Excellence in Healthcare: Towards a Responsive and Innovative Approach

1. Tom Peters’ X25*Toward Health(care) Excellence!Inova Leadership Institute/13 March 2007*In Search of Excellence 1982-2007

2. Part 1

3. EXCELLENCE. ALWAYS.

4. EXCELLENCE. THE MANDATE.

5. “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”—Charles Darwin

6. EXCELLENCE. ALWAYS.EVERYWHERE.

7. “Why in the world did you go to Siberia?”

8. 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.

9. Excellence1982: The Bedrock “Eight Basics” 1. A Bias for Action 2. Close to the Customer 3. Autonomy and Entrepreneurship 4. Productivity Through People 5. Hands On, Value-Driven 6. Stick to the Knitting 7. Simple Form, Lean Staff 8. Simultaneous Loose-Tight Properties”

10. Part 2

11. “What’s Really Propping Up the Economy: Healthcare has added 1.7 million jobs since 2001. The rest of the private sector? None.”Source: Title, cover story, BusinessWeek, 0925.2006

12. EXCELLENCE. HEALTH(CARE).

13. “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)

14. March-June 2006: Sample ofHealthcare “PR”

15. Doctors/Hospitals53 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)

16. 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)

17. 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

18. TP’s Health(care) Rants & Passions

19. Quality!Prevention!Wellness! Chronic care!Childhood obesity!H5N1!

20. “Quality”:COULD IT TRULY BE THIS AWFUL?

21. 2m38s

22. CDC 1998:90,000killed and 2,000,000injuredfrom hospital-caused drug errors & infections

23. 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

24. 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

25. 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 30clinicians 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

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

27. “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

28. “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 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

29. “A healthcare delivery system characterized by idiosyncratic and often ill-informed judgments must be restructured according toevidence-based medical practice.”Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

30. “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

31. 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)

32. The Necessary IS/WebREVOLUTION

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

34. “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

35. Health

36. TP Reccomendation* #1:Dubai Healthcare City to Dubai Health City**Presentation at “First Middle Eastern Healthcare Summit/01.2006**Cleveland Clinic and Canyon Ranch Partnership

37. Childhood Obesity > Terrorism

38. “Sanitary revolution”: mortality in major citiesdown55%between 1850 and 1915Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

39. Wellness

40. Aging reversal!!!!**Why wasn’t I “informed” until age 59?

41. Report Card.

42. Re-imagine Healthcare: Reportcard2006Evidence-based/Outcomes-based ……………….………...... DPay-for-performance ………………………………………….… DIS/IT (general) ………………………………..………………..…. C-Use of information (for decisionmaking-measurement) .… C-EMR (Electronic Medical Records) ……………………..….... C-/DCPOE (Computerized Physician Order Entry) ……….……. C-/DQuality/100K+ unnecessary deaths …………..……… D-(kind)Acute care to chronic care-home care shift ………….….... D/D-Acute-care to Prevention/Wellness Obsession…..… D/D-Patient-centric/Client-centric………………………………….. DDocs’ acceptance of “evidence-based” …………............… D/D-“Revolutionary”-intensity Incentives re evidence …..……. D- Childhood obesity epidemic …………………………….. D- H5N1 preparedness ………………………………….…….. DCorporate focus on Prevention/Wellness…………..…..…..... C-/DIndividual focus on Prevention/Wellness…………………..… DIndividuals’ health education/self-management …….…...…. C-Workforce acceptance of self-responsibility ….…….…...….. C-Workforce transition to “Brand You” attitude……..……..….. C-/D 3 March 2006/Tom Peters

43. Part 2A

44. Planetree: A Radical Model for New Healthcare/Healing/Wellness ExcellenceTom Peters/17 September 2006

45. “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

46. “Much of our current healthcare is about curing . Curing is good. But healingis spiritual, and healing is better, because we can heal many people we cannot cure.”—Leland Kaiser, “Holistic Hospitals”

47. 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

48. 1.The Importance of Human Interaction

49. “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

50. Press Ganey Assoc:139,380 former patients from 225 hospitals:noneof THE top 15 factors determining Patient Satisfaction referred to patient’s health outcomePSdirectly related to StaffInteractionPSdirectly correlated with Employee SatisfactionSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel