Tom Peters’
Re-Imagine2006!
Business Excellence
in a Disruptive Age
Aetna National Accounts 2006 Consultants
Forum/Laguna Niguel/01March2006
1
Tom Peters’
Re-imagine!
Toward
Health(care)
Excellence!
1
January
February
Duke
April
.
.
.
Tom Peters’
Re-imagine!
Toward
Health(care)
Excellence!
Aetna National Accounts 2006 Consultants
Forum/Laguna Niguel/01Duke2006/Part #1
1
Re-imagine!
Not Your
Father’s
World I.
1
THREE
BILLION NEW
CAPITALISTS
—Clyde Prestowitz
1
m
1
h
1
THE CUSTOMER IS
GOD AND THE
MARKET DECIDES
EVERYTHING
Source: Banner, Hua Xin Dress Co, Ltd., Rongcheng Industry Zone
1
Re-imagine!
Not Your
Father’s
World II.
1
“There is no job that
is America’s God-given
right anymore.”
—Carly Fiorina/HP/January2004
1
“Income Confers
No Immunity as
Jobs Migrate”
—Headline/USA Today/02.2004
1
No Limits?
“Short on Priests,
U.S. Catholics
Outsource Prayer to
Indian Clergy”
—Headline,
New York Times/06.13.04 (“Special intentions,”
$.90 for Indians, $5.00 for Americans)
1
“In a global economy, the
government cannot give
anybody a guaranteed
success story, but you
can give people the tools
to make the most of their
own lives.”
—WJC, from Philip Bobbitt, The
Shield of Achilles: War, Peace, and the Course of History
1
The General’s
Story.
(And Harry’s) (And Darwin’s)
(And James Yorke’s) (And the Admiral’s.)
1
“If you don’t like
change, you’re
going to like
irrelevance even
less.”
—General Eric Shinseki, Chief of Staff. U. S. Army
1
“It is not the strongest
of the species that
survives, nor the most
intelligent, but the one
most responsive
to change.” —Charles Darwin
1
“[Other]
admirals more
frightened of
losing than anxious
to win”
Nelson’s secret:
1
My Story.
(And
Charles’.)
1
Point of
View!/Point of
Dramatic
Difference!
1
1. Re-imagine
Permanence: The
Naked Emperor
Problem!
1
“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
1
“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
1
De-central-iza-tion!
Ex-ecu-tion!
Ac-counta-bil-ity!
6:15A.M.
2. Re-imagine:
Innovate or Die!
1
No Option!
1
Innovate
or
Die!!
1
Brilliant!
1
“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/2004)
1
“Under his former boss, Jack Welch, the skills GE prized
above all others were cost-cutting, efficiency and dealmaking. What mattered was the continual improvement
of operations, and that mindset helped the $152 billion
industrial and finance behemoth become a marvel of
earnings consistency. Immelt hasn’t turned his back on
But in his GE, the
new imperatives are risktaking, sophisticated
marketing and, above all,
innovation.”
the old ways.
—BW/2005
1
Different!*
*“Dramatic Difference” (DH), “Remarkable Point of view” (SG)
1
Franchise Lost!
TP:
“How many of you
really
[600]
crave
a new Chevy?”
NYC/IIR/061205
1
This is not a
“mature
category.”
1
This is an
“undistinguished
category.”
1
My (Les’s) Dinner with Henri
JUSTWHATIZZITUMAKE?
1
???????????
Millionaires/Decimillionaires talk about
“shareholder value.”*
Billionaires talk about
“product.”**
*BigCo CEOs
**Gates, Ellison, Jobs, Smith, Branson,
Buffett, Walton, Schultz, Murthy
1
“To grow, companies need
to break out of a vicious
cycle of competitive
benchmarking and
imitation.”
—W. Chan Kim & Renée Mauborgne,
“Think for Yourself —Stop Copying a Rival,” Financial Times/2003
1
“The ‘surplus society’ has a surplus
of
similar companies, employing
similar people, with similar
educational backgrounds, coming up
similar ideas, producing similar
things, with similar prices and similar
with
quality.” —Kjell Nordström and Jonas Ridderstråle,
Funky Business
1
“Get better”
vs
“Get different”
1
Summary:
WallopWal*Mart16*
*Or: Why it’s so unbelievably easy
to beat a GIANT Company
1
The “Small Guys” Guide: Wallop Wal*Mart16
*Niche-aimed. (Never, ever “all things for all people,” a “miniWal*Mart.)
*Never attack the monsters head
niche business and lukewarm customers.)
*“Dramatically
on! (Instead steal
Different”
(La Difference ... within our community, our industry regionally, etc
… is as obvious as the end of one’s nose!) (THIS IS WHERE MOST
MIDGETS COME UP SHORT.)
*Compete
on value/experience/intimacy, not
price. (You ain’t gonna beat the behemoths on cost-price in 9.99
out of 10 cases.)
*Emotional bond with Clients,
BIGGIES ON EMOTION/CONNECTION!!)
Vendors. (BEAT THE
1
The “Small Guys” Guide: Wallop Wal*Mart16
*Hands-on, emotional leadership. (“We are
a great & cool & intimate & joyful & dramatically
different team working to transform our Clients lives
via Consistently Incredible Experiences!”)
*A community star! (“Sell” local-ness per se.
Sell the hell out of it!)
*An
incredible experience, from the first
to last moment—and then in the followup! (“These guys are cool! They ‘get’ me! They love
me!”)
*DESIGN DRIVEN! (“Design” is a premier
weapon-in-pursuit-of-the sublime for small-ish
enterprises, including the professional services.)
1
The “Small Guys” Guide: Wallop Wal*Mart16
*Employer of choice. (A very cool, well-paid
place to work/learning and growth experience in at
least the short term … marked by notably progressive
policies.) (THIS IS EMINENTLY DO-ABLE!!)
*Sophisticated
use of information
technology. (Small-“ish” is no excuse for “small
aims”/execution in IS/IT!)
*Web-power! (The Web can make very small very
big … if the product-service is super-cool and one
purposefully masters buzz/viral marketing.)
*Innovative! (Must keep renewing and expanding
and revising and re-imagining “the promise” to
employees, the customer, the community.)
1
The “Small Guys” Guide: Wallop Wal*Mart16
*Brand-Lovemark* (*Kevin Roberts) Maniacs!
