The Affordable Care Act (ACA) continues to trigger polarizing debate across the country, but Americans agree with the triple-aim goals of healthcare reform: a healthier population, a better patient experience, and lower cost. The unanswered questions revolve around the best ways to get there.

Healthcare is going through unprecedented waves of reform. Surviving and thriving in the face of such pervasive and complex change will require transformational thinking and peak levels of organizational performance. To move effectively toward that end, healthcare leaders must expand quality-improvement efforts beyond clinical care to include organizational health as an explicit goal. This requires a precise definition of “high performance” and a clear understanding of what it takes for an organization to get there.

The Performance Imperative: A framework for social-sector excellence (PI) provides a valuable resource to guide healthcare organizations on a journey toward high performance.

From Florence Nightingale to the modern-day efforts of such organizations as The Joint Commission, The National Committee for Quality Assurance, and the Institute for Healthcare Improvement, healthcare leaders have recognized the importance of using data to improve outcomes. Although these efforts and many others have made contributions to healthcare quality and patient safety, they have not yet solved the issues that plague the American healthcare system–growing costs, inequitable access, and inconsistent outcomes. Internationally respected studies continue to rank the U.S. below other developed countries in quality, while our costs are at the top.

The complicated way the U.S. has historically paid for healthcare is a major contributing factor. Cost-based, fee-for-service, and prospective-payment systems of reimbursement fueled an industry that was compensated for providing care based on volume, not value.

The authorization of the ACA successfully added millions of covered Americans to the system. At the same time, it imposed stringent quality standards and sizable reimbursement incentives and penalties for achieving (or missing) certain benchmarks. It also stimulated the growth of new care models such as Accountable Care Organizations, which are designed to coordinate care for specific populations and link payments to quality and cost. These developments mark the beginning of an unprecedented switch from fee-for-service to value-based contracting and population health.

Internal and external pressures on healthcare to become more value-driven will continue. Employers, patients, and their families will continue to demand higher quality and lower cost. Providers will have to find ways to eliminate shortfalls in the quality and efficiency of care delivery. They will also be compelled to factor the social determinants of health–the effects of where people live, learn, work, and play–into population-based care-delivery systems. Healthcare will be marked by more and more disruption as it shifts to a major focus on health before care is required.