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Without a clear focus on the needs and experiences of individual patients, much of the financial and structural reorganization now rampant in health care will be unlikely to yield improvements that matter to the patients we serve. As we change the system of care, five principles can help guide our investment of energy: 1) Focus on integrating experiences, not just structures; 2) learn to use measurement for improvement, not measurement for judgment; 3) develop better ways to learn from each other, not just to discover "best practices"; 4) reduce total costs, not just local costs; and 5) compete against disease, not against each other.
Donald M. Berwick (Fri,) studied this question.