Healthcare at Its Foundations

This chapter argues that meaningful healthcare reform requires returning to foundational questions about purpose and structure rather than incremental system adjustments. Three critical fractures impede reform: eroding public trust (declining from 51% to 32% between 2020-2025), failure to progress beyond goods and services delivery to patient transformation, and consolidation-driven system design that undermines patient-centered care while fueling physician burnout. Before proposing solutions, the authors insist healthcare leaders must address five worldview questions: What is healthcare for? What is a patient? What good are we pursuing? What does it mean to be a healer? What system best serves human dignity? Only then can leaders effectively apply the six-component Strategy Development Process: Strategic Foresight, Strategic Thinking, Strategic Innovation, Strategic Planning, Strategic Implementation, and Strategic Analysis and Assessment. This framework enables continuous adaptation in an era of exponential change while maintaining moral clarity and operational excellence.

Duke Scholars

Author Walter T Lee Head & Neck Surgical Oncology