Transcript Tom Peters’ EXCELLENCE. ALWAYS. Healthcare Financial Management Association Las Vegas/26 June 2008 To appreciate this presentation [and ensure that it is not a mess], you need Microsoft.

Tom Peters’
EXCELLENCE.
ALWAYS.
Healthcare Financial Management Association
Las Vegas/26 June 2008
To appreciate
this presentation [and ensure
that it is not a mess], you need
Microsoft fonts:
NOTE:
“Showcard Gothic,”
“Ravie,” “Chiller”
and “Verdana”
Slides at …
tompeters.com
Part One: A
Civilian Looks
at Your World
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
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
“[Dartmouth Professor Elliott] Fisher and his
colleagues discovered that
patients who went to hospitals
and
did the most
procedures —were 2 to 6
that spent the most—
percent more likely to die than
patients that went to hospitals
that spent the least.”
Source: Overtreated: Why Too Much Medicine Is Making
Us Sicker and Poorer, Shannon Brownlee
“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
Journalist Tim Noah writes about his wife’s cancer treatment
“Much of our effort
involved retrieving information from one
source and sending it to another. This wasn’t
in a high-rep private med center:
something we could count on happening on its own. Very
expensive blood test results, we observed, had perhaps a
50%
chance of being misplaced under a pile of faxes
and therefore not finding their way into Marjorie [William’s]
medical chart. So we made a habit of getting the labs to fax
to our house. Films of CT scans would be misfiled perhaps
30%
of the time and thus become permanently
irretrievable. So I took my checkbook to all of Marjorie’s CT
scans and purchased my own spare copy on the spot.”
Source: Foreword to Best Care Any where: Why VA
Healthcare Is Better Than Yours, Phillip Longman
“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
98,000 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 = equivalent of 390 full
jumbos/747s in the drink per year—more than one-a-day.
There is little
evidence that patient
safety has improved in the
last five years.”
Comments:
—Dr. Samantha Collier
Source: Boston Globe/2005
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
“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
1 41
m
s
“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
“Plus God alone
knows how many
casualties in
doctors’ offices,
Tom”
—Thom Mayer
“Can’t you
Put a muzzle
on him?”
Part Two:
Some Stuff, a
40 Year
Journey
Thank
you Ike
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
Give
good
tea!
Thank
you ,Herb
“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)
Thank
you Sheik
Mohammad
Single
greatest act
of pure
imagination
Thank
you Bob
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”
“Breakthrough” 82*
People!
Customers!
Action!
Values!
*In Search of Excellence
“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
You don’t
get better
by being
bigger. You
Dick Kovacevich:
#4 Japan
#3 USA
#2 China
#1 Germany
Reason!!!
Mittelstand
Basement
Systems
Inc.
*Basement Systems Inc.
*Larry Janesky
*Dry Basement Science
(115,000!)
*1990: $0; 2003: $13M;
2007:
$62,000,000
#2
The
black
swan
1982 (-) =
200
Years (+)
1982/Default Latin
America =
years
200
[Total historical earnings]
The Black Swan: The Impact of the
Highly Improbable, Nassim Nicholas Taleb
Career =
1 or 2
black swans
Conrad Hilton, at a gala
celebrating his life,
was asked, “What was the
most important lesson
you’ve learned in your long
and distinguished career?”
His immediate answer …
“remember
to tuck the
shower curtain
inside the
bathtub.”
2-cent
candy
<TGW
vs.
>TGR
“We have a
‘strategic plan.’
It’s called doing
things.”
— Herb Kelleher
“This is so simple it sounds stupid, but it is amazing
how few oil people really understand that
you only find
oil if you drill
wells.
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
#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
Culture of Prototyping
“Effective prototyping may
the most
valuable core
competence an
be
innovative organization can
hope to have.” —Michael Schrage
“Experiment
fearlessly”
Source: BW0821.06, Type A Organization Strategies/
“How to Hit a Moving Target”—Tactic #1
“FAIL, FAIL
AGAIN. FAIL
BETTER.”
—Samuel Beckett
X =XFX*
*Excellence = Cross-functional Excellence
The “XF-50”: 50 Ways to
Enhance CrossFunctional
Effectiveness and
Deliver Speed, “Service
Excellence” and “Valueadded Customer
‘Solutions’”
Never
waste a
lunch!*
????
% XF
lunches*
*Measure!
K.i.s.s.
*Keep It Simple, Stupid
Case: The
“simple”
Checklist!
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)
**Replicate in Inner City Detroit
(resource strapped—$$$, staff cut 1/3rd, poorest patients in USA)
**Nurses QB the process
**Project manager for overall process implementation
**Exec involvement (help with “little things”—it’s all “little things”)
**Blue Cross/insurers, small bonuses for participating
66%
**6 months,
decrease in infection rate; USA:
bottom 25% in hospital rankings to …
top 10%
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
“[Pronovost] is focused on work that is not normally
considered a significant contribution in academic
medicine. As a result, few others are venturing to extend
Yet his work has
already saved more lives
than that of any
laboratory scientist in
the last decade.”
his achievements.
