Transcript Tom Peters’ EXCELLENCE. ALWAYS. McKesson 2008 Executive Leadership Summit The Broadmoor/Colorado Springs/23 July 2008

Tom Peters’
EXCELLENCE.
ALWAYS.
McKesson 2008 Executive Leadership Summit
The Broadmoor/Colorado Springs/23 July 2008
Slides at …
tompeters.com*
*Also: “Long” version
Part One: A
Civilian Looks
at Your World
DVM/Lyme/2005-2008
**Multiple diagnoses (>5)
**Specialist self-certainty
**Health deterioration failed to produce urgencycommunication
**Virtually no communications between specialists
**Follow-up very spotty unless bugged incessantly
**Lost major test results, mis-placed 3 or 4
occasions
**Near fatal drug mistake (one nurse takes charge)
**Effectively, disinterest in chronic-care
**Lack of curiosity
1900-1960, life
expectancy grew 0.64 %
per year; 1960-2002,
0.24% per year, half from
airbags, gun locks,
service employment …
“Bottom line” :
Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“The more doctors and specialists around, the more tests
and procedures performed. And the results of all these
tests and procedures? Lots more medical bills, exposure
to medical errors, and a loss of life expectancy.
“It was this last conclusion that was truly shocking, but it became
unavoidable when [Dartmouth’s Dr. Jack] Wennberg and others
They found it’s not
just that renowned hospitals
and their specialists tend to
engage in massive
overtreatment. They also tend
to be poor at providing critical
but routine care.”
broadened their studies.
Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“If we sent 30 percent of
the doctors in this
country to Africa, we
might raise the level of
health on both
continents.” —Dr Elliott Fisher,
Center of Evaluative Clinical Sciences, Dartmouth
Medical School (“Overdose,” Atlantic, Shannon
Brownlee.)
98,000 killed
and 2,000,000
CDC 1998:
injured from
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
“Hospital infections kill an
estimated 103,000 people
in the United States a year,
as many as AIDS, breast
cancer and auto accidents
combined.
… Today, experts estimate that more than 60 percent of
staph infections are M.R.S.A. [up from 2 percent in 1974]. Hospitals in Denmark,
Finland and the Netherlands once faced similar rates, but brought them down to below
1 percent. How? Through the rigorous enforcement of rules on hand washing, the
meticulous cleaning of equipment and hospital rooms, the use of gowns and
disposable aprons to prevent doctors and nurses from spreading germs on clothing
and the testing of incoming patients to identify and isolate those carrying the germ. …
Many hospital administrators say they can’t afford to take the necessary precautions.”
—Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (New York Times/06.06.2005)
“Experts estimate that more
than a hundred thousand
Americans die each year not
from illness but from their
prescription drugs. Those deaths, occurring
quietly, almost without notice in hospitals, emergency rooms, and
homes, make medicines one of the leading causes of death in the
United States. On a daily basis, prescription pills are estimated to kill
more than 270 Americans. … Prescription medicines, taken
according to doctors’ instructions, kill more Americans than either
diabetes or Alzheimer’s disease.”
Source: Our Daily Meds: How the Pharmaceutical Companies
Transformed Themselves into Slick Marketing Machines and
Hooked the Nation on Prescription Drugs —Melody Petersen
140,000,000
illegible
prescriptions
per year
—John Hammergren & Phil Harkins, Skin in the Game: How
Putting Yourself First Today Will Revolutionize Healthcare
Tomorrow
**1,500,000,000,000
claims per year
**30% errors
**15% lost
**25% paper-based
Source: John Hammergren & Phil Harkins, Skin in the Game:
How Putting Yourself First Today Will Revolutionize
Healthcare Tomorrow
“stunning lack of
scientific knowledge
about which
treatments and
procedures actually
work”
Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“The results are deadly. In addition
to the 98,000 killed by medical
errors in hospitals and the 90,000
deaths caused by hospital
infections, another 126,000 die
from their doctor’s failure to
observe evidence-based protocols
for just four common conditions:
hypertension, heart attack,
pneumonia, and colorectal cancer.”
[TP: total 314,000]
Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“Plus God alone
knows how many
casualties in
doctors’ offices,
Tom”
—Thom Mayer
Part Two: The
“Last 98%”
“… it is
the
game.”
“If I could have chosen not to tackle the IBM culture head-on, I
probably wouldn’t have. My bias coming in was toward strategy,
analysis and measurement. In comparison, changing the
attitude and behaviors of hundreds of thousands of people is
[Yet] I came to see in
my time at IBM that culture
isn’t just one aspect of the
very, very hard.
game —it is the
game.”
