Transcript LONG Tom Peters’ Toward Health(care) Excellence! Michigan Health & Hospital Association Annual Membership Meeting Grand Hotel/Mackinac Island/0629.2006

LONG
Tom Peters’
Toward
Health(care)
Excellence!
Michigan Health & Hospital Association
Annual Membership Meeting
Grand Hotel/Mackinac Island/0629.2006
Part 1
EXCELLENCE.
ALWAYS.
The
Irreducible209
EXCELLENCE.
THE MANDATE.
“It is not the strongest
of the species that
survives, nor the most
intelligent, but the
one most responsive
to change.”
—Charles Darwin
EXCELLENCE.
THE WORD.
Synonyms
Purity
Transcendence
Virtue
Elegance
Majesty
Antonyms
Mediocrity
EXCELLENCE.
1982.
Excellence1982: The Bedrock “Eight Basics”
1.
2.
3.
4.
5.
6.
7.
8.
A Bias for Action
Close to the Customer
Autonomy and Entrepreneurship
Productivity Through People
Hands On, Value-Driven
Stick to the Knitting
Simple Form, Lean Staff
Simultaneous Loose-Tight
Properties”
EXCELLENCE.
ALWAYS.
“Why in the
world did
you go to
Siberia?”
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.
An emotional,
vital, innovative, joyful, creative,
entrepreneurial endeavor that
elicits maximum concerted
human potential in the
wholehearted service
of others.***
Business* ** (*at its best):
**Excellence. Always.
***Employees, Customers, Suppliers, Communities, Owners, Temporary partners
The
Ultimate
Business:
Creative
Endeavor.
The
Ultimate
Business:
Personal
DevelopmentGrowth
Experience.
The
Ultimate
Business:
Transcendent
Service
Opportunity.
EXCELLENCE.
YOU & ME.
“This is the true joy of Life, the
being used for a purpose
recognized by yourself as a
mighty one … the being a force of
Nature instead of a feverish,
selfish little clod of ailments
and grievances complaining that
the world will not devote itself
to making you happy.”
—GB Shaw/Man and Superman
“Life is not a journey to the
grave with the intention of
arriving safely in a pretty and
well-preserved body—but
rather a skid in broadside,
thoroughly used up, totally
worn out, and loudly
proclaiming, ‘Wow, what
a ride!’ ” —anon.
EXCELLENCE.
INNOVATE.
OR. DIE.
“A focus on cost-cutting and efficiency has
helped many organizations weather the
downturn, but this approach will ultimately
Only the
constant pursuit of
innovation can ensure
long-term success.”
render them obsolete.
—Daniel Muzyka, Dean, Sauder School of Business,
Univ of British Columbia (FT/09.17.04)
“I am often asked by would-be entrepreneurs
seeking escape from life within huge corporate
structures, ‘How do I build a small firm for
Buy
a very large one
and just wait.”
myself?’ The answer seems obvious:
—Paul Ormerod, Why Most Things Fail:
Evolution, Extinction and Economics
More than $$$$
#1 R&D
spending,
last 25 years?
GM
Innovation:
The Secrets
Parallel
universe!
“Venture” fund
(E.g. Gerstner/Amex,
Dow/Marriott, Grove/Intel,
Bedbury/Starbucks)
“This is so simple it sounds stupid, but it is amazing
you
only find oil if you
drill wells.
how few oil people really understand that
You may think you’re
finding it when you’re drawing maps and
studying logs, but you have to drill.”
Source: The Hunters, by John Masters, Canadian O & G wildcatter
“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 No. 5. By the time our rivals are ready
with wires and screws, we are on version
It gets back to planning
versus acting: We act from day
one; others plan how to plan—
for months.” —Bloomberg by Bloomberg
No. 10.
Culture of Prototyping
“Effective prototyping may be
the most valuable core
competence an innovative
organization can hope to have.”
