SAFe is built on these ten Lean-Agile principles that scale from team to enterprise level:

1. Take an economic view - Make decisions in the right economic context to maximize business value

2. Apply systems thinking - Optimize the entire hospital system rather than isolated departments or functions

3. Assume variability; preserve options - Maintain flexibility until sufficient empirical data is available

4. Build incrementally with fast, integrated learning cycles - Deliver solutions in short iterations with integrated increments

5. Base milestones on objective evaluation of working systems - Use evidence-based assessments to verify value delivery

6. Visualize and limit WIP, reduce batch sizes, manage queue lengths - Maintain steady flow from idea to implementation

7. Apply cadence, synchronize with cross-domain planning - Use regular cycles and synchronized planning for predictability

8. Unlock intrinsic motivation of knowledge workers - Foster autonomy, purpose, and mastery for clinical and IT staff

9. Decentralize decision-making - Push decisions to the lowest practical level for faster responses

10. Organize around value - Structure the organization by Value Streams implemented through Agile Release Trains

"These principles transform how hospitals deliver on their digital initiatives, creating a foundation for sustainable innovation while maintaining compliance and patient safety."