LONG
Tom Peters’
Toward
Health(care)
Excellence!
Michigan Health & Hospital Association
Annual Membership Meeting
Grand Hotel/Mackinac Island/0629.2006
Part 1
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)
Doctors/Hospitals
Dr Robert Wachter, Chief of Medical Service, UCSF Medical Center:
Internal Bleeding: The Truth Behind America’s Terrifying Epidemic
of Medical Mistakes (Time) Dr Niteesh Choudry, Harvard Med
School: “More than half the studies [reviewed] found decreasing
performance with increasing years of practice for all outcomes
assessed; only 4% found increasing performance with increasing
age … one study found that for heart attack patients, mortality
increased 0.5% for every year the physician had been out of medical
school.” (Time) “My pizza parlor is more thoroughly
computerized than most of healthcare.” (Don Berwick, Time)
“Teaching Doctors to Care” (feature, Time, 05.29)
Big Pharma
Digger the
Dermatophyte*
*Lamisil/Novartis/#4/$110M/3X in 10 to 100,000
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 OF
EMERGENCY
Manifesto
“Healthcare”
vs “Health”
TP’s Healing & Wellness Manifesto2006
(1) Acute-care facilities are “killing fields.”
(WE KNOW WHAT TO DO.)
(2) Shift the “community” focus 90 degrees
(not 180, but not 25) from “fix it” to
“prevent it.” (WE KNOW WHAT TO DO.)
(3) There are three primary aims for “all this”:
Wellness-Healing-Health. (WE KNOW
WHAT TO DO.)
(4) I’m mad as hell and I’m not going to take
it anymore. (I KNOW WHAT TO DO.)
TomRant2006
1. Hospital “quality control,” at least in the U.S.A., is a bad,
bad joke: Depending on whose stats you believe,
hospitals kill 100,000 or so of us a year—and wound
many times that number. Finally, “they” are “getting around to” dealing
2.
with the issue. Well, thanks. And what is it we’ve been buying for our Trillion or
so bucks a year? The fix is eminently do-able … which makes the condition even
more intolerable.
The “system”—training, docs, insurance incentives,
“culture,” “patients” themselves—is hopelesslymindlessly-insanely (as I see it) skewed toward fixing
things (e.g. me) that are broken—not preventing the
problem in the first place and providing the Maintenance
Tools necessary for a healthy lifestyle. Sure, bio-medicine will
soon allow us to understand and deal with individual genetic pre-dispositions.
(And hooray!) But take it from this 63-year old, decades of physical and
psychological self-abuse can literally be reversed in relatively short order by an
encompassing approach to life that can only be described as a “Passion for
Wellness (and Well-being).” Patients—like me—are catching on in record numbers;
but “the system” is highly resistant. (Again, the doctors are among the biggest
sinners—no surprise, following years of acculturation as the “man-with-the-whitecoat-who-will-now-miraculously-dispense-fix it-pills-and-surgical-incisions-foryou-the-unwashed.”
BIGGEST
DEAL OF
ALL
!!!!!!!!!!!!!
“Healthcare”
vs “Health”
TP Recce #1:
Dubai Healthcare City
to
Dubai Health City*
*Cleveland Clinic and Canyon Ranch
State of
Play
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 …………………..... DQuality: F
Scientific basis for action: C-/D
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task … D
Priorities ……………………...... F
Big Pharma …………………..... DEmphasis on Acute care: C
De-emphasis of WPC/WellnessPrevention-Chronic care: F (F-??)
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task … D
Priorities ……………………...... F
Big Pharma …………………..... D“Me too”: DOvercomplexity/Drug discovery: DDisease creation: DHiring pretty girls: A
Hiring lotsa pretty girls: A
BONUS
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task ……... D
Priorities ……………………............ F
Big Pharma …………………........... DFDA …………………………………….. DKill a few, save a lot: D-
Bust
fat docs!
Health:
Century21.Job # 1
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
“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)
2 38
m
s
Welcome to the Homer Simpson Hospital
a/k/a
The Killing
Fields
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
Childhood
Obesity >
Terrorism
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
The Ultimate “Culture Change”
“Healthcare”
vs.
“Health”
Report
Card.
Quality (100K+ deaths)
“Evidence/Outcomes-based” medicine
IS/IT-in-health(care) revolution
Wellness/Prevention
Health“care” to Health “culture” transformation
Wash your hands!
Home-care (as the population rapidly ages)
Med-school re-orientation
“Public health” emphasis
Childhood Obesity
Mind-boggling (15 years?) social-moral-technological
impact of life sciences (“the Singularity”?)
H5N1/WMDs/Environmental degradation
Risk assessment (private, public)
Market opportunity
Public vs/+ Private responsibilities & partnerships
Africa! (Unconscionable failure to attend to/staggering Health consequences for all)
Re-imagine Healthcare: Reportcard2006
Evidence-based/Outcomes-based ……………….………...... D
Pay-for-performance ………………………………………….… D
IS/IT (general) ………………………………..………………..…. CUse of information (for decisionmaking-measurement) .… CEMR (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/DAcute-care to Prevention/Wellness Obsession…..… D/DPatient-centric/Client-centric………………………………….. D
Docs’ acceptance of “evidence-based” …………............… D/D“Revolutionary”-intensity Incentives re evidence …..……. DChildhood obesity epidemic …………………………….. DH5N1 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 ….…….…...….. CWorkforce transition to “Brand You” attitude……..……..….. C-/D
3 March 2006/Tom Peters
“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
Wash Your
Hands .
Neighbor and
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
hands. ”
wash your
—CDC/National Center for Infectious Diseases
Tommy Thompson: take
your
meds; chronic illness
75% to 80%; “curative
healthcare system” to
“prevention system”
Source: Advertising Age, 05.08.06
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
Wash your hands.
Apply #50 sunscreen.
Banish trans fat
Banish high fructose corn syrup.
Exercise “30-7.”
Breathe.
Stockpile for H5N1.* (*not Tamiflu!)
Women.
Women business owners.
Boomers-Geezers.
Single-adults (Urban)
Health-Wellness-Chronic Care
COULD
IT TRULY BE THIS
AWFUL?
“Quality”:
“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)
90,000 killed
and 2,000,000
CDC 1998:
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.”
