tom peters’ toward health(care) excellence! michigan health & hospital association annual...

Tom Peters’

Toward Health(care) Excellence!

Michigan Health & Hospital AssociationAnnual Membership Meeting

Grand Hotel/Mackinac Island/0629.2006

Slides* at …

tompeters.com

*also “long”

“Beware of the tyranny of making

Small Changes to Small

Things. Rather,

make Big Changes

to Big Things.”

—Roger Enrico, former Chairman, PepsiCo

Five MYTHS About Changing Behavior

*Crisis is a powerful impetus for change*Change is motivated by fear*The facts will set us free

*Small, gradual changes are always easier to make and sustain*We can’t change because our brains become “hardwired” early in life

Source: Fast Company/05.2005

“Reward excellent failures.

Punish mediocre

successes.”Phil Daniels, Sydney exec

“Wealth in this new regime flows directly from innovation, not optimization. That is,

wealth is not gained by perfecting the known,

but by imperfectly seizing the unknown.” —Kevin

Kelly, New Rules for the New Economy

Part 1

EXCELLENCE.

ALWAYS.

EXCELLENCE. THE

MANDATE.

“It is not the strongest of the

species that survives, nor the most intelligent, but the one most

responsive to change.” —Charles Darwin

EXCELLENCE. THE WORD.

Synonyms

PurityTranscendence

VirtueEleganceMajesty

Antonyms

Mediocrity

EXCELLENCE.

1982.

Excellence1982: The Bedrock “Eight Basics”

1. A Bias for Action2. Close to the Customer3. Autonomy and Entrepreneurship4. Productivity Through People5. Hands On, Value-Driven6. Stick to the Knitting7. Simple Form, Lean Staff8. Simultaneous Loose-Tight Properties”

EXCELLENCE.

ALWAYS.

“Why in the world did you go to Siberia?”

The Peters Principles: Enthusiasm.

Emotion. Excellence. Energy. Excitement. Service. Growth.

Creativity. Imagination. Vitality. Joy. Surprise. Independence. Spirit. Community. Limitless human potential. Diversity. Profit. Innovation. Design.

Quality. Entrepreneurialism. Wow.

Business* ** (*at its best): An emotional, vital, innovative, joyful,

creative, entrepreneurial endeavor that elicits

maximum concerted human potential in the

wholehearted service of others.***

**Excellence. Always.***Employees, Customers, Suppliers, Communities, Owners, Temporary partners

Business: The Ultimate Creative

Endeavor.

Business: The Ultimate Personal

Development-Growth

Experience.

Business: The Ultimate

Transcendent Service

Opportunity.

EXCELLENCE.

YOU & ME.

“Life is not a journey to the grave with the

intention of arriving safely in a pretty and well-preserved body—but

rather a skid in broadside, thoroughly used up, totally worn out, and

loudly proclaiming, ‘Wow, what

a ride!’ ” —anon.

EXCELLENCE. INNOVATE.

OR. DIE.

“I am often asked by would-be entrepreneurs seeking escape from life within huge corporate structures, ‘How do I build a small firm for myself?’ The

answer seems obvious: Buy a very large one and just wait.”

—Paul Ormerod, Why Most Things Fail: Evolution, Extinction and Economics

More than $$$$

#1 R&D spending,

last 25 years?

GM

Innovation: The Secrets

Parallel universe!

“Venture” fund (E.g. Gerstner/Amex,

Dow/Marriott, Grove/Intel, Bedbury/Starbucks)

“This is so simple it sounds stupid, but it is amazing how few oil people really

understand that you only find oil if you drill wells. You may

think you’re finding it when you’re drawing maps and

studying logs, but you have to drill.”

Source: The Hunters, by John Masters, Canadian O & G wildcatter

“We made mistakes, of course. Most of them were omissions we didn’t think of when we

initially wrote the software. We fixed them by doing it over and over, again and again. We

do the same today. While our competitors are still sucking their thumbs trying to make the design perfect, we’re already on prototype

version No. 5. By the time our rivals are ready with wires and screws, we are on version

No. 10. It gets back to planning versus acting: We act from day one; others plan how to plan—

for months.” —Bloomberg by Bloomberg

“Never doubt that a small group of

committed people can change the

world. Indeed it is the only thing that

ever has.” —Margaret Mead

EXCELLENCE. DRAMATIC.

DIFFERENCE.DOABLE.

