Toward a Flourishing Society

Peter J. Pronovost, MD

It was a Sunday morning around six-thirty, a few days before Valentine’s Day. It was quite cold. Some light snow was falling. I was on my way to work in the intensive care unit (ICU) at Johns Hopkins Hospital in Baltimore, and I stopped at a nearby doughnut shop. It was across the street from a bail bondsman, and a block from a homeless shelter. On winter Sunday mornings, the line was often an eclectic mix of nurses and police officers going to work, homeless people trying to stay warm, and churchgoers on their way to services.

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That morning, a couple stood in front of me. They were obviously homeless. Their clothes and fingernails were dirty. I could see their deep affection for each other. They were going through their pockets for change, counting it out, because they wanted a heart-shaped doughnut with pink frosting. They were a nickel short. The woman turned around and asked if I could spare one.

I was about to buy a bag of bagels and doughnuts for everyone on my unit. I knew that couple would hear me place my order. So I told the woman not to count out her change. “Get whatever you want,” I said, “and tell them to add it to my tab.”

The cashier wouldn’t take their order. “The person behind me is buying,” the couple told her. I said it was fine and that they could have whatever they wanted.

Then something happened that I have thought about ever since. A nurse was standing next to me. She said, out loud, “What a good idea.” She turned to the homeless man behind her and asked if she could buy him breakfast. A Sunday school teacher heard her and did the same for another person. So did a police officer behind me. In a few minutes, my small act of kindness replicated itself through seven more people standing in line, one stranger to the next.

Nobody organized it. Nobody was in charge of it. A nurse, a teacher, a cop, and a man with nowhere to sleep, in a doughnut shop on a cold morning, briefly became one. You couldn’t even call us a community; most of us would never see one another again.

But perhaps a few would. The nurse and the Sunday school teacher started talking and said, “Hey, could we meet here next Sunday to do this again?”

As I was walking out past the homeless couple at their table, they asked to speak with me for a minute. “We’re not nobodies,” the man said. “We made bad decisions, but we’re getting our act together.” He offered to pay me back.

“You and me both, brother,” I said. “We all make bad decisions.” I told them that they were obviously learning to do better. “Do me a favor,” I said. “When you get settled, buy someone else breakfast. Pay it forward.” He said he would.

I went from there to ICU rounds—the meeting where everyone gathers each morning to update one another on patient status. I was so moved by what I’d seen at the doughnut shop that I mentioned it. An environmental services worker named Deshaan spoke up. “You know, Peter, I used to be one of those homeless people at that shelter. What I would have given to have someone believe in me.”

The work of civilization

I tell this story often, because it affected the way I look at things. I recognize the importance of individual choices. Yet I also appreciate the power of a flourishing society: a collective whole in which people see one another’s potential, support one another when the opportunity is right, and continually make every effort to pay it forward.

Modern culture often celebrates independence more readily than gratitude, originality more readily than inheritance, and achievement more readily than stewardship. History recounts the lives of great reformers, gifted scientists, courageous leaders, and visionary artists.

Yet civilization is quietly carried forward by moments of human connection and relationship, like that doughnut shop experience. These moments seldom appear in history books, but there are millions of them every day: the teacher who awakens wonder in a child, the nurse who sits beside a frightened patient through the night, the craftsperson who refuses careless work, the parent who listens with patience, the neighbor who keeps a promise, the friend who tells the truth with kindness when silence would be easier—and the person in line who buys a meal for a homeless person, who then pays that gift forward to someone else.

Every generation inherits a beautiful world it did not create. Every generation must decide what kind of world it will leave to those who follow. Between those two gifts lies the work of civilization.

We tend to overlook the quiet web of relationships, sacrifices, traditions, and institutions that make our achievements possible. If we truly want individuals to flourish—to realize their potential—we must create the conditions that make flourishing possible.

You may argue that those moments of connection are few and far between. You may feel that life, especially in modern society, can be grim and exploitative. In reality, we tend to overemphasize the grimness. Editor Art Kleiner compares our modern-day experience to driving down a highway and noticing the accidents at the side of the road. We conclude that the world is a dangerous, unforgiving place. We don’t notice all the people driving in their lanes, leaving room between their car and the one in front, getting safely to their destinations. Driving at a safe speed is also a form of relationship, even if we don’t see it that way. It involves a basic restraint, grounded in respect for the continued health and well-being of the people in the cars around us.