(“Branding” is not just for big folks with big budgets.
And modest size is actually a Big Advantage in
becoming a local-regional-niche “lovemark.”)
*Focus on
How stupid.)
women-as-clients. (Most don’t.
*Excellence! (A small player … per
me … has no right or reason to exist unless they are in
Relentless Pursuit of Excellence. One earns the right—
one damn day and client experience at a time!—to beat
the Big Guys in your chosen niche!)
1
Easy!
1
FLASH!
Innovation
is easy!
1
Innovation’s Saviors-in-Waiting
Disgruntled Customers
Off-the-Scope Competitors
Rogue Employees
Fringe Suppliers
Wayne Burkan, Wide Angle Vision: Beat the Competition by Focusing on
Fringe Competitors, Lost Customers, and Rogue Employees
1
CUSTOMERS: “Futuredefining customers may
account for only 2% to 3%
of your total, but they
represent a crucial
window on the future.”
Adrian Slywotzky, Mercer Consultants
1
“How do dominant
companies lose their
position? Two-thirds of
the time, they pick the
wrong competitor to
worry about.”
—Don Listwin, CEO,
Openwave Systems/WSJ/06.01.2004 (commenting on Nokia)
1
“Don’t
benchmark,
futuremark!”
Impetus: “The future is already here; it’s just
not evenly distributed” —William Gibson
1
Employees: “Are
there
enough weird
people in the lab
these days?”
V. Chmn., pharmaceutical house, to a lab director
1
We become
who we hang
out with!
1
Measure “Strangeness”/Portfolio Quality
Staff
Consultants
Vendors
Out-sourcing Partners (#, Quality)
Innovation Alliance Partners
Customers
Competitors (who we “benchmark” against)
Strategic Initiatives
Product Portfolio (LineEx v. Leap)
IS/IT Projects
HQ Location
Lunch Mates
Language
Board
1
Bold!
1
No Wiggle Room!
“Incrementalism
is innovation’s
worst enemy.”
Nicholas Negroponte
1
Just Say No …
“I don’t intend to be
known as the ‘King of
the Tinkerers.’ ”
CEO, large financial services company
1
CI/6S/Etc Concerns
Olives
Deck Chairs
Cow Paths
1
On a Scale of 1 to 10*
My main activity is a DeckChair Shuffling, Cow-Path
Paving, Olive- Reducing
Project (DCSP, CPPP, ORP)
____
* 1 = No way! 10 = ’Fraid so.
1
“Beware of the tyranny
of making Small Changes
to Small Things. Rather,
make Big Changes to
Big Things.”
—Roger Enrico, former Chairman, PepsiCo
1
“Reward excellent
failures. Punish
mediocre
successes.”
Phil Daniels, Sydney exec
1
Action!
1
“Execution is
the job of the
business
leader.”
—Larry Bossidy & Ram Charan/
Execution: The Discipline of Getting Things Done
1
“Execution is a
systematic
process
of rigorously
discussing hows and whats, tenaciously
following through, and ensuring
accountability.”
—Larry Bossidy & Ram Charan/ Execution: The Discipline of Getting Things Done
1
P+M=G
1
Measurable!
1
Innovation Index: How many
of your Top 5 Strategic
Initiatives/Key Projects
score 8 or higher (out of 10) on a
“Weirdness”/ “Profundity”/
“Wow”/ “Gasp-worthy”/
“Game-changer” Scale?
1
Personal!
1
Step #1:
Buy a
Mirror!
1
“The First step in a
‘dramatic’ ‘organizational
change program’ is
obvious—dramatic personal
change!” —RG
1
3. Re-imagine
Organizing I: IS/IT
as Disruptive
Tool!
1
We all live in
Dell-Wal*MarteBay-Google
World!
1
“UPS used to be a trucking company
Now it’s
a technology
company with
trucks.”
with technology.
—Forbes
1
“Our entire facility is digital. No paper, no
film, no medical records. Nothing. And it’s all
integrated—from the lab to X-ray to records to physician
order entry. Patients don’t have to wait for anything. The
information from the physician’s office is in registration
and vice versa. The referring physician is immediately
sent an email telling him his patient has shown up. … It’s
wireless in-house. We have 800 notebook computers that
are wireless. Physicians can walk around with a
computer that’s pre-programmed. If the physician wants,
we’ll go out and wire their house so they can sit on the
couch and connect to the network. They can review a
chart from 100 miles away.” —David Veillette, CEO, Indiana
Heart Hospital (HealthLeaders/12.2002)
1
“Ebusiness is about
rebuilding the organization
from the ground up. Most
companies today are not built to exploit the
Internet. Their business processes, their
approvals, their hierarchies, the number of
people they employ … all of that is wrong
for running an ebusiness.” —Ray Lane,
Kleiner Perkins
1
Power Tools
for Power
Solutions/
Strategies!
—TP
1
Sysco!
1
Go for the Bold
*Bold/Aggressive/$$$$
* Bold/GameChanger
* Bold/Creative Destruction
* Bold/“Cool” Supplier
Portfolio
* Bold/Web Fanaticism
1
5% F500 have
CIO on Board:
“While
some of the world’s most admired companies—
Tesco, Wal*Mart —are transforming the
business landscape by including technology
experts on their boards, the vast majority are
missing out on ways to boost productivity,
competitiveness and shareholder value.”
Source: Burson-Marsteller
1
4. Re-imagine
Organizing II: What
Organization?
1
“Organizations will still
be critically important
in the world, but as
‘organizers,’ not
‘employers’!”
— Charles Handy
1
TP In Nagano …
Revenue: $10B
FTE: 1*
*Maybe
1
Not “out sourcing”
Not “off shoring”
Not “near shoring”
Not “in sourcing”
but …
“Best Sourcing”
1
“global innovation
networks”
vs
“research in large
monolithic companies”
Source: George Colony/Forrester Research
1
st
21
“In the
century
we’ll see a rise
of invention
companies [earning
licensing fees].
