Transcript Tom Peters’ Leading for Excellence: Surpassing “Unrealistic” Expectations AHCA/NCAL 55th Annual Convention & Expo Miami Beach/10.04.2004

Tom Peters’
Leading for Excellence:
Surpassing “Unrealistic”
Expectations
AHCA/NCAL 55th Annual Convention & Expo
Miami Beach/10.04.2004
AHCA
is … the American Healthcare
Association.
NCAL is … the National Center for Assisted
Living.
Slides at …
tompeters.com
Goals.
Tom’s Healthcare9: Goals2004
1. Stop killing people in acute-care settings through
negligence/lousy management/craft mores. (THIS IS ABOUT
ATTITUDE & WILL … NOT $$$$.)
2. Adopt Patient-centric acute-care models (a la Planetree).
3. Embrace the Boomer Tsunami.
4. Prepare for consumer-driven healthcare.
5. Revise-Revolutionize the entire system (K-90) to revolve
around Wellness-Prevention.
6. Erase the disgrace of uninsured American’s … in Planet’s
Wealthiest Economy.
7. Re-orient Boomer-driven Eldercare toward Optimism
(“The time of your life!”) (60 – 30 = 90 – 60).
8. Re-imagine! What an Opportunity!
9. Excellence = State of Mind.
Musings …
This is the most
important speech
I’ve given since
NAESP!
Never felt it so keenly …
Problem-focused?
Opportunity-focused?
Regulations
Sky-high (“Unrealistic”) Expectations
Inadequate Funding
Staffing Woes
Etc.
Etc.
Etc.
“Growth market” or …
Magical Opportunity to
Lead this Demographic
Revolution … and Reimagine Aging?
Biases.
95/Ginger Cove/
Life Care Services
WHY THE HELL
SHOULDN’T MY
EXPECTATIONS BE
“TOWERING”?
T = SS – 34D
Cool? Oh Bleep?
60 – 30 = 90 - 60
A Magical
Time to
fully/finally
appreciate life!
“Old Age”:
TP/61/CR: Diet … Eating Habits/Philosophy …
Nutrition Supplements … Breathing …
Stretching … Meditation (Short, Long) …
Exercise … Mini-walks … Sound … Flowers …
Aromatherapy … Baths … Labyrinthine …
Massage … Acupuncture … Chiropractic … Big
CR/“CR Pauses” … Water (Japanese bath) …
“Stop. Look. Listen.” ... Monitor & Measure &
Record. New World Order = Reverse 5 decades
of abuse (With damn little help from my M.D. friends)
Context.
Weird.
“Uncertainty is the only
thing to be sure of.” —Anthony Muh,
head of investment in Asia, Citigroup Asset Management
“If you don’t like change,
you’re going to like
irrelevance even less.” —General Eric
Shinseki, Chief of Staff,
U. S. Army
“It’s no longer enough to
be a ‘change agent.’ You
must be a change
insurgent—provoking,
prodding, warning
everyone in sight that
complacency is death.”
—Bob Reich
“In Tom’s world, it’s
always better to try a swan
dive and deliver a
colossal belly flop than to
step timidly off the
board while holding your
nose.” —Fast Company /October2003
Revolution.
Period.
It is the foremost task—
and responsibility—
of our generation to
re-imagine our
enterprises, private
and public. —from the back cover,
Re-imagine!
No Wiggle Room!
“Incrementalism
is innovation’s
worst enemy.”
Nicholas Negroponte
“Beware of the
tyranny of making
Small Changes
to Small Things.
Rather, make Big
Changes to Big
Things.”
—Roger Enrico, former Chairman, PepsiCo
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
Characteristics of the “Also rans”*
“Minimize risk”
“Respect the chain of
command”
“Support the boss”
“Make budget”
*Fortune, article on “Most Admired Global Corporations”
IS/IT. Go for the
Gold. (Or: At Least Try and
Get Off the Bench.)
Productivity!
McKesson 2002-2003:
Revenue … +$7B
Employees … +500
Source: USA Today/06.14.04
“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
Want email consultation: 90%
patients, 15% docs.
