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Mark Britnell uses the Porter and co definition of value: value = outcome / cost. This is wrong. For if that were true then logically value would always increase as costs decrease, regardless of whether the outcome is valuable to the patient or not. That makes no sense.

So what Mark and others, perhaps, really mean is VALUE FOR MONEY (bang for our buck) and/or RELATIVE VALUE (how much more or less valuable A is than B). But either way, why start there? Why not start with defining value itself? Perhaps the assumption is that value is so obvious as to need no definition?

As for lean, well there is plenty of evidence that this is not the heaven sent answer to managements known problems. That very assumption – that we already know what our real problems are – runs directly counter to the teachings of the originator of "lean" (a label he would have rejected), Taiichi Ohno http://vanguardinhealth.blogspot.co.uk/2012/05/does-going-lean-going-wrong.html.

Finally, Mark seems to fall into the trap that it is a people problem. Our evidence is that in most systems 95% of performance can be attributed to the system design itself (the design and management of work) http://vanguardinhealth.blogspot.co.uk/2012/05/its-system-stupid.html.

Ultimately Marks analysis of high performing organisations describes doing the same things only better. Yet genuine transformation means doing better things. Do this and there will be no need to 'get staff motivated' because they already are.