1. Tom Peters’ Leading for Excellence: Surpassing “Unrealistic” Expectations AHCA/NCAL 55 th Annual Convention & Expo Miami Beach/10.04.2004

2. Slides at … tompeters.com

3. Goals.

4. Tom’s Healthcare9: Goals2004 1. Stop killing people in acute-care settings through negligence/lousy management/craft mores. (THIS IS ABOUT ATTITUDE & WILL … NOT $$$$.) 2. Adopt Patient-centric acute-care models (a la Planetree). 3. Embrace the Boomer Tsunami. 4. Prepare for consumer-driven healthcare. 5. Revise-Revolutionize the entire system (K-90) to revolve around Wellness-Prevention. 6. Erase the disgrace of uninsured Americans … in Planet’s Wealthiest Economy. 7. Re-orient Boomer-driven Eldercare toward Optimism (“The time of your life!”) (60 – 30 = 90 – 60). 8. Re-imagine! What an Opportunity! 9. Excellence = State of Mind.

5. Musings …

6. This is the most important speech I’ve given since NAESP!

7. Never felt it so keenly … Problem-focused? Opportunity-focused?

8. Regulations Sky-high (“Unrealistic”) Expectations Inadequate Funding Staffing Woes Etc. Etc. Etc.

9. “Growth market” or … Magical Opportunity to Lead this Demographic Revolution … and Re- imagine Aging?

10. Biases.

11. 95/Ginger Cove/ Life Care Services

12. T = SS – 34D

13. Cool? Oh Bleep? 60 – 30 = 90 - 60

14. TP/61/CR: Diet … Eating Habits/Philosophy … Nutrition Supplements … Breathing … Stretching … Meditation (Short, Long) … Exercise … Mini-walks … Sound … Flowers … Aromatherapy … Baths … Labyrinthine … Massage … Acupuncture … Chiropractic … Big CR/“CR Pauses” … Water (Japanese bath) … “Stop. Look. Listen.”... Monitor & Measure & Record. New World Order = Reverse 5 decades of abuse (With damn little help from my M.D. friends)

15. Revolution. Period.

16. It is the foremost task— and responsibility— of our generation to re-imagine our enterprises, private and public. —from the back cover, Re-imagine!

17. “Beware of the tyranny of making Small Changes to Small Things. Rather, make Big Changes to Big Things.” —Roger Enrico, former Chairman, PepsiCo

18. The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it. Michelangelo

19. IS/IT. Go for the Gold. (Or: At Least Try and Get Off the Bench.)

20. “Some grocery stores have better technology than our hospitals and clinics.” —Tommy Thompson, HHS Secretary Source: Special Report on technology in healthcare, U.S. News & World Report (07.04)

21. “ 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 (HealthLeaders/12.2002)

22. Consumerism.

23. “We expect consumers to move into a position of dominance in the early years of the new century.” Dean Coddington, Elizabeth Fischer, Keith Moore & Richard Clarke, Beyond Managed Care

24. Amen! “The Age of the Never Satisfied Customer” Regis McKenna

25. Quality. Whoops. Ouch. Yikes.

26. “Without being disrespectful, I consider the U.S. healthcare delivery system the largest cottage industry in the world. There are virtually no performance measurements and no standards. Trying to measure performance … is the next revolution in healthcare.” Richard Huber, former CEO, Aetna

27. “As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called ignorant care. A surprising 85% of everyday medical treatments have never been scientifically validated. … For instance, when family practitioners in Washington were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies.” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

28. CDC 1998: 90,000 killed and 2,000,000 injured from nosocomial [hospital-caused] drug errors & infections

29. 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

30. 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

31. It’s the “Experience”!

32. “ Experiences are as distinct from services as services are from goods.” Joseph Pine & James Gilmore, The Experience Economy: Work Is Theatre & Every Business a Stage

33. “The [Starbucks] Fix” Is on … “We have identified a ‘third place.’ And I really believe that sets us apart. The third place is that place that’s not work or home. It’s the place our customers come for refuge.” Nancy Orsolini, District Manager

34. Experience: “Rebel Lifestyle!” “What we sell is the ability for a 43-year-old accountant to dress in black leather, ride through small towns and have people be afraid of him.” Harley exec, quoted in Results-Based Leadership

35. A Certain Sort of Experience: Women.

36. 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.

