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Tom Peters’ Leading for Excellence: Surpassing “Unrealistic” Expectations AHCA/NCAL 55 th 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.

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Slides at tompeters

Tom Peters’Leading for Excellence: Surpassing “Unrealistic” ExpectationsAHCA/NCAL 55th Annual Convention & ExpoMiami Beach/10.04.2004


Ahca is the american healthcare association ncal is the national center for assisted living

AHCA is … the American Healthcare Association.NCAL is … the National Center for Assisted Living.


Slides at tompeters com

Slides at …tompeters.com


Goals

Goals.


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Tom’s Healthcare9: Goals20041. 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

Musings …


This is the most important speech i ve given since naesp

This is the most important speech I’ve given since NAESP!


Never felt it so keenly problem focused opportunity focused

Never felt it so keenly …Problem-focused?Opportunity-focused?


Regulations sky high unrealistic expectations inadequate funding staffing woes etc etc etc

RegulationsSky-high (“Unrealistic”) ExpectationsInadequate FundingStaffing WoesEtc.Etc.Etc.


Growth market or magical opportunity to lead this demographic revolution and re imagine aging

“Growth market” or … Magical Opportunity to Lead this Demographic Revolution … and Re-imagine Aging?


Biases

Biases.


95 ginger cove life care services

95/Ginger Cove/Life Care Services


Why the hell shouldn t my expectations be towering

WHY THE HELL SHOULDN’T MY EXPECTATIONS BE “TOWERING”?


T ss 34d

T = SS – 34D


Cool oh bleep 60 30 90 60

Cool? Oh Bleep?60 – 30 = 90 - 60


Old age a magical time to fully finally appreciate life

“Old Age”: A Magical Time to fully/finally appreciate life!


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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

Context.Weird.


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“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


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“It’s no longer enough to be a ‘change agent.’ You must be a changeinsurgent—provoking, prodding, warning everyone in sight that complacency is death.”—Bob Reich


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“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

Revolution.Period.


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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

No Wiggle Room!“Incrementalism is innovation’s worst enemy.” Nicholas Negroponte


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“Beware of the tyranny of making Small Changes to Small Things. Rather, make Big Changes to Big Things.”—Roger Enrico, former Chairman, PepsiCo


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The greatest dangerfor most of usis not that our aim istoo highand we miss it,but that it istoo lowand we reach it.Michelangelo


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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

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

Productivity!McKesson 2002-2003: Revenue … +$7B Employees … +500Source: USA Today/06.14.04


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“Some grocery stores have better technology than our hospitals and clinics.”—Tommy Thompson, HHS SecretarySource: Special Report on technology in healthcare, U.S. News & World Report (07.04)


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“We’re in the Internet age, and the average patient can’t email their doctor.”Donald Berwick, Harvard Med School


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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 of u s hospitals source healthleaders 06 02

Computerized Physician Order Entry/CPOE: 5% of U.S. hospitalssource: HealthLeaders/06.02


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Telemedicine …Reduces days/1000 patients and physician visits for the chronically illDecreases costs of managing chronic diseaseExpands service areas for providersReduces travel costs to and from medical ed seminarsDouglas Goldstein, e-Healthcare


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“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)


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The VHA gets it!E.g.: Laptop at bedside calls up patient e-records from one of 1,300 hospitals. Bar-coded 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%. Blame-free 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

Consumerism.


Amen the age of the never satisfied customer regis mckenna

Amen!“The Age of the NeverSatisfied Customer”Regis McKenna


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“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


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Today’s Healthcare “Consumer”:“skeptical and demanding”Source: Ian Morrison, Health Care in the New Millennium


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“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


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Consumer ImperativesChoiceControl (Self-care, Self-management)Shared Medical Decision-makingCustomer ServiceInformationBrandingSource: Institute for the Future


Savior for the sick vs partner for good health source npr

“Savior for the Sick”vs. “Partner for Good Health”Source: NPR


Quality whoops ouch yikes

Quality.Whoops.Ouch.Yikes.


