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The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning, competitive markets, such outcomes would be inconceivable. In health care, these results are intolerable. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.

Nearly all areas of business--not just sales and human resources--call for interpersonal savvy. Relational know-how comprises a greater variety of aptitudes than many executives think. Some people can "talk a dog off a meat truck," as the saying goes. Others are great at resolving interpersonal conflicts. Some have a knack for translating high-level concepts for the masses. And others thrive when they're managing a team. Because people do their best work when it most closely matches their interests, the authors contend, managers can increase productivity by taking into account employees' relational interests and skills when making personnel choices and project assignments. After analyzing the psychological tests of more than 7,000 business professionals, the authors identified four dimensions of relational work: influence, interpersonal facilitation, relational creativity, and team leadership. This article explains each one and offers practical advice to managers--how to build a well-balanced team, for instance, and how to gauge the relational skills of potential employees during interviews. Understanding these four dimensions will help you get optimal performance from your employees, appropriately reward their work, and assist them in setting career goals. It will also help you make better choices when it comes to your own career development. To get started, try the authors' free online assessment tool, which measures both your orientation toward relational work in general and your interest level in each of its four dimensions.

Anyone who has ever managed people who abuse time--whether they are chronic procrastinators or individuals who work obsessively to meet deadlines weeks in advance--knows how disruptive they can be to a business's morale and operating efficiency. But lessons in time management will have no impact on these employees. That's because real time abuse results from psychological conflict that neither a workshop nor a manager's cajoling can cure. Indeed, the time abuser's quarrel isn't even with time but rather with a brittle self-esteem and an unconscious fear of being evaluated and found wanting. This article describes four types of time abusers typically encountered in the workplace: Perfectionists are almost physically afraid of receiving feedback. Their work has to be "perfect," so they can increase their likelihood of earning a positive evaluation or at least avoid getting a negative one. Preemptives try to be in control by handing in work far earlier than they need to, making themselves unpopular and unavailable in the process. People pleasers commit to far too much work because they find it impossible to say no. Procrastinators make constant (and often reasonable-sounding) excuses to mask a fear of being found inadequate in their jobs. Managing these four types of people can be challenging--time abusers respond differently from most other employees to criticism and approval. Praising a procrastinator when he is on time, for instance, will only exacerbate the problem, because he will fear that your expectations are even higher than before. In fact, some time abusers, like the perfectionist, may need professional treatment. This article will give you insight into why they are the way they are--and what can be done to help them manage their problems.

Of late, offshoring and outsourcing have become political hot buttons--they have been conflated to mean that high-paying, white-collar jobs have been handed to well-trained but less expensive workers in India and other locales. The brouhaha over the loss of service jobs, which currently account for over 80% of private sector employment in the United States, is not merely an American phenomenon. The fact is that service sector jobs in all developed countries are at risk. Regardless of what the politicians now say, worry focused on offshoring and outsourcing misses the point, the author argues. We are in the middle of a fundamental change, which is that services are being industrialized. Three factors in particular are combining with outsourcing and offshoring to drive that transformation: The first is increasing global competition, where just as with manufactured goods in the recent past, foreign companies are offering more services in the United States, taking market share from U.S. companies. The second is automation: New hardware and software systems that take care of backroom and front-office tasks such as counter operations, security, billing, and order taking are allowing firms to dispense with clerical, accounting, and other staff positions. The third is self-service. Why use a travel agent when you can book your own flight, hotel, and rental car online? As these forces combine to sweep across the service sector, executives of all stripes must start thinking about arming and defending themselves, just as their manufacturing cousins did a generation ago. This will demand proactive and far-reaching changes, including focusing specifically on customer preference, quality, and technological interfaces; rewiring strategy to find new value from existing and unfamiliar sources; deintegrating and radically reassembling operational processes; and restructuring the organization to accommodate new kinds of work and skills.

