Box 3.
Simple rules for the design of the 21st century healthcare system in the United States
| Traditional approach | New rule |
| Care is based primarily on visits | Care is based on continuous healing relationships |
| Professional autonomy drives variability | Care is customised according to patients' needs and values |
| Professionals control care | The patient is the source of control |
| Information is a record | Knowledge is shared and information flows freely |
| Decision making is based on training and experience | Decision making is evidence based |
| “Do no harm” is an individual responsibility | Safety is a system property |
| Secrecy is necessary | Transparency is necessary |
| The system reacts to needs | Needs are anticipated |
| Cost reduction is sought | Waste is continually decreased |
| Preference is given to professional roles over the system | Cooperation among clinicians is a priority |