Tom Peters’ EXCELLENCE. ALWAYS. Healthcare Financial Management Association Las Vegas/26 June...

Tom Peters’ Tom Peters’

EXCELLENCEXCELLENCE. ALWAYS.E. ALWAYS.Healthcare Financial Management AssociationHealthcare Financial Management Association

Las Vegas/26 June 2008Las Vegas/26 June 2008

NOTENOTE:: To appreciateTo appreciate this presentation this presentation [and [and

ensure that it is not a ensure that it is not a messmess],], you need Microsoft you need Microsoft

fonts:fonts:

“Showcard Gothic,”“Showcard Gothic,” “Ravie,”“Ravie,” “Chiller”“Chiller”

andand “Verdana”“Verdana”

Slides at …Slides at …

tompeters.comtompeters.com

Part One:Part One: A A Civilian Looks Civilian Looks at Your Worldat Your World

““Bottom line” :Bottom line” : 19001900--19601960, , life expectancy grew life expectancy grew 0.64 0.64 %% per year; per year; 19601960--20022002, ,

0.24%0.24% per year, half from per year, half from airbags, gun locks, airbags, gun locks,

service employment …service employment …

Source:Source: Best Care Anywhere: Why VA Healthcare Is Better Than YoursBest Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman/Phillip Longman

DVM/Lyme/2005-2008DVM/Lyme/2005-2008

**Multiple diagnoses (>5)**Multiple diagnoses (>5)**Specialist self-certainty**Specialist self-certainty**Health deterioration failed to produce urgency-**Health deterioration failed to produce urgency- communication communication**Virtually no communications between specialists**Virtually no communications between specialists**Follow-up very spotty unless bugged incessantly**Follow-up very spotty unless bugged incessantly**Lost major test results, mis-placed 3 or 4**Lost major test results, mis-placed 3 or 4 occasions occasions**Near fatal drug mistake (one nurse takes charge)**Near fatal drug mistake (one nurse takes charge)**Effectively, disinterest in chronic-care**Effectively, disinterest in chronic-care**Lack of curiosity**Lack of curiosity

““[Dartmouth Professor Elliott][Dartmouth Professor Elliott] Fisher and his Fisher and his colleagues discovered that colleagues discovered that

patients who went to hospitals patients who went to hospitals

that spent the most— that spent the most— and and did the most did the most

pproceduresrocedures —were 2 to —were 2 to 6 percent more likely to die than 6 percent more likely to die than patients that went to hospitals patients that went to hospitals

that spent the least.”that spent the least.”Source:Source: Overtreated: Why Too Much Medicine Is Making Overtreated: Why Too Much Medicine Is Making

Us Sicker and PoorerUs Sicker and Poorer, Shannon Brownlee, Shannon Brownlee

““The more doctors and specialists around, the more The more doctors and specialists around, the more tests and procedures performed. And the results of all tests and procedures performed. And the results of all these tests and procedures? Lots more medical bills, these tests and procedures? Lots more medical bills,

exposure to medical errors, and a exposure to medical errors, and a loss of life exloss of life exppectancectancy.y.

““It was this last conclusion that was truly shocking, but it became It was this last conclusion that was truly shocking, but it became unavoidable when [Dartmouth’s Dr. Jack] Wennberg and others unavoidable when [Dartmouth’s Dr. Jack] Wennberg and others

broadened their studies.broadened their studies. They found it’s not They found it’s not just that renowned hospitals just that renowned hospitals and their specialists tend to and their specialists tend to

engage in massive engage in massive overtreatment. They also tend overtreatment. They also tend to be to be poor at poor at pprovidinroviding critical g critical

but but routine careroutine care.”.”Source:Source: Best Care Anywhere: Why VA Healthcare Is Better Than YoursBest Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman /Phillip Longman

Journalist Tim Noah writes about his wife’s cancer treatment Journalist Tim Noah writes about his wife’s cancer treatment

in a high-rep private med center:in a high-rep private med center: “ “Much of our effort Much of our effort involved retrievininvolved retrievingg information from one information from one

source and sendinsource and sendingg it to another it to another.. This wasn’t This wasn’t something we could count on happening on its own. Very something we could count on happening on its own. Very expensive blood test results, we observed, had perhaps a expensive blood test results, we observed, had perhaps a

50%50% chance of being misplaced under a pile of faxes chance of being misplaced under a pile of faxes

and therefore not finding their way into Marjorie [William’s] and therefore not finding their way into Marjorie [William’s] medical chart. So we made a habit of getting the labs to fax medical chart. So we made a habit of getting the labs to fax to our house. Films of CT scans would be misfiled perhaps to our house. Films of CT scans would be misfiled perhaps

30%30% of the time and thus become permanently of the time and thus become permanently

irretrievable. So I took my checkbook to all of Marjorie’s CT irretrievable. So I took my checkbook to all of Marjorie’s CT scans and purchased my own spare copy on the spot.”scans and purchased my own spare copy on the spot.”

