tasks need to be taken, who should perform them, and how to do them most efficiently. Wal-Mart pioneered this strategy in retail trade as Toyota did in automobiles, and it has spread to other parts of manufacturing, online sales, and even professional services. In health care, by contrast, there is little information available on the quality of different providers, the value of different types of care, and the steps involved in providing care efficiently. Rewarding good work. In all successful businesses, the economic case supports doing the right thing. Employees are rewarded for adding value, not doing too much?witness banks gambling with taxpayer money—or too little—salaries with no performance incentives. Health care has traditionally rewarded providing more intensive care, but not coordinating care or making sure the care provided is appropriate. Operating on a patient with a heart attack is reimbursed highly, but helping people avoid a heart attack is not. The result is inadequate prevention and excessive costs when care is needed. Employee and customer empowerment. The most successful firms are not hierarchical; rather, decision-making is decentralized to employees, individually or in groups. Because employees are given the right information and the right economic incentives, they can make good decisions for the firm as a whole. This is not the case in health care. Doctors and nurses have great latitude in how they care for individual patients, but have little say in how the hospital overall operates or how the unit they work in is structured. ]