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Step I: Separate simple care, especially simple preventive services required for large numbers of people. Nurses, or other appropriately trained individuals, in easily accessible settings like retail clinics, can provide prevention to healthy individuals.
Step II: Empower workgroup competition. Apply performance measures at the level of the performing group, and make the measurements visible to competing groups. Trust this as an incentive, and avoid regulating costs or quality.
Step III: Create superdoctor teams. Innovate in teams of physicians and professional providers to rapidly diagnose and treat highly complex conditions. Just as string quartets can play more complex music than soloists, teams can provide highly complex care.
Step IV: Accelerate intake routing to rapidly identify the right provider. Separate emergency cases, simple and complex.
Step V: Improve communication to prevent prescription errors in paper and electronic systems. Electronic systems vary widely in effectiveness, increasing redundancy and reducing distraction are the keys to preventing errors.
Step VI: Create disinfection gateways at internal boundaries between sections of hospitals and between hospitals to dramatically reduce hospital-based infections. This type of boundary-based prevention is a high-leverage strategy.
Step VII: Use e-records for research. The large volume of data represents a unique resource for advances in medical knowledge and effective care.
Step VIII: Promote "First Day" Celebrations. Personal and community engagement in renewal is the most important force for improved health.