$798

$415/SqFt/Wal*Mart$798/SqFt/Whole

Foods

“It’s simple, really, Tom. Hire for s,

and, above all, promote for s.”

—Starbucks middle manager/field

#1/100

“Best Companies to

Work for”/2005

Wegmans

EXCELLENCE.

OPPORTUNITY.

1. Men and women are different.2. Very different.3. VERY, VERY DIFFERENT.4. Women & Men have a-b-s-o-l-u-t-e-l-y nothing in common.5. Women buy lotsa stuff.

6. WOMEN BUY A-L-L THE STUFF.7. Women’s Market = Opportunity No. 1.8. Men are (STILL) in charge.9. MEN ARE … TOTALLY, HOPELESSLY CLUELESS ABOUT WOMEN.10. Women’s Market = Opportunity No. 1.

EXCELLENCE. THE STORY.

“Storytelling

is the core of culture.”

—Branded Nation: The Marketing of Megachurch, College Inc., and Museumworld, James Twitchell

“Management has a lot to do with answers. Leadership is a function of questions. And the

first question for a leader always

is: ‘Who do we intend to be?’ Not ‘What are we going to do?’

but ‘Who do we intend to be?’” —Max De Pree, Herman Miller

EXCELLENCE.

BEDROCK.

Organizing Genius / Warren Bennis and Patricia Ward Biederman

“Groups become great only when everyone in them, leaders and

members alike, is free to do his or her absolute best.”

“The best thing a leader can do for a

Great Group is to allow its members to discover their

greatness.”

Leadership’s Mt Everest/Mt Excellence

“free to do his or her absolute best” …

“allow its members to discover their

greatness.”

“The role of the Director is to create a

space where the actor or actress can become more than they’ve ever been before, more than

they’ve dreamed of being.” —Robert Altman, Oscar

acceptance

“In the end, management doesn’t

change culture. Management

invites

the workforce itself to change the culture.”

—Lou Gerstner

A review of Jack and Suzy Welch’s Winning claims there are but two key differentiators that set GE “culture” apart from the herd:

First: Separating financial forecasting and performance measurement. Performance measurement based, as it usually is, on budgeting leads to an epidemic of gaming the system. GE’s performance measurement is divorced from budgeting—and instead reflects how you do relative to your past performance and relative to competitors’ performance; ie it’s about how you actually do in the context of what happened in the real world, not as compared to a gamed-abstract plan developed last year.

Second: Putting HR on a par with finance and marketing.

DD$21M

“AS LEADERS, WOMEN

RULE: New Studies find that

female managers outshine their male counterparts in almost every measure”

Title, Special Report/BusinessWeek

EXCELLENCE.

STRETCH.

The greatest dangerfor most of us

is not that our aim istoo high

and we miss it,but that it is

too lowand we reach it.

Michelangelo

Kevin Roberts’ Credo

1. Ready. Fire! Aim.2. If it ain’t broke ... Break it!3. Hire crazies.4. Ask dumb questions.5. Pursue failure.6. Lead, follow ... or get out of the way!7. Spread confusion.8. Ditch your office.9. Read odd stuff.

10. Avoid moderation!

Part 2

EXCELLENCE.

HEALTH(CARE).

“When I climb Mount Rainier I face less

risk of death than I’ll face on the

operating table.” —Don Berwick, “Six Keys to Safer Hospitals: A Set of Simple Precautions Could Prevent 100,000 Needless Deaths Every Year,” Newsweek (1212.2005)

March-June 2006: Sample of

Healthcare “PR”

Docs & Hospitals

Doctors/Hospitals

53 autopsy studies … 24% misdiagnosis rate (The Independent, 06.27)

“Medical Guesswork: From heart surgery to prostate care, the health industry knows little about which common treatments really work”

(Cover, BusinessWeek, 0529) Dr David Eddy/Kaiser Permanente Care Management Institute: “The problem is we do not know what we are doing.” Eddy: 15% of what doctors do is “backed by hard

evidence” (BW); in general, 20% to 25%.

