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Brief analytical summaries or syntheses #45

A CEO Checklist for High-Value Health Care


This discussion paper reflects an Institute of Medicine Roundtable Discussion among the CEOs of major American health systems. It provides a checklist of 10 strategies that, in their experience, have proven effective and essential to improving quality and reducing costs.


Leaders of health care organizations are acutely aware of the pressures that rising health care costs place on individuals, employers, and the government, and of unacceptable shortfalls in the quality and efficiency of care.

They have also learned, through experiences in their own institutions and through communication and collaboration with colleagues in other institutions, that better outcomes at lower costs can be achieved through care transformation initiatives that yield improved results, more satisfied patients, and cultures of continuous learning. These transformation efforts have generated certain foundational lessons relevant to every CEO and Board member, and the health care delivery organizations they lead. This CEO Checklist for High-Value Health Care describes touchstone principles, illustrated by case studies, for sustaining and reinforcing the system-wide transformation necessary for continuous improvement in the face of rapidly increasing pressures, demands, and market changes.

Analysis and results

Foundational elements

To create lasting, sustainable change, the pursuit of continuous improvement and better value for patients must define an organization’s culture, mission, and leadership. It is a pursuit that is never complete, but the value potential for the care provided by institutions can be continuously improved along with the health of the populations served.

1.  Governance priority — visible and determined leadership by CEO and Board

2.  Culture of continuous improvement—commitment to ongoing, real-time learning

Infrastructure fundamentals

Infrastructure components serve as foundation stones that enable the delivery of high-value care. As fundamental as governance and culture, certain technical capabilities promote the delivery of best practices and enable quality-improvement processes and assessment. These infrastructure elements are often critical first steps to transitioning to a system of high-value health care.

3. IT best practices — automated, reliable information to and from the point of care

4. Evidence protocols — effective, efficient, and consistent care

5. Resource utilization — optimized use of personnel, physical space, and other resources

Care delivery priorities

The core motivation for any hospital or health system is to deliver care that is safe, effective, patient-centered, timely, efficient, and equitable. Certain strategies can help care-delivery organizations reengineer care around these principles.

6. Integrated care — right care, right setting, right providers, right teamwork

7. Shared decision making — patient–clinician collaboration on care plans

8. Targeted services — tailored community and clinic interventions for resource-intensive patients

Reliability and feedback

No single action, project, or program can drive transformation. Continuous improvement on the delivery of high-value care requires health care institutions to continually monitor and improve reliability and performance. Equally important are the collection and analysis of feedback data on cost, quality, and outcomes.

9. Embedded safeguards — supports and prompts to reduce injury and infection

10. Internal transparency — visible progress in performance, outcomes, and costs


Ultimately, health institution leaders are responsible for improving care delivery, eliminating waste from the system and reinvesting to maximize the quality and efficiency of health care in the United States. They seek to rise to the challenges of a changing health care landscape and transform their organizations into engines of sustainable, efficient, high- quality care for all Americans.

Implications and recommendations

The items in the Checklist summarize interventions to improve health care while lowering costs. Leaders who use this Checklist to improve the value of care provided in their institutions, should pay particular attention to the phasing and sequencing of adoption. Early successes will pave the way for continued improvement. The pace of implementation will be derived from the particular culture of the institution and the needs of its patient population.

Partnerships with insurers and employers are also fundamentally important in building demand for and enabling the transition to high-value care. Experiences with these initiatives have brought to light the advantages of direct, transparent communication with all stakeholders. Such partnerships can help accelerate the shift to reimbursement models that favour high-value care and ensure that adhering to the strategies in this Checklist is fiscally sustainable.

Successful implementation of the items on this Checklist is dependent on close partnerships between executives and their Boards. Responsibility rests with hospital health system leaders to embrace higher quality and lower costs as institutional aims. Boards bear responsibility for holding the organization and its executives accountable for the outcomes achieved and for fostering high-value care as an institutional priority.


A CEO Checklist for High-Value Health Care