”
—Nathan Myhrvold, Forbes, 11.05
1
5. Re-imagine
Organizing III:
Welcome to a
You
Brand
World …
Distinct or Extinct
1
“One of the defining characteristics
[of the change] is that it will be less driven
by countries or corporations and
more driven by real people. It will
unleash unprecedented creativity,
advancement of knowledge, and
economic development. But at the
same time, it will tend to undermine
safety net systems and penalize the
unskilled.” —Clyde Prestowitz, Three Billion New Capitalists
1
R.D.A.
Rate: 15%?, 25%?
Therefore: Formal “Investment
Strategy”/
R.I.P.*
*Renewal Investment Plan
1
Have you invested as
much this year in
your career as in
your car?
Source: Molly Sargent
1
New Work SurvivalKit2006
1. Mastery! (Best/Absurdly Good at Something!)
2. “Manage” to Legacy (All Work = “Memorable”/“Braggable”
WOW Projects!)
3. A “USP”/Unique Selling Proposition (R.POV8: Remarkable Point
of View … captured in 8 or less words)
4. Rolodex Obsession (From vertical/hierarchy/“suck up” loyalty to
horizontal/“colleague”/“mate” loyalty)
5. Entrepreneurial Instinct (A sleepless … Eye for Opportunity!
E.g.: Small Opp for Independent Action beats faceless part
of Monster Project)
6. CEO/Leader/Businessperson/Closer (CEO, Me Inc. Period! 24/7!)
7. Mistress of Improv (Play a dozen parts simultaneously, from
Chief Strategist to Chief Toilet Scrubber)
8. Sense of Humor (A willingness to Screw Up & Move On)
9. Comfortable with Your Skin (Bring “interesting you” to work!)
10. Intense Appetite for Technology (E.g.: How Cool-Active is your
Web site? Do you Blog?)
11. Embrace “Marketing” (Your own CSO/Chief Storytelling Officer)
12. Passion for Renewal (Your own CLO/Chief Learning Officer)
13. Execution Excellence! (Show up on time! Leave last!)
1
Distinct … or
… Extinct
1
“It’s always
showtime.”
—David D’Alessandro, Career Warfare
1
100 WAYS TO SUCCEED #35: Lovemark or Bust!
(1) Enjoy your the Holiday Season!
(2) Between now and 1JAN2005, invent 10 actions, solo or with
pals, to Launch Your “Lovemark Journey2005.”
(3) Focus directly—Architect or Lawyer or Realtor—on the following
“KRWs”/Kevin Roberts Words: Mystery … Magic … Sensuality …
Enchantment … Intimacy … Exploration.
(3A) The words in #3 above Do Apply to You!
(4) Develop a “No Bull” Action Schedule that includes 2 Hard First
Steps by 10JAN05, 5 Hard First Steps by 01FEB05.
(5) Report back to this Website, tompeters.com.
Pronunciamento: I HEREBY DESIGNATE, IN ACCORDANCE WITH
THE POWERS GRANTED TO ME (the Inalienable Right To Blog)
THAT 2005 IS PROCLAIMED AS “THE YEAR OF THE
PROFESSIONAL SERVICE LOVEMARK.”
Welcome aboard!
Source: TPBlog/12.17.2004
1
6. Re-imagine
Organizing IV: The
Talent
Obsession.
1
“The Creative Age
is a wide-open
game.”
—Richard Florida, The Rise of the Creative Class
1
Brand =
Talent.
1
From “1, 2 or you’re out” [JW] to …
“Best Talent in
each industry segment
to build best proprietary
intangibles” [EM]
Source: Ed Michaels, War for Talent
1
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
1
7. Re-imagine
Organizing V: The
Power of “We”
1
“THE POWER OF US:
Mass Collaboration
on THE INTERNET
Is Shaking Up
Business”
—Cover/BusinessWeek/06.20.05
1
“The fluidity of
information will bring
about a radically
democratized society
where consumers
enjoy unprecedented
power.”
—Fast Company/10th anniversary
issue/March2006
1
Globalization1.0: Countries globalizing (1492-1800)
Globalization2.0: Companies globalizing (18002000)
Globalization3.0
:
Individuals collaborating
& competing globally
(2000+)
Source: Tom Friedman/The World Is Flat
1
“The nearly 1 billion people online
worldwide—along with their shared
knowledge, social contacts, online
reputations, computing power, and
more—are rapidly becoming a
collective force of unprecedented
power. For the first time in human
history, mass cooperation across
time and space is suddenly
economical.” —BW/06.20.05
1
“There’s a fundamental shift
in power happening.
Everywhere, people are
getting together and, using
the Internet, disrupting
whatever activities they’re
involved in.” —Pierre Omidyar, founder, eBay
1
“The architecture
of participation”
—Tim O’Reilly/Tech-book publisher
1
“Blogging made my year!”
—TP
Portal!
Conversations!
Collaboration!
New value!
1
8. Re-imagine
Organizing VI: The
White-Collar Tsunami and
the Professional Service
Firm (“PSF”) Imperative.
1
Up,
Re-imagine:
Up,
Up,
Up
the Value-added Ladder.
1
“ ‘Disintermediation’ is overrated. Those who fear
disintermediation should in fact be afraid of
irrelevance—disintermediation is just another way
you’ve
become
irrelevant to your
customers.”
of saying that …
—John Battelle/Point/Advertising Age/07.05
1
Answer:
1
The “PSF35”:
Thirty-Five
Professional Service Firm
Marks of Excellence
1
The PSF35: The Work & The Legacy
1. CRYSTAL CLEAR POINT OF VIEW
(Every
Practice Group: “If you can’t explain your position in eight words or
less, you don’t have a position”—Seth Godin)
2. DRAMATIC DIFFERENCE (“We are the only ones who do what
we do”—Jerry Garcia)
3. Stretch Is Routine (“Never bite off less than you can chew”—anon.)
4. Eye-Appetite for Game-changer Projects (Excellence at Assembling
“Best Team”—Fast)
5. “Playful” Clients (Adventurous folks who unfailingly Aim to Change
the World)
6. Small “Uneconomic” Clients with Big Aims
7. Life Is Too Short to Work with Jerks (Fire lousy clients)
8. OBSESSED WITH LEGACY (Practice Group and Individual: “Dent the
Universe”—Steve Jobs)
9. Fire-on-the-spot Anyone Who Says, “Law/Architecture/Consulting/
I-banking/ Accounting/PR/Etc. has become a ‘commodity’ ”
10. Consistent with #9 above … DO NOT SHY AWAY FROM THE
WORD (IDEA) “RADICAL”
1
Best is not
good enough!
