Transcript Tom Peters’ Re-Imagine! Business Excellence in a Disruptive Age CHIME Fall CIO Forum Dynamic Times Demand Dynamic Strategies Hilton La Jolla Torrey Pines/10.27.2004

Tom Peters’
Re-Imagine!
Business Excellence in
a Disruptive Age
CHIME Fall CIO Forum
Dynamic Times Demand Dynamic Strategies
Hilton La Jolla Torrey Pines/10.27.2004
Slides at …
tompeters.com
V.A. Moment …
1Y/2N: Commerce Bank
2 Pizzas: JB
Plastic Bulldozer: MD
XYZ Corp: Complete Vision & Values
Any Service or Product of ours is yours
for absolutely NO CHARGE if
any employee says—or implies—to you
at any point …
“It’s Not My Fault.”
V. Big Cheese, Founder, CEO & Dictator
Employee Manual
Item 1.0. I.N.M.F. =
F.O.
Part I:
A Brand New
Ballgame!
Re-imagine!
Summer 2004:
Not Your Father’s
World.
“We’re now entering a new phase of
business where the group will be a
franchising and management company
where brand management is central.” —David
Webster, Chairman, InterContinental Hotels Group
“InterContinental will now have far more to
do with brand ownership than hotel
ownership.” —James Dawson of Charles Stanley (brokerage)
Source: International Herald Tribune, 09.16, on the sacking of CEO Richard North,
whose entire background is in finance
1. Re-imagine
Everything: All
Bets Are Off.
Jobs
New Technology
Globalization
Security
2. Re-imagine
Permanence:
The Emperor Has
No Clothes!
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
3. Re-imagine
Organizing I:
IS/IT Leads the
(Virtual) Way!
Productivity!
McKesson 2002-2003:
Revenue … +$7B
Employees … +500
Source: USA Today/06.14.04
square feet
E.g. …
Jeff Immelt: 75% of “admin, back
room, finance” “digitalized” in
years.
Source: BW (01.28.02)
“Dawn Meyerreicks, CTO of the Defense Information Systems Agency, made
one of the most fateful military calls of the 21st century. After 9/11 … her office
quickly leased all the available transponders covering Central Asia. The
implications should change everything about U.S. military thinking in the
years ahead.
“The U.S. Air Force had kicked off its fight against the Taliban with an
ineffective bombing campaign, and Washington was anguishing over whether
to send in a few Army divisions. Donald Rumsfeld told Gen. Tommy Franks to
give the initiative to 250 Special Forces already on the ground. They used
satellite phones, Predator surveillance drones, and GPS- and laser-based
targeting systems to make the air strikes brutally effective.
“In effect, they ‘Napsterized’ the battlefield by cutting out the middlemen
(much of the military’s command and control) and working directly with the
real players. … The data came in so fast that HQ revised operating procedures
to allow intelligence analysts and attack planners to work directly together.
Their favorite tool, incidentally, was instant messaging over a secure
network.”—Ned Desmond/“Broadband’s New Killer App”/Business 2.0/
OCT2002
“MIT Everyware: EVERY LECTURE,
EVERY QUIZ, ALL ONLINE, FOR
FREE. MEET THE GLOBAL GEEKS
GETTING AN MIT EDUCATION,
OPEN SOURCE-STYLE.”
—Headline/Wired/09.03
“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)
“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)
“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
Words to Live By …
“Hierarchy is an
organization with its face
toward the CEO and it’s a__
toward the customer.”
Jack Welch
07.04/TP In Nagano …
Revenue: $10B
FTE: 1*
*Maybe
Not “out sourcing”
Not “off shoring”
Not “near shoring”
Not “in sourcing”
but …
“Best Sourcing”
IS/IT
strategy!
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
4. Re-imagine the
Organizing II: The
Professional Service
Firm (“PSF”)
Imperative.
Sarah:
Papa:
“ Papa, what do
you do?”
“I’m ‘overhead.’ ”
Sarah:
Papa:
“ Daddy, what do
you do?”
“I manage a ‘cost
center.’ ”
Sarah:
“ Daddy, what do
you do?”
“I’m a
‘bureaucrat.’ ”
Papa:
Answer: PSF!
[Professional Service Firm]
Department Head
to …
Managing Partner,
Finance [IS, etc.] Inc.
“Typically in a mortgage company or
financial services company, ‘risk
management’ is an overhead, not a
revenue center. We’ve become more
We pay for
ourselves, and we
actually make money
for the company.” —Frank Eichorn,
than that.
