programs to meet their needs, the authors' research suggests, you'll be rewarded with workers who display more motivation, more loyalty, and better performance.

In the decade that the chairman, president and chief operating officer of Linens 'N Things (LNT) had been leading the firm, there had been significant changes to the industry. Specifically, its main competitor was experiencing higher sales and profits with the result of increased market share. External advice was sought to identify strategies available to LNT to catch up to its competitor and a successful Guest Oriented, Locally-Driven (GOLD) pilot was launched. Due to dwindling interests and internal resistance to the initiative, however, the chairman was left to decide what to do with the roll-out. He had several options to consider: Should he maintain the current pilot, or simply shut it down? Could it be changed or altered to encourage participation? Should it be district-specific? Or perhaps issuing an executive mandate would generate involvement. The chairman knew any decision would have to consider these and other cultural and strategic issues.

In 2005, the vice-president of Lundbeck, a Danish based central nervous system (CNS) pharmaceutical firm, needed to decide what to do with one of his most promising subsidiaries, Lundbeck Korea. Over its short lifetime, under the leadership of the country manager and the Asia regional manager, the subsidiary had grown well beyond the original goals set for it. The vice-president wanted to create a reporting structure and management mix that would balance the local demands that Lundbeck Korea required for growth with Lundbeck's overall strategy of specialization, speed, integration and results. While focusing on Lundbeck Korea, the case also traces Lundbeck's internationalization efforts in Asia over the past 20 years. Over that time, the company has grown from pure licensing arrangements to establishing its own country level subsidiaries. This case introduces the dynamic tensions between taking advantage of local management expertise and executing a corporate strategy developed for an entire global group. In addition, it illustrates the importance, but difficulties, of being sensitive to local management goals, while promoting a global corporate culture.

Ruffian Kelowna, one of 19 British Columbia Ruffian Apparel locations, is under performing. Recent management turnover and low unemployment in the region have left Kelowna short-staffed and in need of a new store manager to take over for the interim manager. Both sales and performance results are far below acceptable levels, and the store appears to be floundering. The newly hired B.C. regional manager for Ruffian Apparel is looking into the problem and needs to report back to Vancouver with his recommendations. This case can be used to demonstrate how different theories of motivation might apply to goal-setting and compensation plans. The case illustrates how an inappropriate or poorly structured compensation plan and motivational goals can lead to ineffective and detrimental results. Students who immediately attribute the problems of the case to the lack of a store manager will fail to explore the potential for increasing employee motivation and productivity across the board.

Jeremy Leahman, president of Filtroil, Inc., and Albert Randolph, founder of the firm, had partnered with a supplier in China to ramp up the manufacture of their China-based filtration system and start a new zinc alloy venture. They opened a new factory in Dongwan that was a merger between Shenzhen Filtroil and their supplier, Liu Li-whose own factory was on the verge of bankruptcy. Liu would own 10% of the merged factory and Shenzhen Filtroil would own the rest and acquire all of the necessary equipment. The two businesses filter and zinc would operate under the same roof. One year later Leahman was on a plane headed for China to hash out problems with Liu, who had demanded a monthly raise for himself and his wife, a new company car, and an increase in profit sharing. He had also threatened to delay product shipment to the United States if his conditions were left unmet. Qian Kai Nam (Qian) and Shea Kai Young (Thomas), who ran Shenzhen Filtroil and were in on the zinc partnership, believed that Liu's behavior put the entire business relationship at risk. The case reveals options Leahman could take to manage the situation. The case is suitable for use in organizational behavior, human resource management, and strategy classes at the MBA and executive education levels. The material can be used to exemplify the challenges of changing a U.S.-based company into a global competitor.

Netflix was among a small group of Silicon Valley companies to emerge from the technology bubble of the late 1990s a clear winner in terms of growth, market share, and profitability. That Netflix was able not only to prevail over this competition but also to thrive was largely attributable to the culture of freedom and responsibility inculcated by founder Reed Hastings. To foster this culture, the company adopted a series of unique employment practices that were meant to attract, retain, and motivate the type of employee that Netflix valued. Among these practices was a compensation system with several unconventional features. Whereas most companies provided compensation packages with a predetermined mix of cash and equity-based awards, Netflix turned the model on its head and allowed employees to request their own mix. Management was interested in finding out whether this practice supported or detracted from the company's main objectives for its employees.

The Academy for Professional Development (APD) was launched in 1993, shortly after Perestroika and the turbulent time of Soviet disintegration. With the support of the Soros Foundation and a local Ministry of Privatization, APD became the most prestigious professional business education and consulting firm in the country. Assembling and training a "team of talents" is always difficult, more so in this case because of the nature of local business practices, the proliferation of professional service firms competing for business and state-director clientele, and the lure of opportunities in more stable environments. As APD gained experience in business education and consulting, different directors implemented new programs and brought different styles of management. As the organization experiences turnover of its professional staff, its founder and Chairman of the Board is concerned about the role he should take as the organization matures.

This is an MIT Sloan Management Review article. The joint venture between Toyota and GM known as NUMMI yielded some surprising success stories, including the transformation of GM's worst plant into a world-class manufacturing model. Examining how this transformation took place provides insight into corporate-culture change and lean manufacturing. The most important and difficult "cultural shift"that has to occur in a lean-manufacturing transformation revolves around the entire concept of problems. What is our attitude toward them? What do we do when someone finds and exposes one? Making it easy to learn from mistakes means changing our attitude toward them. That is the lean cultural shift. The way to change culture is not first to change how people think, but instead to start by changing how people behave. Integrating quality, support and ownership into the job is vital. Those of us trying to change our organizations'culture need to define the things we want to do, establish the ways we want to behave and want others to behave, provide training and then do what is necessary to reinforce those behaviors.

A neuroscience research team at MIT has discovered that success can rewire your brain-and that failure has no impact at all.

If emotional decisions guide later rational moments, well, then we're not terribly sophisticated decision makers, are we?

A new production supervisor at an automobile engine plant has encountered his first challenging task. The production supervisor must find a way to diffuse the tension between his team leader and other machine operators on the line. The team leader, the hardest worker among the group, was repeatedly criticized for over-exerting himself in many areas of the line. The workers feared that their jobs would be in jeopardy if workaholics like the team leader started undertaking multiple tasks. In addition, the workers began to feel that they were receiving unequal treatment from the production supervisor as the team leader was given special permission to break team norms. As the morale of the group continued to deteriorate, the production supervisor wanted to confront the team leader about this unique quandary. The production supervisor needed to figure out a solution to best please the team leader and the entire group.