—Atul Gawande,
“The Checklist” (New Yorker, 1210.07)
Compression hose would mostly fix the hospital
problem: “According to the American Heart Association,
up to two million Americans are affected annually by deep
vein thrombosis. Of those who develop pulmonary
embolism, up to 300,000 will die each year. ... Deep vein
thrombosis also is among the leading causes of
preventable hospital death. Even more disturbing is the
fact that, according to a U.S. multi-center study published
by two of ClotCare's editorial board members,
58%
of patients who developed a DVT while in
the hospital received no preventive
treatment despite the presence of
multiple risk factors and overwhelming
data that prophylaxis is very effective at
reducing these events.” —Marie B. Walker,
clotcare.com, March 2008
“Everything matters”
-80%
Source: Nudge, Richard Thaler and Cass
Sunstein, etching of fly in the urinal
reduces “spillage” by 80%, Schiphol Airport
“How to flush
$500,000 down
the toilet in one
easy lesson!!”
TP:
< CAPEX
> People!
#9.1
Organizations exist to serve. Period.
Leaders live to serve. Period.
Passionate servant leaders, determined to create a
legacy of earthshaking transformation in their domain
create/must necessarily create organizations which
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 jointly
are …
perceived soaring purpose and personal and community
and client service Excellence.
… 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.
#9.2
#1 cause of
Dis-satisfaction?
Employee retention & satisfaction:
Overwhelmingly,
based on their
immediate manager!
Source: Marcus Buckingham & Curt Coffman, First, Break All
the Rules:
What the World’s Greatest Managers Do Differently
#9.3
EMPHASIZE
THE “SOFT
SKILLS.”
“A man
without a
smiling face
must not open
a shop.”
—Chinese Proverb
Hard Is Soft
Soft Is Hard
“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
Hard Is Soft
Soft Is Hard
R.O.I.R.
Return On
Investment In
Relationships
Hard Is Soft
Soft Is Hard
???????
“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!”
Hard Is Soft
Soft Is Hard
THE PROBLEM IS
RARELY/NEVER THE
PROBLEM. THE
RESPONSE TO THE
PROBLEM INVARIABLY
ENDS UP BEING THE
REAL PROBLEM.
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.
Hard Is Soft
Soft Is Hard
“Courtesies of a small and
trivial character are the
ones which strike
deepest in the grateful
and appreciating heart.”
—Henry Clay
The Manager’s Book
of Decencies: How
Small /gestures
Build Great
Companies.
—Steve Harrison, Adecco
#11
Questions: What do others think of you? [Are you sure?] What
do you think of you? [Are you sure?] What is your impact on
others? [Are you sure?] What is your impact on others? [Are
you sure?] What is your impact on others? [Are you sure?]
What are the “little things” you (perhaps unconsciously) do that
cause people to shrivel—or blossom? [Are you sure?] What do
you want? [Are you sure?] Are you aware of your changing
moods? [Are you sure?] How fragile is your ego? [Are you sure?]
Do you have a true confidant? [Are you sure?] Do you perform brief
or not-so-brief self-assessments? Do you talk too much? [Are you
sure?] Do you know how to listen? [Are you sure?] Do you
listen? [Are you sure?] What is your style of “hashing things
out”? Are you perceived as (a) arrogant, (b) abrasive (c) attentive,
(d) genuinely interested in people, (e) etc? [Are you sure?] Are
you flexible? Have you changed your mind about anything important
in a while? Are you comfortable-uncomfortable with folks on the
front line? Do you think you’re “in touch with the pulse of
things around here”? [Are You Sure?] Are you too
emotional/intuitive? Are you too unemotional/rational? Do you
spend much time with people who are new to you? [Do you think
questions like this are “so much BS”?]
Attending to
the “Last 98%”:
The New
Management “Science,”
or …
“Hard Is Soft,
Soft Is Hard”
Tom Peters/12.03.2008
S = f( ___ )
Success Is a
Function of …
S = ƒ(#&DR; -2L, -3L, 4L; I&E)
Number and depth of relationships 2, 3, and 4 levels down,
inside and outside the organization
S = ƒ(SD>SU)
Sucking down is more important than sucking up—the idea is to have
the entire organization working for you.
S = ƒ(#non-FF, #non-FL)
Number of friends, number of lunches with people not in my function
S = ƒ(#FF)
Number of friends in the finance function-organization
S = ƒ(OF)
Oddball friends
S = ƒ(PDL)
Purposeful, deep listening—this is very hard
S = f(%TM“TSS,”
PM“TSS,”
D“TD”“TSS”)
% of time, measured, on This Soft Stuff,
purposeful management of this Soft Stuff, daily
“to do” concerning “this Soft Stuff”
“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
Experience: “Rebel Lifestyle!”
“What we sell is the
ability for a 43year-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
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
“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
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
Aroma therapy
(e.g., “smell of baking cookies”—from kitchenettes
in each ward)
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
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
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
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)