Evidence: Patients do not
pester docs. Time is saved. No
one has sued (shows “care & connection”—
the absence of which is the major cause
of suits).
Source: New York Times
Computerized Physician Order
Entry/CPOE:
5%
hospitals
source: HealthLeaders/06.02
of U.S.
Telemedicine …
Reduces days/1000 patients and
physician visits for the chronically ill
Decreases costs of managing chronic
disease
Expands service areas for providers
Reduces travel costs to and from medical
ed seminars
Douglas Goldstein, e-Healthcare
“Our entire facility is digital. No paper, no film, no
medical records. Nothing. And it’s all integrated—from the lab to
X-ray to records to physician order entry. Patients don’t have to
wait for anything. The information from the physician’s office is
in registration and vice versa. The referring physician is
immediately sent an email telling him his patient has shown up.
… It’s wireless in-house. We have 800 notebook computers that
are wireless. Physicians can walk around with a computer that’s
pre-programmed. If the physician wants, we’ll go out and wire
their house so they can sit on the couch and connect to the
network. They can review a chart from 100 miles away.” —David
Veillette, CEO, Indiana Heart Hospital (HealthLeaders/12.2002)
The VHA gets it!
E.g.: Laptop at bedside calls
up patient e-records from one of 1,300 hospitals. Barcoded wristband confirms meds. National Center for
Patient Safety in Ann Arbor. Docs and researchers
discuss optimal treatment regimens—research center
in Durham NC. Doc measures & guidelines; e.g.,
pneumonia vaccinations from 50% to 84%. Blamefree system, modeled after airlines. “What’s needed
in the U.S. is nothing short of a medical revolution and
the VHA has gone further than most any other
organization to revamp its culture and systems.”—
Rand/Source:WSJ 12.10.2001
Consumerism.
Amen!
“The Age of the
Never Satisfied
Customer”
Regis McKenna
“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
“Medical care has traditionally
followed a ‘professional’ model,
based on two assumptions: that
patients are unable to become
sufficiently informed about their
own care to allow them a pivotal
role, and that medical judgments
are based on science.”
Joseph Blumstein, Vanderbilt Law School
Consumer Imperatives
Choice
Control (Self-care, Self-management)
Shared Medical Decision-making
Customer Service
Information
Branding
Source: Institute for the Future
“Savior for the Sick”
vs.
“Partner for Good
Health”
Source: NPR
Quality.
Whoops.
Ouch.
Yikes.
“Without being disrespectful, I
consider the U.S. healthcare delivery
system the largest cottage industry in
the world. There
are virtually no
performance measurements
and no standards. Trying to
measure performance … is the next
revolution in healthcare.”
Richard Huber, former CEO, Aetna
“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
PARADOX: Many, many
formal case reviews …
failure to systematically/
systemically/ statistically
look at and act on evidence.
C.f., Complications, Atul Gawande
“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
“As unsettling as the prevalence of
inappropriate care is the enormous amount of
what can only be called ignorant care. A
surprising 85% of everyday medical
treatments have never been scientifically
validated. … For instance, when family
practitioners in Washington 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
“Quality of care
is the problem, not
managed care.”
Institute of Medicine
CDC 1998: 90,000 killed
and 2,000,000 injured
from nosocomial
[hospital-caused] drug
errors & infections
HealthGrades/Denver:
195,000
hospital deaths per year in the U.S., 2000-2002 =
390 full jumbos/747s in the drink per year.
Comments: “This should give you pause when
you go to the hospital.” —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
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
Various studies: 1 in 3,
1 in 5, 1 in 7, 1 in 20
patients “harmed by
treatment”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
“In a disturbing 1991 study, 110
nurses of varying experience levels
took a written test of their ability to
calculate medication doses. Eight out
of 10 made calculation mistakes at
least 10% of the time, while four out
of 10 made mistakes 30 % of
the time.”
Demanding Medical Excellence: Doctors and Accountability
in the Information Age, Michael Millenson
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
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
(10X Baton Rouge vs. Binghamton).
Breast cancer screening: 4X NE, FL, MI
vs. SE, SW. (Source: various)
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
It’s the
“Experience”!