“What Doctors Hate About Hospitals” (Cover, Time, 05.01) “It remains almost a stroke of luck to enter a U.S. hospital and receive precisely the right treatment.” (Time) “No day passed—not one—without a medication error. The errors were not rare; they

were the norm” (Don Berwick, on his wife’s treatment) “One medication was discontinued by a physician’s order on the first day of admission [Berwick’s wife] and yet was brought by a nurse every single evening fo 14 days straight.” (Time) Harvard Public Health,

2002 study: “More than 1 in 3 doctors reported errors in their own or a family member’s medical care.” (Time)

Big Pharma

Big Pharma

“Pushing Pills: How Big Pharma Got Addicted To Marketing” (Cover, Forbes, 05.08) Novartis: #4 best seller, Lamisil, toe fungus, $850 for 3-month treatment, “Digger Dermatopphyte” (Forbes) $42 billion on

R&D, $46 billion on marketing and admin. Salespeople: up 100,000 in last 10 years, 1 per 9 docs vs 1 per 18 docs. (Forbes) Clinical trials

favor sponsor’s drug 90% of the time. “The comparative studies are a joke.” —Dr Jack Rosenblatt (Forbes)

“Psychiatric Drugs Fare Favorably When Companies Pay for Studies” (headline, USA Today. 05.25) 57% of studies paid by drug companies, up from 25% in 1992. Favorable outcome for sponsor: 78%. Sponsored by neutral: 48%. Sponsored by competitor: 28%.

USA Today /American Psychiatric Association)

“Hey, You Don’t Look So Good: As diagnoses ofr once-rare illnesses soar, doctors say drugmakers are ‘disease-mongering’ to boost

sales” (feature, BusinessWeek, 05.08)

Intractable Problems

Other

“Hazardous To Your Health” (New York Times Op-ed on High Fructose Corn Syrup, 04.11); 112,000

deaths/year, $75 billion/per year associated with too much fat; 2/3rd of Americans over-weight, 1/3rd children

“Call for Switch to Preventive Measures as 29 billion [pound] Cost of Heart Disease is Revealed” (headline,

The Independent, 05.15)

“The Fat Police” “Obesity Tests: Every four-year-old in the country to be officially screened”

(headline, The Independent, 05.21)

“The Politics of Fat” (headline, Time, 03.27); childhood

obesity up 3X in 25 years

STATE OFEMERGENCY

Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-

Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-

Quality: FScientific basis for action: C-/D

Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-

Emphasis on Acute care: CDe-emphasis of WPC/Wellness-Prevention-Chronic care: F (F-??)

Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-

“Me too”: D-Overcomplexity/Drug discovery: D-Disease creation: D-Hiring pretty girls: AHiring lotsa pretty girls: A

BONUS

Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task ……... DPriorities ……………………............ FBig Pharma …………………........... D-FDA …………………………………….. D-

Kill a few, save a lot: D-

Manifesto

“Healthcare” vs “Health”

Health:Century21.Job # 1

Quality!Prevention!Wellness!

Chronic care!Childhood obesity!

H5N1!

Quality!Prevention!Wellness!

Chronic care!Childhood obesity!

H5N1!

22mm3838ss

Welcome to the Homer Simpson Hospital

a/k/a

The Killing Fields

Quality!Prevention!Wellness!

Chronic care!

Childhood obesity!H5N1!

Childhood Obesity > Terrorism

Bust fat

docs!

Quality!

Prevention!Wellness!

Chronic care!Childhood obesity!

H5N1!

The Ultimate “Culture Change”

“Healthcare”

vs.

“Health”

“If God spoke to me by saying, ‘Mark, you’re down to your last three words: What would you want to say to

your fellow humans that would make the most positive impact?’ It would be a close call between Love Thy

Neighbor and Wash Your Hands . A close third would be Move,

Move, Move.” —Mark Pettus, M.D., The Savvy Patient

“The most important thing you can do to keep

from getting sick is to wash your hands. ” —CDC/National Center for Infectious Diseases

Report Card.

Re-imagine Healthcare: Reportcard2006

Evidence-based/Outcomes-based ……………….………...... DPay-for-performance ………………………………………….… DIS/IT (general) ………………………………..………………..…. C-Use of information (for decisionmaking-measurement) .… C-EMR (Electronic Medical Records) ……………………..….... C-/DCPOE (Computerized Physician Order Entry) ……….……. C-/DQuality/100K+ unnecessary deaths …………..……… D-(kind)Acute care to chronic care-home care shift ………….….... D/D-Acute-care to Prevention/Wellness Obsession…..… D/D-Patient-centric/Client-centric………………………………….. DDocs’ acceptance of “evidence-based” …………............… D/D-“Revolutionary”-intensity Incentives re evidence …..……. D-Childhood obesity epidemic …………………………….. D-H5N1 preparedness ………………………………….…….. D

Corporate focus on Prevention/Wellness…………..…..…..... C-/DIndividual focus on Prevention/Wellness…………………..… DIndividuals’ health education/self-management …….…...…. C-

Workforce acceptance of self-responsibility ….…….…...….. C-Workforce transition to “Brand You” attitude……..……..….. C-/D

3 March 2006/Tom Peters

Wash your hands.Apply #50 sunscreen.

