We have seen several surprising and disconcerting snapshots of the health-care system in the recent past.

• According to the Centers for Medicare and Medicaid Spending, last year's health-care spending was $1.6 trillion, or $5,440 per person. This is an increase of 9.3 percent from last year, compared to an overall economic growth rate of 3.6 percent.

• The Rand Group reports that Americans get quality treatment that is demonstrated to be safe and effective less than 60 percent of the time. Inappropriate care includes underuse and overuse of the health-care resources.

• According to the World Health Association, about 50 percent of patients take medication as prescribed. Highly educated patients in upper tax brackets fared no better than any others.

• The Roberts Wood Johnson Foundation published a first-of-its-kind study in The Journal of the American Medical Association investigating how doctors and patients talk to each other about health-care costs. About 20 percent of health-care costs are paid out-of-pocket by patients. Of the 63 percent of patients who want to talk about costs with their doctors, 15 percent actually did so. And, 79 percent of doctors think patients want to talk about their out-of-pocket expenses and about 35 percent do so.

• Up to 13 percent of the work force experiences a loss of productivity from common pain conditions, costing business $62.7 billion per year in lost production time. This study published in JAMA November 2003 estimates that over 75 percent of the lost productivity time was explained by reduced performance while at work and not work absences.

• The number up uninsured Americans is up to 43.6 million ... or one in six Americans.

• Up to 100,000 patients die in the hospital each year as a result of preventable medical errors. The average cost of a medical error is in increase in hospital stay of 10 days, and a bill that's $40,000 higher.

Our country has the highest per capita health-care spending, and we're far from delivering the highest quality care that yields the best outcomes.

The function of the health-care system is to serve patients ... many of whom are your employees.

Here's how health-care costs are generated. At some point, a patient decides that something isn't right and makes an appointment with the doctor. The doctor and patient collect information and move toward a diagnosis and treatment plan.

The bulk of the health-care costs reflect services that are available only when a doctor picks up a pen and writes an order, as only licensed practitioners can open the door to most medical services.

According to the doctrine of "informed consent" the patients, your employees, accept the recommended treatment after understanding the risks, benefits and alternatives. Health-care charges are generated by choices made between a doctor and a patient in the privacy of a doctor's office or a patient's hospital room.

The party ultimately responsible for how many or how few health-care services are used is the patient. Your employee makes choices every day that can lead in the direction of health or of disease. What goes on his tray in the cafeteria, and will he wash his hands before he eats it? Will she go for a 20 minute walk after dinner or rest on the couch and watch TV? By conservative estimates, over 50 percent of the diseases we currently treat could be avoided with better day-to-day choices such as these.

Your employees' choices also play a major role in health-care costs once a health problem arises. Your employees decide when it's time to call the doctor, whether to tell their doctors the whole truth or take medication as prescribed.

These snapshots command attention; they will propel change. How do you implement change in your business? You identify and address systems problems, and you engage the end-user early on.

Changes in health-care will use that template. For example, good medical choices are based on the availability of complete medical information. A systems solution is the development of an electronic medical record. Why not ask your employees to assume responsibility for providing doctors with their complete medical records? We trust American citizens to maintain their own driver's license and passport. Why not ask them to assume similar responsibility for a "health passport."

As I connect these health-care dots I see tremendous opportunity. We can make a huge impact with low-tech, high-touch solutions, such as doctors and patients talking and listening to each other, hospitalized patients asking a nurse what medication they're about to get and why they're getting it, and asking employees to wash their hands regularly. We can make tremendous strides by getting back to basics.