Michael Schrage
“Never doubt that a
small group of
committed people
can change the
world. Indeed it is
the only thing that
ever has.”
—Margaret Mead
EXCELLENCE.
DRAMATIC.
DIFFERENCE.
DOABLE.
$415/SqFt/Wal*Mart
$798/SqFt/Whole
Foods
7X. 730A800P.
F12A.*
*’93-’03/10 yr annual return: CB: 29%; WM: 17%;
HD: 16%. Mkt Cap: 48% p.a.
“It’s simple, really,
Tom. Hire for s,
and, above all,
promote for s.”
—Starbucks middle manager/field
#1/100
“Best Companies to
Work for”/2005
Wegmans
EXCELLENCE.
OPPORTUNITY.
“Women are
the majority
market”
—Fara Warner/The Power of the Purse
“Forget China,
India and the
Internet: Economic
Growth Is Driven
by Women.”
—Headline, Economist,
April 15, Leader, page 14
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.
EXCELLENCE.
EXPERIENCE IT.
“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
“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
C
*Chief e
O*
Xperience Officer
EXCELLENCE.
THE STORY.
“Storytelling
is the core
of culture.”
—Branded Nation: The Marketing of Megachurch,
College Inc., and Museumworld, James Twitchell
“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
EXCELLENCE.
BEDROCK.
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.”
Leadership’s Mt Everest/Mt Excellence
“free to do his or her
absolute best” …
“allow its members to
discover their
greatness.”
“The role of the Director
is to create a space
where the actor or
actress can become
more than they’ve ever
been before, more than
they’ve dreamed of
being.” —Robert Altman, Oscar acceptance
“In the end, management
doesn’t change culture.
Management
invites
the workforce itself to
change the culture.”
—Lou Gerstner
Our Mission
To develop and manage talent;
to apply that talent,
throughout the world,
for the benefit of clients;
to do so in partnership;
to do so with profit.
WPP
DD$21M
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; ie 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.
Second: Putting HR on
a par with finance
and marketing.
“Leaders
‘do’ people.
Period.”
—Anon.
“AS
LEADERS,
WOMEN
RULE:
New Studies find that
female managers outshine their male
counterparts in almost every measure”
Title, Special Report/BusinessWeek
EXCELLENCE.
BEDROCK.
X.Step #1:
Buy a Mirror!
“The First step in a
‘dramatic’ ‘organizational
change program’ is
obvious—dramatic personal
change!” —RG
“You must
be
the change you wish
to see in the world.”
Gandhi
EXCELLENCE.
STRETCH.
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
Kevin Roberts’ Credo
1. Ready. Fire! Aim.
2. If it ain’t broke ... Break it!
3. Hire crazies.
4. Ask dumb questions.
5. Pursue failure.
6. Lead, follow ... or get out of the way!
7. Spread confusion.
8. Ditch your office.
9. Read odd stuff.
10. Avoid moderation!
“It’s always
showtime.”
—David D’Alessandro, Career Warfare
EXCELLE
ALWAYS
Part 2
EXCELLENCE.
HEALTH(CARE).
March-June 2006:
Sample of
Healthcare “PR”
Docs &
Hospitals
Doctors/Hospitals
53 autopsy studies … 24% misdiagnosis rate
(The Independent, 06.27)
“Medical Guesswork: From heart surgery to prostate care, the health
industry knows little about which common treatments really work”
(Cover, BusinessWeek, 0529) Dr David Eddy/Kaiser Permanente
Care Management Institute: “The problem is we do not know what
we are doing.” Eddy: 15% of what doctors do is “backed by hard
evidence” (BW); in general, 20% to 25%.
