The outsourcing gurus have been driving the theory, and they are saying everybody ought always to do this. But it is really contingent on where you are on the spectrum from "not good enough" to "more than good enough," relative to each tier of the market.

One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year.

Many think of management as cutting deals and laying people off and hiring people and buying and selling companies. That's not management, that's deal making. Management is the opportunity to help people become better people. Practiced that way, it's a magnificent profession.

One of the factors that make great companies so great is that they have processes that allow them to solve difficult problems again and again. These processes have developed over time as teams have successfully wrestled with a certain type of challenge. Eventually, people begin to say, "This is just how we do something around here." The problem develops when that team then has to solve a very different set of challenges. The processes that are such strengths can be crushing liabilities.

I've concluded that the metric by which God will assess my life isn't dollars, but the individual people whose lives I've touched. I think that's the way it will work for us all. Don't worry about the level of individual prominence you have achieved; worry about the individuals you have helped become better people.

It's like in biological evolution: The population will evolve, even though individuals can't. The same thing happens in the corporate world: The population of business units within corporations evolves, even though individual business units can't. That's because the capabilities of business units reside in their processes and their values, and by their very nature, processes and values are inflexible and meant not to change.

I was lucky enough to build on the work of a number of people who had already run laps around this theory-building track. The original classification scheme, years ago, distinguished radical from incremental change. The theory said that established firms managed incremental change well, but would be expected to founder when their industry encountered a radical change.