The Medical Industry is ultimately a “service industry”. It exists to serve its patients. Over the last 30 years, advances in science, medications and technology have given health care practitioners many tools to improve the quality of our patient’s lives. The medical industry has responded to the increasing complexity by creating ever-larger organizations with specialization. Yet, despite the advances in treatments and large numbers of hardworking talented professionals working individually and in groups, the amount of chronic diseases and costs of medical care continue to mount. Judged by the amount of disease and cost, medical professionals and organizations have failed their communities. Many sectors are contributing to this problem. These include the government, legal profession, businesses, medical organizations, patients and medical professionals.

I believe that medical organizations are the key to reversing the “tragedy of our health commons” on a large scale. The responsibility within medical organizations resides with the authorizing sponsors who have access to the significant amounts of money needed to fund successful innovation. It is always important to begin a journey with the goal in mind. I propose a goal of “world-class service”. World-class service would result in not only the absence of disease but also the presence of a good quality of life and efficient error free systems of medical care at minimal cost. My article, A Path to World-Class Service for Medical Organizations, provides a review of the challenges and a proposed path.

The journey to will require money and proper focus. There are two areas in health care where proper innovation can yield significant savings. Personnel costs account for up to 75% of the budget of health care organizations. The few studies done on the efficient use of health care professionals have demonstrated that at least 50% of their time is devoted to wasteful activities. The Vision Services pilot discussed in my article demonstrates what is possible when this area is successfully targeted. Chronic conditions treatments account for up to 80% of medical costs. By emphasizing secondary prevention this area can result in tremendous savings. The focus should be on the fundamental work unit in medicine, the clinical team. The characteristics of the clinical team will determine whether to focus on efficiency or/and chronic conditions. For instance the focus in the Vision Services pilot was on a referral service where the return on investment was greater by targeting the appropriate use of personnel initially. The payback for secondary prevention of chronic conditions is less then in primary care specialties. Leaders should begin with the clinical teams that will show the most return on investment.