Intangible assets--patents and know-how, brands, a skilled workforce, strong customer relationships, software, unique processes and organizational designs, and the like--generate most of a company's growth and shareholder value. Yet, extensive research indicates that investors systematically misprice the shares of intangibles-intensive enterprises. Clearly, overpricing wastes capital. But underpricing raises the cost of capital, hamstringing executives in their efforts to take advantage of further growth opportunities. How do you break this vicious cycle? By generating better information about your investments in intangibles and by disclosing at least some of that data to the capital markets. Getting at that information is easier said than done, however. There are no markets generating visible prices for intellectual capital, brands, or human capital to assist investors in correctly valuing intangibles-intensive companies. And current accounting practices lump funds spent on intangibles with general expenses, so that investors and executives don't even know how much is being invested in them, let alone what a return on those investments might be. At the very least, companies should break out the amounts spent on intangibles and disclose them to the markets. More fundamentally, executives should start thinking of intangibles not as costs but as assets, so that they are recognized as investments whose returns are identified and monitored. The proposals laid down in this article are only a beginning, the author stresses. Corporations and accounting bodies should make systematic efforts to develop information that can reliably reflect the unique attributes of intangible assets. The current serious misallocations of resources should be incentive enough for businesses to join--and even lead--such developments.

By making the most of organizational capabilities--employees' collective skills and fields of expertise--you can dramatically improve your company's market value. Although there is no magic list of proficiencies that every organization needs to succeed, the authors identify 11 intangible assets that well-managed companies tend to have: talent, speed, shared mind-set and coherent brand identity, accountability, collaboration, learning, leadership, customer connectivity, strategic unity, innovation, and efficiency. Such companies typically excel in only three of these capabilities while maintaining industry parity in the other areas. Organizations that fall below the norm in any of the 11 are likely candidates for dysfunction and competitive disadvantage. To determine how your company fares in these categories (or others, if the generic list doesn't suit your needs), the authors explain how to conduct a "capabilities audit," describing in particular the experiences and findings of two companies that recently performed such audits. In addition to highlighting which intangible assets are most important given the organization's history and strategy, this exercise gauges how well your company delivers on its capabilities and guides you in developing an action plan for improvement. A capabilities audit can work for an entire organization, a business unit, or a region--indeed, for any part of a company that has a strategy to generate financial or customer-related results. It enables executives to assess overall company strengths and weaknesses, senior leaders to define strategy, mid-level managers to execute strategy, and frontline leaders to achieve tactical results.

For decades, CEOs have been looking for the holy grail of corporate transformation, asking, "What is the best way to transform my company? Which model should I use?" Management consultants and academics have been working overtime to supply the answer. They haven't succeeded, however, because the search is a futile one. Every organization is unique. Leaders can adopt ideas that have worked elsewhere, but they need to create their own one-of-a-kind change model through experimentation, learning, blueprint creation and, most of all, a strong focus on results.

Environmental scanning systems are useless in the face of strategic inflection points--the dangerous quantum changes in competitive environments. Top managers and strategic planners lack the will and the intuition, respectively, to deal with those points the system does detect. More often than not, however, the system will simply fail to see them at all. To do so requires a synthesis that can be provided only by line managers who have both the right intuitions, by virtue of day-to-day contact with the real world, and access to unfiltered information, by virtue of their lowly station in the corporate hierarchy.

What wisdom could a horse trainer have to offer a corporate manager? Let's start with the fact that the word "manage" has an equine origin. It comes from Latin, by way of the Italian "maneggiare"--to handle, to train horses. To find out whether the connection goes any further than etymology, senior editor Julia Kirby interviewed the man who is perhaps the most famous thoroughbred trainer of all time: D. Wayne Lukas. Over the course of his 40-year career, Lukas has broken virtually every record in the history of the sport. He's had a horse in every Kentucky Derby for the past 23 years. In 14 different years, he has made more money than any other trainer in the United States; his lifetime earnings mark is now approaching an incredible $250 million. Although his accomplishments are undeniable, Lukas remains a controversial figure in his industry. Early on, he bucked long-standing traditions and came up with a training program unlike anyone else's. His willingness to ship horses across the country to compete in fields where they had better chances of prevailing meant more victories, happier clients, and a reputation for success that brought Lukas even better horses. One of the biggest assets a trainer can have is a good eye for selecting not just talented horses but also talented assistants. Horse training is a trial-and-error, learn-by-experience profession, and a lot of it is handed down. There aren't any books that demonstrate how to train a horse to win the Kentucky Derby. Lukas may be famous for holding almost every record in racing, but his ability to develop a whole new generation of great trainers may be his most important legacy.