Source: Foreword toSource: Foreword to Best Care Any where: Why VA Best Care Any where: Why VA Healthcare Is Better Than Yours,Healthcare Is Better Than Yours, Phillip Longman Phillip Longman

““stunning lack of stunning lack of scientific knowledge scientific knowledge

about which about which treatments and treatments and

procedures actually procedures actually work.”work.”

Source:Source: Best Care Anywhere: Why VA Healthcare Is Better Than YoursBest Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman/Phillip Longman

CDC 1998CDC 1998:: 98,00098,000 killedkilled and and 2,000,0002,000,000

injuredinjured from from hospital-caused drug hospital-caused drug

errors & infectionserrors & infections

HealthGrades/Denver:HealthGrades/Denver:

195,000195,000 hospital deaths per hospital deaths per

year in the U.S., 2000-2002 = equivalent of year in the U.S., 2000-2002 = equivalent of 390 full 390 full jjumbos/747s in the drink umbos/747s in the drink pper er yyear—more than one-a-daear—more than one-a-day.y.

Comments: Comments: There is little There is little evidence that patient evidence that patient safety has imsafety has impproved in roved in the last five yearsthe last five years.”.” —Dr. Samantha —Dr. Samantha

CollierCollier

Source: Source: Boston Globe/2005Boston Globe/2005

1,000,0001,000,000 “serious medication errors per “serious medication errors per year” … “illegible handwriting, year” … “illegible handwriting, misplaced decimal points, and misplaced decimal points, and missed drug interactions and missed drug interactions and

allergies.”allergies.”

Source: Source: Wall Street Journal /Wall Street Journal /Institute of MedicineInstitute of Medicine

““The results are deadly. In addition The results are deadly. In addition

to the to the 98,00098,000 killed by medical killed by medical

errors in hospitals and the errors in hospitals and the 90,00090,000 deaths caused by hospital deaths caused by hospital

infections, another infections, another 126,000126,000 die die from their doctor’s failure to from their doctor’s failure to

observe evidence-based protocols observe evidence-based protocols for for jjustust fourfour common conditions: common conditions:

hypertension, heart attack, hypertension, heart attack, pneumonia, and colorectal cancer.” pneumonia, and colorectal cancer.”

[TP: total [TP: total 314,000314,000]]Source:Source: Best Care Anywhere: Why VA Healthcare Is Better Than YoursBest Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman/Phillip Longman

11mm4141ss

““HosHosppital infections kill an ital infections kill an estimated 103,000 estimated 103,000 ppeoeopplele

in the United States a in the United States a yyear, ear, as manas manyy as AIDS, breast as AIDS, breast

cancer and auto accidents cancer and auto accidents combinedcombined.. … Today, experts estimate that more than 60 percent of … Today, experts estimate that more than 60 percent of

staph infections are M.R.S.A. [up from 2 percent in 1974]. Hospitals in Denmark, staph infections are M.R.S.A. [up from 2 percent in 1974]. Hospitals in Denmark, Finland and the Netherlands once faced similar rates, but brought them down to below Finland and the Netherlands once faced similar rates, but brought them down to below

1 percent. How? Through the rigorous enforcement of rules on hand washing, the 1 percent. How? Through the rigorous enforcement of rules on hand washing, the meticulous cleaning of equipment and hospital rooms, the use of gowns and meticulous cleaning of equipment and hospital rooms, the use of gowns and

disposable aprons to prevent doctors and nurses from spreading germs on clothing disposable aprons to prevent doctors and nurses from spreading germs on clothing and the testing of incoming patients to identify and isolate those carrying the germ. … and the testing of incoming patients to identify and isolate those carrying the germ. … Many hospital administrators say they can’t afford to take the necessary precautionsMany hospital administrators say they can’t afford to take the necessary precautions ..””

—Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (—Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (New York TimesNew York Times/06.06.2005)/06.06.2005)

““ExExpperts estimate that moreerts estimate that more than a hundred thousand than a hundred thousand

Americans die each Americans die each yyear notear not from illness but from their from illness but from their pprescrirescripption drution druggss.. Those deaths, Those deaths,

occurring quietly, almost without notice in hospitals, emergency occurring quietly, almost without notice in hospitals, emergency rooms, and homes, make medicines one of the leading causes of rooms, and homes, make medicines one of the leading causes of death in the United States. On a daily basis, prescription pills are death in the United States. On a daily basis, prescription pills are

estimated to kill more than 270 Americans. … Prescription medicines, estimated to kill more than 270 Americans. … Prescription medicines, taken according to doctors’ instructions, kill more Americans than taken according to doctors’ instructions, kill more Americans than

either diabetes or Alzheimer’s disease.”either diabetes or Alzheimer’s disease.”