“What Doctors Hate About Hospitals” (Cover, Time, 05.01) “It
remains almost a stroke of luck to enter a U.S. hospital and receive
precisely the right treatment.” (Time) “No day passed—not one—
without a medication error. The errors were not rare; they were
the norm” (Don Berwick, on his wife’s treatment) “One medication
was discontinued by a physician’s order on the first day of
admission [Berwick’s wife] and yet was brought by a nurse every
single evening fo 14 days straight.” (Time) Harvard Public Health,
2002 study: “More than 1 in 3 doctors reported errors in their own or
a family member’s medical care.” (Time)
Doctors/Hospitals
Dr Robert Wachter, Chief of Medical Service, UCSF Medical Center:
Internal Bleeding: The Truth Behind America’s Terrifying Epidemic
of Medical Mistakes (Time) Dr Niteesh Choudry, Harvard Med
School: “More than half the studies [reviewed] found decreasing
performance with increasing years of practice for all outcomes
assessed; only 4% found increasing performance with increasing
age … one study found that for heart attack patients, mortality
increased 0.5% for every year the physician had been out of medical
school.” (Time) “My pizza parlor is more thoroughly
computerized than most of healthcare.” (Don Berwick, Time)
“Teaching Doctors to Care” (feature, Time, 05.29)
Big Pharma
Big Pharma
“Pushing Pills: How Big Pharma Got Addicted To Marketing” (Cover,
Forbes, 05.08) Novartis: #4 best seller, Lamisil, toe fungus, $850 for
3-month treatment, “Digger Dermatopphyte” (Forbes) $42 billion on
R&D, $46 billion on marketing and admin. Salespeople: up 100,000 in
last 10 years, 1 per 9 docs vs 1 per 18 docs. (Forbes) Clinical trials
favor sponsor’s drug 90% of the time. “The comparative studies
are a joke.” —Dr Jack Rosenblatt (Forbes)
“Psychiatric Drugs Fare Favorably When Companies Pay for
Studies” (headline, USA Today. 05.25) 57% of studies paid by drug
companies, up from 25% in 1992. Favorable outcome for sponsor:
78%. Sponsored by neutral: 48%. Sponsored by competitor: 28%.
USA Today /American Psychiatric Association)
“Hey, You Don’t Look So Good: As diagnoses ofr once-rare illnesses
soar, doctors say drugmakers are ‘disease-mongering’ to boost
sales” (feature, BusinessWeek, 05.08)
Intractable
Problems
Other
“Hazardous To Your Health” (New York Times Op-ed on
High Fructose Corn Syrup, 04.11); 112,000
deaths/year, $75 billion/per year associated with too
much fat; 2/3rd of Americans over-weight, 1/3rd children
“Call for Switch to Preventive Measures as 29 billion
[pound] Cost of Heart Disease is Revealed” (headline,
The Independent, 05.15)
“The Fat Police” “Obesity Tests: Every four-year-old
in the country to be officially screened” (headline,
The Independent, 05.21)
“The Politics of Fat” (headline, Time, 03.27); childhood
obesity up
3X
in 25 years
STATE OF
EMERGENCY
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task … D
Priorities ……………………...... F
Big Pharma …………………..... D-
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task … D
Priorities ……………………...... F
Big Pharma …………………..... DQuality: F
Scientific basis for action: C-/D
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task … D
Priorities ……………………...... F
Big Pharma …………………..... DEmphasis on Acute care: C
De-emphasis of WPC/WellnessPrevention-Chronic care: F (F-??)
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task … D
Priorities ……………………...... F
Big Pharma …………………..... D“Me too”: DOvercomplexity/Drug discovery: DDisease creation: DHiring pretty girls: A
Hiring lotsa pretty girls: A
BONUS
Funding …………………........... N.A.
Access …………………………… N.A.
Execution of chosen task ……... D
Priorities ……………………............ F
Big Pharma …………………........... DFDA …………………………………….. DKill a few, save a lot: D-
Manifesto
“Healthcare”
vs “Health”
TP Recce #1:
Dubai Healthcare City
to
Dubai Health City*
*Cleveland Clinic and Canyon Ranch
TP’s Healing & Wellness Manifesto2006
(1) Acute-care facilities are “killing fields.”