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“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


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“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


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PARADOX: Many, many formal case reviews … failure to systematically/ systemically/ statistically look at and act on evidence.C.f., Complications, Atul Gawande


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“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


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“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

“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

CDC 1998: 90,000 killed and 2,000,000 injuredfrom nosocomial [hospital-caused] drug errors & infections


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HealthGrades/Denver: 195,000hospital 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 Forum.“There is little evidence that patient safety has improved in the last five years.”—Dr. Samantha CollierSource: Boston Globe/07.27.04


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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


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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


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“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


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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

“In health care,geography is destiny.”Source: Dartmouth Medical School 1996 report


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Geography Is DestinyE.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)


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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 curethe 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

It’s the “Experience”!


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“Experiencesare 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

The “Experience Ladder”Experiences ServicesGoods Raw Materials


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“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


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“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


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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


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“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

A Certain Sort of Experience: Women.


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?????????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%)Allconsumerpurchases … 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

Read This Book …EVEolution: The Eight Truths of Marketing to WomenFaith Popcorn & Lys Marigold


Eveolution truth no 1 connecting your female consumers to each other connects them to your brand

EVEolution: Truth No. 1Connecting Your Female Consumers to Each Other Connects Them to Your Brand


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“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 brands they join them eveolution

“Women don’t buy brands. They join them.”EVEolution


2 6 vs 21

2.6vs.21


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“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


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“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


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“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


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“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


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“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)


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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.


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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-Wellness-Green-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-Boomers-Wellness-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

WomenBoomersWellnessGreenIntangibles


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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

Experience Plus: Planetree.


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“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


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“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


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“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


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The 9 Planetree Practices1. The Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends and Family4. Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing6. Human Touch: The Essentials of Communicating Caring Through Massage7. Healing Arts: Nutrition for the Soul8. Integrating Complementary and Alternative Practices into Conventional Care9. Healing Environments: Architecture and Design Conducive to HealthSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


1 the importance of human interaction

1. The Importance of Human Interaction


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“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


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Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals0 of top 15 factors determining Patient Satisfaction referred to patient’s health outcomePS directly related to Staff InteractionPS directly correlated with ES (Employee Satisfaction)Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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Mgrs re staff: wages, security, promotion opportunitiesStaff 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


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The Customer Comes Second: Put your People First and Watch ’Em Kick Butt —Hal Rosenbluth (and Diane McFerrin Peters)


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“100 Best Places to Work”/RLevering/2001Get straight answersAppreciationCollaborationInterest in me as a personCamaraderie (“Fun place to work”)


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“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


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“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

2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information


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Planetree Health Resources Center/1981Planetree Classification SystemConsumer Health LibrariansVolunteersClasses, lectures (CR)Health FairsGriffin’s Mobile Health Resource CenterOpen Chart PolicyPatient Progress NotesCare 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

3. Healing Partnerships: The importance of Including Friends and Family


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“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


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“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 EyesSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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“A 7-year follow-up of women diagnosed with breast cancer showed that those who confidedinatleastoneperson 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


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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


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Institute of Medicine/ “Crossing the Quality Chasm”Respect for preferencesInvolvement in Decision MakingAccess to careCoordination of careInformation and educationPhysical comfortEmotional supportInvolvement of Friends and FamilyContinuity of careSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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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 ConferencesClinical Guidelines DiscussionsFamily SpacesPet Visits(POP: Patients’ Own Pets)Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


4 nutrition the nurturing aspect of food

4. Nutrition: The Nurturing Aspect of Food


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Meals are central eventsvs“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


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KitchenBeautiful cutlery, plates, etc.Chef repSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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Aroma therapy (e.g., “smell of baking cookies”)Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


5 spirituality inner resources for healing

5. Spirituality: Inner Resources for Healing


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Spirituality: Meaning and Connectedness in Life1. Connected to supportive and caring group2. Sense of mastery and control3. Make meaning out of disease/find meaning in sufferingSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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Spiritualitybody-mind-spiritprayer-meditation-visualizationSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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Griffin: redesign chapel (waterfall, quiet music, open prayer book)Other: music, flowers, portable labyrinthSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


