Improvement in healthcare has not delivered on its promise, outside of a few examples. This is because it has not sufficiently been linked to resources - thus argues this book. Value improvement focuses on changes which raise quality and lower costs. This is effective because it unites professions, patients, payers and purchasers in a common cause and uses tested solutions and methods. Value improvement works with the realities of resources and politics, and with knowledge of what is effective in different situations. The purpose of healthcare is to reduce avoidable suffering. This includes the suffering unknowingly caused by a service, when we do not use an effective treatment or make an error. These events are also waste, and they have a financial cost. The good news is that we now have more knowledge about these adverse or subA-optimal events, and about effective solutions. We now know these organisational events are not inevitable and we can prevent them. We are also beginning to discover that many, if prevented, will reduce the costs of healthcare. Improving diagnosis and prescribing reduces both avoidable sufferA- ing and higher costs, as do hygiene strategies and changes to ensure professionals pass on correct information about patients to the next caregiver. We are entering an exciting time in healthcare, equivalent to earA- lier periods of medical discoveries. The discoveries of improvement and implementation science in organisations are now being linked to the discoveries about the costs and savings of quality and safety changes. This knowledge is beginning to be used by clinicians, manA-agement and purchasers, and alliances are forming to bring in a new era of quality and safety improvement. The aim of this book is to show how ordinary leaders can comA-bine improvement knowledge with resource knowledge to reduce suffering and the costs of healthcare. It does not assume good inforA-mation technology or special resources to help improvement. It recA-ognises that our colleagues may not want to spend time on this work, and often do not do what they are asked to do. It recognises some improvements are not value improvements: they do not add value for patients and reduce costs. Where improvements do both, we may find that the financing system penalises the provider for making the change, or we cannot covert the saved resources into lower costs or higher income. Thus, it is also about both short A-term and long A-term value improvements. It is about how managers and other leaders find and awaken energy in themselves to make improvement, and bring this energy to life in the people they work with. How we channel this energy in effective ways and enable others to make improvement. It is about tomorrow, and next week and about where the real innovation, creativity and inspiration happens: in the routine but changing, short A-staffed, semiA- chaos of most health services. We are not powerless and can choose not to accept failings of the health system as being outside of our influence. A few others have shown what can be achieved when we join in a common cause and use these effective methods. The challenge is for us is to do this in our local service and to connect our services.