Source:Source: Our Daily Meds: How the Pharmaceutical Companies Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs Hooked the Nation on Prescription Drugs —Melody Petersen—Melody Petersen

““Plus God alone Plus God alone knows how many knows how many

casualties in casualties in doctors’ offices, doctors’ offices,

Tom”Tom” —Thom Mayer—Thom Mayer

““Can’t you Can’t you Put a Put a

muzzle on muzzle on him?”him?”

Part Two:Part Two: Some Stuff, a Some Stuff, a

40 Year 40 Year Journey Journey

ThankThank you Ike you Ike and Benand Ben

““Allied commands depend Allied commands depend on mutual confidence on mutual confidence [and this confidence] [and this confidence] is gained, above all is gained, above all

through the through the develodeveloppmentment of friendshiof friendshippss.”.”

——General D.D. Eisenhower, General D.D. Eisenhower, Armchair GeneralArmchair General* (05.08)* (05.08)

*“Perhaps his most outstanding ability [at West Point] was*“Perhaps his most outstanding ability [at West Point] was the ease with which he made friends and earned the trust the ease with which he made friends and earned the trust of fellow cadets who came from widely varied backgrounds;of fellow cadets who came from widely varied backgrounds; it was a quality that would pay great dividends during his it was a quality that would pay great dividends during his

future coalition commandfuture coalition command

GiveGive good good tea! tea!

ThankThank you ,Herb you ,Herb

““You have to You have to treat your treat your

employees like employees like customers.”customers.” —Herb Kelleher, —Herb Kelleher,

upon being asked his “secret to success”upon being asked his “secret to success”

Source: Joe Nocera, Source: Joe Nocera, NYTNYT, “Parting Words of an Airline Pioneer,” , “Parting Words of an Airline Pioneer,” on the occasion of Herb Kelleher’s retirement after 37 years on the occasion of Herb Kelleher’s retirement after 37 years at Southwest Airlines (SWA’s pilots union took out a full-pageat Southwest Airlines (SWA’s pilots union took out a full-page ad in USA Today thanking HK for all he had done; across thead in USA Today thanking HK for all he had done; across the

way in Dallas American Airlines’ pilots were picketing theway in Dallas American Airlines’ pilots were picketing the Annual Meeting)Annual Meeting)

ThankThank you Sheik you Sheik MohammadMohammad

24%24%

Single Single greatest act greatest act

of pure of pure imaginationimagination

dubaidubai

ThankThank you Bob you Bob

Excellence1982: The Bedrock “Eight Basics”Excellence1982: The Bedrock “Eight Basics”

1. A Bias for 1. A Bias for ActionAction2. Close to the 2. Close to the CustomerCustomer3. 3. AutonomAutonomyy and and EntreEntreppreneurshireneurshipp4. Productivity Through 4. Productivity Through PeoPeopplele5. 5. Hands OnHands On, , Value-DrivenValue-Driven6. 6. Stick toStick to the Knitting the Knitting7. 7. SimSimpplele Form, Form, LeanLean Staff Staff8. Simultaneous 8. Simultaneous Loose-TightLoose-Tight Properties” Properties”

““Breakthrough” 82*Breakthrough” 82*

People! People! CustomersCustomers

! ! Action! Action! Values! Values!

**In Search of ExcellenceIn Search of Excellence

“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 Buy a very large one very large one and just waitand just wait.”.”

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

Dick Kovacevich: You don’t get better by

being bigger. You get worse.”

#4 Japan#4 Japan#3 USA#3 USA

#2 China#2 China

#1 #1 GermanyGermany

Reason!!!Reason!!!

MittelstandMittelstand

Basement Basement Systems Inc.Systems Inc.

*Basement Systems Inc.*Basement Systems Inc.*Larry Janesky*Larry Janesky**Dry Basement ScienceDry Basement Science (115,000!)(115,000!)

*1990: $0; 2003: $13M; *1990: $0; 2003: $13M; 2007: 2007:

$62,000,000$62,000,000

The The

black black swanswan

1982 1982 (-)(-) = = 200 200

Years Years (+)(+)

1982/Default Latin 1982/Default Latin

America = America = 200 200 yearsyears [Total historical [Total historical

earnings]earnings]

The Black Swan: The Impact of theThe Black Swan: The Impact of the Highly Improbable Highly Improbable, Nassim Nicholas Taleb, Nassim Nicholas Taleb

Career =Career = 11 or or 22 black black swansswans

Conrad Hilton, at a gala Conrad Hilton, at a gala celebrating his life,celebrating his life,

was asked, “What was the was asked, “What was the most important lesson most important lesson

you’ve learned in your long you’ve learned in your long and distinguished career?” and distinguished career?”