(WE KNOW WHAT TO DO.)
(2) Shift the “community” focus 90 degrees
(not 180, but not 25) from “fix it” to
“prevent it.” (WE KNOW WHAT TO DO.)
(3) There are three primary aims for “all this”:
Wellness-Healing-Health. (WE KNOW
WHAT TO DO.)
(4) I’m mad as hell and I’m not going to take
it anymore. (I KNOW WHAT TO DO.)
Health:
Century21.Job # 1
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
“When I climb Mount
Rainier I face less
risk of death than
I’ll face on the
operating table.”
—Don Berwick, “Six Keys to Safer Hospitals: A Set of Simple Precautions
Could Prevent 100,000 Needless Deaths Every Year,” Newsweek (1212.2005)
2 38
m
s
Welcome to the Homer Simpson Hospital
a/k/a
The Killing
Fields
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
Childhood
Obesity >
Terrorism
Bust
fat docs!
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
The Ultimate “Culture Change”
“Healthcare”
vs.
“Health”
“If God spoke to me by saying, ‘Mark, you’re down to
your last three words: What would you want to say to
your fellow humans that would make the most positive
impact?’ It would be a close call between Love Thy
Wash Your
Hands .
Neighbor and
A close third would be Move,
Move, Move.”
—Mark Pettus, M.D., The Savvy Patient
“The most important thing you can do to keep
from getting sick is to
hands. ”
wash your
—CDC/National Center for Infectious Diseases
Quality!
Prevention!
Wellness!
Chronic care!
Childhood obesity!
H5N1!
Report
Card.
Re-imagine Healthcare: Reportcard2006
Evidence-based/Outcomes-based ……………….………...... D
Pay-for-performance ………………………………………….… D
IS/IT (general) ………………………………..………………..…. CUse of information (for decisionmaking-measurement) .… CEMR (Electronic Medical Records) ……………………..….... C-/D
CPOE (Computerized Physician Order Entry) ……….……. C-/D
Quality/100K+ unnecessary deaths …………..……… D-(kind)
Acute care to chronic care-home care shift ………….….... D/DAcute-care to Prevention/Wellness Obsession…..… D/DPatient-centric/Client-centric………………………………….. D
Docs’ acceptance of “evidence-based” …………............… D/D“Revolutionary”-intensity Incentives re evidence …..……. DChildhood obesity epidemic …………………………….. DH5N1 preparedness ………………………………….…….. D
Corporate focus on Prevention/Wellness…………..…..…..... C-/D
Individual focus on Prevention/Wellness…………………..… D
Individuals’ health education/self-management …….…...…. C-
Workforce acceptance of self-responsibility ….…….…...….. CWorkforce transition to “Brand You” attitude……..……..….. C-/D
3 March 2006/Tom Peters
Wash your hands.
Apply #50 sunscreen.
Banish trans fat
Banish high fructose corn syrup.
Exercise “30-7.”
Breathe.
Stockpile for H5N1.* (*not Tamiflu!)
COULD
IT TRULY BE THIS
AWFUL?
“Quality”:
90,000 killed
and 2,000,000
CDC 1998:
injured from
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.”
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
1,000,000
“serious medication errors per
year” … “illegible handwriting,
misplaced decimal points, and
missed drug interactions and
allergies.”
Source: Wall Street Journal /Institute of Medicine
Dear Mr. & Mrs. Smith,
XYZ hospital regrets to inform you …….
……………………………………………………………………
……………………………………………………………………
……………………………………………………………………
……………………………………………………………………
……………………….
Sincerely,
A. S. Jackson, Administrator
T. D. Jones, M.D., Chief Medical Officer
L.S. Donald, CFO
W.N. Arnold, CIO
Cost
(at All Costs*) Minimization
Professional?
Or/to: Full Partner-
“Purchasing Officer” Thrust #1:
Leader in Lifetime
Value-added
Maximization?