Of course, society needs to cultivate more flourishing. Loneliness persists among people who have never been more connected; about half of US adults report feeling lonely. Distrust grows even as communication becomes instantaneous; 34 percent of Americans say most people can be trusted, down from 46 percent in 1972. Institutions become increasingly sophisticated while many people experience a quiet erosion of meaning and belonging. We possess extraordinary expertise, yet often struggle to bring it together in ways that genuinely strengthen the lives of individuals, families, and communities.

The moments of connection, like the one I found in the doughnut shop, are just a start. Those moments show that flourishing is contagious. We need to cultivate more of them, and on a broader scale: taking advantage of the connections made possible by the institutions and organizations that hold our civilization together today.

The greatest opportunity, I believe, lies in the industry where I work: healthcare. In principle, if not always in practice, this industry is already associated with caregiving and respect for all people. Every other institution gets to choose who belongs. A hospital does not. Whoever comes through the door is, by definition, a person we have promised to care for—the insured and the uninsured, the grateful and the furious, the neighbor and the stranger. We do not get to ration who counts. And so, of all the institutions in a divided country, a hospital is uniquely positioned to encourage our civilization to flourish—if we understand and seize the opportunity.

A moment in history for flourishing

It may seem hopelessly idealistic for me to articulate a future of healthcare as a catalyst for a flourishing society—especially given all the dissension, exploitation, and blame in current public life, including around healthcare. But I do not write this in a vacuum. A growing number of thinkers are raising the idea of human flourishing as a purpose: that our institutions should dedicate themselves to improving general well-being and helping people grow into their potential. They recognize that this is not just a matter of individual development. We flourish when our teams, organizations, and communities foster quality of life through the normal pace of events.

Flourishing is particularly relevant right now because humanity is at a turning point. For most of history, people lived in conditions of scarcity. Not enough food, not enough medicine, not enough years in an average person’s lifespan. Our civilizations built institutions to make the best of those grim circumstances.

But in the last three centuries, much of the world’s population has transcended the struggle for survival. That doesn’t mean people are anywhere near as economically secure as they would wish to be, or that modernity has solved the problems of the past—far from it. Indeed, modernity has created its own severe problems. Nonetheless, by any standard, life today is qualitatively different from life in the past.

Since the introduction of commercial electricity, power is no longer scarce. Transportation is abundant, and so are means of communication. On average, as individuals, we are healthier than ever before. The average life expectancy of a child born today is more than twice as long as it was for a child born in 1770.

When material scarcity disappears, it’s like the water receding from a lake. You see other problems that have previously been hidden under the surface. Today, in the United States and perhaps other Western countries, we are seeing a different kind of scarcity emerge—not of things, but of relationships. People are lonelier, more anxious, unsure if anyone will care for them. The institutions that managed lives of relative scarcity are not equipped for a society of relative abundance.

Today’s most crucial scarcity is within ourselves. We lack trust, confidence, and spirit. We may be fragile rather than resilient, contemptuous of others rather than appreciative, self-righteous rather than generous, and closed rather than open. When these attitudes become habitual, they drain away the emotional and organizational resources we need to create a society where people thrive.

The idea of a society built around human flourishing has emerged in a variety of separate contexts recently, but always in response to this inner scarcity: always seeking ways to build a society of mutual well-being. Martin Seligman, who launched the positive psychology movement, titled his account of well-being Flourish. Daniel Coyle used the same title for his recent book about how communities foster meaningful lives. Tyler VanderWeele, a Harvard epidemiologist, co-leads the Global Flourishing Study, which has followed more than 200,000 people across 22 countries. Economists such as Tyler Cowen and historians of progress such as Johan Norberg locate the engine of flourishing in economic growth.

And in his recent book Incorruptible, business author Eric Ries argues for fostering “an era of organizations that truly serve human flourishing. Miss this moment, and we’ll be locked into another century of institutional betrayal.” Ries, a well-known advisor to Silicon Valley startups, came to this view in the 2010s, disillusioned with companies he had helped. They may have started high-minded—as with Google’s original company motto, “Don’t be evil”—but they succumbed to the pressure of what he calls financial gravity: the psychological and structural forces unleashed by conventional investment and corporate governance practices.

