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Radical Resolutions

As I reflect on this past year and prepare for new challenges in 2018, I have been inspired by the Institute for Healthcare Improvement (IHI) Leadership Alliance’s 10 guiding principles or simple rules for radical health care redesign. As we move into a new year, it seems appropriate to revisit this simple, yet thought provoking, guidance for quality improvement in health care.


  1. Change the balance of power. Co-produce health and well-being in partnership with patients, families and communities.
  1. Standardize what makes sense. Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care.
  1. Customize to the individual. Contextualize care to an individual’s needs, values and preferences, guided by an understanding of what matters to the person in addition to “What’s the matter?”
  1. Promote well-being. Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care.
  1. Create joy in work. Cultivate and mobilize the pride and joy of the healthcare workforce.
  1. Make it easy. Continually reduce waste and all nonvalue-added requirements and activities for patients, families and clinicians.
  1. Move knowledge, not people. Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.
  1. Collaborate and cooperate. Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
  1. Assume abundance. Use all the assets that can help to optimize the social, economic and physical environment, especially those brought by patients, families and communities.
  1. Return the money. Give the money from health care savings to other public and private purposes.
These 10 principles will guide our End Stage Renal Disease (ESRD) team as we begin new efforts to raise awareness of the benefits of transplantation to those with ESRD and increase the transplant waitlist. Transplants for many may seem unattainable, so efforts to debunk common myths are needed. We will also focus on reducing infections in the dialysis setting, some of which can be life threatening. We will also begin renewed efforts to empower dialysis patients to dialyze in the comfort of their home. 

These goals and guiding principles will help us give power back to the patients. How many times have we relegated our health to our physician or health care team? It is time to empower our patients, our friends, our families and ourselves. Join me in creating radical redesign resolutions for 2018 and Happy New Year!  

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