Highly intelligent, confident, and successful, alpha males represent about 70% of all senior executives. Natural leaders, they willingly take on levels of responsibility most rational people would find overwhelming. But many of their quintessential strengths can also make alphas difficult to work with. Their self-confidence can appear domineering. Their high expectations can make them excessively critical. Their unemotional style can keep them from inspiring their teams. That's why alphas need coaching to broaden their interpersonal tool kits while preserving their strengths. Drawing from their experience coaching more than 1,000 senior executives, the authors outline an approach tailored specifically for the alpha. Coaches get the alpha's attention by inundating him with data from 360-degree feedback presented in ways he will find compelling. Such an assessment is a wake-up call for most alphas, providing undeniable proof that their behavior doesn't work nearly as well as they think it does. That paves the way for a genuine commitment to change. To change, the alpha must admit vulnerability, accept accountability not just for his own work but for others', connect with his underlying emotions, learn to motivate through a balance of criticism and validation, and become aware of unproductive behavior patterns. The goal of executive coaching is not simply to treat the alpha as an individual problem, but to improve the entire team dynamic.

Eliot Spitzer's investigations into the mutual fund and investment banking industries have made the New York State attorney general the de facto flag bearer of corporate reform. His exposure of conflicts of interest between investment bankers and research analysts in Wall Street firms led to the $1.4 billion global settlement between regulators and banking houses in 2003. In this interview, Spitzer describes the challenge of protecting public markets from conflicts of interest, paying particular attention to how such conflicts get institutionalized in an industry. "The cases that have gotten me and my fellow regulators most upset are the ones where we've seen senior management being tolerant of rank abuses," he says. "Because then you know that the entire structure is rotten." He also points the finger squarely at boards, maintaining that board members are drawn from pools of company and industry insiders. He cites "a void in values in a lot of boardrooms," holding up executive compensation as a powerful example. "Board compensation committees...are self-selected and interwoven--it's a rigged marketplace." He continues, "It would be interesting to see what the world would look like if CEO pay packages had to be submitted to shareholder votes." Spitzer suggests that what's really needed is for all business leaders to reinstill throughout their organizations the critical notion of a fiduciary duty--whether it is to the shareholder or to the customer. Using the mutual fund industry as an example, he also contrasts the value of enforcement with that of regulation and articulates an important--and surprisingly limited--role for government in protecting free markets.

Many companies have tried to copy Toyota's famous production system--but without success. Part of the reason why, says the author, is that imitators fail to recognize the underlying principles of the Toyota Production System (TPS), focusing instead on specific tools and practices. This article tells the other part of the story. Building on a previous HBR article, "Decoding the DNA of the Toyota Production System," Spear explains how Toyota inculcates managers with TPS principles. He describes the training of a star recruit--a talented young American destined for a high-level position at one of Toyota's U.S. plants. Rich in detail, the story offers four basic lessons for any company wishing to train its managers to apply Toyota's system--rather than go through the cursory walk-throughs, orientations, and introductions of most companies. First, there's no substitute for direct observation. Toyota employees are encouraged to observe failures as they occur--for example, by sitting next to a machine on the assembly line and waiting and watching for any problems. Second, proposed changes should always be structured as experiments. Employees embed explicit and testable assumptions in the analysis of their work. That allows them to examine the gaps between predicted and actual results. Third, workers and managers should experiment as frequently as possible. The company teaches employees at all levels to achieve continuous improvement through quick, simple experiments rather than through lengthy, complex ones. Finally, managers should coach, not fix. Toyota managers act as enablers, directing employees but not telling them where to find opportunities for improvements.

With the battle for the best and brightest people heating up again, you're most likely out there looking for first-rate talent in the ranks of your competitors. Chances are, you're sold on the idea of recruiting from outside your organization--developing people within the firm takes time and money. But the authors, who have tracked the careers of high-flying CEOs, researchers, software developers, and leading professionals, argue that top performers quickly fade after leaving one company for another. To study this phenomenon in greater detail, the authors analyzed the ups and downs of more than 1,000 star stock analysts, a well-defined group for which there are abundant data. The results were striking. After a star moves, not only does his performance plunge, but so does the effectiveness of the group he joins--and the market value of his new company. Moreover, transplanted stars don't stay with their new organizations for long, despite the astronomical salaries firms pay to lure them from rivals. Most companies that hire stars overlook the fact that an executive's performance is not entirely transferable because his personal competencies inevitably include company-specific skills. When the star leaves the old company for the new, he also leaves behind many of the resources that contributed to his achievements. As a result, he is unable to repeat his performance in another company--at least not until he learns to work the new system, which could take years. The authors conclude that companies should focus on cultivating talent from within and do everything possible to retain the stars they create.