National Quality Forum
—Dr. Kenneth Kizer,
. “There is little evidence
that patient safety has improved in
the last five years.” —Dr. Samantha Collier
Source: Boston Globe/07.27.04
Welcome to the Homer Simpson Hospital
a/k/a
The Killing
Fields
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
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
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
50%, appropriate
preventive care. 60%,
recommended treatment,
per medical studies, for
chronic conditions. 20%
chronic care treatment that
is wrong. 30% acute care
treatment that is wrong.
RAND (1998):
Various studies: 1
in 3, 1 in 5, 1 in 7,
1 in 20 patients
“harmed by
treatment”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
“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
“In health care,
geography
is destiny.”
Source: Dartmouth Medical School 1996 report
Geography Is Destiny
“Often all one must do to acquire a
disease is to enter a country where a
disease is recognized—leaving the
country will either cure the malady or
turn it into something else. … Blood
pressure considered treatably high in the United States
might be considered normal in England; and the low
blood pressure treated with 85 drugs as well as
hydrotherapy and spa treatments in Germany would
entitle its sufferer to lower life insurance rates in the
United States.” – Lynn Payer, Medicine & Culture
Geography Is Destiny
E.g.: Ft. Myers 4X Manhattan—back
surgery. Newark 2X New Haven—
prostatectomy. Rapid City SD 34X
Elyria OH—breast-conserving
surgery. VT, ME, IA: 3X differences
in hysterectomy by age 70; 8X
tonsillectomy; 4X prostatectomy
Breast cancer screening: 4X NE, FL,
MI vs. SE, SW. (Source: various)
“A healthcare delivery system characterized by
idiosyncratic and often ill-informed judgments
must be restructured according to
evidence-based
medical
practice.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
“Without being disrespectful, I consider the U.S.
healthcare delivery system the largest cottage industry in
There are
virtually no
performance
measurements and
no standards.
the world.
Trying to measure
performance … is the next revolution in healthcare.”
Richard Huber, former CEO, Aetna
“Practice variation is not caused by ‘bad’ or ‘ignorant’
Rather, it is a natural
consequence of a system that
systematically tracks neither its
processes nor its outcomes,
preferring to presume that good
facilities, good intentions and good
training lead automatically to good
results. Providers remain more comfortable with the
doctors.
habits of a guild, where each craftsman trusts his fellows,
than with the demands of the information age.”
Source: Michael Millenson, Demanding Medical Excellence
“As unsettling as the prevalence of inappropriate care is
the enormous amount of what can only be called
A surprising 85%
of everyday medical
treatments have never
been scientifically
validated. … For instance, when family
ignorant care.
practitioners in Washington State 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
“Most physicians believe that diagnosis
can’t be reduced to a set
of generalizations—to a ‘cookbook.’
… How often does my intuition lead me
astray? The radical implication of
the Swedish study is that the
individualized, intuitive approach
that lies at the center of modern
medicine is flawed—it causes
more mistakes than it prevents.”
—Atul Gawande, Complications
Deep Blue Redux*:
2,240
EKGs … 1,120 heart
attacks. Hans Ohlin
: 620.
Lars Edenbrandt’s
software: 738.
(50 yr old chief
of coronary care, Univ of Lund/SW)
*Only this time it matters!
Dr Larry Weed/POMR (“problem-oriented
medical record”)/Etc: “It’s impossible to keep
up with the avalanche of knowledge.
Therefore it’s essential to use a valid
diagnostic-decision aid like Larry’s” —Neil de
Crescenzo, VP Global Healthcare/IBM Consulting
“There
is no other profession that
tries to operate in the fashion
we do. We go on hallucinating
about what we can do.” —Dr Charles
Burger (using Weed’s software for 20 years)
100 studies: Statistical formulas > Human
“In virtually all
cases, statistical thinking
equaled or surpassed
human judgment.”
judgment.
—Atul Gawande, Complications
PARADOX: Many,
many formal case reviews …
failure to systematically/
systemically/statistically look
at and act on evidence.
Source: Complications, Atul Gawande
Genius
Required?
Leapfrog Group:
CPOE/Computerized Physician
Order Entry*
ICU staffing by trained
intensivists**
EHR/Evidence-based Hospital
Referral***
*Duh I: Welcome to the computer age.
**Duh II: How about using experts?
***Duh III: If you do stuff a lotta times, you tend to get/be
better.
Source: HealthLeaders
The Benefits of …
FOCUSED EXCELLENCE
Shouldice/Hernia Repair:
30-45 min, 1%
recurrence. Avg: 90
min, 10%-15%
recurrence.
Source: Complications, Atul Gawande
Hospitals Pay Appropriate Attention
To Medical Errors
Yes …………………………………..
Aware and Trying Hard ……...
Aware But Tepid Response ...
No ……………………………….......
An Inexcusable Tragedy ……..
Source: 12.2005 Poll/tompeters.com
1%
8%
22%
25%
44%
About Time!
100,000 Lives
Campaign*
*Don Berwick/Institute for Healthcare Improvement
“What’s your
name?
When’s your
birthday?”
Attention/
“Being
There”: Job
One!
You = Your
Calendar
be
“You must
the change you
wish to see in the
world.”
Gandhi
The Necessary
IS/Web
REVOLUTION
We all live in
Dell-Wal*MarteBay-Google
World!
We [almost] all
live in DellWal*Mart-eBayGoogle World!
“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
Computerized Physician Order
Entry/CPOE:
5%
of U.S. hospitals
source: HealthLeaders/06.02
Henry Lowe, U. of Pitt. School of
“Broadband,
Internet-based,
‘multimedia’
electronic medical
records”
Medicine:
Telemedicine: E.g. …
HANC* [Home Assisted
Nursing Care]
*BP, ECG, pulse, temp
Telemedicine …
Reduces days/1000 patients and
physician visits for the chronically
ill
Decreases costs of managing
chronic disease
Expands service areas for providers
Reduces travel costs to and from
medical ed seminars
Douglas Goldstein, e-Healthcare
“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
“Gwen [former healthcare exec] has wonderful health insurance and
an abundance of healthcare. What Gwen does not have is health.
And there is nothing our health system can do to give it to her.”
“The battle cry is always health, but in fact the struggle has always
been over healthcare.” “For all its inspiring, high-tech cures,
medicine is just not very effective at curing our era’s major killers.”