His immediate answer …His immediate answer …

““remember remember to tuck the to tuck the

shower curtain shower curtain inside the inside the bathtubbathtub.”.”

2-cent 2-cent candycandy

<TG<TGWWvs.vs.

>TG>TGRR

1/401/40

““We have a We have a ‘strategic plan.’ ‘strategic plan.’ It’s called It’s called doing doing thingsthings.”.” — Herb Kelleher

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

understand that you only you only find oil if you find oil if you drill wellsdrill 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 We made mistakes, of course. Most of them were omissions we didn’t think of when we initially wrote the omissions we didn’t think of when we initially wrote the software. software. We fixed them by doing it over and over, again We fixed them by doing it over and over, again and again.and again. We do the same today. While our competitors We do the same today. While our competitors are still sucking their thumbs trying to make the design are still sucking their thumbs trying to make the design

perfect, we’re already on prototype versionperfect, we’re already on prototype version ##55..

By the time our rivals areBy the time our rivals are ready with wires and screws, we are on versionready with wires and screws, we are on version

##1010.. It gets back to It gets back to planning versus actingplanning versus acting: : We act We act from day onefrom day one; ; others plan how others plan how toto planplan——for monthsfor months.”.” —Bloomberg by —Bloomberg by

BloombergBloomberg

Culture of PrototypingCulture of Prototyping

“Effective prototyping may “Effective prototyping may

be be thethe most most valuablevaluable core core competencecompetence an an

innovative organization can innovative organization can hope to have.”hope to have.” —Michael Schrage

““ExperimenExperiment t

fearlessly”fearlessly”Source: BW0821.06, Type A Organization Strategies/

“How to Hit a Moving Target”—Tactic #1Tactic #1

““FAIL, FAIL FAIL, FAIL AGAIN. FAIL AGAIN. FAIL BETTER.”BETTER.”

—Samuel Beckett

X X =XFX*=XFX*

**ExcellenceExcellence = Cross-functional Excellence = Cross-functional Excellence

The “XF-50”: 50 Ways The “XF-50”: 50 Ways to Enhance Cross-to Enhance Cross-

Functional Functional Effectiveness and Effectiveness and

Deliver Speed, Deliver Speed, “Service Excellence” “Service Excellence”

and “Value-added and “Value-added Customer ‘Solutions’”Customer ‘Solutions’”

Never Never waste a waste a lunch!*lunch!*

????????

% XF % XF lunches*lunches*

*Measure!*Measure!

K.i.s.s.K.i.s.s.*Keep It Simple, Stupid*Keep It Simple, Stupid

Case: The Case: The “simple” “simple” Checklist!Checklist!

90K in U.S.A. 90K in U.S.A. ICUsICUs on any on any given day; given day; 178178 steps/day steps/day

in ICU. in ICU.

50%50% stays result stays result

in “serious complication”in “serious complication”

Source: Atul Gawande, “The Checklist” (Source: Atul Gawande, “The Checklist” (New YorkerNew Yorker, 1210.07), 1210.07)

****Peter PronovostPeter Pronovost, Johns Hopkins, , Johns Hopkins, 20012001**Checklist, line infections**Checklist, line infections**1/3**1/3rdrd at least one error when he started at least one error when he started**Nurses/permission to stop procedure **Nurses/permission to stop procedure if doc, other not following checklistif doc, other not following checklist**In 1 year, 10-day line-infection rate:**In 1 year, 10-day line-infection rate:

11% to … 11% to … 0%0%

Source: Atul Gawande, “The Checklist” (Source: Atul Gawande, “The Checklist” (New YorkerNew Yorker, 1210.07), 1210.07)

**Docs, nurses make own **Docs, nurses make own checklists on whateverchecklists on whatever process-procedure they choose process-procedure they choose**Within **Within weeksweeks, average stay in , average stay in

ICUICU down down 50%50%Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)

**Replicate in **Replicate in Inner City DetroitInner City Detroit (resource strapped—$$$, staff cut 1/3 (resource strapped—$$$, staff cut 1/3rdrd, poorest patients in USA), poorest patients in USA)

**Nurses QB the process**Nurses QB the process**Project manager for overall process implementation**Project manager for overall process implementation**Exec involvement **Exec involvement (help with “little things”—it’s all “little things”)(help with “little things”—it’s all “little things”)

**Blue Cross/insurers, small bonuses for participating**Blue Cross/insurers, small bonuses for participating

**6 months, **6 months, 66%66% decrease in infection rate; USA: decrease in infection rate; USA:

bottom 25% in hospital rankings bottom 25% in hospital rankings to … to …

top 10%top 10%Source: Atul Gawande, “The Checklist” (Source: Atul Gawande, “The Checklist” (New YorkerNew Yorker, 1210.07), 1210.07)