Director of Credit Risk Data Management Group, Wells Fargo
Home Mortgage (Source: sas.com)
Eichorning
Mantra:
“Eichorn it!”
5. Re-imagine Business’
Basic Value Proposition:
PSFs Unbound/ The
“Solutions Imperative.”
And the “M” Stands for … ?
“Systems
Integrator of
choice.”
IBM Global Services: $35B
Gerstner’s IBM:
(BW)
“Big Brown’s New
Bag: UPS Aims to Be
the Traffic Manager
for Corporate
America”
—Headline/BW/07.19.2004
New York-Presbyterian: 7-year,
$500M consulting (systemic)
and equipment contract with
GE Medical Systems
Source: NYT/07.18.2004
Eichorning
Mantra:
Eichorn it!”
9. Re-imagine the
Fundamental Selling
Proposition: “It” all adds
up to …
THE BRAND
(THE STORY).
“WHO ARE
WE?”
“WHAT’S
OUR
STORY?”
Story > Brand
10. Re-imagine the
Roots of Innovation:
THINK WEIRD … the
High Value Added
Bedrock.
FLASH:
Innovation
is easy
!
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
“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/08.11.03
“This is an essay about what it takes to create and sell something
remarkable. It is a plea for originality, passion, guts and daring. You can’t be
remarkable by following someone else who’s remarkable. One way to figure
out a theory is to look at what’s working in the real world and determine what
the successes have in common. But what could the Four Seasons and Motel
6 possibly have in common? Or Neiman-Marcus and Wal*Mart? Or Nokia
(bringing out new hardware every 30 days or so) and Nintendo (marketing
the same Game Boy 14 years in a row)? It’s like trying to drive looking in the
The thing that all these companies
have in common is that they have nothing in
common. They are outliers. They’re on the fringes. Superfast or
rearview mirror.
superslow. Very exclusive or very cheap. Extremely big or extremely small.
The reason it’s so hard to follow the leader is this: The leader is the leader
precisely because he did something remarkable. And that remarkable thing
is now taken—so it’s no longer remarkable when you decide to do it.” —Seth
Godin, Fast Company/02.2003
Innovation!
NOT
Imitation
13. Re-imagine
Excellence I: The
Talent
Obsession.
Brand =
Talent.
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
Did We Say “Talent Matters”?
“The top software developers
are more productive than
average software developers
not by a factor of 10X or 100X,
or even 1,000X,
but 10,000X.” —Nathan Myhrvold,
former Chief Scientist, Microsoft
14. Re-imagine
Excellence II: Meet the
New Boss … Women
Rule!
“AS LEADERS, WOMEN
RULE: New Studies find
that female managers
outshine their male
counterparts in almost
every measure”
Title, Special Report/BusinessWeek
Women’s Strengths Match New Economy
Imperatives: Link [rather than rank] workers;
favor interactive-collaborative leadership style
[empowerment beats top-down decision making];
sustain fruitful collaborations; comfortable with
sharing information; see redistribution of power
as victory, not surrender; favor multi-dimensional
feedback; value technical & interpersonal skills,
individual & group contributions equally; readily
accept ambiguity; honor intuition as well as pure
“rationality”; inherently flexible; appreciate
cultural diversity.
Source: Judy B. Rosener, America’s Competitive Secret: Women Managers
16. Re-imagine Leadership
for Totally Screwed-Up
Times:
The Passion
Imperative.
Start a
Crusade!
“Create a
‘cause,’ not
a ‘business.’ ”
G.H.:
“Beware of the
tyranny of making
Small Changes to Small
Things. Rather, make
Big Changes to Big
Things.”
—Roger Enrico, former Chairman, PepsiCo
Make It a
Grand
Adventure!
“Ninety percent of what
we call ‘management’
consists of making it
difficult for people to
get things done.” – Peter Drucker
“I don’t
know.”
Quests!
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.”
Yes!!!!!!!!!!!!!!!!!
“free to do his or her
absolute best” …
“allow its members
to discover their
greatness.”
“Reward
excellent
failures. Punish
mediocre successes.”
Phil Daniels, Sydney exec (and, de facto, Jack)
Dispense
Enthusiasm!
“You can’t behave
in a calm, rational
manner. You’ve got
to be out there on
the lunatic fringe.”