“Experiences are as
distinct from services
as services are from
goods.”
Joseph Pine & James Gilmore, The Experience Economy:
Work Is Theatre & Every Business a Stage
The “Experience Ladder”
Experiences
Services
Goods
Raw Materials
“Club Med
is more
than just a ‘resort’; it’s a
means of rediscovering
oneself, of inventing an
entirely new ‘me.’ ”
Source: Jean-Marie Dru, Disruption
“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
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
“Most executives have no
idea how to add value to a
market in the metaphysical
world. But that is what the market
will cry out for in the future. There
is no lack of ‘physical’ products to
choose between.”
Jesper Kunde, Unique Now ... or Never [on the excellence of
Nokia, Nike, Lego, Virgin et al.]
A Certain Sort
of Experience:
Women.
?????????
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%
Read This Book …
EVEolution:
The Eight Truths of
Marketing to Women
Faith Popcorn & Lys Marigold
EVEolution: Truth No. 1
Connecting Your Female
Consumers to Each
Other Connects Them to
Your Brand
“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
“Women don’t buy
They
join them.”
brands.
EVEolution
2.6
vs.
“Resting” State: 30%, 90%: “A
woman knows her children’s
friends, hopes, dreams, romances,
secret fears, what they are
thinking, how they are feeling. Men
are vaguely aware of some short
people also living in the house.”
Barbara & Allan Pease, Why Men Don’t Listen & Women Can’t Read Maps
“As a hunter, a man needed vision that
would allow him to zero in on targets in the
distance … whereas a woman needed eyes
to allow a wide arc of vision so that she
could monitor any predators sneaking up
on the nest. This is why modern men can
find their way effortlessly to a distant pub,
but can never find things in fridges,
cupboards or drawers.”
Barbara & Allan Pease, Why Men Don’t Listen & Women Can’t Read Maps
“Female hearing advantage
contributes significantly to what is
called ‘women’s intuition’ and is one
of the reasons why a woman can read
between the lines of what people say.
Men, however, shouldn’t despair.
They are excellent at imitating
animal sounds.”
Barbara & Allan Pease, Why Men Don’t Listen & Women Can’t Read Maps
“When a woman is upset,
she talks emotionally to
her friends; but an upset
man rebuilds a motor or
fixes a leaking tap.”
Barbara & Allan Pease, Why Men Don’t Listen &
Women Can’t Read Maps
“Women are more
comfortable talking or
thinking about people and
relationships, while men
prefer to contemplate
things.” —research reported in the New York
Times (08.10.2003)
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.
The Hunch of a Lifetime: An Emergent (Market) Nexus
I have a sense/hunch there’s an interesting nexus among several of the ideas
about New Market Realities that I promote … namely Women-Boomers-WellnessGreen-Intangibles. Each one drives the Fundamental (Traditional) Economic Value
Proposition toward the “softer side”: From facts- & figures-obsessed males
toward relationship-oriented Women. From goods-driven youth toward
“experiences”-craving Boomers. From quick-fix & pill-popping “healthcare”
toward a holistically inclined “Wellness Revolution.” From mindless exploitation of
the Earth’s resources toward increased awareness of the fragility and
preciousness of our Environment. From “goods” and “services” toward Design& Creativity-rich Intangibles-Experiences-Dreams Fulfilled. This so-called “softer
side”—as the disparate likes of IBM’s Sam Palmisano and Harley-Davidson’s Rich
Teerlink teach us—is now & increasingly “where the loot is,” damn near all the
loot. That is, the “softer side” has become the Prime Driver of tomorrow’s “hard”
economic value. Furthermore, each of the Five Key Ideas (Women-BoomersWellness-Green-Intangibles) feeds off and complements the other four. Dare I use
the word “synergy”? Perhaps. (Or: Of course!) I can imagine an enterprise defining
its raison d’etre in terms of these Five Complementary Key Ideas. (HINT: DAMN
FEW DO TODAY.)