1
?????
Do good (excellent?!)
work
Make a lot of
money
1
Point of
View!
1
“Gaspworthy!”
1
The PSF35: The Client Experience
11. Always team with client: “full partners in
achieving memorable results” (Wanted: “Chimeras
of Moonstruck Minds”!)
12. We will seek assistance Anywhere to assemble the Best-inPlanet Team for the Project
13. Client Team Members routinely declare that working with us
was “the Peak Experience of my Career”
14. The job’s not done until implementation is
“100.00% complete” (Those who don’t “get it” must go)
15. IMPLEMENTATION IS NOT COMPLETE UNTIL THE CLIENT
HAS EXPERIENCED “CULTURE CHANGE”
16. IMPLEMENTATION IS NOT COMPLETE UNTIL SIGNIFICANT
“TECHNOLOGY TRANSFER” HAS TAKEN PLACE-ROOT
(“Teach a man to fish …”)
17. The Final Exam: DID WE MAKE A DRAMATIC, LASTING,
GAME-CHANGING DIFFERENCE?
1
“The business of selling is not just about matching
viable solutions to the customers that require
them. It’s
equally about managing
the change process the customer
will need to go through to
implement the solution and
achieve the value promised by
the solution.”* (*E.g.: CRM failure rate/Gartner: 70%)
—Jeff Thull, The Prime Solution: Close the Value Gap,
Increase Margins, and Win the Complex Sale
1
The PSF35: The People & The Leadership
18. TALENT FANATICS (“Best-Coolest place to work”) (PERIOD)
19. EYE FOR THE PECULIAR (Hiring: Go beyond “same old,
same old”)
20. Early Opportunities (vs. “Wait your turn”)
21. Up or Out (Based on “Legacy”/Mentoring as much as
“Billings”/“Rainmaking”)
22. Slide the Old Aside/Make Room for Youth (Find oldsters
new roles?)
23. TALENT IS OBSESSED WITH RENEWAL FROM DAY #1 TO
DAY #“R” [R = Retirement]
24. Office/Practice Leaders Evaluated Primarily on
Mentoring-Team Building Skills
25. A “PROPRIETARY” TALENT DEVELOPMENT PROCESS (GE)
26. Team Leadership Skills Valued Early
27. Partner with B.I.W. [Best In World] Outsiders as Needed
and to Infuse Different Views
1
The PSF35: The Firm & The Brand
28. EAT-SLEEP-BREATHE-OOZE INTEGRITY (“My life is
my message”—Gandhi)
29. Excellence+ in EXECUTION … 100.00% of the Time
(No such thing as a “small sins”/World Series Ring to
the Batboy!)
30. “Drop everything”/“Swarm” to Support a Harried-On
The Verge Team
31. SPEND AS AGGRESSIVELY ON R&D AS A TECH FIRM OR
CIRQUE DU SOLEIL
32. A PROPRIETARY METHODOLOGY (FBR, McKinsey, Chiat Day, IDEO,
old EDS)
33. Web (Technology) Obsession
34. BRAND/“LOVEMARK” MANIACS (Organize Around a Point
of View Worth BROADCASTING: “You must be the
change you wish to see in the world”—Gandhi)
35. PASSION! ENTHUSIASM! (Passion & Enthusiasm have as
much a place at the Head Table in a “PSF” as in a
widgets factory: “You can’t behave in a calm, rational
manner. You’ve got to be out there on the lunatic
fringe”—Jack Welch)
1
Static/Imitative
Integrity.
Quality.
Excellence.
Continuous Improvement.
Superior Service (Exceeds Expectations.)
Completely Satisfactory Transaction.
Smooth Evolution.
Market Share.
Dynamic/Different
Dramatic Difference!
Disruptive!
Insanely Great! (Quality++++)
Life-(Industry-)changing Experience!
Game-changing!
WOW!
Surprise!
Delight!
Breathtaking!
Punctuated Equilibrium!
Market Creation!
1
Big Idea:
“Corporation” as
“Mega-PSF”*
* “Virtual” Collection of Entrepreneurially-minded
Professionals (“Talent”/“Roster”) Creating/ Applying
Intellectual Capital (“Work Product”)
1
Game-changing Solutions: Core Mechanism
PSF
(Professional Service Firm “model”)
+
Wow Projects
(“Different” vs “Better”)
+
Brand You
(“Distinct” or “Extinct”)
The
WOW!
Project.
1
Your Current Project?
1. Another day’s work/Pays the
rent.
4. Of value.
7. Pretty Damn Cool/Definitely
subversive.
10. WE AIM TO CHANGE THE
WORLD.
1
“Insanely
Great”
1
9. Re-imagine Business’s
Fundamental Value
Proposition: PSFs
Unbound, or Fighting
“Inevitable Commoditization”
via “The ‘Gamechanging
Solutions’ Imperative.”
1
Up,
Re-imagine:
Up,
Up,
Up
the Value-added Ladder.
1
1
And the “M” Stands for … ?
“Systems
Integrator of choice.”/BW
Gerstner’s IBM:
(“Lou, help us turn ‘all this’ into that long-promised ‘revolution.’ ” )
IBM Global Services*
(*Integrated Systems Services Corp.):
$55B
1
Planetary Rainmaker-in-Chief!
“Palmisano’s strategy is to
expand tech’s borders by pushing
users—and entire industries—
toward radically different business
models. The payoff for IBM would be access to an
ocean of revenue—Palmisano estimates it at $500
billion a year—that technology companies have
never been able to touch.” —Fortune
1
“By making the Global Delivery Model both legitimate and mainstream,
we have brought the battle to our territory. That is, after all, the purpose
of strategy. We have become the leaders, and incumbents [IBM, Accenture]
are followers, forever playing catch-up. … However, creating a new
business innovation is not enough for rules to be changed. The
innovation must impact clients, competitors, investors, and society. We
have seen all this in spades. Clients have embraced the model and are
demanding it in even greater measure. The acuteness of their
circumstance, coupled with the capability and value of our solution, has
made the choice not a choice. Competitors have been dragged kicking
and screaming to replicate what we do. They face trauma and disruption,
Investors have
grasped that this is not a passing fancy,
but a potential restructuring of the way
the world operates and how value will be
created in the future.” —Narayana Murthy, chairman’s
but the game has changed forever.
letter, Infosys Annual Report
1
“Big Brown’s New Bag: UPS
Traffic
Manager for
Corporate
America”
Aims to Be the
—Headline/BW/2004
1
And …
MasterCard
Advisors
1
“Customer Satisfaction” to “Customer Success”
“We’re getting better at [Six Sigma] every
day. But we really need to think about the
Are
customers’ bottom lines
really benefiting from what
we provide them?”
customer’s profitability.