6 human touch the essentials of communicating caring through massage

6. Human Touch: The Essentials of Communicating Caring Through Massage


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“Massage is a powerful way to communicate caring.”—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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Mid-Columbia Medical Center/Center for Mind and BodyMassage for every patient scheduled for ambulatory surgery (“Go into surgery with a good attitude”) Infant massageStaff 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

7. Healing Arts: Nutrition for the Soul


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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


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Planetree: “Environment conducive to healing”Color!Light!Brilliance!Form!Art!Music!Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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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

8. Integrating Complementary and Alternative Practices into Conventional Care


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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 incDon’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


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Griffin IMC/Integrative Medicine CenterMassageAcupunctureMeditationChiropracticNutritional supplementsAroma therapySource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


9 healing environments architecture and design conducive to health

9. Healing Environments: Architecture and Design Conducive to Health


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“Planetree Look”Woods and natural materialsIndirect lightingHomelike settingsGoals: 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 beautySource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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SoundTextureLightingColorSmellTasteSacred spaceSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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Access to nurses station:“Happen to”vs“Happen with”Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


The eden alternative

The Eden Alternative


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The Ten Principals of the Eden Alternative1. 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 Elder-centered 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


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“The Eden paradigm allows elders to care for animals, birds, and children as well each other.”—Susan Eaton, Harvard/JFK schoolSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel


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The Ten Principals of the Eden Alternative5. 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


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The Ten Principals of the Eden Alternative8. 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

Conclusion: Caring/Growth “Experience”


Care control connect engage grow de stress

Care!Control!Connect! Engage!Grow! De-stress!


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“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

Learn more about Planetree/The Planetree Alliance : www.planetree.org


Talent i

Talent I.


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“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

PARC’s Bob Taylor: “Connoisseur of Talent”


Brand talent

Brand = Talent.


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What’s your company’s … EVP?Employee Value Proposition, per Ed Michaels et al., The War for Talent; IBP/Internal Brand Promiseper TP


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EVP = Challenge, professional growth, respect, satisfaction, opportunity, rewardSource: Ed Michaels et al., The War for Talent


High t o is not inevitable costco vs wal mart

High T/O Is Not Inevitable!CostCo vs. Wal*Mart


Talent ii

Talent II.


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“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


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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


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Lead.


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“Ninety percent of what we call ‘management’ consists of making it difficult for people to get things done.” – P.D.


G h create a cause not a business

G.H.: “Create a ‘cause,’ not a ‘business.’ ”


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“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

BZ: “I am a …Dispenser of Enthusiasm!”


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“Make it fun to work at your agency. … Encourage exuberance. Get rid of sad dogs who spread gloom.”—David Ogilvy


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“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


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“The two most powerful things in existence: a kind word and a thoughtful gesture.”Ken Langone, CEO, Invemed Associates [from Ronna Lichtenberg, It’s Not Business, It’s Personal]


The deepest human need is the need to be appreciated william james

“The deepest human need is theneed to be appreciated.”William James


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“We look for ...“... listening, caring, smiling, saying ‘Thank you,’ being warm.”— Colleen Barrett, President, Southwest Airlines


Soft is hard isoe

“Soft” Is “Hard”- ISOE


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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.]


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“A key – perhaps the key – to leadership isthe effective communication of a story.”Howard GardnerLeading Minds: An Anatomy of Leadership


Leaders don t just make products and make decisions leaders make meaning john seely brown

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

“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

“The single best way to predict the future is to create it.”—anon


Appendix i healthcare 21

Appendix IHealthCare21


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HealthCare21: 21 Ideas for Century211. 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.


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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.


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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.) * *


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HealthCare21 (Cont.)21. ALL THIS = ENORMOUS OPPORTUNITY.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

Appendix IIHealthCare2


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  • Healthcare’s 1-2 Punch

  • 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, bio-medicine will soon allow us to understand and deal with individual genetic pre-dispositions. (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-white-coat-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?)


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