Women
Boomers
Wellness
Green
Intangibles
An Emergent Nexus
Men …………………………….……………….... Women
Youth ………………………………… Boomers/Geezers
“Fix It” Healthcare……………….. Wellness/Prevention
Exploit-the-Earth ……...... Preserve/Cherish the Planet
Tangibles ……………………………………… Intangibles
Experience
Plus:
Planetree.
“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
“It was the goal of the
Planetree Unit to help
patients not only get well
faster but also to stay well
longer.” —Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
“Much of our current
healthcare is about curing.
Curing is good. But healing
is spiritual, and healing is
better, because we can hewal
many people we cannot
cure.” —Leland Kaiser, “Holistic Hospitals”
Source: 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
The Customer Comes
Second: Put your People
First and Watch ’Em Kick
Butt —Hal Rosenbluth (and Diane McFerrin Peters)
“100 Best Places to
Work”/RLevering/2001
Get straight answers
Appreciation
Collaboration
Interest in me as a person
Camaraderie (“Fun place to work”)
“Perhaps the simplest and most profound
of al human interactions is kindness. …
But if it is so simple, it is surprising how
frequently it is absent from our healthcare
environments. … Many staff members
report verbal ‘abuse’ by physicians,
managers and coworkers.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
“Planetree is about
human beings caring
for other human
beings.” —Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel (“Ladies and
gentlemen serving ladies and gentlemen”—4S credo)
2. Informing and
Empowering Diverse
Populations: Consumer
Health Libraries and
Patient Information
Planetree Health Resources Center/1981
Planetree Classification System
Consumer Health Librarians
Volunteers
Classes, lectures (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
“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.”
Source: Institute for the Future
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
Institute of Medicine/ “Crossing the Quality Chasm”
Respect for preferences
Involvement in Decision Making
Access to care
Coordination of care
Information and education
Physical comfort
Emotional support
Involvement of Friends and Family
Continuity of care
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Care Partner Programs (IDs, discount meals, etc.)
Unrestricted visits (“Most Planetree hospitals have eliminated
visiting restrictions altogether.”) (ER at one hospital “has a policy of never
separating the patient from the family; and there is no limitation on how many
family members may be present.”)
Collaborative Care Conferences
Clinical Guidelines Discussions
Family Spaces
Pet Visits (POP: Patients’ Own Pets)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
4. Nutrition: The
Nurturing Aspect
of Food
Meals are central events
vs
“There, you’re fed.”*
*Irony: Focus on “nutrition” has reduced focus on “food” and “service”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Kitchen
Beautiful cutlery, plates, etc.
Chef rep
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Aroma therapy (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
Spirituality
body-mind-spirit
prayer-meditation-visualization
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
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
Florence Nightingale/Notes on
Nursing/patient’s need for beauty,
windows, flowers: “People say the
effect is only on the mind. It is no such
thing. The effect is on the body, too”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
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
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%)
OTA: <30% procedures used in conv med have
undergone RCTs (randomized clinical trials)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
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
Sound
Texture
Lighting
Color
Smell
Taste
Sacred space
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
The Eden
Alternative
The Ten Principals of the Eden Alternative
1. The three plagues of loneliness, helplessness, and boredom
account for the bulk of suffering among Elders.
2. Life in an Elder-centered community revolves around close
and continuing contact with children, plants, and animals.
These ancient relationships provide young and old alike with a
pathway to a life worth living.
3. Companionship is the antidote to loneliness. In an Eldercentered community we must provide easy access to human
and animal companionship.
4. A healthy Elder-centered community seeks to balance the
care that is being given with the care that is being received.
Elders need opportunity to give care and caregivers need
opportunities need opportunities to receive care.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“The Eden paradigm allows
elders to care for animals,
birds, and children as well
each other.” —Susan Eaton, Harvard/JFK school
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Ten Principals of the Eden Alternative
5. Variety and Spontaneity are the antidotes to
boredom. The Elder-centered community is rich is rich
in opportunities to sample these ancient pleasures.
6. An Elder-centered community understands that
passive entertainment cannot fill a human life.
7. The Elder-centered community takes medical
treatment down from its pedestal and places it into the
service of genuine human caring.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
The Ten Principals of the Eden Alternative
8. In an Elder-centered community, decisions should
be made by the Elders or those as close to the Elders
as possible.