37. Experience Plus: Planetree.

38. “If one didn’t know better, one might think that hospitals set out to design systems that provide the most sophisticated technical care but deliver the worst possible experience to sick people.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

39. “It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

40. The 9 Planetree Practices 1. The Importance of Human Interaction 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 3. Healing Partnerships: The importance of Including Friends and Family 4. Nutrition: The Nurturing Aspect of Food 5. Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

41. 1. The Importance of Human Interaction

42. “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

43. 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

44. Mgrs re staff: wages, security, promotion opportunities Staff re staff: interesting work (M: 5 of 10), appreciation (8 of 10), sense of being “in” about what’s going on (10 of 10) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

45. The Customer Comes Second: Put your People First and Watch ’Em Kick Butt —Hal Rosenbluth (and Diane McFerrin Peters)

46. “Planetree is about human beings caring for other human beings.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies and gentlemen”—4S credo)

47. 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information

48. 3. Healing Partnerships: The importance of Including Friends and Family

49. “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

50. “Family members, close friends and ‘significant others’ can have a gar greater impact on patients’ experience of illness, and on their long-term health and happiness, than any healthcare professional.” —Through the Patient’s Eyes Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

51. 4. Nutrition: The Nurturing Aspect of Food

52. Meals are central events vs “There, you’re fed.”* *Irony: Focus on “nutrition” has reduced focus on “food” and “service” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

53. 5. Spirituality: Inner Resources for Healing

54. Spirituality: Meaning and Connectedness in Life 1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/find meaning in suffering Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

55. 6. Human Touch: The Essentials of Communicating Caring Through Massage

56. “Massage is a powerful way to communicate caring.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

57. 7. Healing Arts: Nutrition for the Soul

58. Griffin: Music in the parking lot; professional musicians in the lobby (7/week, 3-4hrs/day) ; 5 pianos; volunteers (120-140 hrs arts & entertainment per month). Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

59. 8. Integrating Complementary and Alternative Practices into Conventional Care

60. Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

61. 9. Healing Environments: Architecture and Design Conducive to Health

62. “Planetree Look” Woods and natural materials Indirect lighting Homelike settings Goals: Welcome patients, friends and family … Value humans over technology … Enable patients to participate in their care … Provide flexibility to personalize the care of each patient … Encourage caregivers to be responsive to patients … Foster a connection to nature and beauty Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

63. Access to nurses station: “Happen to” vs “Happen with” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

64. The Eden Alternative

65. The Ten Principals of the Eden Alternative 1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders. 2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living. 3. Companionship is the antidote to loneliness. In an Elder- centered community we must provide easy access to human and animal companionship. 4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunity to give care and caregivers need opportunities need opportunities to receive care. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

66. The Ten Principals of the Eden Alternative 5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich is rich in opportunities to sample these ancient pleasures. 6. An Elder-centered community understands that passive entertainment cannot fill a human life. 7. The Elder-centered community takes medical treatment down from its pedestal and places it into the service of genuine human caring. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

67. The Ten Principals of the Eden Alternative 8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible. 9. An Elder-centered community understands human growth cannot be separated from human life. 10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

68. Conclusion: Caring/Growth “Experience”

69. “The most basic question we need to pose in caring for others is this: Is this a loving act?” —Leland Kaiser, “Holistic Hospitals” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

70. Talent I.

71. “The leaders of Great Groups love talent and know where to find it. They revel in the talent of others.” Warren Bennis & Patricia Ward Biederman, Organizing Genius

72. EVP = Challenge, professional growth, respect, satisfaction, opportunity, reward Source: Ed Michaels et al., The War for Talent

73. High T/O Is Not Inevitable! CostCo vs. Wal*Mart

74. Talent II.

75. “AS LEADERS, WOMEN RULE: New Studies find that female managers outshine their male counterparts in almost every measure” Title, Special Report, BusinessWeek, 11.20.00

76. Lead.

77. “ Ninety percent of what we call ‘management’ consists of making it difficult for people to get things done.” – P.D.

78. G.H.: “Create a ‘cause,’ not a ‘business.’ ”

79. “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

80. BZ: “I am a … Dispenser of Enthusiasm!”

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

82. “The single best way to predict the future is to create it.” —anon