Coming to their perspective from different disciplines, these authors all propose that a good life, with meaning, prosperity, and relationships, can be fostered by people and institutions working together. They all advocate investing in society for the well-being of its people.

The word flourish comes from the Latin florere, to bloom or blossom; it shares its root with flower. A flower does not bloom because it is ordered to. It blooms when the soil, the light, and the water are right. Our work is not to command anyone to flourish—not the patients, not the caregivers, and not the broader community. Our work is to be the soil. One example of this is what happened in the doughnut shop that Sunday morning. Nobody organized that line, and nobody could have. What an institution can do is prepare the ground, so that mornings like it are less rare.

I remember driving back and forth through Death Valley, California, one spring several years ago. When I passed through going east, it was barren and dry. When I made the return trip, after some rain had fallen, the same spot was a carpet of colorful wildflowers. The seeds were always there; they just needed watering, just as the seeds of flourishing are in all of us. We need to develop a society that still holds us accountable for our actions, but that cultivates those seeds.

The many theories of human flourishing

One reason why it is difficult to build a flourishing society is that our ideas about human purpose and value are fragmented. We lack a unifying consensus about how to solve the problems that hold us back. That is a function of the way knowledge has evolved in human culture.

When we set out to create a flourishing society, we inevitably face questions about human purpose and community—questions asked throughout human history. What allows a person to become fully alive? How should we live with one another? What do we owe those who came before us? What responsibilities do we bear toward those who will come after us? Do all people deserve to flourish, and if not, who is excluded? What kind of people must we become if the world entrusted to us is to become wiser, more compassionate, and more beautiful?

Over time, most disciplines of thought and practice have developed their own answers to these questions. Philosophers have reflected upon virtue, justice, and the conditions in which people flourish. Psychologists have deepened our understanding of resilience, belonging, purpose, and human development. Educators, economists, neuroscientists, and cosmologists have theories about human capability. Organizational science has revealed how trust, shared purpose, and learning shape collective achievement. Systems thinking has shown that relationships matter as much as the individual parts they connect. These fields of study, framed with different histories and apertures of interest, write about flourishing in different ways. There is not yet an integrative framework that makes it easy to cross these boundaries and think together.

Alongside these intellectual traditions, humanity’s philosophical and spiritual traditions have explored dimensions of life that cannot easily be codified but are no less real. The Hebrew and Christian traditions reflected deeply on covenant, justice, forgiveness, hope, and the dignity of every human person. Buddhist traditions illuminated compassion, mindfulness, and the nature of suffering. Indigenous wisdom traditions preserved profound insights into reciprocity, gratitude, belonging, and humanity’s relationship with the living world. Eastern and Western philosophies, though differing in language and emphasis, returned again and again to many of the same enduring virtues: humility, truthfulness, curiosity, compassion, courage, generosity, reverence, and love.

Each tradition has illuminated part of the promise of human flourishing. None has provided a conclusive answer to the question of how to realize that promise. This ambiguity is not a weakness of human understanding but a reflection of the richness of reality. As our knowledge has become deeper, it has also become more divided. Specialized disciplines develop their own languages, methods, assumptions, and measures of success.

I do not condemn specialization. It has taken us very far. But no single discipline can explain human society. Each illuminates a portion of reality with remarkable clarity, yet none can illuminate the whole. Perhaps this is why humanity’s search for wisdom has never ended, and why many of our deepest challenges remain stubbornly familiar. Every generation receives the conversation where the last one left it, and adds its own voice. The greatest contribution we may yet make is not to discover something new, but to listen with humility and understand more deeply the inheritance that has already been entrusted to our care.

The prospects for flourishing are part of our inheritance. They represent the quiet accumulation of daily choices that form character, strengthen relationships, and shape culture. When we are born, we have already received more than we can fully comprehend. Someone cultivated the fields that would feed us, discovered the medicines that would heal us, composed the music that would move us, built the schools that would teach us, created the institutions that would employ us, and defended the freedoms that would allow us to imagine our own future.

