Tom Peters’ X25*
Toward
Health(care)
Excellence!
Inova Leadership Institute/13 March 2007
*In Search of Excellence 1982-2007
11
Slides* at …
tompeters.com
*also “long”
21
Part 1
1
EXCELLENCE.
ALWAYS.
1
“Why in the
world did
you go to
Siberia?”
1
Synonyms
Purity
Transcendence
Virtue
Elegance
Majesty
Antonyms
Mediocrity
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.
Part 2
1
EXCELLENCE.
HEALTH(CARE).
1
“When I climb Mount
Rainier I face less
risk of death than
I’ll face on the
operating table.”
—Don Berwick
1
TP’s
Health(care)
Rants &
Passions
1
Quality!
DSS!
Prevention!
Wellness!
Chronic care!
Elder care!
Convenient care!
Childhood obesity!
H5N1!
1
COULD
IT TRULY BE THIS
AWFUL?
“Quality”:
1
90,000 killed
and 2,000,000
CDC 1998:
injured from
hospital-caused drug
errors & infections
1
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
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
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
“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
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.”
intuition lead me astray?
—Atul Gawande, Complications
1
“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
1
Part 2A
1
Planetree:
A Radical Model for New
Healthcare/Healing/
Wellness Excellence
Tom Peters/17 September 2006
1
The 9 Planetree Practices
1. The Importance of Human Interaction
2. Informing and Empowering Diverse Populations: Consumer
Health Libraries and Patient Information
3. Healing Partnerships: The importance of Including
Friends and Family
4. Nutrition: The Nurturing Aspect of Food
5. Spirituality: Inner Resources for Healing
6. Human Touch: The Essentials of Communicating
Caring Through Massage
7. Healing Arts: Nutrition for the Soul
8. Integrating Complementary and Alternative Practices
into Conventional Care
9. Healing Environments: Architecture and Design
Conducive to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
1. The Importance
of Human
Interaction
1
139,380 former
patients from 225 hospitals:
Press Ganey Assoc:
none
of THE top 15 factors
determining Patient Satisfaction
referred to patient’s health outcome
PS directly related to Staff Interaction
PS directly correlated with Employee
Satisfaction
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
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 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
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
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
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
Kitchen
Beautiful cutlery,
plates, etc
Chef reputation
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
5. Spirituality:
Inner Resources
for Healing
1
Griffin:
redesign chapel (waterfall,
quiet music, open prayer book)
Other:
music, flowers, portable
labyrinth
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
6. Human Touch:
The Essentials of
Communicating
Caring Through
Massage
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”)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1
7. Healing Arts:
Nutrition for
the Soul
1
Griffin:
Music in the parking
lot; professional musicians in
the lobby (7/week, 3-4hrs/day) ;
5 pianos ;
volunteers (120-140 hrs arts &
entertainment per month).
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
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
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
F.Y.I.
1
Griffin Hospital/Derby CT (Planetree Alliance “HQ”) Results:
Financially successful.
Expanding programsphysically. Growing market
share. Only hospital in “100
Best Cos to Work for”—
7 consecutive years,
currently #6.
—“Five-Star Hospitals,” Joe Flower,
strategy+business (#42)
1
Learn more about Planetree/
The Planetree Alliance:
www.planetree.org
1
Part 3
1
“Little Stuff”:
The True
“Basics”
501
Thank
You!
511
FLOWER
POWER
521
“Courtesies of a small and
trivial character are the
ones which strike
deepest in the grateful
and appreciating heart.”
—Henry Clay
1
Jim Jeffords
oversight!
The …
1
The Manager’s Book of Decencies:
How Small gestures Build Great
Companies. —Steve Harrison, Adecco
Servant Leadership
—Robert Greenleaf
One: The Art and Practice of
Conscious Leadership —Lance Secretan,
founder of Manpower, Inc.
1
“Leaders
‘SERVE’
people.
Period.”
—Anon.
561
Servant Leadership/Robert Greenleaf
1. Do those served grow as
persons?
2. Do they, while being served,
become healthier wiser, freer,
more autonomous, more likely
themselves to become servants?
1
THE PROBLEM
IS RARELY THE
PROBLEM.
