Our country, the richest society in human history, features a healthcare system — avoidable by none — in which the level of dysfunction is beyond compare. The version of healthcare good enough for the people we call patients will not be reached passively. Whether we improve enough to give our patients and communities the quality they deserve depends upon whether we treat our problems seriously or handle them superficially. These are my observations:

1. There’s no such thing as just “doing the work.” In taking jobs as healthcare professionals we commit to continuous improvement — we must always engage with the systems around us to make ourselves more accessible to the people we can help.
2. Systems — hierarchies, medical records, and standard practices — exist to support and enable clinical providers, not the other way around.
3. Patient care is joyful work, and we should feel privileged each day that we get to do it. When we don’t, this oftentimes says much more about the systems we work within than it does about ourselves.
4. There may not be a more valuable focus in healthcare than improving diagnostic accuracy.
5. We’re all here to help people. If you came to work for any other reason, it’s time to move on.
6. Be pragmatic, not perfect: maybe a social admission isn’t ideal, or a problem could be addressed via outpatient care in a large system, but what kind of follow-up resources are really out there for your patients?
7. Quality is an engine. Once you start moving toward better quality care, you’ll attract people who want to do great work, improvement will accelerate, and from there you can’t be stopped. But starting the engine at all demands deep commitment.
8. Hospital nurses are superheroes. The amount of knowledge and skill required to do their job well is incredible, and how they navigate patient and hospital staff personalities, dynamics, and pressures is staggering. No other job comes close.
9. If you aren’t legitimately helping a patient, why on earth are you involved in their care?
10. Call things out, and make sure the people around you are willing to do the same. Ego is not a part of taking care of people.
11. “Patient” is a label, and it makes us think about people differently. Set aside whatever biases you can.
12. Any person or institution can be a leader, it just takes a little more effort to emulate the mindset of a teaching hospital when you’re not practicing in one. Don’t be afraid to lead.
13. Don’t work at places that chase lagging indicators (e.g., falls) instead of addressing their root cause (e.g., hospital acquired deconditioning) — these facilities won’t be up to par until they undergo a sweeping leadership change.
14. Management — the concept — is not the devil. But an ineffective manager can do a lot of harm simply by being in a management position.
15. Find and create opportunities where your personal value is greater than what the next best available person can offer. This is how you do the most good for the most people.
16. Outcomes are important, and processes matter, but everything is built on top of culture. If the foundation is bad, there’s no sense in focusing on the top floor.
17. When the wrong culture festers, good people leave, and bad ones stay. Over time, the work force will self-select into something very different than it might have become had the culture been better or more supportive.
18. A hospital is not a family, it’s a high-performance team with a mission to execute. Close relationships are important, but the goal of excellent patient care cannot be compromised.
19. Incentives are a mess, but it is possible to provide excellent care and also be a stable and profitable institution. While it may be simpler to look only a quarter or a year ahead and prioritize revenues and cost-savings, that is almost never what is best for patients (at least in our current system of healthcare).
20. Burnout is not inevitable: we can endure long hours and grueling work and emotional pain as long as we’re doing it for the right reasons. But when we’re abused and limited in our capacities to help people, the wheels will soon fall off.

Healthcare professionals can all be much happier, patients can achieve better health outcomes, and facilities can continue to be very profitable — these are not competing goals. To approach them as if success in one area must come at the expense of another is to totally undercut organizational capacity.

John Corsino, DPT, MBA, is a hospital physical therapist and writer based in Massachusetts.

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