Introduction: How Important Are Decisions about People?

Anyone who thinks seriously about change initiatives in health care quickly runs into a conundrum. Is it the people who matter most, or is it the processes? Is the most important thing to get personnel decisions right—or are those decisions essentially irrelevant, with establishing great processes being what really counts?

This is no idle dispute, because it reflects a great debate taking place not only in health care but also in management generally.

On one side are the process advocates. Consider the point of view of Fujio Cho, who at this writing is chairman of Toyota Motor Corporation: “At Toyota we get brilliant results from average people managing a brilliant process. Others get average ...

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