“Medicine doesn’t do much
chronic disease.” “When the most common
killers of our era are mostly incurable and our preventive treatments
pretty feeble, you have to wonder about medical care as a whole.”
“There is a widely held view that medical care contributes little to
health.” (John Bunker/ Journal of the
Royal College of Physicians)
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“The
Leading
Causes of
Health”
Part 1:
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“Our mistake is not that
we value medical care—
but that we have
misunderstood what it can
and cannot do.”
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
Smoking, excess drinking,
lack of exercise, shitty
diet: 40% of deaths
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“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
Context Change:
The Most Powerful Force (??)
Wastebaskets: Japan v
U.S.; Christchurch NZ v
Sydney AUS*
*“Broken windows”
“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
+10: Sardinians,
Adventists, Okinawans
Don’t smoke. Put family first.
Be active every day. Keep
socially engaged. Eat fruits,
vegetables, whole grains. [Other:
nuts, red wine, pecorino cheese, small portions.]
Source: National Geographic (National Institute on Aging), November 2005
“An estimated 60 to
90 percent of doctor
visits involve stressrelated complaints.”
—Newsweek/09.27.2004
Wellness
“The ‘curative model’
narrowly focuses on the goal
of cure. … From many
quarters comes evidence
that the view of health
should be expanded to
encompass mental, social
and spiritual well-being.”
Institute for the Future
“Ontario To Split
Health Ministry” —
Headline/ Globe And Mail /06.05
(New ministry will focus on
Prevention/ Wellness/Eldercare)
“Savior for the Sick”
vs.
“Partner for Good
Health”
Source: NPR
“Companies Step Up
Wellness Efforts: Rising
health costs provide
incentive to promote
healthier employee
lifestyles” —headline/USA Today/08.05
“Prevention
Program At Dow
Chemical Aims To
Save Money”
—IBD/08.05
Sprint/Overland Park KS:
Slow elevators, distant
parking lots with
infrequent buses, “food
court” as “poorly” placed
as possible, etc.
Source: New York Times
Tom’s
Story
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)
Bextra
Lipitor
Toprol
Propranolol
Aging
reversal!!!!*
*Why wasn’t I “informed”
until age 59?
“Fixes”
Diet
Extreme exercise
Meditation
Supplements
Eliminate all alcohol
(Meds)
Determinants of Health
Access to care: 10%
Genetics: 20%
Environment: 20%
Health Behaviors:
50%
Source: Institute for the Future
Planetree:
A Radical Model for New
Healthcare/Healing/Health/
Wellness Excellence
“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
“Much of our current
healthcare is about curing.
Curing is good. But healing
is spiritual, and healing is
better, because we can heal
many people we cannot
cure.” —Leland Kaiser, “Holistic Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1.
2.
3.
4.
5.
6.
7.
8.
9.
The Nine Planetree Practices
The Importance of Human Interaction
Informing and Empowering Diverse Populations:
Consumer Health Libraries and Patient Information
Healing Partnerships: The importance of Including
Friends and Family
Nutrition: The Nurturing Aspect of Food
Spirituality: Inner Resources for Healing
Human Touch: The Essentials of Communicating
Caring Through Massage
Healing Arts: Nutrition for the Soul
Integrating Complementary and Alternative Practices
into Conventional Care
Healing Environments: Architecture and Design
Conducive to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1. The Importance
of Human
Interaction
“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
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
“Perhaps the simplest and most profound
of all human interactions is KINDNESS. …
But if it is so simple, it is surprising
how frequently it is absent from our
healthcare environments. … Many
staff members report verbal
‘abuse’ by
physicians, managers and coworkers.”
—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“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)
2. Informing and
Empowering Diverse
Populations: Consumer
Health Libraries and
Patient Information
Planetree Health Resources Center/1981
Planetree Classification System
Consumer Health Librarians
Volunteers
Classes, lectures
Health Fairs
Griffin’s Mobile Health Resource Center
Open Chart Policy
Patient Progress Notes
Care Coordination Conferences (Est goals,
timetable, etc.)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
3. Healing
Partnerships: The
Importance of
Including
Friends and Family
“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
The Patient-Family Experience
“Patients are stripped of control, their clothes are taken
away, they have little say over their schedule, and they are
deliberately separated from their family and friends.
Healthcare professionals control all of the information about
their patients’ bodies and access to the people who can
answer questions and connect them with helpful resources.
Families are treated more as intruders than loved ones.”
—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“Family members, close friends
and ‘significant others’ can
have a far 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
“A 7-year follow-up of women
diagnosed with breast cancer
showed that those who confided in
at least one person in the 3 months
after surgery had a 7-year survival
72.4%
rate of
, as compared to
56.3% for those who didn’t have a
confidant.”
Sourcde: Institute for the Future
Institute of Medicine/ “Crossing the Quality Chasm”
Respect for preferences
Involvement in Decision Making
Access to care
Coordination of care
Information and education
Physical comfort
Emotional support
Involvement of Friends and Family
Continuity of care
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Care Partner Programs (IDs, discount meals,
etc.)
Unrestricted 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 Conferences
Clinical Guidelines Discussions
Family Spaces
Pet Visits (POP: Patients’ Own Pets)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
4. Nutrition: The
Nurturing Aspect
of Food
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
Kitchen
Beautiful cutlery, plates,
etc
Chef rep
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“Aroma therapy” (eg “smell
of baking cookies”)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
5. Spirituality: Inner
Resources for
Healing
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
6. Human Touch:
The Essentials of
Communicating
Caring Through
Massage
“Massage is a
powerful way to
communicate
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
ambulatory surgery (“Go into surgery with a good
attitude”)
Infant massage
Staff massage (“caring for the caregivers”)
Healing environments: chemo!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
7. Healing Arts:
Nutrition for
the Soul
Planetree: “Environment conducive to healing”
Color!
Light!
Brilliance!
Form!
Art!