The problem with flourishing is not a lack of answers for how to achieve it. We have become far better at accumulating knowledge than at integrating it. The unfinished work before us is to bring these answers together: to develop a transdisciplinary tapestry of insight about the nature of a flourishing society.

Our inquiry also has an emotional and spiritual component. The work before us is not simply to build better organizations or discover better ideas. It is to become better stewards of one another.

If we become better stewards of one another, that changes the purpose of our institutions.

Organizational stewardship

The work of flourishing will take place in many spheres. In democratic societies, that will include politics. However, we cannot build a flourishing society through political power alone. Most of this work will continue to take place through the organizations where we work and spend our time.

Organizations are communities of people influencing one another over time, oriented toward a set of common goals. That influence—the growth of their people’s capabilities—is always part of their purpose. A school is more than a building in which lessons are taught. A hospital is more than a place where diseases are treated. A business is more than an engine of production. Every organization becomes a place where habits form, standards are set, hopes grow—or shrink—and lives quietly take shape through thousands of ordinary encounters.

Organizations influence people through their cultures—which typically embody a set of assumptions about people and collective purpose. These assumptions shape what organizations measure, reward, forgive, and expect. They determine whether people are regarded primarily as problems to be managed, resources to be optimized, consumers to be persuaded, or persons whose dignity precedes their achievement and whose possibilities exceed their present performance.

The assumptions may remain unspoken. Their consequences never do. In particular, when institutions forget the essential dignity of people, their character changes. On one hand, they can become remarkably efficient. They compete effectively, dominate their niches, and produce results that look impressive at first glance.

But they also lose their soul. Their leaders come to see success as productivity, compliance as motivation, and activity as output. They learn to measure what is easy to count and neglect what should be most deeply valued. The institution may continue to function, yet something essential begins to disappear. People no longer experience themselves as participants in a shared endeavor. They become occupants of a system. Sooner or later, the organization’s ability to promote flourishing declines, and it must find other, more exploitative ways to survive.

Some organizations have a more positive culture. They promote flourishing, not just through what they do, but through what they are. They understand that excellence and humanity are not competing aspirations but faithful companions and best friends. A great school does more than transmit knowledge; it awakens a lifelong love of learning. A great hospital does more than treat illness; it restores dignity alongside health. A great business creates more than economic value; it develops people whose judgment, character, and imagination continue to enrich every community they touch. Their enduring contribution is not only in measurable outcomes—number and value of offerings, number of people reached, and financial returns—but also in their people. It is in who people become because they passed through those walls.

This is the quiet work of a flourishing society. I think of it as formation: the gradual maturing of a person and a community. Formation is easy to overlook because it unfolds slowly. It cannot be rushed, and it rarely announces itself. We notice it only in retrospect, when we realize that our habits, our judgment, and even our hopes have been shaped by where we worked and belonged.

A flourishing organization is marked by moments of connection: a teacher who awakens curiosity, a colleague who follows through on a request in a way nobody expected, an executive whose integrity quietly raises the standard for everyone around them. They usually involve mentors, peers, and colleagues who believe in one another, even when they don’t fully believe in themselves.

None of these moments appears extraordinary in isolation. Together, they become the architecture of a life.

No one becomes fully themselves when they are alone. We become ourselves in relationship.

This may be the most overlooked truth of human flourishing. We assume it develops through large-scale decisions, but it is actually shaped by what psychologist Barbara Fredrickson, in her book Love 2.0, calls micro-moments of positivity resonance: encounters among people that lead to mutual care and shared positive emotion. A respectful exchange with a stranger, a hand on the arm of a worried colleague, or the spark of insight from a community of practice. The people around us enlarge or diminish our vision of what is possible.

Catalytic organizations

How, then, can an organization move in the direction of human flourishing? How can it become a catalyst, helping its employees, constituents, customers, leaders, and neighbors to flourish?

It can draw on a broad range of robust practices that have emerged during the past 60 years. These practices include psychological safety, as championed by Amy Edmondson; dynamic work design (and its antecedents in lean practice and systems thinking), as codified by Nelson Repenning and Donald Kieffer; and practices of transparent governance, emerging in Silicon Valley and described by Eric Ries in Incorruptible. At University Hospitals, we have done a lot of work with fractal management, echoing practices that go back at least to management pioneer Mary Parker Follett. Our core principle is that authority should reside with the people closest to the work, who continually exchange knowledge and hold themselves to shared, high standards.