—Bob Nardelli, GE Power Systems
1
Bear In Mind:
Customer
Satisfaction
versus
Customer
Success
1
The Value-added Ladder/Stuff ‘n’ Things
Goods
Raw Materials
1
The Value-added Ladder/Stuff & Transactions
Services
Goods
Raw Materials
1
The Value-added Ladder/Opportunity-seeking
Gamechanging
Solutions/
Business Advantage
Services
Goods
Raw Materials
1
1
“Game-changing Solutions”:
Core Mechanism
PSF
(Professional Service Firm “model”)
+
Wow Projects
(“Different” vs “Better”)
+
Brand You
(“Distinct” or “Extinct”)
Era #1/Obvious Value:“Our ‘it’ works, is
delivered on time” (“Close”)
Era #2/Augmented Value: “How our ‘it’ can
add value—a ‘useful it’ ” (“Solve”)
Era #3/Complex Value Networks: “How our
‘system’ can change you and deliver
‘business advantage’ ” (“CultureStrategic change”)
Source: Jeff Thull, The Prime Solution: Close the Value Gap,
Increase Margins, and Win the Complex Sale
1
10. Re-imagine
Enterprise as
Theater I: A World
of Scintillating
“Experiences.”
1
1
$415/SqFt/Wal*Mart
$798/SqFt/Whole Foods
1
7X. 730A800P.
F12A.*
*’93-’03/10 yr annual return: CB: 29%; WM: 17%; HD: 16%. Mkt Cap: 48% p.a.
1
“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
1
1
Experience: “Rebel Lifestyle!”
“What we sell is the ability
for a 43-year-old
accountant to dress in
black leather, ride through
small towns and have
people be afraid of him.”
Harley exec, quoted in Results-Based Leadership
1
“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
1
The Value-added Ladder/Memorable Connection
Scintillating
Experiences
Gamechanging Solutions/
Business Advantage
Services
Goods
Raw Materials
1
11. Re-imagine
Enterprise as
Theater II: Embracing
the “Dream Business.”
1
DREAM: “A dream is a complete
moment in the life of a client.
Important experiences that tempt
the client to commit substantial
resources. The essence of the
desires of the consumer. The
opportunity to help clients
become what they want to be.”
—Gian Luigi Longinotti-Buitoni
1
The Value-added Ladder/Emotion
Dreams Come True
Scintillating Experiences
Gamechanging Solutions/
Business Advantage
Services
Goods
Raw Materials
1
“The Ritz-Carlton
experience enlivens the
senses, instills well-being,
and fulfills even the
unexpressed wishes and
needs of our guests.”
— from the Ritz-Carlton Credo
1
Six Market Profiles
1. Adventures for Sale
2. The Market for Togetherness,
Friendship
and Love
3. The Market for Care
4. The Who-Am-I Market
5. The Market for Peace of Mind
6. The Market for Convictions
Rolf Jensen/The Dream Society: How the Coming Shift from
Information to Imagination Will Transform Your Business
1
Six Market Profiles
1. Adventures for Sale/IBM-UPS-GE
2. The Market for Togetherness, Friendship
and Love/IBM-UPS-GE
3. The Market for Care/IBM-UPS-GE
4. The Who-Am-I Market/IBM-UPS-GE
5. The Market for Peace of Mind/IBM-UPS-GE
6. The Market for Convictions/IBM-UPS-GE
Rolf Jensen/The Dream Society: How the Coming Shift from
Information to Imagination Will Transform Your Business
1
IBM, UPS, GE …
Dream
Merchants!
1
The Power
Is the Story
1
Story >
Brand
1
“Storytelling
is the core
of culture.”
—Branded Nation: The Marketing of Megachurch,
College Inc., and Museumworld, James Twitchell
1
“The branding of
cultural capital may
be the next step in the
evolution of
community.”
— “When All Business Is
Show Business, What’s Next,” Branded Nation: The
Marketing of Megachurch, College Inc., and Museumworld,
James Twitchell
1
Market Power =
Story Power =
Dream Power
1
12. Re-imagine the
Customer: A Trend
Worth Trillion$$$ …
Women
Roar.
1
“Women are
the majority
market”
—Fara Warner/The Power of the Purse
1
?????????
Home Furnishings … 94%
Vacations … 92% (Adventure Travel … 70%/ $55B travel equipment)
Houses … 91%
D.I.Y. (major “home projects”) … 80%
Consumer Electronics … 51% (66% home computers)
Cars … 68% (90%)
All consumer purchases … 83%
Bank Account … 89%
Household investment decisions … 67%
Small business loans/biz starts … 70%
Health Care … 80%
1
Editorial/Men: Tables, rankings.*
Editorial/Women:
Narratives that cohere.*
*Redwood (UK)
1
Initiate Purchase
Men: Study “facts &
features.”
Women: Ask lots of people
for input.
Source: Martha Barletta, Marketing to Women
1
Thanks,
Marti Barletta!
1
The Perfect Answer
Jill and Jack buy
slacks in black…
Read This Book …
EVEolution:
The Eight Truths
of Marketing
to Women
Faith Popcorn & Lys Marigold
1
EVEolution: Truth No. 1
Connecting Your
Female Consumers to
Each Other Connects
Them to Your Brand
1
“The ‘Connection Proclivity’ in
women starts early. When asked,
‘How was school today?’ a girl
usually tells her mother every
detail of what happened, while a
boy might grunt, ‘Fine.’ ”
EVEolution
1
“Women don’t buy
They
join them.”
brands.
EVEolution
1
2.6
vs.
1
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.
1
10. Women’s
Market =
Opportunity
No. 1.
1
Why?
1
Good Thinking, Guys!