Banish trans fatBanish high fructose corn syrup.

Exercise “30-7.”Breathe.

Stockpile for H5N1.* (*not Tamiflu!)

“Quality”:

COULD IT TRULY BE

THIS AWFUL?

CDC 1998: 90,000 killed and 2,000,000

injured from hospital-caused drug

errors & infections

HealthGrades/Denver:

195,000 hospital deaths per

year in the U.S., 2000-2002 = 390 full jumbos/747s in the drink per year.

Comments: “This should give you pause when you go to the hospital.” —Dr. Kenneth Kizer,

National Quality Forum. “There is little evidence that patient safety has improved in the last five years.” —Dr.

Samantha Collier

Source: Boston Globe/07.27.04

1,000,000

“serious medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug interactions and

allergies.”

Source: Wall Street Journal /Institute of Medicine

Dear Mr. & Mrs. Smith,

XYZ hospital regrets to inform you ……. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Sincerely,A. S. Jackson, AdministratorT. D. Jones, M.D., Chief Medical OfficerL.S. Donald, CFOW.N. Arnold, CIO

“Purchasing Officer” Thrust #1: Cost (at All Costs*) Minimization

Professional? Or/to: Full Partner-Leader in Lifetime

Value-added Maximization?

(*Lopez: “Arguably ‘Villain #1’ in GM tragedy”/Anon VSE-Spain)

YE GADS! New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). “Subsequent investigations around the

country have confirmed the ubiquity of error.” “In one small study of how clinicians perform when patients

have a sudden cardiac arrest, 27 of 30 clinicians made an error in using the defibrillator.” Mistakes in administering drugs (1995 study) “average once every

hospital admission.” “Lucian Leape, medicine’s leading expert on error, points out that many other industries—whether the task is manufacturing semiconductors or

serving customers at the Ritz Carlton—simply wouldn’t countenance error rates like those in hospitals.”

—Complications, Atul Gawande

“In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to

calculate medication doses. Eight out of 10 made calculation mistakes at

least 10% of the time,

while four out of 10 made mistakes 30% of the

time.”Demanding Medical Excellence: Doctors and Accountability

in the Information Age, Michael Millenson

20%: not get prescriptions filled

50%: use meds inconsistentlySource: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

About Time!

100,000 Lives Campaign*

*Don Berwick/Institute for Healthcare Improvement

“You must be the change you wish to see in the world.”

Gandhi

You = Your Calendar

The Necessary

IS/Web

REVOLUTION

“Some grocery stores have better technology than our hospitals and clinics.” —Tommy Thompson, former

HHS Secretary

Source: Special Report on technology in healthcare, U.S. News & World Report

“Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s

office is in registration and vice versa. The referring physician is immediately sent an email telling him his

patient has shown up. … It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians

can walk around with a computer that’s pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the network.

They can review a chart from 100 miles away.”

—David Veillette, CEO, Indiana Heart Hospital

Health

“Sanitary revolution”: mortality in major

cities down 55% between 1850 and

1915Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

“Curve Shifting”

Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

“Bump into factor”: Extra-size portions, eat more.

Higher % shelf space snacks, more obesity. More

liquor stores, more crime. High vs low fat: Japanese

who emigrate to U.S. suffer 3X increase in heart

disease.

Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

Sprint/Overland Park KS: Slow elevators, distant

parking lots with infrequent buses, “food

court” as “poorly” placed as possible, etc.

Source: New York Times

Wellness

Obesity/-79(-36); BP (140-85 to 90-60); Blood sugar (180-87); Blood chemistry (normal+);

Cholesterol (140-58); Metabolic rate/RMR (+250);

Mental state (dramatic improvement*)

Off …

Univasc (<1/2)BextraLipitorToprol

Propranolol

Aging reversal!!!!**Why wasn’t I “informed”

until age 59?