(*Lopez: “Arguably ‘Villain #1’ in GM tragedy”/Anon VSE-Spain)
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 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
20%: not get
prescriptions filled
50%: use meds
inconsistently
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“In health care,
geography
is destiny.”
Source: Dartmouth Medical School 1996 report
“Without being disrespectful, I consider the U.S.
healthcare delivery system the largest cottage industry in
There are
virtually no
performance
measurements and
no standards.
the world.
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
“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
“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
Dr Larry Weed/POMR (“problem-oriented
medical record”)/Etc: “It’s impossible to keep
up with the avalanche of knowledge.
Therefore it’s essential to use a valid
diagnostic-decision aid like Larry’s” —Neil de
Crescenzo, VP Global Healthcare/IBM Consulting
“There
is no other profession that
tries to operate in the fashion
we do. We go on hallucinating
about what we can do.” —Dr Charles
Burger (using Weed’s software for 20 years)
About Time!
100,000 Lives
Campaign*
*Don Berwick/Institute for Healthcare Improvement
be
“You must
the change you
wish to see in the
world.”
Gandhi
You = Your
Calendar
The Necessary
IS/Web
REVOLUTION
We all live in
Dell-Wal*MarteBay-Google
World!
“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
“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
Health
“Sanitary revolution”:
mortality in major cities
down
55% between
1850 and 1915
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“Our mistake is not that
we value medical care—
but that we have
misunderstood what it can
and cannot do.”
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“Gwen [former healthcare exec] has wonderful health insurance and
an abundance of healthcare. What Gwen does not have is health.
And there is nothing our health system can do to give it to her.”
“The battle cry is always health, but in fact the struggle
has always been over healthcare.” “For all its inspiring, hightech cures, medicine is just not very effective at curing our era’s
“Medicine
doesn’t do much
chronic disease.”
major killers.”
“When the
most common killers of our era are mostly incurable and our
preventive treatments pretty feeble, you have to wonder about
medical care as a whole.” “There is a widely held view that medical
care contributes little to health.” (John Bunker/ Journal of the
Royal College of Physicians)
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
“Curve
Shifting”
Source: Tom Farley & Deborah Cohen,
Prescription for a Healthy Nation
“Bump into factor”: Extra-size
portions, eat more. Higher
% shelf space snacks, more
obesity. More liquor stores,
more crime. High vs low fat:
Japanese who emigrate to
U.S. suffer 3X increase in
heart disease.
Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation
Sprint/Overland Park KS:
Slow elevators, distant
parking lots with
infrequent buses, “food
court” as “poorly” placed
as possible, etc.
Source: New York Times
Determinants of Health
Access to care: 10%
Genetics: 20%
Environment: 20%
Health Behaviors:
50%
Source: Institute for the Future
Wellness
Obesity/-79(-36); BP (140-85 to
90-60); Blood sugar (180-87);
Blood chemistry (normal+);
Cholesterol (140-58);
Metabolic rate/RMR (+250);
Mental state (dramatic
improvement*)
Off …
Univasc (<1/2)
Bextra
Lipitor
Toprol
Propranolol
Aging
reversal!!!!*
*Why wasn’t I “informed”
until age 59?
“Fixes”
Diet
Extreme exercise
Meditation
Supplements
Eliminate all alcohol
(Meds)
Planetree:
A Radical Model for New
Healthcare/Healing/Health/
Wellness Excellence
1.
2.
3.
4.
5.
6.
7.
8.
9.