Music!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
8. Integrating
Complementary and
Alternative Practices
into Conventional Care
Griffin IMC/Integrative Medicine Center
Massage
Acupuncture
Meditation
Chiropractic
Nutritional supplements
Aroma therapy
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
CAM (Complementary & Alternative Medicine):
83M in US (42%)
CAM visits 243M, greater than to PCP (Primary
Care Physician) (With min insurance coverage)
W-Educated-Hi inc
Don’t tell PCP (40%)
And: <30% procedures used in conventional
medicine have undergone RCTs (randomized
clinical trials)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
9. Healing
Environments:
Architecture and
Design Conducive
to Health
“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
Access to nurses station:
“Happen to”
vs
“Happen with”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Conclusion:
Caring/Growth
“Experience”
Care!
Control!
Connect!
Engage!
Grow!
De-stress!
Learn more about Planetree/
The Planetree Alliance:
www.planetree.org
Life Sciences
Revo Rocks
Our World*
*Coming soon to a …
“On February 12, 2001, anyone with
access to the Internet …
Could suddenly look at a new atlas …
One containing
the whole human
genome.”
Source: Juan Enriquez, As The Future Catches You
“WE ARE BEGINNING TO
ACQUIRE … DIRECT AND
DELIBERATE CONTROL …
OVER THE EVOLUTION
OF ALL LIFE FORMS …
ON THE PLANET.”
Source: Juan Enriquez, As The Future Catches You
“In a couple of decades the world’s dominant language became … strings
of ones and zeroes.
Your world … and your language …
THE DOMINANT
LANGUAGE … AND
ECONOMIC DRIVER … OF
THIS CENTURY … IS GOING
TO BE … GENETICS.”
are about to change again.
Source: Juan Enriquez, As The Future Catches You
“We face the biggest change in tens of
thousands of years in what it means to
be human.” … “In just 20 years the
boundary between fantasy and reality
will be rent asunder.” (Rodney Brooks, AIL/MIT) …
“We are at an inflection point in history.” …
“It is about the defining cultural, social,
and political issue of our age. It is about
human transformation.”
Source: Radical Evolution: The Promise and Peril of Enhancing Our
Minds, Our Bodies—and What It Means to Be Human, Joel Garreau
GRIN: Genetics,
Robotics (nanotech),
Information,
Nanotech
Source: Radical Evolution: The Promise and Peril of Enhancing Our
Minds, Our Bodies—and What It Means to Be Human, Joel
Garreau
Ray Kurzweil:
“Singularity”
415-page doc, Department
of Commerce/NSF:
Converging Technologies
for Increasing Human
Performance
Source: Radical Evolution: The Promise and Peril of Enhancing Our
Minds, Our Bodies—and What It Means to Be Human, Joel Garreau
“Soldiers having no
physical, physiological, or
cognitive limitations will
be key to survival and
operational dominance
in the future.”
—Michael Goldblatt,
Director, Defense Sciences Office/DARPA
Source: Radical Evolution: The Promise and Peril of Enhancing Our Minds,
Our Bodies—and What It Means to Be Human, Joel Garreau
“Singularity”/“Bionic Tom,”
circa 2006: Medtronic
pacemaker (heart micro-management) ;
psychotropics (mental micromanagement) ; Google (mind-extension—
smart-beyond-measure) ; Samsung
cell phone (instant-permanent
planetary connectedness) ; Orvis
shirt (“smart skin”)
“If you don’t like
change, you’re
going to like
irrelevance even
less.”
—General Eric Shinseki, Chief of Staff. U. S. Army
H5N1
“don’t
over-react”
Kroll/SARS:
Kroll/H5N1:
“devastating”
Source: Newsweek/10.24.05
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 appropriateproven alternative therapies is an important part.) (HUGE INCENTIVES FOR
EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)
Healthcare27
7. “Boomers” will determine HC’s (very different?) future.
(They are from a different & demanding planet compared to yesterday’s
Oldsters.)
8. “Focus on Women.” (It’s my generic—and correct—rallying cry,
and it applies to HC in spades, women-as-patients-with different-woes-thanmen; women-as-HC decision makers at the “consumer”—and commercial—
level.)
9. “Patient/Consumer-driven” may be a buzz phrase
bandied about all to easily … but it is true. (And changes
the game.)
10. Reduce incentives for unnecessary tests. (Malpractice
caps would help, though the issue is complex. Insurers-HMOs doing so-so
on this.)
11. OUTCOME-BASED MEDICINE IS A MUST! (There is a long,
long way to go!) (Measure until you’re blue in the face!)
12. Science-based medicine is a terrific idea!! (Many
“therapies” unproven scientifically, uneven in application when proven.)
Healthcare27
13. Over the next 5-25 years, the Life Sciences Revolution
will make the likes of the “info revolution” look like small
beer. (Get ready.)
14. Radical increase in “best practices” utilization—
inculcate in Med school!
15. Med school “revolution” imperative—outcome-based
medicine, abiding emphasis on Wellness & Prevention,
etc.
16. Get info to Patients! (HIPAA mostly good.—“I wanna see my
records!”) (Detailed hospital-by-hospital, disease-by-disease, doc-by-doc
success records a must despite controversy.)
17. Upgrade IS-IT in the entire system, starting with acutecare institutions. (Current grade: D-.) (Winners include: Indiana
Heart Hospital; Inova Fairfax Heart Institute.)
18. Healtheon WebMD-like (if it had worked) mega-,
integrated-info network will-should emerge. (A healthcare
Google+?)
Healthcare27
19. MOVE HEAVEN & EARTH TO IMPLEMENT ELECTRONIC
MEDICAL RECORDS. NOW.
20. By hook or by crook, something approximating basic
universal care, starting with kids—50 state partial
experiments is a help; some are quite far along. (“Marketbased” as much as possible—but this is far from a “perfect market.”)
21. Deal with the enormous HMO “I want my doc”
perception problem. (Fact: MARCUS WELBY, STATISTICALLY, AIN’T
THAT GREAT A HEALER IN TODAY’S “HIGH SCIENCE” WORLD!
Incidentally, same perception problem re Congress, schools. “My
Congressman is great, Congress has 434 other crook-clowns.” “My kids’
school is good, the system is awful.”)
22. Blitzkrieg of Patient/Customer/Citizen education (eg
re “outcomes-based HC”; “Get the most for your HC dollar”).
(Corporate cuts should motivate this.)
23. “Healing-centric” care supported. (E.g., Planetree model—
reduces future problems.)