— Jack Welch
Part II:
Healthcare
Horrors & Hope
1. Premise.
“If one didn’t know better, one
might think that hospitals set
out to design systems that
provide the most sophisticated
technical care but deliver the
worst possible experience to sick
people.” —Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
Golden American Age of Patient-centric,
Genetics-driven Healthcare Looms!
Current status: $1.3T+. 30M-70M uninsured. 100K killed
and 2M injured p.a. in hospitals. 85% treatments
unproven. Cure prescribed depends on locale in which
treated. 50% prescriptions do not work. 2X hospitals.
IS primitive. Accountability & measurement nil.
And … EVERYBODY’S MAD-AS-HELL AND FEELS
POWERLESS: DOCS, PATIENTS, NURSES, INSURERS,
EMPLOYERS, PHARMA & DEVICE COS, HOSPITAL
ADMINISTRATORS AND STAFF.
2. Consumerism (Patientcentric Healthcare Arrives)
“We expect consumers to
move into a position of
dominance in the early
years of the new century.”
Dean Coddington, Elizabeth Fischer, Keith
Moore & Richard Clarke, Beyond Managed Care
Today’s Healthcare “Consumer”:
“skeptical and
demanding”
Source: Ian Morrison, Health Care in the New Millennium
“Savior for the Sick”
vs.
“Partner for Good
Health”
Source: NPR
CAM (Complementary & Alternative Medicine):
83M in US (42%)
CAM visits 243M greater than to PCP (Primary Care
Physician) (With min insurance coverage)
W-F-Educated-Hi inc
Don’t tell PCP (40%)
(<30% procedures used in conventional medicine have
undergone RCTs/randomized clinical trials)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Consumer Imperatives
Choice
Control (Self-care, Self-management)
Shared Medical Decision-making
Customer Service
Information
Branding
Source: Institute for the Future
3. Demographics:
The BOOMERS
Reach 60 in ’05!
“NOT ACTING THEIR
AGE: As Baby Boomers
Zoom into Retirement,
Will America Ever Be the
Same?”
USN&WR Cover
Boomer World
“From jogging to plastic
surgery, from vegetarian diets
to Viagra, they are fighting to
preserve their youth and
defy the effects of gravity.”
M.W.C. Howgill, “Healthcare Consumerism, the Information
Revolution and Branding”
“Pick up any copy of Glamour or
Men’s Health, and you’ll see pages of
advertisements encouraging readers
to enlarge their breasts, retard
baldness, correct their vision,
improve their smile, or relieve stress
through herbs, massage therapy,
acupuncture—you name it.”
Coddington, Fischer, Moore & Clarke, Beyond Managed Care
“Sixty Is the
New Thirty”
—Cover/AARP/11.03
4. “Quality”: COULD
IT
TRULY BE THIS AWFUL?
“Quality of care
is the problem, not
managed care.”
Institute of Medicine
“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
“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
CDC 1998: 90,000 killed
and 2,000,000 injured
from nosocomial
[hospital-caused] drug
errors & infections
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
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.” —Dr. Kenneth Kizer, National Quality
. “There
is little evidence that
patient safety has improved in the
last five years.” —Dr. Samantha Collier
Forum
Source: Boston Globe/07.27.04
“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.”
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.
“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
YE GADS!
New England Journal of Medicine/
Harvard Medical Practice Study: 4% error rate (1 of 4
negligence). “Subsequent investigations around the
country have confirmed the ubiquity of error.” “In one
small study of how clinicians perform when patients
have a sudden cardiac arrest, 27 of 30 clinicians made
an error in using the defibrillator.” Mistakes in
administering drugs (1995 study) “average once every
hospital admission.” “Lucian Leape, medicine’s
leading expert on error, points out that many other
industries—whether the task is manufacturing
semiconductors or serving customers at the Ritz
Carlton—simply wouldn’t countenance error rates like
those in hospitals.”—Complications, Atul Gawande
“In 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)
PARADOX: Many, many
formal case reviews …
failure to systematically/
systemically/ statistically
look at and act on evidence.
C.f., Complications, Atul Gawande
“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!
“Practice variation is not caused by ‘bad’ or
‘ignorant’ doctors. 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 habits of a guild, where
each craftsman trusts his fellows, than with the
demands of the information age.”
Michael Millenson, Demanding Medical Excellence
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
IS/Web
5. The
REVOLUTION
“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)
“We’re in the Internet
age, and the average
patient can’t email
their doctor.”
Donald Berwick, Harvard Med School
Computerized Physician Order
Entry/CPOE:
5%
hospitals
source: HealthLeaders/06.02
of U.S.