““[Pronovost] is focused on work that is [Pronovost] is focused on work that is not normallnot normallyy considered a siconsidered a siggnificant contribution in academic nificant contribution in academic

medicinemedicine. As a result, few others are venturing to extend . As a result, few others are venturing to extend

his achievements.his achievements. Yet his work has Yet his work has already saved more already saved more

lives than that of any lives than that of any laboratory scientist in laboratory scientist in the last decadethe last decade.”.” —Atul Gawande,—Atul Gawande,

“The Checklist” (New Yorker, 1210.07) “The Checklist” (New Yorker, 1210.07)

Compression hose would mostly fix the hospital Compression hose would mostly fix the hospital problem:problem: “According to the American Heart Association, “According to the American Heart Association, up to two million Americans are affected annually by deep up to two million Americans are affected annually by deep

vein thrombosis. Of those who develop pulmonary vein thrombosis. Of those who develop pulmonary embolism, up to 300,000 will die each year. ... Deep vein embolism, up to 300,000 will die each year. ... Deep vein

thrombosis also is among the leading causes of thrombosis also is among the leading causes of preventable hospital death. Even more disturbing is the preventable hospital death. Even more disturbing is the

fact that, according to a U.S. multi-center study fact that, according to a U.S. multi-center study published by two of ClotCare's editorial board members,published by two of ClotCare's editorial board members,

58%58% of of ppatients who develoatients who developped a DVT ed a DVT while in the hoswhile in the hosppital received no ital received no ppreventive treatment desreventive treatment desppite the ite the

ppresence of multiresence of multipple risk factors and le risk factors and overwhelminoverwhelmingg data that data that pprophylaxis is rophylaxis is

ververyy effective at reducin effective at reducingg these events these events.”.” —Marie B. Walker, clotcare.com, March 2008—Marie B. Walker, clotcare.com, March 2008

““Everything matters”Everything matters”

-80%-80%Source:Source: Nudge,Nudge, Richard Thaler and Cass Richard Thaler and Cass

Sunstein, etching of fly in the urinalSunstein, etching of fly in the urinal reduces “spillage” by 80%, Schiphol Airportreduces “spillage” by 80%, Schiphol Airport

TP: TP: “How to flush

$500,000 down

the toilet in one easy

lesson!!”

< CAPEX< CAPEX> People!> People!

#9.1#9.1

Organizations exist to serve. Period.Organizations exist to serve. Period.Leaders live to serve. Period.Leaders live to serve. Period.

Passionate servant leaders, determined to create a Passionate servant leaders, determined to create a legacy of earthshaking transformation in their domainlegacy of earthshaking transformation in their domain create/must create/must necessarilynecessarily create organizations which create organizations which

are …are … no less than Cathedrals in no less than Cathedrals in which the full and awesome which the full and awesome

power of the Imagination and power of the Imagination and Spirit and native Spirit and native

Entrepreneurial flairEntrepreneurial flair of of diverse individualsdiverse individuals is is

unleashedunleashed … … In passionate pursuit of jointly In passionate pursuit of jointly perceived soaring purposeperceived soaring purpose and personal and and personal and

community and client service Excellence. community and client service Excellence.

… … no less than no less than CathedralsCathedrals in which the full and in which the full and

awesome power of the awesome power of the Imagination and Spirit and Imagination and Spirit and native Entrepreneurial flairnative Entrepreneurial flair

of diverse individualsof diverse individuals is is unleashed in passionate unleashed in passionate pursuit of … Excellence.pursuit of … Excellence.

#9.2#9.2

#1#1 cause of cause ofDis-satisfaction?Dis-satisfaction?

Employee retention & satisfaction:Employee retention & satisfaction: OverwhelminOverwhelmingglly, y, based on their based on their

immediateimmediate manamanaggerer!!

Source: Marcus Buckingham & Curt Coffman, Source: Marcus Buckingham & Curt Coffman, First, Break All First, Break All the Rules: the Rules:

What the World’s Greatest Managers Do DifferentlyWhat the World’s Greatest Managers Do Differently

#9.3#9.3

EMPHASIZEMPHASIZE THE E THE “SOFT “SOFT

SKILLS.”SKILLS.”

“A man without A man without a smiling face a smiling face

must not open a must not open a shop.”shop.” —Chinese Proverb

#10#10

Hard Is SoftHard Is SoftSoft Is HardSoft Is Hard

“If I could have chosen not to tackle the IBM culture head-on, I probably wouldn’t have. My bias coming in was toward strategy, analysis and measurement. In comparison, changing the attitude and behaviors of

hundreds of thousands of people is very, very hard. [Yet] I came to see in my time at IBM that culture

isn’t just one aspect of the

game ——it is the it is the gamegame.”.” —Lou Gerstner,

Who Says Elephants Can’t Dance

R.O.I.RR.O.I.R..