Healthcare27
24. Emphasize front-to-back “customer care”
practices—cuts waaaaay down on malpractice
claims among other things.
25. Specialization in acute care works wonders,
regardless of howls! (E.g., Shouldice/hernia repair.)
26.Shorten the FDA approval process. (Tom, age 63, wants
the good new stuff and will accept associated risk; so will most
boomers-geezers.)
27.DON’T MESS AROUND WITH H5N1/AVIAN FLU!
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 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 Care
American OBESITY = African AIDs (??)
ELIMINATE/OBLITERATE HIGH FRUCTOSE
CORN SYRUP!
ELIMINATE/OBLITERATE TRANSFATS!
(HFTC/TF = The Real “WMDs”)
FDA: Kill! Kill! Kill! (Please)
CEO Bonus: 50+%: P.S./WPOCC
OBNOXIOUS labels
Incentives for BILLBOARDS
Natl Advertising Council
PARENTING education, etc.
STOP THE GRATUITOUS KILLING
STOP THE
GRATUITOUS
KILLING
STOP THE
GRATUITOUS
KILLING
STATE OF
EMERGENCY
Part 2
Tom Peters’
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.
GAMECHANGER.
Excellence1982: The Bedrock “Eight Basics”
1.
2.
3.
4.
5.
6.
7.
8.
A Bias for Action
Close to the Customer
Autonomy and Entrepreneurship
Productivity Through People
Hands On, Value-Driven
Stick to the Knitting
Simple Form, Lean Staff
Simultaneous Loose-Tight
Properties”
ExIn*: 1982-2002/Forbes.com
DJIA: $10,000 yields $85,000
EI: $10,000 yields $140,050
*Forbes/Excellence Index /Basket of 32 publicly traded stocks
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.
An emotional,
vital, innovative, joyful, creative,
entrepreneurial endeavor that
elicits maximum concerted
human potential in the
wholehearted service
of others.***
Business* ** (*at its best):
**Excellence. Always.
***Employees, Customers, Suppliers, Communities, Owners, Temporary partners
The
Ultimate
Business:
Creative
Endeavor.
The
Ultimate
Business:
Personal
DevelopmentGrowth
Experience.
The
Ultimate
Business:
Transcendent
Service
Opportunity.
EXCELLENCE.
YOU & ME.
“This is the true joy of Life, the
being used for a purpose
recognized by yourself as a
mighty one … the being a force of
Nature instead of a feverish,
selfish little clod of ailments
and grievances complaining that
the world will not devote itself
to making you happy.”
—GB Shaw/Man and Superman
“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.
“A focus on cost-cutting and efficiency has
helped many organizations weather the
downturn, but this approach will ultimately
Only the
constant pursuit of
innovation can ensure
long-term success.”
render them obsolete.
—Daniel Muzyka, Dean, Sauder School of Business,
Univ of British Columbia (FT/09.17.04)
“Forbes100” from 1917 to 1987: 39
members of the Class of ’17 were
alive in ’87; 18 in ’87 F100; 18 F100
“survivors” underperformed the
market by 20%; just 2 (2%), GE
& Kodak, outperformed the
market 1917 to 1987.
S&P 500 from 1957 to 1997: 74 members of the Class of ’57 were
alive in ’97; 12 (2.4%) of 500 outperformed the market from 1957 to
1997.
Source: Dick Foster & Sarah Kaplan, Creative Destruction:
Why Companies That Are Built to Last Underperform the Market
“I am often asked by would-be entrepreneurs
seeking escape from life within huge corporate
structures, ‘How do I build a small firm for
Buy
a very large one
and just wait.”
myself?’ The answer seems obvious:
—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)
2/50*
*Scott Bedbury/Starbucks/<1%/<4 of 400/
grabbed best/all wanted to be there/2%-50%
“This is so simple it sounds stupid, but it is amazing
you
only find oil if you
drill wells.
how few oil people really understand that
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
It gets back to planning
versus acting: We act from day
one; others plan how to plan—
for months.” —Bloomberg by Bloomberg
No. 10.
Culture of Prototyping
“Effective prototyping may be
the most valuable core
competence an innovative
organization can hope to have.”
Michael Schrage
Demos!
Heroes!
Stories!
“Never doubt that a
small group of
committed people
can change the
world. Indeed it is
the only thing that
ever has.”
—Margaret Mead
You only find
oil if you drill
wells.
—T he Hunters, by John Masters,
Canadian O & G wildcatter
“FAIL, FAIL
AGAIN. FAIL
BETTER.”
—Samuel Beckett
“The secret of fast
progress is
inefficiency, fast
and furious and
numerous failures.”
—Kevin Kelly
EXCELLENCE.
4/40.
De-central-iza-tion!
Ex-ecu-tion!
“We have a
‘strategic plan.’
It’s called doing
things.”
— Herb Kelleher
“Execution is
the job of the
business
leader.”
—Larry Bossidy & Ram Charan/
Execution: The Discipline of Getting Things Done
Ac-counta-bil-ity!
“GE has set a standard
of candor. … There is no
puffery. … There isn’t an
ounce of denial in the
place.” —Kevin Sharer, CEO Amgen,
on the “GE mystique” (Fortune)
6:15A.M.
????????
Work Hard >
Work Smart
EXCELLENCE.
WANTING.
This is not a
“mature
category.”
This is an
“undistinguished
category.”
EXCELLENCE.
DRAMATIC.
DIFFERENCE.
DOABLE.
$415/SqFt/Wal*Mart
$798/SqFt/Whole
Foods
7X. 730A800P.
F12A.*
*’93-’03/10 yr annual return: CB: 29%; WM: 17%;
HD: 16%. Mkt Cap: 48% p.a.
“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.
#1.
Cirque
du Soleil!
And the Winner is …
1. Audacity of Vision
2. Innovation/R&D/Design
3. Talent Acquisition & Development
4. Resultant “Experience”
5. Strategic Alliances
6. Operations
7. Financial Management
8. Overall/Sustaining Excellence
9. “Wow!”
10. Lovemark!
EXCELLENCE.
OPPORTUNITY.
“Women are
the majority
market”
—Fara Warner/The Power of the Purse
“Forget China,
India and the
Internet: Economic
Growth Is Driven
by Women.”
