Tom Peters’ Toward Health(care) Excellence! Michigan Health & Hospital Association Annual Membership Meeting Grand Hotel/Mackinac Island/

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/

“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 Purity Transcendence Virtue Elegance Majesty Antonyms Mediocrity

EXCELLENCE

Excellence1982: The Bedrock “Eight Basics” 1. A Bias for Action 2. Close to the Customer 3. Autonomy and Entrepreneurship 4. Productivity Through People 5. Hands On, Value-Driven 6. Stick to the Knitting 7. Simple Form, Lean Staff 8. 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 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 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

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 ( )

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 ) 57% of studies paid by drug companies, up from 25% in 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; 2/3 rd of Americans over-weight, 1/3 rd 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 OF EMERGENCY

Funding ………………… N.A. Access …………………………… N.A. Execution of chosen task … D Priorities …………………… F Big Pharma …………………..... D-

Funding ………………… N.A. Access …………………………… N.A. Execution of chosen task … D Priorities …………………… F Big Pharma …………………..... D- Quality: F Scientific basis for action: C-/D

Funding ………………… N.A. Access …………………………… N.A. Execution of chosen task … D Priorities …………………… F Big Pharma …………………..... D- Emphasis on Acute care: C De-emphasis of WPC/Wellness- Prevention-Chronic care: F (F-??)

Funding ………………… N.A. Access …………………………… N.A. Execution of chosen task … D Priorities …………………… F Big Pharma …………………..... D- “Me too”: D- Overcomplexity/Drug discovery: D- Disease creation: D- Hiring pretty girls: A Hiring lotsa pretty girls: A

BONUS Funding ………………… N.A. Access …………………………… N.A. Execution of chosen task ……... D Priorities …………………… F Big 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!

2 m 38 s

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 ……………….……… D Pay-for-performance ………………………………………….… D IS/IT (general) ………………………………..………………..…. C- Use of information (for decisionmaking-measurement).… C- EMR (Electronic Medical Records) ……………………..….... C-/D CPOE (Computerized Physician Order Entry) ……….……. C-/D Quality/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………………………………….. D Docs’ 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-/D Individual focus on Prevention/Wellness…………………..… D Individuals’ 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 fat Banish 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., = 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/

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, Administrator T. D. Jones, M.D., Chief Medical Officer L.S. Donald, CFO W.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 inconsistently Source: 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 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 1915 Source: 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 ( 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) Bextra Lipitor Toprol Propranolol

Aging reversal!!!!* *Why wasn’t I “informed” until age 59?

“Fixes” Diet Extreme exercise Meditation Supplements 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 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

Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals 0 of top 15 factors determining P atient S atisfaction 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 Massage Acupuncture Meditation Chiropractic Nutritional 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 Safety P.S.O.s Fund the living hell out of it (P.S.) CEO (etc): REFLECT IT IN CALENDAR EMERGENCY STATUS H.M.O.s: Big/Enormous (+/-) incentives for docs, hospitals, etc, etc BOARD: Patient Safety Committee BOARD: WPCC Committee Patient 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 WPOCC INSURANCE COMPANY VISIBILITY/SPONSORSHIP/ MEGA-INCENTIVES Awards Galore P.S./WPOCC) BOARD Committee: H5N1 Govt HHS: Split HC & PWO (Ontario) Write off ½ of med school loan if “pay” with 3-5 years service in Public Health Glamorize Family Practice, Public Health Service, etc FAT legislation?? (Almost certainly) (Density, HFCS, Trasfats, etc, etc) (A FIRST FOR TP) SUE the hell out of One & All re Obesity (Cigarettes II)

Research N.I.H. (Etc, Etc, ETC) 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 Care American OBESITY = African AIDs (??) ELIMINATE/OBLITERATE HIGH FRUCTOSE CORN SYRUP! ELIMINATE/OBLITERATE TRANSFATS! (HFTC/TF = The Real “WMDs”) FDA: Kill! Kill! Kill! (Please)

STATE OF EMERGENCY

EXCELLENCE. ALWAYS.