We often begin with attention. Before we can develop another person, we must first learn to see them. Not merely their performance, their credentials, or their present limitations, but their dignity, their possibility, and the gifts that have not yet found their fullest expression. Such vision is not naïve optimism. It is disciplined hope. It refuses to confuse present circumstance with ultimate potential.

Trust flows more freely when people recognize one another that way. People know they will be treated with dignity, so they feel it is safe to show up as themselves, in a less guarded way. They can be curious without risk. They can ask questions to explore answers, rather than to appear knowledgeable or score points. Mistakes become opportunities for learning rather than occasions for shame. Truth is spoken more freely because honesty is met with respect instead of humiliation. Organizations such as these do not eliminate failure; they transform failure into one of the ways by which wisdom is acquired.

Each of these practices deserves an article in itself, and we will be exploring many of them, and others, in this Illuminators Substack newsletter. There will always be questions about how viable each practice is, and how universally applicable. The most relevant test will be whether it helps us see reality more clearly. Does it reduce suffering and strengthen trust? Does it deepen our understanding of the people around us? Does it elevate and connect people, expanding our capacity to care faithfully for one another and for the world entrusted to us?

Healthcare and human flourishing

My colleagues and I believe that healthcare is particularly well-suited to a leading role in these endeavors. It is large and prevalent throughout society: the industry employs one in nine workers in the US economy today and will account for 37 percent of all new jobs in the next decade.

To be sure, the healthcare industry struggles with structural and cultural pressures that make people skeptical of its future. These include workforce shortages and discontent, the loss of public trust, and a disconnect between the broad-based participative leadership we need and the way physicians and nurses are trained. We also face unique constraints embedded in some of today’s Medicare and private insurance reimbursement policies, and in other regulations.

Yet healthcare has a built-in affinity for flourishing that other industries may not have. Our mission is tied to it. Hospitals were created to care for people. We are the institutions that people encounter when they are hurt, frightened, or dying. My own organization, University Hospitals, is descended from a hospital founded in 1868 by a civic society that had been caring for people displaced by the US Civil War.

Healthcare leaders have understandably been afraid to take on this role: to accept accountability for the health and well-being of everyone in society. We tend to see the task as impossible, as if we’re making a promise we cannot keep. We also see ourselves as fragmented, overwhelmed, financially stressed, and incapable. Some of our organizations can barely stay out of bankruptcy, or so we think.

But when we believe that we can step up to this mission, we rise to the occasion. When we adopt a belief in zero care, behave like we belong to a common cause, and build the management structures that channel our activity in positive direciions, the quality of our patient care improves, and we profit financially as well. Our expenses go down because we emphasize preventive and relational care. If we embrace our mission wholeheartedly, with a full understanding of what care means as St. Francis might have defined it, then we have the opportunity to transform ourselves, prosper through the transformation, and perhaps help our society do the same.

A few months after that Sunday morning, in June, I stopped into the same doughnut shop for another round of breakfast. “Hey, Doc,” the cashier said. “Some guy left this note for you.” It was handwritten, on a page torn from a spiral notebook: “I bought somebody breakfast.”

I never learned the writer’s name, or what happened to that couple. But it reminds me that, when our system is working correctly, people are continually paying it forward.

SOURCES

Loneliness persists among people who have never been more connected; distrust grows even as communication becomes instantaneous: Vivek H. Murthy, Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community (US Department of Health and Human Services, 2023). On distrust: Pew Research Center, “Americans’ Declining Trust in Each Other and Reasons Behind It,” May 8, 2025.

The average life expectancy of a child born today is more than twice as long as it was for a child born three centuries ago: Our World in Data, “Life Expectancy.”

Martin Seligman titled his account of well-being Flourish: Martin E. P. Seligman, Flourish: A Visionary New Understanding of Happiness and Well-being (Simon & Schuster, 2011).

Daniel Coyle used the same title for his book: Daniel Coyle, Flourish: The Art of Building Meaning, Joy, and Fulfillment (Bantam, February 3, 2026).