Companies facing new requirements for governance are scrambling to buttress financial reporting systems, overhaul board structures--whatever it takes to comply. But there are limits to how much the outside can impose good governance. Boards know what they ought to be: seats of challenge and inquiry that add value without meddling and make CEOs more effective but not all-powerful. A board can reach that goal only by functioning as a high-performance team, one that is competent, coordinated, collegial, and focused on an unambiguous goal. Such entities don't just evolve; they must be constructed to an exacting blueprint--what the author calls "board building." In this article, Nadler offers an agenda and a set of tools for boards to define and achieve their objectives. It's important for a board to conduct regular self-assessments and to pay attention to the results of those analyses. As a first step, the directors and the CEO should agree on which of the following common board models best fits the company: passive, certifying, engaged, intervening, or operating. The directors and the CEO should then analyze which business tasks are most important and allot sufficient time and resources to them. Next, the board should take inventory of each director's strengths to ensure that the group as a whole possesses the skills necessary to do its work. Directors must exert more influence over meeting agendas and make sure they have the right information at the right time and in the right format to perform their duties. Finally, the board needs to foster an engaged culture characterized by candor and a willingness to challenge.

A carefully chosen story can help the leader of an organization translate an abstract concept into a meaningful mandate for employees. The key is to know which narrative strategies are right for what circumstances. Knowledge management expert Stephen Denning explains that, for optimal effect, form should follow function. Challenging one professional storyteller's view that more is better, Denning points out that it's not always desirable (or practical) to launch into an epic that's jam-packed with complex characters, cleverly placed plot points, an intricate rising action, and a neatly resolved denouement. If the aim is to motivate people to act when they might not be inclined to do so, it's best to take an approach that's light on detail--particulars can bog down listeners and prevent them from focusing on the message. Drawing on his experiences at the World Bank and observations made elsewhere, the author provides several dos and don'ts for organizational storytellers, along with examples of narratives that get results. Denning also presents seven distinct types of stories, the situations in which they should be told, and tips on how to tell them. Leaders with the strength to push past some initial skepticism about the enterprise of storytelling will find that the creative effort pays off.

Some projects have such diverse requirements that they need a variety of specialists to work on them. But often the best-qualified specialists are scattered around the globe, perhaps at several companies. Remarkably, an extensive benchmarking study reveals, it isn't necessary to bring team members together to get their best work. In fact, they can be even more productive if they stay separated and do all their collaborating virtually. The scores of successful virtual teams the authors examined didn't have many of the psychological and practical obstacles that plagued their more traditional, face-to-face counterparts. Team members felt freer to contribute--especially outside their established areas of expertise. The fact that such groups could not assemble easily actually made their projects go faster, as people did not wait for meetings to make decisions, and individuals, in the comfort of their own offices, had full access to their files and the complementary knowledge of their local colleagues. Reaping those advantages, though, demanded shrewd management of a virtual team's work processes and social dynamics. Rather than depend on videoconferencing or e-mail, which could be unwieldy or exclusionary, successful virtual teams made extensive use of sophisticated online team rooms, where everyone could easily see the state of the work in progress, talk about the work in ongoing threaded discussions, and be reminded of decisions, rationales, and commitments. Differences were most effectively hashed out in teleconferences, which team leaders also used to foster group identity and solidarity.

NASA's fabled Faster, Better, Cheaper initiative sped up the agency's spacecraft development. But when missions began to fail, it was faulty organizational learning--not hardware--that was to blame.

Companies struggling to rejuvenate tired brands may want to look east. SoBe beverages, Nissan, and others are exploiting Westerners' fascination with products that are--or merely seem--Asian.

If they know the unwritten rules about how people in their companies whine, to whom, and about what, managers can determine where not to put their problem-solving energies.

University of Chicago's Roman Weil charges that many audit committee members are financially illiterate--and he has the test results to prove it.