—Headline, Economist,
April 15, Leader, page 14
The Perfect Answer
Jill and Jack buy
slacks in black…
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.
“Goldman Sachs in Tokyo has
developed an index of 115
companies poised to benefit from
women’s increased purchasing
power; over the past decade the
value of shares in Goldman’s
basket has risen by 96%, against
the Tokyo stockmarket’s rise of
13%.” —Economist, April 15
EXCELLENCE.
OPPORTUNITY.
2000-2010 Stats
18-44: -1%
55+: +21%
(55-64: +47% )
44-65: “New
Customer
Majority” *
*45% larger than 18-43; 60% larger by 2010
Source: Ageless Marketing, David Wolfe & Robert Snyder
EXCELLENCE.
VALUE ADDED.
The
[Only?]
Answer
PSF
(Professional Service Firm “model”/The Organizing Principle)
+
Brand You
(“Distinct” or “Extinct”/The Talent)
+
Wow! Projects
(“Different” vs “Better”/The Work)
Chicago:
HRMAC
“support
function” / “cost
center”/
“overhead”
or …
Are you …
“Rock
Stars of the
Age of
Talent”
Department Head
to …
Managing Partner,
IS [HR, R&D, etc.] Inc.
EXCELLENCE.
ATTITUDE.
TRANSFORMATION.
Cost
(at All Costs*) Minimization
Professional?
Or/to: Full Partner-
“Purchasing Officer” Thrust #1:
Leader in Lifetime
Value-added
Maximization?
(*Lopez: “Arguably ‘Villain #1’ in GM tragedy”/Anon VSE-Spain)
HCare CIO: “Technology
Executive” (workin’ in a hospital)
Full-scale,
Accountable (life or death)
Member-Partner of XYZ
Hospital’s Senior
Or/to:
Healing-Services
Team
(who happens to be a techie)
EXCELLENCE.
EXPERIENCE IT.
“Experiences are
as distinct from
services as services
are from goods.”
—Joe Pine & Jim Gilmore, The Experience Economy:
Work Is Theatre & Every Business a Stage
“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
The Value-added Ladder/Memorable Connection
Spellbinding
Experiences
Gamechanging Solutions
Services
Goods
Raw Materials
C
*Chief e
O*
Xperience Officer
EXCELLENCE.
THE STORY.
“Storytelling
is the core
of culture.”
—Branded Nation: The Marketing of Megachurch,
College Inc., and Museumworld, James Twitchell
C
O*
*Chief Storytelling Officer
EXCELLENCE.
K.I.S.S.
450/8
“I wanted GE to operate with
the speed, informality, and open
communication of a corner
store. Corner stores often have
strategy right. With their limited
resources, they have to rely on
laser-like focus on doing one
thing very well.”
—Jack Welch/Fortune/04.05
“The art of war does not
require complicated
maneuvers; the simplest are
the best, and common sense
is fundamental. From which
one might wonder how it is
generals make blunders; it is
because they try to be
clever.” —Napoleon on Simplicity, from
Napoleon on Project Management by Jerry Manas.
EXCELLENCE.
BEDROCK.
“Management has a lot to do with
answers. Leadership is a function of
questions. And the first question for a
‘Who do
we intend to be?’
leader always is:
Not ‘What are we going to do?’ but
‘Who do we intend to be?’”
—Max De Pree, Herman Miller
EXCELLENCE.
PASSION.
“Nothing is so
contagious as
enthusiasm.”
—Samuel Taylor Coleridge
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
Our Mission
To develop and manage talent;
to apply that talent,
throughout the world,
for the benefit of clients;
to do so in partnership;
to do so with profit.
WPP
From
sweaters to …
Les Wexner:
people!
“Leaders
‘do’ people.
Period.”
—Anon.
DD$21M
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.
EXCELLENCE.
BEDROCK.
“The key difference between
checkers and chess is that in
checkers the pieces all move
the same way, whereas in chess
all the pieces move differently.
… Discover what is unique
about each person and
capitalize on it.” —Marcus Buckingham,
The One Thing You Need to Know
“The one thing you need
to know about sustained
individual success:
Discover what you don’t
like doing and stop doing
it.” —Marcus Buckingham, The One Thing You Need to
Know
EXCELLENCE.
WOMEN.
RULE.
“AS
LEADERS,
WOMEN
RULE:
New Studies find that
female managers outshine their male
counterparts in almost every measure”
Title, Special Report/BusinessWeek
EXCELLENCE.
BEDROCK.
X.Step #1:
Buy a Mirror!
“The First step in a
‘dramatic’ ‘organizational
change program’ is
obvious—dramatic personal
change!” —RG
“You must
be
the change you wish
to see in the world.”
Gandhi
MBWA*
*HS/25+
EXCELLENCE.
LEADING.
Leadership23
Leadership23
1. Enthusiasm. Energy. Exuberance.
2. Action. Execution.
3. Tempo. Metabolism.
4. Relentless.
5. Master of Plan B.
6. Accountability.
7. Meritocracy.
8. Leaders “do” people. Mentor. (“Success creation business.”)
9. Women. Diversity.
10. Integrity. Credibility. Humanity. Grace.
11. Realism.
12. Cause. Adventures. Quests.
13. Legacy.
14. Best story wins.
15. On the edge. (“Wildest chimera of a moonstruck mind.”)
16. “Reward excellent failures. Punish mediocre successes.”
17. Different > Better. (“Only ones who do what we do.”)
18. MBWA. Customer MBWA.
19. Laughs.
20. Repot. Curiosity. Why?
21. You = Calendar. “To Don’t.” Two.
22. Excellence. Always.
23. Nelsonian! (“Other admirals more afraid of losing
than anxious to win.”)
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
“Beware of the tyranny
of making Small Changes
to Small Things. Rather,
make Big Changes to
Big Things.”
—Roger Enrico, former Chairman, PepsiCo
“Reward excellent
failures. Punish
mediocre
successes.”
Phil Daniels, Sydney exec
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!
EXCELLENCE.
TRANSCENDENCE.
THRILLS.
Radically Thrilling Language!
“Radically
Thrilling.”
—BMW Z4 (ad)
C
O*
*Chief Thrills Officer
Synonyms
Purity
Transcendence
Virtue
Elegance
Majesty
Antonyms
Mediocrity
C
O*
*Chief Transcendence Officer
EXCELLENCE.