Tyler VanderWeele, a Harvard epidemiologist, co-leads the Global Flourishing Study: Global Flourishing Study, “About the Study,” 200,000-plus participants across 22 countries, co-directed by Tyler VanderWeele of Harvard’s Human Flourishing Program and Byron R. Johnson of Baylor’s Institute for Global Human Flourishing.

Economists such as Tyler Cowen … locate the engine of flourishing in economic growth: Tyler Cowen, Stubborn Attachments: A Vision for a Society of Free, Prosperous, and Responsible Individuals (Stripe Press); Cowen is professor of economics at George Mason University and director of the Mercatus Center.

Historians of progress such as Johan Norberg: Johan Norberg, Progress: Ten Reasons to Look Forward to the Future (Oneworld, 2016); see also The Capitalist Manifesto (Atlantic Books, 2023).

Eric Ries, “an era of organizations that truly serve human flourishing … another century of institutional betrayal”: Eric Ries, Incorruptible: Why Good Companies Go Bad… and How Great Companies Stay Great (Authors Equity, May 26, 2026), page xxv (Introduction). Also see: Vikas Shah, “Incorruptible: Eric Ries on Why Good Companies Go Bad — and How to Build Ones That Don’t,” Thought Economics, May 21, 2026.

The word flourish comes from the Latin florere: Online Etymology Dictionary and Merriam-Webster.

Death Valley … a carpet of colorful wildflowers: National Park Service, “Explore Wildflowers in Death Valley,”

Psychologist Barbara Fredrickson, in her book Love 2.0: Barbara L. Fredrickson, Love 2.0: How Our Supreme Emotion Affects Everything We Feel, Think, Do, and Become (Hudson Street Press, 2013). She is Kenan Distinguished Professor of Psychology at the University of North Carolina at Chapel Hill.

Psychological safety, as championed by Amy Edmondson: Amy Edmondson, “Psychological Safety and Learning Behavior in Work Teams,” Administrative Science Quarterly 44, no. 2 (June 1999): 350–383, and The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth (Wiley, 2019). Edmondson is Novartis Professor of Leadership and Management at Harvard Business School.

Dynamic work design … as codified by Nelson Repenning and Donald Kieffer: Nelson P. Repenning and Donald Kieffer, There’s Got to Be a Better Way (PublicAffairs, August 2025).

Fractal management, a practice that goes back at least to management pioneer Mary Parker Follett: Follett’s law of the situation — that both parties should “take their orders from the situation” rather than from each other — appears in “The Giving of Orders” (1925), collected in Dynamic Administration: The Collected Papers of Mary Parker Follett, ed. Metcalf and Urwick (Harper, 1940).

The industry employs one in nine workers in the US economy today and will account for 37 percent of all new jobs in the next decade.: Bureau of Labor Statistics, “Employment Projections — 2025–35,” BLS, “Employment Situation,” August 2026, Table B-1.

Workforce shortages and discontent, the loss of public trust … some of our organizations can barely stay out of bankruptcy: Shortages: AAMC, “New AAMC Report Shows Continuing Projected Physician Shortage,” March 21, 2024 — a shortfall of up to 86,000 physicians by 2036. Trust: Gallup, “Confidence in U.S. Institutions Remains Near All-Time Low” — 28 percent of Americans express a great deal or quite a lot of confidence in the medical system, a record low against a post-1993 high of 51 percent. Finances: Kaufman Hall, National Hospital Flash Report, February 10, 2026 — hospitals’ 2025 year-to-date operating margin was 1.3 percent,

University Hospitals is descended from a hospital founded in 1868… University Hospitals, “Our History,” “the first meeting of civic leaders and parishioners of Cleveland’s Old Stone Church to establish a hospital took place on May 14, 1866”; the Wilson Street Hospital opened in 1868. Encyclopedia of Cleveland History, Case Western Reserve University.

What care means as St. Francis might have defined it: Francis of Assisi, Testament: “When I was in sin, the sight of lepers nauseated me beyond measure; but then God himself led me into their company, and I had pity on them.” Discussed in “Saint Francis Meets the Leper,” St. Anthony Messenger, August 2018.

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