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To improve population health and well-being, a health-care system must deliver results—that is, it must create value. But how do we define and measure that value? 

This is a critical question at a time when health systems around the world seem increasingly overwhelmed. Population aging is often blamed, but that was a predictable trend. What needs deeper scrutiny is how health systems are organized—and how they must evolve. 

The best way to create value in health care is to achieve the Quintuple Aim (defined by the Institute for Healthcare Improvement). This model targets five goals: better patient experience, a healthier population, lower per capita costs, improved care team well-being and health equity. 

Care organization at the heart of the solution 

Health systems are defined by how they are administered, financed, and—most crucially—how care is organized. This third element must be central to any transformation and grounded in a clear, adaptable architecture. 

The model I propose is evolutionary. It supports building the most appropriate service offering for a given population, tailored to local needs rather than one-size-fits-all solutions imposed by health authorities. 

A well-designed architecture to reduce care variability is essential. Today, patients consulting multiple teams for the same issue often receive inconsistent treatment. This lack of coherence, long documented, impedes performance and makes it harder to create value. 

Architecture evolves in response to external factors – such as changes in demographics, clinical practices, resources, and regulations – and internal system principles linked to patients, care teams, and operational excellence. 

Seven strategic levers for an efficient system 

External factors and guiding principles point to seven levers for transforming a health-care system into focusing on adding value. They fall into three groups:  

• Levers that professionalize the management of the health system 

• Levers that connect system-wide vision with local change action 

• Levers that move the whole system from reactive to proactive 

Professionalize management of the health-care system  

High-performance systems require agile, resilient governance. Clear roles, responsibilities, structures, processes and rules must support both daily operations and long-term transformation. Clinical governance, focused on value for patients, must actively engage all stakeholders. 

This governance must be solid enough to withstand crises and agile enough to adapt quickly to change. 

Multilevel governance (a minister, the Department of Health, national and regional agencies and health-care providers) requires clear definition of roles and responsibilities. It also relies on a management system, at all levels, that ensures continuity of daily operations while executing the transformation strategy without compromising performance.  

The second lever requires resource management to be precise and dynamic. Human, material, technological, building and financial resources must be carefully identified, deployed, and maintained. This can mean regularly reviewing team structures or creating new job categories, redesigning care spaces to improve productivity and care capacity. 

Human resources, the system’s most valuable asset, are too often taken for granted. A flexible structure should allow remuneration to be decoupled from rigid job structure. This would allow adaptation without losing staff.  

In some jurisdictions, working conditions are negotiated before determining what services the system should deliver – an inversion that constrains innovation. Instead, remuneration should follow service design, not drive it. 

Think globally, act locally 

Three tools are needed to link system-wide vision to local action.  

First, we need to improve citizens’ health literacy, so that they better understand their health status, the services available and how to access them, as well as their responsibility for their own health. Among health-care professionals, we need to improve digital literacy to take advantage of the technological tools essential to transforming the health-care system. 

Second, care pathways must be simplified. That includes monitoring service access in real time, accompanying vulnerable clients throughout their care journey, updating clinical knowledge on practices and prevention, fostering interdisciplinary teams, integrating precision health, and optimizing care transitions. 

Streamlined care pathways reduce inefficiencies and shift expensive interventions to cost-effective ones. For example, early cancer screening or quit-smoking programs can prevent the need for complex treatment later. 

Third, digitization is essential. A unified digital health record, expanded telehealth, and task automation (e.g., laboratory analyses or supply transport) can dramatically improve efficiency. 

Shifting from reactive to proactive care 

A proactive system requires real-time monitoring of both population health status and system performance. Agility comes from being able to adapt quickly to these internal and external signals. 

Financing must also evolve. Instead of paying for volume, we must pay for value. Organizations—not individuals—should be compensated based on their performance in achieving the Quintuple Aim. A health-care delivery network could, for example, be funded based on the efficacy of their screening outreach programs or post-surgical complication rates. 

The levers act on five key design parameters: the four standard care pathways (episodic care, long-term conditions, infants, youths and seniors), the distribution of expertise across levels of care (primary, specialized, superspecialized), care settings (home, community, hospital), team geography, and care transition mechanisms. 

Benefits beyond the health-care system  

By drawing on external and internal factors, transformation levers and design parameters, we can build an architecture focused on value creation, in which the service offering is a means to achieving the Quintuple Aim. 

Achieving the Quintuple Aim has effects far beyond the health-care system: a healthier population participates more fully in society, fostering economic and social development and increasing the State’s capacity to invest in other key sectors, such as education, the environment, housing, public safety and, of course, health care.
 

Editor’s note: This article is the first of two by the author. A second article will outline a roadmap for implementing these ideas.