WOW. NOW.
“It’s always
showtime.”
—David D’Alessandro, Career Warfare
C
O*
*Chief WOW Officer
C
*Chief
O
!
Officer
EXCELLE
ALWAYS
Bonus
The
Irreducible209
A frustrated participant at a seminar for investment bankers in Mauritius listened
impatiently to my explanation of differences of opinion among me, Mike Porter,
“What,
if anything,” he asked,
“do you believe ‘for
sure’?”
Gary Hamel, Jim Collins, etc. Finally, he’d had enough.
I mumbled something, but his query started rumbling
around in my mind. Three days later, wandering on a Sunday in London, the idea of
“the irreducibles” occurred to
me—and I started jotting down notes on stuff I do indeed believe “for sure.” Before
I knew it, a few days later, the list had grown to 209 items. Hence “The
Irreducible209” that follows.
Tom Peters
1.
2.
3.
4.
Hare 1, Tortoise 0. (Hare-y times.)
Tempo. (O.O.D.A.)
MBWA.
Appreciation. (“Motivator” #1.)
(Can’t be faked. Good.)
5. Decency.
6. Hurry.
7. Time out.
8. One matters.
9. Big change. Short time. (Alt not work.)
10. Excellence. Always.
11. Passion. Energy. Hustle. Enthusiasm.
Exuberance. (Move mountains. No alt.)
12. You must care.
13. Emotion.
14. Hard is soft. (Soft is hard.)
15.
16.
17.
18.
19.
20.
21.
22.
23.
Men. Women. Different. Contend. Connect.
Women. Buy. All. (RU listening?)
Quality. (“Mind-blowing.” Beyond 6-Sigma.)
Re-invent. Re-pot. (Required.)
Jaywalk.
Big change. Small # of people. (Always.)
Experiment. Now.
Failure. Normal.
Most failures, most success.
(Fail. Forward. Fast.)
24. “Reward excellent failures. Punish
mediocre successes.”
25. Women leaders. (Altered times.)
26. Extremism. (Good business. Bad politics.)
27. Innovation source. Only. Extreme irritation.
28. Smile.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
You must care.
Mentor. (Highest ROI.)
Best “roster” wins.
Wow. (Okay in biz.)
We all have customers. (Biz. Personal.)
All contacts = Experiences.
Cirque du Soleil. (Peerless.)
Leaders create space for growth.
Quests. (Only.)
High aspirations, “high” results.
(Self-fulfilling prophecy.)
39. Attitude 1, Skills 0. (Mostly.)
(Attitude 1, Skill 0.3?)
40. Sometimes: Skill 1, Attitude 0.1.
41. Must “love,” not “like.”
42. Wegman’s.” (No excuses. “Mere” groceries.)
43. Less than your best. Cheating.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
Brand You. (No alt.)
Self-sufficiency. (Biggest LT turn-on.)
In the moment.
The moment wins.
Tomorrow = Never.
Action 1, Plan 0.1.
“Execution” can be a “system.”
Realism.
Own up. Move on.
Accountability.
Work hard > Work smart. (Mostly.)
Feedback. Necessary. Fast. (R.F.A. in
“RFA times.”)
56. Customers. Listen. Lead. (Paradox.)
57. “On stage.” Always. (GW, FDR, RG =
Supreme actors.)
58.
59.
60.
61.
62.
63.
64.
65.
66.
Master statistical analysis.
Excellence = Set the table.
Legacy. (Will it have mattered?)
“Great.” (Why not?)
Radicals rule. (Think … Olympics.)
!!! = Good.
Red 1, Brown 0. (Red times.)
Talk. Listen. (“Big 2.” Master.)
Politics. (Normal-inevitable state
of affairs. Master.)
67. Student. Forever.
68. “Why?” (Question #1.)
69. Don’t belittle.
70. Respect.
71. All we have: this moment.
(“Moments matter most”?)
72. Now. (Procrastination. Death.)
73.
74.
75.
76.
Exercise.
Paint. (Leader. Portraits of Excellence.)
Best story wins.
“You must be the change you wish
to see in the world.”
77. Two “big ones.” Max. (Priorities.)
78. No “I” in Team. (“I” in Win.)
79. “I” in Win. (No “I” in Team.)
80. Different 1, Better 0. (Better = 0.1)
81. Imitation = Mistake. (Learn, from who?)
82. Choose/battle the “right” competitor.
83. Schools. Creativity. Entrepreneurship.
(Not.)
84. MBAs. Creativity. Entrepreneurship.
Leadership. (Not.)
85. Design. Under-rated. Wildly.
(Still.) (Everything.)
86.
87.
88.
89.
You = Calendar. (Calendar. Never. Lies.)
Laugh.
Handshake. (Quantity. Quality.)
Don’t fold your hands in front of your
chest. Ever. (Never.)
90. Grace. (“Works” in biz.)
91. Weird. Wins. (Weird times.)
92. Crazy times. Crazy orgs.
93. Internet. All.
94. Women. Boomers-Geezers. Market. All.
95. Passion.
(Repeat. So what?)
96. Energy.
(Repeat. So what?)
97. Hustle.
(Repeat. So what?)
98. Enthusiasm. (Repeat. So what?)
99. Exuberance. (Repeat. So what?)
100. Smile.
(Repeat. So what?)
101. Care.
(Repeat. So what?)
102. Simplicity. Redundancy. Resilience. Bloodymindedness. Visible optimism. (Success.)
103. Act. (Repeat. So what?)
104. Appreciate. (Repeat. So what?)
105. Fun. (Biz. Why not?)
106. Joy. (Biz. Why not?)
107. Sales = Life.
108. Marketing = Life.
109. Long-term. “Top line.”
110. Great company = Creates the most
individual success stories. (RE/MAX)
111. Talent first, performance byproduct.
112. Sustained Wow* 1, “Shareholder
value,” 0.2 (*Product, People.)
113. Commitment, by invitation only.
114. Creativity, by invitation only.
115. HR = #1. (Ought to.)
116. Face-to-face. (5K miles, 5 minutes.)
117. Negotiation. Make all winners.
(Save face.)
118. Grace makes enemies friends.
119. Network.
120. Invest in relationships. (Think ROIR.
Return On Investment in Relationships.)