“Kodak Sharpens Digital Focus
On Its Best Customers:
Women”
—Page 1 Headline/WSJ/0705
1
1
Duh!
“More Hotels Try to
Offer What Women
Want”
—Headline, USA Today, 11.08.05
1
Fastest growing demographic:
Single-person
Households (>50% in
the likes of London, Stockholm)
Source: Richard Scase
1
“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
[Yet] I
came to see in my time at
IBM that culture isn’t just
one aspect of the game—
it is the game.” —Lou Gerstner, Who
of people is very, very hard.
Says Elephants Can’t Dance
1
12. Re-imagine
Leadership for Totally
Screwed-Up Times: The
Passion
Imperative.
1
Lead It …
Loud!
1
Create a
Cause!
1
“Create a
‘cause,’ not a
‘business.’ ”
G.H.:
1
“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
1
“the wildest
chimera of a
moonstruck
mind”
—The Federalist on TJ’s Louisiana Purchase
1
Make It a
Grand
Adventure!
1
Quests!
1
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.”
1
Yes!!!!!!!!!!!!!!!!!
“free to do his or her
absolute best” …
“allow its members to
discover their
greatness.”
1
“In the end, management
doesn’t change culture.
Management invites the
workforce itself to
change the culture.”
—Lou Gerstner
1
Trumpet an
Exhilarating
Story!
1
“Leaders don’t just make
products and make decisions.
Leaders make
meaning.”
– John Seely Brown
1
“A key – perhaps the key – to
leadership is
the effective
communication
of a story.”
—Howard Gardner/Leading Minds:
An Anatomy of Leadership
1
Wow!
1
Live Your
Story!
1
“To change minds effectively,
leaders make particular use
of two tools: the stories that
they tell and the lives that
they lead.” —Howard Gardner, Changing Minds
1
“It is necessary for the
President to be the
nation’s …
No. 1 actor.”
FDR
1
“You must
be
the change you wish
to see in the world.”
Gandhi
1
Try It!
1
Sam’s
Secret #1!
1
“Reward excellent
failures. Punish
mediocre successes.”
Phil Daniels, Sydney exec
1
Insist on
Speed!
1
“If things seem
under control,
you’re just not going
fast
enough.” —Mario Andretti
1
Eat
Change!
1
“We eat
change for
breakfast!”
—Harry Quadracci, QuadGraphics
1
Dispense
Enthusiasm!
1
BZ: “I am a …
Dispenser of
Enthusiasm!”
1
“Nothing is so
contagious as
enthusiasm.”
—Samuel Taylor Coleridge
1
“Most important,
upped the
energy level at
he
Motorola.”
—Fortune on Ed Zander/08.05
1
“A man without a
smiling face must not
open a shop.”
—Chinese Proverb*
*Courtesy Tom Morris, The Art of Achievement
1
Excellence.
Always.
1
Leader Job No.1
Paint
Portraits of
Excellence!
1
Avoid …
Moderation!
1
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!
1
Stay Hungry.
Stay Foolish.
Steve Jobs
1
Free the
Lunatic
Within!
1
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
1
“You can’t behave in a
calm, rational manner.
You’ve got to be out
there on the lunatic
fringe.”
— Jack Welch
1
1
Tom Peters’
Toward
Health(care)
Excellence!
Aetna/Laguna Niguel/Part #2
1
Tom Peters’
Re-Imagine!
Toward Client-driven, CustomerExperienceanimated, QUALITY-OBSESSED,
OutcomeAccountability-focused,
InformationMeasurement-intensive, EMRdetermined, Science-aware,
PreventionWellness-centric,
Healing-aimed, ChronicCare-oriented,
HomeCare-based, Boomer-sensitive,
Women’sHealth-directed, Revolution-insistent
HEALTH(CARE) EXCELLENCE
Aetna/Laguna Niguel/Part #2
Health(care): Seven Main Messages
1. Quality (Error reduction/
Evidence-based Medicine)
2. “Healthcare” vs. “Health” (Wellness +
Prevention)
3. “Models of Excellence” available
4. Life sciences (“Singularity”)
5. Avian flu
1
Health:
Century21.Job # 1
(HC21.J1)
Tom Peters/0206.2006
1
!!!!!!!!!!!!!
“Healthcare”
vs “Health”
1
Quality!
Prevention!
Wellness!
1
Go Bubba!
WASHINGTON (Feb. 28) - Former
President Clinton, a reformed overeater,
urged state governors on Tuesday to
embrace a long-term effort to change
the nation's culture of too much food
and too little exercise. (AOL.0301.0338am, re NGA)
1
“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 (12.12.2005)
1
Quality (100K deaths)
“Evidence/Outcomes-based” medicine
IS/IT-in-health(care) revolution
Wellness/Prevention
Health“care” to Health transformation
Wash your hands!
Home-care (as the population rapidly ages)
Med-school re-orientation
“Public health” emphasis
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) 1
“If God spoke to me by saying, ‘Mark, you’re down to your last
three words: What would you want to say to your fellow humans
that would make the most positive impact?’ It would be a close
call between Love Thy Neighbor and
Your Hands.
Move, Move, Move.”
Wash
A close third would be
—Mark Pettus, M.D.,The Savvy Patient
“The most important thing you can do to keep from getting
wash your
hands.”
sick is to
—CDC/National Center for Infectious Diseases
1
Manifesto(s)
1
!!!!!!!!!!!!!
“Healthcare”
vs “Health”
1
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.)
1
Tom’s Rant2006
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 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. (“Disgrace” is far too kind a label for the “condition.” Who’s to blame? Just
about everybody, starting with the docs who consider oversight from anyone other than fellow
clan members to be unacceptable.)
2.
The “system”—training, docs, insurance incentives, “culture,”
“patients” themselves—is hopelessly-mindlessly-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-thewhite-coat-who-will-now-miraculously-dispense-fix it-pills-and-surgical-incisions-for-you-theunwashed.” (Come to think of it, maybe I’ll start wearing a White Coat to my doctor’s office—
after all, I am the Professional-in-Charge when it comes to my Body & Soul. Right?)
1
BIGGEST
DEAL OF
ALL
1
!!!!!!!!!!!!!
“Healthcare”
vs “Health”
1
COULD IT
TRULY BE THIS
AWFUL?