“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)
“Patient by patient, problem by
problem—drug reactions, hospital
caused infections—Salt Lake City’s
LDS Hospital has attacked treatmentcaused injuries and deaths. One of the
secrets of LDS’s success is a custombuilt clinical computer system that
may serve as a national model for how
to save patient lives.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
21
6. HealthCare
HealthCare21: 21 Ideas for Century21
1. Hospitals kill people. (And many of those they don’t kill, they
wound.) (And they deny it.) (ERRORS RULE!) And: Hustling
ambulances kill pedestrians—and don’t save patients.
2. Doctors are spoiled brats—who don’t like measurements.
Or any form of “interference.” Docs are also cover-up artists.
The REAL Hippocritic [sic?] Oath: “DON’T RAT ON A
FELLOW DOC”.
3. Most prescription drugs don’t work—for a PARTICULAR
patient. Current drugs = Blunderbusses.
4. Think … WELLNESS. Think … PREVENTION.
5. THERE IS LITTLE “SCIENCE” IN “MEDICINE.” (See state to
state variations … country to country variations … the general
lack of agreed-upon treatments.)
6. You could save thousands of lives—if you simply outlawed
handwritten prescriptions.
7. “Detailers” will disappear … when GenX docs arrive.
HealthCare21 (Cont.)
8. IS/IT in hospitals is primitive (despite smart people and
enormous expenditures—think Sears v. Wal*Mart).
9. Systemic IS/IT is worse—links between docs, insurers,
providers, patients.
10. ELECTRONIC MEDICAL RECORDS …TO UNIFORM
STANDARDS. (NOW.)
11. THE WEB WILL LIBERATE. (Info = Power.)
12. 80M BOOMERS RULE. ($$$$$. Desire for c-o-m-p-l-e-t-e
CONTROL. NOW. “LEADERSHIP” OF AGING PROCESS.)
13. “Drug Discovery” processes at Big Pharma are … hopelessly
over-complicated.
(???: Bye Bye … Big Pharma.)
14. 90% of the “healthcare fix”: HARVEST THE LOW-HANGING
FRUIT. “They” are … NOT … the Enemy. “I have seen the
enemy … and it am me.” Damn it.
HealthCare21 (Cont.)
15. The number of U.S. un-insured is the nation’s #1 disgrace.
That said, insured “consumers” are spoiled brats.
They/we/me act as if healthcare were a free good … and
believe that an incipient hangnail calls for at least a CAT scan
… or two. ANSWER: MAKE US FEEL THE PAIN.
16. Genetic engineering & biotech change … EVERYTHING.
(Within 15 years.)
17. New Medical Devices change … EVERYTHING. (Within 15
years.)
18. IS/IT changes … EVERYTHING. (Within 10 years.)
19. New Docs change … EVERYTHING. (Within 10 years.)
20. New Patients change … EVERYTHING. (Within 5 years.)
*
*
HealthCare21 (Cont.)
ALL THIS =
ENORMOUS
OPPORTUNITY.
21.
The
Opportunity of Several Lifetimes. (For the Bold & Brave.)
H’Care WILL be … TOTALLY … re-invented in the next two
decades. (And, hey, it is our largest “industry.”)
7. Doing It Right
Planetree: A Radical
Model for New
Healthcare/Healing/
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
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. 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
Mgrs re staff: wages, security, promotion
opportunities
Staff re staff: interesting work (M:5 of 10),
appreciation (5 of 10), sense of being “in” about
what’s going on (10 of 10)
Source: 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 (CR)
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 rate of 72.4%, as
compared to 56.3% for those who
didn’t have a confidant.”
Institute for the Future
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
Aroma therapy (e.g., “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
Griffin: redesign chapel (waterfall, quiet
music, open prayer book)
Other: music, flowers, portable labyrinth
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
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
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
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
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!
8. Tom’s
HealthCare
2
Healthcare’s 1-2 Punch
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, biomedicine will soon allow us to understand and deal with individual genetic predispositions. (And hooray!) But take it from this 61-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-for-you-the-unwashed.” (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?)
CR
07.03: 60/264/180/145-85/140
10.04: 61/195/092/097-60/058
Off …
Univasc (<1/2)
Bextra
Lipitor
Toprol
Propranolol
Determinants of Health
Access to care: 10%
Genetics: 20%
Environment: 20%
Health Behaviors: 50%
Source: Institute for the Future