118. Relationship investment. Forethought.
Calendar item. Intensity.
119. Innovation. Easy. (Hang out
with weird.)
120. Weird = Win. (Weird times.)
121. “The bottleneck is at the top
of the bottle.”
122. Good Board = Weird Board.
(At least, surprising.)
123. No contention, no progress.
124. “Crucial conversations.” “Crucial
confrontations.” (Study. Learn. Do.)
125. Honest feedback.
126. Gaspworthy. Yes.
127. “Insanely great.”
128. “Astonish me.”
129. “Make it immortal.”
130. “Will you remember it in 20 years?”
131. No small opportunities. (Reframe.)
132. One playmate, one playpen = Enough.
133. End run. Sensible.
134. Allies are there for the finding.
135. Find successes. Build on successes.
(Pos > Neg. Encourage > Fix.)
136. Somebody’s doing it today. Find ’em.
137. Someone is living 2016 in 2006.
(Find ’em. Study ’em.)
138. Don’t “benchmark,” “futuremark.”
(2016. Happening. Somewhere.)
139. “PMA.” It works.
140. There are no experts. (You are the expert.)
141. Life is short.
142. “Sustained success.” Fat chance.
Make today matter. (“Sustained.” Ha.)
143. Collaborate. (Networked world.)
144. Go solo. (Individual. Unit of
Intellectual Capital.)
145. There are no “perfect” plans. (Do. Wins.)
146. Plans motivate. (Right or wrong.
Sense of purpose.)
147. Never rest.
148. Get some sleep.
149. Winning = Embracing paradox.
150. Ambiguity = Opportunity.
151. Resilience.
152. Relentless-ness.
153. None. Above. Comeuppance.
(GM. Sears. U.S. Steel. DEC.)
154. Be yourself. Period.
155. Never work with jerks. Including
customers. (Life. Too short.)
156. Under-promise, over-deliver.
157. Talent. (Powerful word.)
158. “Customer = Anyone whose actions
affect your results.”
159. Competition stinks. (Seek the soft
spots where you can dominate.)
160. K.I.S.S./Keep It Simple, Stupid.
161. Beauty. (Good biz word.)
162. “See the beauty in a hamburger bun.”
(Go. Ray.)
163.
164.
165.
166.
Own up. Quick. ( Denial. Cancer.)
Celebrate. Often.
78 people = 78 approaches. (Each. Unique.)
Weed. Ceaselessly. (Prune. Stupid.
Rules. Non-stop.)
167. Get out of the way. (You = The problem.)
168. Smile. Sunny. Optimism. (If it kills you.)
169. Flowers. (Cheery workplace.)
170. Enjoy. (Or get the hell.)
171. Be intolerant of “sour.” (1 = Major pollution)
172. No “quick trigger” on promotion.
(Too important.)
173. Evaluation = Lots of study-time.
174. Evaluation = “Life or death” to evaluee.
175. “360” evaluation. No fad.
176. Exit when you’re done. (Done.
Sooner than you think.)
177. Today. Now. My Project. Am. Is. I. Period.
178. “Beautiful” systems. (Good biz phrase.
Not oxymoron.)
179. Build on strengths > Fix weaknesses.
180. “To don’t” = “To do.” (“To don’t” >
“To do” ?)
181. Leaders “Do” People. (Period.)
182. Leaders enjoy leading.
183. Serious leadership training = Serious.
184. Priorities. Obvious. (Or else.)
185. 5 “Priorities” = 0 Priorities.
(3 “Priorities” = 0 Priorities?)
186. People. First. Last. Always.
187. It. Is. Always. The. People.
188. Handshake. (Quantity. Quality.)
189. Don’t fold your hands in front of
your chest. Ever. (Never.)
190. Simplicity. Redundancy. Resilience.
Bloody-mindedness. Visible
optimism. (Success.) (Repeat.)
191. Employee Entrance = Guest
Entrance.
192. Put the customer SECOND.
(Thanks, Hal.)
193. Flowers. (Or did I say that before?
No matter if I did.)
194. Big Mergers don’t work. Small
acquisitions can/do work—if you
don’t screw with their energy.
195. Instinctively “head for the front
line.” (In all contexts.)
196. Success = DDMMPR/"D-squared,
M-squared, PR” = DramDiff +
Money-Financial Acumen + Good
“Marketing” Instincts + Stellar People
+ Resilience (The “fab five”: What.
Every. Small. Biz. Needs.) (Big too.)
197. Core Mechanism (“Game-changing
Solutions”): PSF (Professional Service
Firm “model”) + Wow! Projects
(“Different” vs “Better”) + Brand You
(“Distinct” or “Extinct”)
198. 2011/2016 has already happened.
Find it.
199. Kids “know” kids. Oldies “know” oldies.
Women “know” women. (Staff
accordingly.)
200. Everybody is my customer.
201. Cosset “vendors.”
202. I want to run a Housekeeping department.
(And you?)
203. The military doesn’t follow the “military
model.” (Initiative = Excellence.)
204. No such thing as “going to absurd lengths”
to serve the Customer. (HSM & Lefties.)
205. Forget the “customer.” All = “Clients.”
206. It takes decades to get over “sleights.”
(So don’t sleight.)
207. Don’t “dumb down.” Ever.
NO LESS THAN
EXCELLENCE.
EVER.
209. EXCELLENCE.
ALWAYS.
208.
Work In Progress
XXX. One size fits. One. Only. (Evaluations. Period.)
XXX. Teaching. Individualized. Only. (6 billion people =
6 billion learning trajectories.) (Montessori.)
XXX. First impression. Matters. Shapes all that comes.
Hard to overcome. (Understatement.)
XXX. Jerks. Don’t work with. (Life = Too short.)
XXX. Manage [the hell out of] first impressions.
XXX. Last impression. Matters. Dominates memory.
Hard to overcome. (Understatement.)
XXX. Manage [the hell out of] last impressions.
XXX. Plain English.
XXX. K.I.S.S. (450/8.)
XXX. $798. $55,000,000,000. 3,000,000,000.
7AM-7PM. 6:15AM.
XXX. Donnelly Weatherstrip rules.
XXX. Managers do things right. Leaders do the
right thing. NOT.
EXCELLENCE.
ALWAYS.