RReturn eturn OOn n

IInvestment In nvestment In

RRelationshipselationships

??????????????

“Success doesn’t depend on the number of “Success doesn’t depend on the number of people you know; it depends on the number people you know; it depends on the number

of people you know in of people you know in hihigghh places!”places!”

oror

“Success doesn’t depend on the number of “Success doesn’t depend on the number of people you know; it depends on the number people you know; it depends on the number

of people you know in of people you know in lowlow places!” places!”

THE PROBLEM IS THE PROBLEM IS RARELY/NEVER THE RARELY/NEVER THE

PROBLEM.PROBLEM. THE THE RESPONSE TO THE RESPONSE TO THE

PROBLEM INVARIABLY PROBLEM INVARIABLY ENDS UP BEING THE ENDS UP BEING THE

REAL PROBLEMREAL PROBLEM.

Relationships (of all varieties): THERE THERE ONCE WAS A TIME WHEN A ONCE WAS A TIME WHEN A

THREETHREE--MINUTEMINUTE PHONEPHONE CALLCALL WOULD HAVE AVOIDED WOULD HAVE AVOIDED

SETTING OFF THE DOWNWARD SETTING OFF THE DOWNWARD SPIRAL THAT RESULTED IN A SPIRAL THAT RESULTED IN A

COMPLETE RUPTURE.COMPLETE RUPTURE.

““Courtesies of a small Courtesies of a small and trivial character are and trivial character are

the ones which strike the ones which strike deepest in the grateful deepest in the grateful

and appreciating heart.”and appreciating heart.”

—Henry Clay

The Manager’s The Manager’s Book of Book of DecenciesDecencies: :

How Small How Small /gestures Build /gestures Build

Great Companies.Great Companies. —Steve Harrison, Adecco

#11#11

Questions:Questions: What do others think of you? What do others think of you? [Are you sure?][Are you sure?] What What do you think of you? do you think of you? [Are you sure?][Are you sure?] What is your impact What is your impact

on others?on others? [Are you sure?][Are you sure?] What is your impact on What is your impact on others?others? [Are you sure?] [Are you sure?] What is your impact on others?What is your impact on others?

[Are you sure?][Are you sure?] What are the “little things” you (perhaps What are the “little things” you (perhaps unconsciously) do that cause people to shrivel—or blossom? unconsciously) do that cause people to shrivel—or blossom? [Are [Are you sure?]you sure?] What do you want? What do you want? [Are you sure?][Are you sure?] Are you aware Are you aware

of your changing moods? of your changing moods? [Are you sure?][Are you sure?] How fragile is your How fragile is your ego? ego? [Are you sure?][Are you sure?] Do you have a true confidant? Do you have a true confidant? [Are you [Are you sure?]sure?] Do you perform brief or not-so-brief self-assessments? Do Do you perform brief or not-so-brief self-assessments? Do you talk too much? you talk too much? [Are you sure?][Are you sure?] Do you know Do you know how how to listen? to listen? [Are you sure?][Are you sure?] DoDo you listen? you listen? [Are you sure?][Are you sure?] What is What is

your style of “hashing things out”? Are you perceived as (a) your style of “hashing things out”? Are you perceived as (a) arrogant, (b) abrasive (c) attentive, (d) genuinely interested in people, arrogant, (b) abrasive (c) attentive, (d) genuinely interested in people,

(e) etc? (e) etc? [Are you sure?][Are you sure?] Are you flexible? Have you changed Are you flexible? Have you changed your mind about anything your mind about anything important important in a while? Are you in a while? Are you

comfortable-uncomfortable with folks on the front line? comfortable-uncomfortable with folks on the front line? Do you Do you think you’re “in touch with the pulse of things around think you’re “in touch with the pulse of things around

here”?here”? [Are You Sure?][Are You Sure?] Are you too emotional/intuitive? Are Are you too emotional/intuitive? Are you too unemotional/rational? Do you spend much time with people you too unemotional/rational? Do you spend much time with people

who are new to you?who are new to you? [Do you think questions like this are [Do you think questions like this are “so much BS”?]“so much BS”?]