581
THE PROBLEM IS
RARELY/NEVER THE
PROBLEM. THE
RESPONSE
TO THE
PROBLEM INVARIABLY
ENDS UP BEING THE
REAL PROBLEM.*
*RMN, M Stewart, WJC, “Scooter” Libby
591
OFTEN AS
NOT/MORE OFTEN
THAN NOT THE
UNDERLYING
PROBLEM IS NOT
MUCH OF A
PROBLEM.
601
PERCEPTION
IS ALL THERE
IS. PERIOD.*
*From Whole Foods to IBM to the corner deli
611
Relationships
THERE
ONCE WAS A TIME WHEN A
(of all varieties):
THREE-MINUTE
PHONE CALL WOULD
HAVE AVOIDED SETTING OFF
THE DOWNWARD SPIRAL
THAT RESULTED IN A
COMPLETE RUPTURE.
621
“WHY NOT
JUST TELL
THE TRUTH?”
—Raymond Carver
1
POWER WORDS!
“I’m sorry.”
641
Respect
1
“It was much later that I realized
Dad’s secret. He gained respect by
giving it. He talked and listened to
the fourth-grade kids in Spring Valley
who shined shoes the same way he
talked and listened to a bishop or a
He was
seriously interested in
who you were and what
you had to say.”
college president.
Sara Lawrence-Lightfoot, Respect
1
“The deepest
human need is
the need to
beappreciated.”
William James
1
“Don’t
belittle!”
—OD Consultant
1
Marcus
Buckingham:
The One Thing You
Need to Know
691
“The key difference between checkers and
chess is that in checkers the pieces all move
the same way, whereas in chess all the pieces
Discover what
is unique about each
person and capitalize
on it.”
move differently. …
—Marcus Buckingham, The One Thing You Need to Know
701
“The mediocre manager believes that most
things are learnable and therefore that the
essence of management is to identify ach
person’s weaker areas and eradicate them.
The great manager believes the opposite.
He believes that the most influential
qualities of a person are innate and
therefore that the essence of management
is to deploy these innate qualities as
effectively as possible and so drive
performance.” —Marcus Buckingham, The One Thing
You Need to Know
711
SWEET SPOT: THE
DISCOMFORT
ZONE.
721
“Do one thing
every day
that scares
you.”
—Eleanor Roosevelt
1
EXCELLENCE.
BEDROCK.
LEADERSHIP.
9Ps.
741
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
751
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
761
“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
771
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
781
“Nothing is so
contagious as
enthusiasm.”
—Samuel Taylor Coleridge
791
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
801
“In the end, management
doesn’t change culture.
Management
invites
the workforce itself to
change the culture.”
—Lou Gerstner
811
“The role of the Director is to create a
space where the actors and
become more
than they’ve ever been
before, more than
they’ve dreamed of
being.”
actresses can
—Robert Altman, Oscar acceptance speech
821
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
831
841
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
851
“You must
be
the change you
wish to see in the
world.”
Gandhi
861
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
871
Relentless: “One of
my superstitions had always been
when I started to go anywhere or
not to
turn back , or stop,
to do anything,
until the thing intended was
accomplished.” —Grant
881
“Success seems to be
largely a matter
of hanging on
after others have
let go.”
—William Feather, author
1
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
901
‘do’
“Leaders
people.
Period.”
—Anon.
911
PARC’s Bob Taylor:
“Connoisseur
of Talent”
921
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; i.e., 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.
Putting HR on
a par with finance
and marketing.
Second:
931
< CAPEX
> People!
1
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
951
"The reasonable man adapts
himself to the world. The
unreasonable one persists in
trying to adapt the world to
himself. Therefore, all
progress depends upon the
unreasonable man.” —GB Shaw,
Man and Superman: The Revolutionists' Handbook.
961
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
971
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
981
PURPOSE.
PASSION.
Potential.
Presence.
Personal.
PERSISTENCE.
PEOPLE.
Potent.
Positive.
991
“Excellence can be obtained if you:
... care more than others think is wise;
... risk more than others think is safe;
... dream more than others think
is practical;
... expect more than others think
is possible.”
Source: Anon. (Posted @ tompeters.com by
K.Sriram, November 27, 2006 1:17 AM)
1
"Life is not a journey to the
grave with the intention of
arriving safely in one pretty
and well preserved piece, but
to skid across the line
broadside, thoroughly used
up, worn out, leaking oil,
shouting ‘GERONIMO!’ ”
—Bill McKenna, professional motorcycle racer
(Cycle magazine 02.1982)
1011
EXCELLE
ALWAYS
1021