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The United States health care system is broken. Critics and commentators point to the staggering costs of health care, the shrinking insurance coverage, and the diminishing access that many U.S. citizens have to essential services and treatments. These problems are compounded by a growing realization that the quality of care across the country is uneven at best, with the goal of finding the appropriate kind and level of care proving elusive. High Stakes enters into the health care debates at a critical time, offering an analysis that homes in on factors that account for many of the inefficiencies and shortcomings of our unsystematic system, and putting forth recommendations that are ideologically blind.

Using real-world examples to illustrate the fragile state of health care today, Drs. Shore and Kupferberg enlist a powerful analytic frame to bear on these conflicts: stakeholder management. That involves addressing the present system of conflicts, in which key groups in the field pursue their own interests at the risk of the system at large. Insurance providers want to reduce their payments, hospitals want higher reimbursements, patients want access to unlimited services, and no one wants to work together. The fights are constant and financially disastrous, for every dollar earned by one group is one less dollar earned by another. For health care to succeed as an enterprise, key stakeholder groups must come to appreciate their dependence on other groups. More importantly, they must find ways to align their interests and move beyond entrenched behaviors. As the authors point out, all constituency groups must begin by acknowledging that where people stand on an issue depends on where they sit, and that greater stakeholder alignment and engagement are prerequisites for more effective and efficient health care. Drawing equally from both scholarly studies and real world examples, High Stakes offers health care leaders the necessary tools to both map their current stakeholder relationships and fashion concrete steps to produce greater stakeholder engagement, collaboration, and cooperative competition.

David A. Shore, PhD, is an Associate Dean at the Harvard School of Public Health. He founded and directs the School's Forces of Change and Project Management in Health Care Programs. His most recent books are The Trust Prescription for Healthcare: Building Your Reputation with Consumers, and The Trust Crisis in Healthcare: Causes, Consequences, and Cures (Oxford University Press).

Eric D. Kupferberg, PhD, is the Senior Assistant Dean of Academic and Faculty Affairs at Northeastern University's College of Professional Studies, where he directs the Masters of Science in Regulatory Affairs of Drugs, Biologics, and Medical Devices. Dr. Kupferberg is also the Associate Director of Harvard School of Public Health's Trust Initiative.