9. An Elder-centered community understands human
growth cannot be separated from human life.
10. Wise leadership is the lifeblood of any struggle
against the Three Plagues. For it, there can be no
substitute.
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Conclusion:
Caring/Growth
“Experience”
Care!
Control!
Connect!
Engage!
Grow!
De-stress!
“The most basic
question we need to
pose in caring for
others is this: Is this a
loving act?” —Leland Kaiser, “Holistic
Hospitals”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Learn more about
Planetree/The
Planetree Alliance :
www.planetree.org
Talent I.
“The leaders of Great
Groups love talent and know
where to find it. They revel in
the talent of others.”
Warren Bennis & Patricia Ward Biederman,
Organizing Genius
PARC’s Bob Taylor:
“Connoisseur
of Talent”
Brand =
Talent.
What’s your company’s …
EVP?
Employee Value Proposition, per Ed
Michaels et al., The War for Talent;
IBP/Internal Brand Promise per TP
EVP = Challenge,
professional growth,
respect, satisfaction,
opportunity, reward
Source: Ed Michaels et al., The War for Talent
High T/O Is Not Inevitable!
CostCo
vs.
Wal*Mart
Talent II.
“AS LEADERS, WOMEN
RULE: New Studies find
that female managers
outshine their male
counterparts in almost
every measure”
Title, Special Report, BusinessWeek, 11.20.00
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
Lead.
“Ninety percent of what
we call ‘management’
consists of making it
difficult for people to get
things done.” – P.D.
“Create a
‘cause,’ not a
‘business.’ ”
G.H.:
“Management has a lot to do
with answers. Leadership is a
function of questions. And the
first question for a leader
always is: ‘Who do we intend
to be?’ Not ‘What are we going
to do?’ but ‘Who do we intend to
be?’” —Max De Pree, Herman Miller
BZ: “I am a …
Dispenser of
Enthusiasm!”
“Make it fun to work
at your agency. …
Encourage
exuberance. Get rid
of sad dogs who
spread gloom.”
—David Ogilvy
“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 college president. He
was
seriously interested in who you
were and what you had to say.”
Sara Lawrence-Lightfoot, Respect
“The two most powerful things
a kind
word and a
thoughtful
gesture.”
in existence:
Ken Langone, CEO, Invemed Associates [from Ronna
Lichtenberg, It’s Not Business, It’s Personal]
“The deepest human
need to
be appreciated.”
need is the
William James
“We look for ...
“... listening, caring,
smiling, saying ‘Thank
you,’ being warm.”
— Colleen Barrett, President, Southwest Airlines
“Soft” Is
“Hard”
- ISOE
Message: Leadership is
all about love! [Passion,
Enthusiasms, Appetite for Life,
Engagement, Commitment, Great
Causes & Determination to Make a
Damn Difference, Shared Adventures,
Bizarre Failures, Growth, Insatiable
Appetite for Change.] [Otherwise, why bother?
Just read Dilbert. TP’s final words: CYNICISM SUCKS.]
“A key – perhaps the key –
to leadership is
the effective
communication
of a story.”
Howard Gardner
Leading Minds: An Anatomy of Leadership
Leaders don’t just make products
and make decisions.
Leaders make
meaning.
– John Seely Brown
“You must be
the change you
wish to see in the
world.”
Gandhi
“The single best
way to predict
the future is to
create it.”
—anon
Appendix I
HealthCare
21
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 Hippocratic 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 (think Schindler)—if you
just outlawed handwritten prescriptions.
7. “Detailers” will disappear … when GenX docs arrive.
HealthCare21 (Cont.)
8. IS/IT in hospitals is sub-primitive (despite enormous
expenditures).
9. Systemic IS/IT is worse—links between docs, insurers,
providers, patients.
10. ELECTRONIC MEDICAL RECORDS …TO UNIFORM
STANDARDS. (NOW.) (PLEASE.)
11. THE WEB WILL LIBERATE. (Info = Power.) (BELIEVE IT.)
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.”)
Appendix II
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?)