“Quality”:
1
Thomas Peters
He Went To The
Hospital
1
CDC 1998: 90,000
killed and 2,000,000
injured from
hospital-caused drug
errors & infections
1
HealthGrades/Denver:
195,000
hospital deaths per year in the U.S., 20002002 = 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
1
“This should give you pause
when you go to the
hospital.”
“There is little evidence
that patient safety
has improved in the last
five years.”
1
2 38
m
s
1
“Silence
surrounds
this issue.”
Source: To Err Is Human: Building a Safer Health System,
by the Institute of Medicine (Subject: 44,000 to 98,000 preventable
hospital deaths per year in the U.S.)
1
Welcome to the Homer Simpson Hospital
a/k/a
The Killing
Fields
1
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
1
Mistakes: 100,000 deaths—“minor
fraction of the total deaths caused
by modern medicine.” Hopkins:
225,000 iatrogenic deaths (people
killed by docs); (Institute for
Medicine higher)
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy
Nation
1
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
1
RAND (1998): 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.
1
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
1
“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,
four out of 10
made mistakes 30%
of the time.”
while
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
1
20%: not get
prescriptions filled
50%: use meds
inconsistently
Source: Tom Farley & Deborah Cohen,
Prescription for a Healthy Nation
1
“In health care,
geography
is destiny.”
Source: Dartmouth Medical School
1
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
1
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)
1
“A healthcare delivery system characterized by
idiosyncratic and often ill-informed judgments mustbe
restructured according to
evidence-based
medical
practice.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
1
“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
doctors.
remain more comfortable with the habits of a guild,
where each craftsman trusts his fellows, than with the
demands of the information age.”
Michael Millenson, Demanding Medical Excellence
1
“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
1
“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
1
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!
1
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
“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
Healthcare/IBM Consulting
years)
1
Probable parole violations: Simple model (age,
# of previous offenses, type of crime) beats
M.D. shrinks.
100 studies: Statistical formulas > Human
“In virtually all
cases, statistical thinking
equaled or surpassed
human judgment.”
judgment.
—Atul Gawande,
Complications
1
PARADOX: Many,
many formal case reviews
… failure to systematically/
systemically/ statistically
look at and act on
evidence.
Source: Complications, Atul Gawande
1
Genius
Required?
1
Leapfrog Group:
CPOE/Computerized Physician
Order Entry*
ICU staffing by trained
intensivists**
EHR/Evidence-based Hospital
Referral***
Source: HealthLeaders
1
The Benefits of …
FOCUSED EXCELLENCE
Shouldice/Hernia Repair:
30-45 min, 1%
recurrence. Avg: 90 min,
10%-15% recurrence.
Source: Complications, Atul Gawande
1
About Time!
100,000 Lives
Campaign*
*Don Berwick/Institute for Healthcare Improvement
1
“What’s your
name?
When’s your
birthday?”
1
Hospitals Pay Appropriate
Attention To Medical Errors
Yes ………………………………. 1%
Aware and Trying Hard ……... 8%
Aware But Tepid Response … 22%
No ………………………………... 25%
An Inexcusable Tragedy …….. 44%
Source: 12.2005 Poll/tompeters.com
1
Attention/
“Being There”:
Job One!
1
You =
Your
Calendar
1
“You must
be
the change you
wish to see in the
world.”
Gandhi
1
The Necessary
IS/Web
REVOLUTION
1
We all live in
Dell-Wal*MarteBay-Google
World!
1
[almost]
We
all live in Dell Wal*Mart-eBayGoogle World!
1
“Some grocery
stores have better
technology than our
hospitals and
clinics.”
—Tommy Thompson, HHS Secretary
Source: Special Report on technology in healthcare, U.S. News & World Report (07.04)
1
Computerized Physician Order
Entry/CPOE:
5%
of U.S.
hospitals
source: HealthLeaders/06.02
1
Henry Lowe, U. of Pitt. School of
“Broadband,
Internet-based,
‘multimedia’ electronic
medical records”
Medicine:
1
Telemedicine: E.g. …
HANC* [Home Assisted
Nursing Care]
*BP, ECG, pulse, temp, etc
1
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
Source: Douglas Goldstein, e-Healthcare
1
“Our entire facility is digital. No paper, no
film, no medical records. Nothing. And it’s all
integrated—from the lab to X-ray to records to physician
order entry. Patients don’t have to wait for anything. The
information from the physician’s office is in registration
and vice versa. The referring physician is immediately
sent an email telling him his patient has shown up. … It’s
wireless in-house. We have 800 notebook computers
that are wireless. Physicians can walk around with a
computer that’s pre-programmed. If the physician
wants, we’ll go out and wire their house so they can sit
on the couch and connect to the network. They can
review a chart from 100 miles away.” —David Veillette, CEO,
Indiana Heart Hospital (HealthLeaders/12.2002)
1
“Information therapy … is the
prescription of specific, evidenced-based medical
information to a specific patient, caregiver or
consumer at just the right time to help him or her
make a specific health decision or behavior change.”
“As we try to refocus our medical resources from
acute care to chronic care we must gain full value
from what the patient and the family can do for
themselves. Without integrating the self-management
of the family no system of chronic care can be either
economically or medically successful.”
“Information Therapy”: not “about” healthcare;
“essential part” of healthcare
Source: Donald Kemper, CEO, Healthwise
1
Health*
*vs Healthcare
1
1
1
1
“Sanitary revolution”:
mortality in major cities
down
55%
between 1850 and 1915
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
1
“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
“Medicine
doesn’t do much chronic
disease.” “When the most common killers of our
curing our era’s major killers.”
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
1
Smoking, excess drinking,
lack of exercise, shitty
diet: 40% of deaths
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
1
“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
1
“Curve
Shifting”
Source: Tom Farley & Deborah Cohen,
Prescription for a Healthy Nation
1
“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
1
Context Change:
The Most Powerful Force (??)
Wastebaskets: Japan v U.S.;
Christchurch NZ v
Sydney AUS*
*“Broken windows”
1
+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
1
“An estimated 60 to
90 percent of doctor
visits involve stressrelated complaints.”
