HOW CAN WE TRANSFORM American healthcare? How can we improve quality while reducing cost? How can we transform our own hospitals and physician practices so we improve quality and safety of care while building an efficient delivery system - one that does not waste up to one-third of precious resources we spend? These questions, posed by Gary Kaplan at beginning of his feature article, are being asked by virtually every healthcare leader. They are at heart of health reform, and they demand answers. And those answers are far from easy.The notion that healthcare organizations can comply with value-based purchasing initiatives, improve clinical quality, eliminate medical errors, and achieve it all at far less cost than ever before - given complexity and interconnectedness of medicine - seems impossible. Yet it must happen. If hospitals and healthcare systems are to survive, their leaders have no other choice but to ensure it does happen.Furthermore, if we are to maintain or increase net margins in midst of decreasing revenue streams, we must develop solutions to improve access, clinical outcomes, and patient perceptions of care and to reduce costs at same time.I had these imperatives in mind as I sat down to write this response to feature articles written by Kaplan and John Toussaint. They represent so-called burning platform that makes need for relentless improvement so urgent.Here's good news: Our can attain and sustain excellence. We can, as Toussaint and Kaplan both point out in discussion of CEO checklist, establish elements of high-value healthcare as core components of an organization's DNA (Cosgrove et al. 2012).First, people who work in healthcare field are passionate about what they do. The desire to provide best possible patient care is in their DNA.Second, our is accustomed to meeting big challenges. Over years, we have dealt with changing payment systems, rise of managed care, nurse shortages (and surpluses), vertical integration, and a host of process improvement and reengineering initiatives. While none of these changes has been easy, we have weathered them. And while those we face now are even more severe, we will rise to occasion.TAKING A CUE FROM THE AIRLINE INDUSTRYAt beginning of 2013, Aviation Safety Network (ASN 2013) proclaimed 2012 the safest year for air travel since 1945. The year saw only 23 crashes occur worldwide, resulting in 475 air fatalities and 36 ground fatalities - or 1 fatal crash per every 2.5 million flights. ASN further reported that these numbers represent a tremendous improvement over tenyear average of 34 fatal crashes and 773 deaths.ASN President Harro Ranter was quoted as saying, Since 1997 average number of airliner accidents has shown a steady and persistent decline, probably for a great deal thanks to continuing safety-driven efforts by international aviation organisations . . . and aviation industry (ASN 2013).If airline can achieve this kind of improvement, so can healthcare. In 2010, Mark Chassin, MD, FACP, president of The Joint Commission, spoke at a Studer Group conference. In comparing healthcare to airline and other industries composed of high-reliability organizations, he noted that healthcare can become highly reliable by using a qualitydriven strategy to eliminate waste, reduce preventable complications, and address other persistent problems.As with airlines, our healthcare organizations perform complex work that involves many moving parts, teams of interdependent people, and great potential for harm when mistakes are made. Taking every possible measure to make healthcare safer (for obvious reasons) and more costeffective (so that we can continue providing lifesaving care to our communities) is nothing less than a sacred trust for healthcare field. …