The health care industry faces daunting challenges. Across developed countries, cost inflation continues unchecked; the average US household, for example, spends more on health insurance than on mortgage repayments. Profound quality and safety problems persist—there are about 90,000 avoidable deaths a year in the United States alone.¹ Many health systems face recruitment challenges despite large pay raises for doctors, and an increasing number of clinicians say they would advise young people against choosing careers in medicine.²

So further change is still needed, despite years of progress in the quality of health care around the world. This transformation will require leadership—and that leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles. Clinicians not only make the frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery.

Unfortunately, the conventional view of health care management divides treatment from administration—doctors and nurses look after patients, while administrators look after the organizations that treat them. But we can learn from a number of pioneering health care institutions that have achieved outstanding performance by radically challenging this...