—Newsweek/09.27.2004
1
“Our focus can no longer be
on cost containment. Rather,
we must emphasize
education, disease
management programs, and
wellness and prevention far
more strongly than we have in
the past.” —Chad Holliday/DuPont
1
Wellness
1
“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
1
“Ontario To Split
Health Ministry”
—Headline/Globe And Mail /06.05
(New ministry will focus on
Prevention/ Wellness/Eldercare)
1
“Savior for the Sick”
vs.
“Partner for
Good Health”
Source: NPR
1
“Companies Step Up
Wellness Efforts: Rising
health costs provide
incentive to promote
healthier employee
lifestyles” —headline/USA Today/08.05
1
“Prevention
Program At Dow
Chemical Aims To
Save Money”
—IBD/08.05
1
Sprint/Overland Park KS:
Slow elevators, distant
parking lots with infrequent
buses, “food court” as
“poorly” placed
as possible, etc.
Source: New York Times
1
Tom’s
Story
1
Obesity/-79(-36); BP (140-85
to 90-60); Blood sugar (18087); Blood chemistry
(normal+); Cholesterol (14058); Metabolic rate/RMR
(+250); Mental state
(dramatic improvement*)
1
CR
07.03: 60/264/180/14585/140
10.04: 61/195/092/09760/058
1
“Fixes”
Diet
Extreme exercise!
Meditation
Dietary supplements
No alcohol
(Psychotropic meds/others
reduced)
(No work reduction)
(eg small portions, slow down)
1
Aging
reversal!!!!*
*Why wasn’t I
“informed” until age 59?
1
Determinants of Health
Access to care: 10%
Genetics: 20%
Environment: 20%
Health Behaviors:
50%
Source: Institute for the Future
1
Planetree:
A Radical Model for New
Healthcare/Healing/Health/
Wellness Excellence*
* “It” can be done!
1
“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
1
“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
The Nine Planetree Practices
1. The Importance of Human Interaction
2. Informing and Empowering Diverse Populations: Consumer
Health Libraries and Patient Information
3. Healing Partnerships: The importance of Including Friends
and Family
4. Nutrition: The Nurturing Aspect of Food
5. Spirituality: Inner Resources for Healing
6. Human Touch: The Essentials of Communicating
Caring Through Massage
7. Healing Arts: Nutrition for the Soul
8. Integrating Complementary and Alternative Practices
into Conventional Care
9. Healing Environments: Architecture and Design Conducive
to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
1. The Importance
of Human
Interaction
1
“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
Kindness
is free.
nothing to the budget.
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
1
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
1
1
“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
‘abuse
members report verbal
’ by
physicians, managers and
coworkers.”
—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
“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)
1
2. Informing and
Empowering Diverse
Populations: Consumer
Health Libraries and
Patient Information
1
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
1
3. Healing
Partnerships: The
Importance of
Including
Friends and Family
1
“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
1
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
1
“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
1
“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 rate of
72.4%, as compared to 56.3%
for those who didn’t have a
confidant.” —Institute for the Future
1
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
1
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
1
4. Nutrition: The
Nurturing Aspect
of Food
1
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
1
Kitchen
Beautiful cutlery, plates, etc
Chef rep
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
“Aroma therapy” (eg “smell
of baking cookies”)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick
Charmel
1
5. Spirituality: Inner
Resources for
Healing
1
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
1
6. Human Touch:
The Essentials of
Communicating
Caring Through
Massage
1
“Massage is a
powerful way to
communicate caring.”
—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
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
1
7. Healing Arts:
Nutrition for the
Soul
1
Planetree: “Environment conducive to healing”
Color!
Light!
Brilliance!
Form!
Art!
Music!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
8. Integrating
Complementary and
Alternative Practices
into Conventional
Care
1
Griffin IMC/Integrative Medicine Center
Massage
Acupuncture
Meditation
Chiropractic
Nutritional supplements
Aroma therapy
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
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
1
9. Healing
Environments:
Architecture and
Design Conducive
to Health
1
“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
1
Access to nurses station:
“Happen to”
vs
“Happen with”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
Conclusion:
Caring/Growth
“Experience”
1
Care!
Control!
Connect!
Engage!
Grow!
De-stress!
1
Griffin/flagship …
On the verge of closing in ’80s
Financially sound
Profitable
Adding programs
Growing Market Share
Only hospital on the “100 Best
Companies To Work For” list
(7 consecutive years; #4 in 2006)
1
Learn more about
Planetree/
The Planetree Alliance:
www.planetree.org
1
Life Sciences
Revo Rocks
Our World*
*Coming soon to a …
1
“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
1
“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
1
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
1
“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
… “We are at an inflection point
in history.” … “It is about the defining
Brooks, AIL/MIT)
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
1
Ray Kurzweil:
“Singularity”
1
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
1
“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
1
“Singularity”/“Bionic Tom,” circa
2006: Medtronic pacemaker (heart micromanagement) ; psychotropics (mental micromanagement) ; Google (mind-extension—smartbeyond-measure) ; Samsung cell phone
(instant-permanent planetary connectedness) ; Orvis
shirt with UV protection (“smart skin”)
1
“The four most dangerous words
in medicine may be ‘First, do
no harm.’ ” —Fortune
“Simply put, the need for certainty in
drug approval is killing people.” —Fortune
“We take harms of action to be worse
than harms of inaction.” —Jonathon Barron/
U Penn
Source: “DEADLY CAUTION: How Our National Obsession With drug
Safety Is Killing People—and What We Can Do about It”/Fortune
(02.20.06)
1
“If you don’t like
change, you’re
going to like
irrelevance even
less.”
—General Eric Shinseki, Chief of Staff. U. S. Army
1
H5N1
1
Kroll/SARS: “don’t
over-react”
Kroll/H5N1:
“devastating”
Source: Newsweek/10.24.05
1
Healthcare27
02.28.2006
1
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.)
1
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.)
1
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+?)
1
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.)
1
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!
1
“If God spoke to me by saying, ‘Mark, you’re down to your last
three words: What would you want to say to your fellow humans
that would make the most positive impact?’ It would be a close
call between Love Thy Neighbor and
Your Hands.
Move, Move, Move.”
Wash
A close third would be
—Mark Pettus, M.D.,The Savvy Patient
“The most important thing you can do to keep from getting
wash your
hands.”
sick is to
—CDC/National Center for Infectious Diseases
1
Wash
Your
Hands.
1
1