—Lou Gerstner,
Who Says Elephants Can’t Dance
-fold!
“culture of cover-up
that pervades healthcare”
“Patient Safety Event Registry” …
“looking for systemic solutions, not seeking
to fix blame on individuals except in the
Ken Kizer/VA 1997:
most egregious cases. The good news was a
thirty-fold
increase
in the number of medical
mistakes and adverse events that got reported.”
“National Center for Patient Safety Ann Arbor”
Thank you
Ike , Charlie, Ben
& Norm, George,
Nelson, and Ben …
“Allied commands depend
on mutual confidence
[and this confidence]
is gained, above all
through the development
of friendships.”
—General D.D. Eisenhower,
Armchair General * (05.08)
*“Perhaps his most outstanding ability [at West Point] was
the ease with which he made friends and earned the trust
of fellow cadets who came from widely varied backgrounds;
it was a quality that would pay great dividends during his
future coalition command.”
George Crile (Charlie Wilson’s War) on Charlie
Wilson: “The way things normally work,
if you’re not Jewish you don’t get into
the Jewish caucus, but Charlie did. And
if you’re not black you don’t get into the
black caucus. But Charlie plays poker
with the black caucus; they had a game,
and he’s the only white guy in it. The
House, like any human institution, is
moved by friendships, and no matter
what people might think about Wilson’s
antics, they tend to like him and enjoy
his company.”
Give
good
tea!
“What I learned
from my years as a hostage
negotiator is that we do not
have to feel powerless—and
The 95% Factor:
that bonding is the
antidote to the hostage
situation.” —George Kohlrieser, Hostage at the Table
“I am a
dispenser of
enthusiasm.”
—Ben Zander
Hard Is Soft
Soft Is Hard
Hard Is Soft (Plans, #s)
Soft Is Hard (people,
customers, values,
relationships))
R.O.I.R.
Return On
Investment In
Relationships
Relationships
(of all varieties):
THERE
ONCE WAS A TIME WHEN A
THREE-MINUTE
PHONE CALL WOULD
HAVE AVOIDED SETTING OFF THE
DOWNWARD SPIRAL THAT RESULTED
IN A COMPLETE RUPTURE.
“Courtesies of a small and
trivial character are the
ones which strike
deepest in the grateful
and appreciating heart.”
—Henry Clay
X =XFX*
*Excellence = Cross-functional Excellence
The “XF-50”: 50 Ways to
Enhance Cross-Functional
Effectiveness and Deliver
Speed, “Service Excellence”
and “Value-added
Customer ‘Solutions’”*
*Entire “XF-50” List is an Appendix to the LONG version of
this presentation, posted at tompeters.com
Never
waste a
lunch!
????
% XF
lunches*
*Measure!
CIO Question:
% Doc
lunches*
*Last 30 days
???????
“Success doesn’t depend on the number of
people you know; it depends on the number
of people you know in
high places!”
or
“Success doesn’t depend on the number of
people you know; it depends on the number
of people you know in
low
places!”
Loser:
“He’s such a
suck-up!”
Winner:
“He’s such a
suck-down.”
George Crile (Charlie Wilson’s War) on Gust
“He had
become something of a
legend with these
people who manned the
underbelly of the
Agency [CIA].”
Avrakotos’ strategy:
William Easterly, The White Man’s Burden:
Why the West’s Effort to Aid the Rest Have
Done So Much Ill and so Little Good: “The
$2.3 trillion
West spent …
on
foreign aid over the last five decades and still
has not managed to get twelve-cent
medicines to children to prevent half of all
malaria deaths. The West spent $2.3 trillion
and still not managed to get three dollars to
each new mother to prevent five million child
deaths. … But I and many other like-
minded people keep trying, not to
abandon aid to the poor, but to make
sure it reaches them.”
Lesson: Show up.
Lesson: Listen to the
“locals.”
Lesson: Hear the
“locals.”
Lesson: Engage the
locals.
Lesson: Try a lot of stuff.
MBWA
Source: How Doctors Think, Jerome Groopman
“Buy in”“Ownership”Authorial bragging
rights-“Born again”
Champion = One
Line of Code!
“We made mistakes, of course. Most of them were
omissions we didn’t think of when we initially wrote the
software. We fixed them by doing it over and over, again
and again. We do the same today. While our competitors
are still sucking their thumbs trying to make the design
perfect, we’re already on prototype version
#5.