#12#12

Attending toAttending to the “Last 98%”:the “Last 98%”:

The New The New Management Management

“Science,” or …“Science,” or … “ “Hard Is Soft,Hard Is Soft, Soft Is Hard”Soft Is Hard”

Tom Peters/12.03.2008Tom Peters/12.03.2008

S = f( ___ )S = f( ___ )Success Is aSuccess Is a

Function of …Function of …

S = ƒ(#&DR; -2L, -3L, 4L; I&E)S = ƒ(#&DR; -2L, -3L, 4L; I&E)Number and depth of relationships 2, 3, and 4 levels down,Number and depth of relationships 2, 3, and 4 levels down,inside and outside the organizationinside and outside the organization

S = ƒ(SD>SU)S = ƒ(SD>SU)Sucking down is more important than sucking up—the idea is to haveSucking down is more important than sucking up—the idea is to havethe entire organization working for you.the entire organization working for you.

S = ƒ(#non-FF, #non-FL)S = ƒ(#non-FF, #non-FL)Number of friends, number of lunches with people not in my functionNumber of friends, number of lunches with people not in my function

S = ƒ(#FF)S = ƒ(#FF)Number of friends in the finance function-organizationNumber of friends in the finance function-organization

S = ƒ(OF)S = ƒ(OF)Oddball friendsOddball friends

S = ƒ(PDL)S = ƒ(PDL)Purposeful, deep listening—Purposeful, deep listening—this is very hardthis is very hard

S = S = f(%TM“TSS,” f(%TM“TSS,”

PM“TSS,” PM“TSS,” D“TD”“TSS”)D“TD”“TSS”)

% of time, measured, on This % of time, measured, on This Soft StuffSoft Stuff, , purposeful management of this purposeful management of this Soft StuffSoft Stuff, , daily “to do” concerning “this daily “to do” concerning “this Soft StuffSoft Stuff””

#13#13

““Experiences Experiences are as distinct are as distinct

from services as from services as services are from services are from goods.”goods.” —Joe Pine & Jim Gilmore, The

Experience Economy: Work Is Theatre & Every Business a Stage

“The [Starbucks] Fix” Is on …

“We have “We have identified a identified a

‘third place.’‘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

Experience: “Rebel Lifestyle!”

“What we sell is the “What we sell is the ability for a 43-year-old ability for a 43-year-old accountant to dress in accountant to dress in

black leather, ride black leather, ride through small towns and through small towns and

have people be afraidhave people be afraid of him.” of him.”

HarleyHarley exec, quoted in Results-Based Leadership

Part Three:Part Three: Five PianosFive Pianos

FiveFivepianopiano

ss

PlanetreePlanetree:: A Radical Model for A Radical Model for

New New Healthcare/Healing/Healthcare/Healing/Wellness Wellness ExcellenceExcellence

Tom PetersTom Peters

The 9 Planetree Practices

1.1. The Importance of Human InteractionThe Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends Healing Partnerships: The importance of Including Friends and Family and Family4. Nutrition: The Nurturing Aspect of Food Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing Spirituality: Inner Resources for Healing6.6. Human Touch: The Essentials of Communicating Human Touch: The Essentials of Communicating Caring Through Massage Caring Through Massage7.7. Healing Arts: Nutrition for the Soul Healing Arts: Nutrition for the Soul8.8. Integrating Complementary and Alternative Practices Integrating Complementary and Alternative Practices into Conventional Care into Conventional Care9.9. Healing Environments: Architecture and Design Conducive Healing Environments: Architecture and Design Conducive to Health to Health

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

1. The The Importance of Importance of

Human Human InteractionInteraction

Press Ganey Assoc: 139,380 former patients from 225 hospitals:

nonenone of THE top 15 factors of THE top 15 factors

determining determining PPatient atient SSatisfaction atisfaction referred to patient’s health referred to patient’s health outcomeoutcome

PSPS directldirectly related to y related to StaffStaff InteractionInteraction

PSPS directldirectly correlated with y correlated with Employee Employee SatisfactionSatisfaction


“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 Kindness is freefree.. 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

2. Informing and Informing and Empowering Diverse Empowering Diverse

Populations: Populations: ConsumerConsumer Health Libraries and Health Libraries and

Patient InformationPatient Information

Planetree Health Resources Center/1981Planetree Health Resources Center/1981Planetree Classification SystemPlanetree Classification System

Consumer Health LibrariansConsumer Health LibrariansVolunteersVolunteers

Classes, lecturesClasses, lecturesHealth FairsHealth Fairs

Griffin’s Mobile Health Resource CenterGriffin’s Mobile Health Resource CenterOpen Chart PolicyOpen Chart Policy

Patient Progress NotesPatient Progress NotesCare Coordination ConferencesCare Coordination Conferences (Est (Est

goals, timetable, etc.)goals, timetable, etc.)


3. Healing Healing Partnerships: Partnerships: The The

Importance of Importance of IncludingIncluding

Friends and Friends and FamilyFamily

““Family members, close friends Family members, close friends and ‘significant others’ can and ‘significant others’ can

have a far greater impact on have a far greater impact on patients’ experience of illness, patients’ experience of illness, and on their long-term health and on their long-term health

and happiness, than any and happiness, than any healthcare professional.”healthcare professional.”

