Jim Collins writes:The Tyranny of the "Or," the Genius of the "And." Having one side of this dichotomy going without the other doesn't work. In a number of professions, such as law and medicine, in academia, and in industries such as healthcare and the utilities, people have traditionally had a very strong core ideology, a strong sense of what they are doing. But they didn't do the other side well, the side of stimulation, progress, and change. Then people began to see that the world is changing. "We have got to be more efficient and effective," they said. "We have got to think about things like markets and segmentation and costs and cycle times." And that's all true. But they get caught up in what we call "The Tyranny of the Or," the belief that you cannot live with two seemingly contradictory ideas at the same time, that you can have change or stability, you can be conservative or bold, you can have low costs or high quality -- but never both. Our visionary companies all operate in what we call "The Genius of the And," the ferocious insistence that they can and must have both at once. One "Tyranny of the Or" in healthcare is the assumption that becoming more businesslike means giving up the social purpose of healthcare. Ironically, it might benefit people in health care to study these for-profit corporations that have strong ideologies, many of them even somewhat altruistic -- to see that they don't have to give up the roots of what they are about, their reason for existence, in order to change, to become more efficient and business-like.