By
the time our rivals are
ready with wires and screws, we are on version
#10. It gets back to planning
versus acting: We act from day
one; others plan how to plan—
for months.” —Bloomberg by Bloomberg
For projects involving children or
health or education or community
development or sustainable
small-business growth (most
women
projects),
are by
far the most reliable and most
central and most indirectly
powerful local players even in the
most chauvinist settings.
“Forget China,
India and the
Internet: Economic
Growth Is Driven
by
Women.”
—Headline,
Economist, April 15, 2006, Leader, page 14
10 UNASSAILABLE REASONS WOMEN RULE
Women make [all] the financial decisions.
Women control [all] the wealth.
Women [substantially] outlive men.
Women start most of the new businesses.
Women’s work force participation rates have
soared worldwide.
Women are closing in on “same pay for same
job.”
Women are penetrating senior ranks rapidly
[even if the pace is slow for the corner
office per se].
Women’s leadership strengths are exceptionally well
aligned with new organizational effectiveness
imperatives.
Women are better salespersons than men.
Women buy [almost] everything—commercial
as well as consumer goods.
So what exactly is the point of men?
“You have to
treat your
employees like
customers.”
—Herb Kelleher,
upon being asked his “secret to success”
Source: Joe Nocera, NYT, “Parting Words of an Airline Pioneer,”
on the occasion of Herb Kelleher’s retirement after 37 years
at Southwest Airlines (SWA’s pilots union took out a full-page
ad in USA Today thanking HK for all he had done; across the
way in Dallas American Airlines’ pilots were picketing the
Annual Meeting)
… no less than
Cathedrals
in which the full and
awesome power of the
Imagination and Spirit and
native Entrepreneurial flair
of diverse individuals is
unleashed in passionate
pursuit of … Excellence.
#1 cause of
Dis-satisfaction?
2 per Year =
Excellence +
Legacy
Nudge.
Sway.
K.I.S.S.
90K in U.S.A. ICUs on any
given day; 178 steps/day
in ICU.
50%
stays result
in “serious complication”
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**Peter Pronovost, Johns Hopkins,
2001
**Checklist, line infections
**1/3rd at least one error when he started
**Nurses/permission to stop procedure
if doc, other not following checklist
**In 1 year, 10-day line-infection rate:
11% to …
0%
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**Docs, nurses make own
checklists on whatever
process-procedure they choose
**Within weeks, average stay in
ICU down
50%
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
“Everything matters”
-80%
Source: Nudge, Richard Thaler and Cass
Sunstein, etching of fly in the urinal
reduces “spillage” by 80%, Schiphol Airport
“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
<TGW
vs.
>TGR
2-cent
candy
Part Three:
Five Pianos
Planetree:
A Radical Model for New
Healthcare/Healing/
Wellness Excellence
Tom Peters
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
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
“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
2. Informing and
Empowering Diverse
Populations: Consumer
Health Libraries and
Patient Information
Planetree Health Resources Center/1981
Planetree Classification System
Consumer Health Librarians
Volunteers
Classes, lectures
Health Fairs
Griffin’s Mobile Health Resource Center
Open Chart Policy
Patient Progress Notes
Care Coordination Conferences (Est
goals, timetable, etc.)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
3. Healing
Partnerships: The
Importance of
Including
Friends and Family
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
Kitchen
Beautiful cutlery,
plates, etc
Chef reputation
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
5. Spirituality:
Inner Resources
for Healing
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
Mid-Columbia Medical Center/Center for Mind and Body
Massage for every patient scheduled for
ambulatory surgery (“Go into surgery with
a good attitude”)
Infant massage
Staff massage (“caring for the caregivers”)
Healing environments: chemo!
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
7. Healing Arts:
Nutrition for
the Soul
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
F.Y.I.: It
works!
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)
9 July 2008/HealthLeaders Media
2008 Top
Leadership Team in
Healthcare: Griffin
Hospital
“How will you know when the healthcare industry has
finally entered the 21st century? When error rates at
hospitals are close to zero. When doctors and nurses
use evidence-based protocols in your treatment. When
you can decide how much to spend on treatment, and
you have the information and the opportunity to
determine the best value. When your primary care
physician is in charge of your extended care team,
operating as your command central. When all members
of the medical community—nurses, doctors, pharmacists
and specialists—work together seamlessly on your
behalf. When their combined efforts are tracked,
measured, and reported on—and the insurance
reimbursements awarded to them are based on
performance. When you see that hospitals, pharmacies
and doctors are working harder in all aspects to
make sure you are an informed consumer who has
trust and confidence in the services they offer and the
prices they charge.” —John Hammergren & Phil Harkins,
Skin in the Game: How Putting Yourself First Today
Will Revolutionize Healthcare Tomorrow