—Through the Patient’s Eyes

Care Partner ProgramsCare Partner Programs (IDs, discount meals, etc.)

Unrestricted visitsUnrestricted visits (“Most Planetree hospitals have eliminated visiting restrictions altogether.”) (ER at one

hospital “has a policy of never separating the patient from the family, and there is no limitation on how many family members

may be present.”)

Collaborative Care ConferencesCollaborative Care ConferencesClinical Guidelines DiscussionsClinical Guidelines Discussions

Family SpacesFamily SpacesPet VisitsPet Visits (POP: Patients’ Own Pets)


4. Nutrition: Nutrition: The Nurturing The Nurturing Aspect of FoodAspect of Food

KitchenKitchen

Beautiful cutlery,Beautiful cutlery, plates, etc plates, etc

Chef reputationChef reputation


Aroma therapyAroma therapy (e.g., “smell of baking cookies”—from kitchenettes

in each ward)


5. Spirituality: Spirituality: Inner Resources Inner Resources

for Healingfor Healing

Spirituality: Meaning and Connectedness in Life

1. Connected to supportive and1. Connected to supportive and caring group caring group2. Sense of mastery and control2. Sense of mastery and control3. 3. Make meaning out of Make meaning out of disease/disease/ find meaning in suffering find meaning in suffering


Griffin: redesign chapelredesign chapel (waterfall, quiet music, open prayer book)

Other: music, flowers, portablemusic, flowers, portable labyrinth labyrinth


6. Human Touch: Human Touch: The Essentials of The Essentials of CommunicatingCommunicating

Caring Through Caring Through MassageMassage

“Massage is a Massage is a powerful way to powerful way to

communicate communicate caring.”caring.” —Putting Patients First,

Susan Frampton, Laura Gilpin, Patrick Charmel

Mid-Columbia Medical Center/Center for Mind and Body

Massage for every patient scheduled for Massage for every patient scheduled for ambulatory surgery ambulatory surgery (“Go into surgery with(“Go into surgery witha good attitude”) a good attitude”) Infant massageInfant massageStaff Staff massage massage (“caring for the caregivers”)(“caring for the caregivers”)Healing environments: chemo!Healing environments: chemo!


7.7. Healing Arts: Healing Arts: Nutrition forNutrition for

the Soul the Soul

Planetree: “Environment conducive to healing”

Color!Color!Light!Light!

Brilliance!Brilliance!Form!Form!Art!Art!

Music!Music!


GriffinGriffin:: Music in the parking Music in the parking lot; professional musicians in lot; professional musicians in

the lobby the lobby (7/week, 3-4hrs/day)(7/week, 3-4hrs/day) ; ;

5 5 pianospianos ; ;

volunteers volunteers (120-140 hrs arts & (120-140 hrs arts &

entertainment per month).entertainment per month).

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

8. Integrating Integrating Complementary and Complementary and

Alternative Practices Alternative Practices into Conventional into Conventional

CareCare

Griffin IMC/Integrative Medicine Center

MassageMassageAcupunctureAcupunctureMeditationMeditation

ChiropracticChiropracticNutritional supplementsNutritional supplements

Aroma therapyAroma therapy


9.9. Healing Healing Environments: Environments:

Architecture andArchitecture and Design ConduciveDesign Conducive

to Healthto Health

“Planetree Look”

Woods and natural materialsWoods and natural materialsIndirect lightingIndirect lighting

Homelike settingsHomelike settings

Goals: Goals: Welcome patients, friends and Welcome patients, friends and family … Value humans over technology .. family … Value humans over technology .. Enable patients to participate in their care Enable patients to participate in their care

… Provide flexibility to personalize the … Provide flexibility to personalize the care of each patient … Encourage care of each patient … Encourage

caregivers to be responsive to patients … caregivers to be responsive to patients … Foster a connection to nature and beautyFoster a connection to nature and beauty


F.Y.I.: It F.Y.I.: It works!works!

Griffin HosGriffin Hosppital/Derbital/Derbyy CT (Planetree Alliance “HQ”) CT (Planetree Alliance “HQ”) ResultsResults::

Financially successful. Financially successful. Expanding programs-Expanding programs-

physically.physically. Growing market Growing market share. share. Only hospital in Only hospital in

“100 Best Cos to Work for”—“100 Best Cos to Work for”—7 consecutive years, 7 consecutive years,

currently #6.currently #6. —“Five-Star Hospitals,” Joe Flower,

strategy+business (#42)

Tom Peters’ EXCELLENCE. ALWAYS. Healthcare Financial Management Association Las Vegas/26 June...

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