“Fixes”

DietExtreme exercise

MeditationSupplements

Eliminate all alcohol(Meds)

TP Recce #1:

Dubai Healthcare City

to

Dubai Health City*

*Cleveland Clinic and Canyon Ranch

Planetree: A Radical Model for New

Healthcare/Healing/Health/Wellness Excellence

The Nine Planetree Practices

1. The Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends and Family4. Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing6. Human Touch: The Essentials of Communicating Caring Through Massage7. Healing Arts: Nutrition for the Soul8. Integrating Complementary and Alternative Practices into Conventional Care9. Healing Environments: Architecture and Design Conducive to Health

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Press Ganey Assoc/1999: 139,380 former patients

from 225 hospitals

0 of top 15 factors determining Patient

Satisfaction referred to patient’s health outcome

PS directly related to Staff Interaction

PS directly correlated with ES (Employee Satisfaction)

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor

costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget.

Kindness is free. Listening to patients or answering their

questions costs nothing. It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. … Angry,

frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring far more time than it would have taken

to interact with them initially in a positive way.”

—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“When hospital staff members

are asked to list the attributes of

the ‘perfect patient and

family,’ their response is

usually a passive patient with no family.” —Putting Patients First, Susan

Frampton, Laura Gilpin, Patrick Charmel

Griffin IMC/Integrative Medicine Center

MassageAcupunctureMeditation

ChiropracticNutritional supplements

Aroma therapy

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Conclusion: Caring/Growth “Experience”

Care!Control!Connect! Engage!Grow!

De-stress!

Access to nurses station:

“Happen to”vs

“Happen with”Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

T.T.D./Healthcare27

Healthcare27

1. Fully utilize Physician’s Assistants to do routine work in a timely fashion. (“Doc in a Kiosk” at Wal*Mart is great!)

2. Maximize Outpatient services!3. Short hospital stays work! 4. Support home care to the max. (E.g., “Declaration of Independents”—Beacon Hill/Boston)

5. STOP THE 100K+ NEEDLESS DEATHS —much/most of the “quality stuff” is eminently fixable. (Don Berwick for President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!)

6. FLIP HC 177 DEGREES TO EMPHASIZE PREVENTION & WELLNESS. (“Steps” are being taken but not enough. Med schools: Awful! Insurers: Little better. Support for appropriate-proven alternative therapies is an important part.) (HUGE INCENTIVES FOR EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)

T.T.D./ACTION.

NOW.

Visible Signs/Measures (Creech)TRAIN. TRAIN. TRAIN. (P.S.)

Med school, Nursing school cirriculum (P.S.)BOLD!/Big change EASIER than

modest change (P.S., etc.)EXCELLENCE. ONLY. ALWAYS. DAMN IT.

EVP/Patient SafetyP.S.O.s

Fund the living hell out of it (P.S.)CEO (etc): REFLECT IT IN CALENDAR

EMERGENCY STATUSH.M.O.s: Big/Enormous (+/-) incentives for

docs, hospitals, etc, etcBOARD: Patient Safety Committee

BOARD: WPCC CommitteePatient Safety BALDRIDGE (POTUS?)

CERTIFICATION/RE-CERTIFICATION for One & All (P.S., etc)

WPOCC Rules!!!!!!! (Wellness/Prevention/Obesity/ChronicCare)WPOCC: N.G.A. (AK)

Dramatically higher involvement in WPOCCINSURANCE COMPANY VISIBILITY/SPONSORSHIP/

MEGA-INCENTIVESAwards Galore P.S./WPOCC)

BOARD Committee: H5N1Govt

HHS: Split HC & PWO (Ontario)Write off ½ of med school loan if “pay” with 3-5

years service in Public HealthGlamorize Family Practice, Public Health

Service, etcFAT legislation?? (Almost certainly) (Density,

HFCS, Trasfats, etc, etc) (A FIRST FOR TP)SUE the hell out of One & All

re Obesity (Cigarettes II)

Research LEAP @ N.I.H. (Etc, Etc, ETC)INCENTIVES @ SCHOOLS (BIG!!)

EMR: Intensify!!!!!!!!!!!!!No leadership position in AHA (AMA?) (DEANs?) (Etc?) without “Safety tour”

No Medical Chief (>150 beds?) without “Safety tour”)

FORGET ABOUT ME!!! (Except Wellness, ChroniCare)

VIGOROUSLYSUPPORT Home CareAmerican OBESITY = African AIDs (??)

ELIMINATE/OBLITERATE HIGH FRUCTOSE CORN SYRUP!

ELIMINATE/OBLITERATE TRANSFATS!(HFTC/TF = The Real “WMDs”)

FDA: Kill! Kill! Kill! (Please)

STATE OFEMERGENCY

EXCELLENCE.

ALWAYS.