The Nine Planetree Practices
The Importance of Human Interaction
Informing and Empowering Diverse Populations:
Consumer Health Libraries and Patient Information
Healing Partnerships: The importance of Including
Friends and Family
Nutrition: The Nurturing Aspect of Food
Spirituality: Inner Resources for Healing
Human Touch: The Essentials of Communicating
Caring Through Massage
Healing Arts: Nutrition for the Soul
Integrating Complementary and Alternative Practices
into Conventional Care
Healing Environments: Architecture and Design
Conducive to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1. The Importance
of Human
Interaction
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
“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
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
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” (eg “smell
of baking cookies”)
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
CAM (Complementary & Alternative Medicine):
83M in US (42%)
CAM visits 243M, greater than to PCP (Primary
Care Physician) (With min insurance coverage)
W-Educated-Hi inc
Don’t tell PCP (40%)
And: <30% procedures used in conventional
medicine have undergone RCTs (randomized
clinical trials)
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
Conclusion:
Caring/Growth
“Experience”
Care!
Control!
Connect!
Engage!
Grow!
De-stress!
Access to nurses station:
“Happen to”
vs
“Happen with”
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
T.T.D./
Healthcare27
Healthcare27
1. Fully utilize Physician’s Assistants to do routine
work in a timely fashion. (“Doc in a Kiosk” at Wal*Mart is great!)
2. Maximize Outpatient services!
3. Short hospital stays work!
4. Support home care to the max. (E.g., “Declaration of
Independents”—Beacon Hill/Boston)
5. STOP THE 100K+ NEEDLESS DEATHS—much/most
of the “quality stuff” is eminently fixable. (Don Berwick for
President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!)
6. FLIP HC 177 DEGREES TO EMPHASIZE
PREVENTION & WELLNESS. (“Steps” are being taken but not
enough. Med schools: Awful! Insurers: Little better. Support for appropriateproven alternative therapies is an important part.) (HUGE INCENTIVES FOR
EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)
T.T.D./
ACTION.
NOW.
Visible Signs/Measures (Creech)
TRAIN. TRAIN. TRAIN. (P.S.)
Med school, Nursing school cirriculum (P.S.)
BOLD!/Big change EASIER than
modest change (P.S., etc.)
EXCELLENCE. ONLY. ALWAYS. DAMN IT.
EVP/Patient Safety
P.S.O.s
Fund the living hell out of it (P.S.)
CEO (etc): REFLECT IT IN CALENDAR
EMERGENCY STATUS
H.M.O.s: Big/Enormous (+/-) incentives for
docs, hospitals, etc, etc
BOARD: Patient Safety Committee
BOARD: WPCC Committee
Patient Safety BALDRIDGE (POTUS?)
CERTIFICATION/RE-CERTIFICATION for
One & All (P.S., etc)
WPOCC Rules!!!!!!! (Wellness/Prevention/
Obesity/ChronicCare)
WPOCC: N.G.A. (AK)
Dramatically higher involvement in WPOCC
INSURANCE COMPANY VISIBILITY/SPONSORSHIP/
MEGA-INCENTIVES
Awards Galore P.S./WPOCC)
BOARD Committee: H5N1
Govt
HHS: Split HC & PWO (Ontario)
Write off ½ of med school loan if “pay” with 3-5
years service in Public Health
Glamorize Family Practice, Public Health Service,
etc
FAT legislation?? (Almost certainly) (Density,
HFCS, Trasfats, etc, etc) (A FIRST FOR TP)
SUE the hell out of One & All
re Obesity (Cigarettes II)
Research LEAP @ N.I.H. (Etc, Etc, ETC)
INCENTIVES @ SCHOOLS (BIG!!)
EMR: Intensify!!!!!!!!!!!!!
No leadership position in AHA (AMA?)
(DEANs?) (Etc?) without “Safety tour”
No Medical Chief (>150 beds?)
without “Safety tour”)
FORGET ABOUT ME!!! (Except
Wellness, ChroniCare)
VIGOROUSLYSUPPORT Home Care
American OBESITY = African AIDs (??)
ELIMINATE/OBLITERATE HIGH FRUCTOSE
CORN SYRUP!
ELIMINATE/OBLITERATE TRANSFATS!
(HFTC/TF = The Real “WMDs”)
FDA: Kill! Kill! Kill! (Please)
STATE OF
EMERGENCY
EXCELLENCE.
ALWAYS.