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Healthcare Horrors & Hope Tom Peters/10. 26. 2004 Healthcare Horrors & Hope Tom Peters/10. 26. 2004

1. Premise. 1. Premise.

“If one didn’t know better, one might think that hospitals set out to design “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

Golden American Age of Patient-centric, Genetics-driven Healthcare Looms! Current status: $1. 3 T+. 30 Golden American Age of Patient-centric, Genetics-driven Healthcare Looms! Current status: $1. 3 T+. 30 M-70 M uninsured. 100 K killed and 2 M injured p. a. in hospitals. 85% treatments unproven. Cure depends on locale in which treated. 50% prescriptions do not work. 2 X docs. 2 X hospitals. IS primitive. Accountability & measurement nil. And … EVERYBODY’S MAD-AS-HELL AND FEELS POWERLESS: DOCS, PATIENTS, NURSES, INSURERS, EMPLOYERS, PHARMA & DEVICE COS, HOSPITAL ADMINISTRATORS AND STAFF.

2. Consumerism (Patientcentric Healthcare Arrives) 2. Consumerism (Patientcentric Healthcare Arrives)

Anne Busquet/ American Express Not: “Age of the Internet” “Age of Customer Control” Is: Anne Busquet/ American Express Not: “Age of the Internet” “Age of Customer Control” Is:

Amen! “The Age of the Never Satisfied Customer” Regis Mc. Kenna Amen! “The Age of the Never Satisfied Customer” Regis Mc. Kenna

“We expect consumers to move into a position of dominance in the early years “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

“Parents, doctors, stockbrokers, even military leaders are starting to lose the authority they once “Parents, doctors, stockbrokers, even military leaders are starting to lose the authority they once had. There all these roles premised on access to privileged information. … What we are witnessing is a collapse of that advantage, prestige and authority. ” Michael Lewis, next

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

“He shook me up. He put his hand on my shoulder, and simply said, “He shook me up. He put his hand on my shoulder, and simply said, ‘Old friend, you have got to take charge of your own medical care. ’ ” Hamilton Jordan, No Such Thing as a Bad Day (on a conversation with a doctor pal, following Jordan’s cancer diagnosis)

“A seismic shift is underway in healthcare. The Internet is delivering vast knowledge and “A seismic shift is underway in healthcare. The Internet is delivering vast knowledge and new choices to consumers—raising their expectations and, in many cases, handing them the controls. [Healthcare] consumers are driving radical, fundamental change. ” Deloitte Research, “Winning the Loyalty of the e. Health Consumer”

“It may be the most far-reaching evolution of them all: the metamorphosis of passive “It may be the most far-reaching evolution of them all: the metamorphosis of passive patient into consumer – and well-informed, assertive consumer at that. The defining axiom of traditional medicine – ‘doctor’s orders’ is being turned on its head. These days it’s the patients who are armed, the doctors who must get wired to keep nimble. ” “E-health is the new house call. ” Richard Firstman, “Heal Thyself, ” On Magazine

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

Consumer Imperatives Choice Control (Self-care, Self-management) Shared Medical Decision-making Customer Service Information Branding Source: Consumer Imperatives Choice Control (Self-care, Self-management) Shared Medical Decision-making Customer Service Information Branding Source: Institute for the Future

“The ‘curative model’ narrowly focuses on the goal of cure. … From many quarters “The ‘curative model’ narrowly focuses on the goal of cure. … From many quarters comes evidence that the view of health should be expanded to encompass mental, social and spiritual well-being. ” Institute for the Future

Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Source: Institute for the Future

“Consumerism”: HMO backlash (e. g. , plans with more choice). Alternative Medicine, Wellness & “Consumerism”: HMO backlash (e. g. , plans with more choice). Alternative Medicine, Wellness & Prevention bias. Info availability (disease, health, docs, support groups, outcomes). Boomers (“I’m in charge!” Discretionary $$$$ to spend: cosmetic surgery, vision improvement, fertility, etc. ). Self-care (chronic disease). High expectations (genetics, etc. ) …

3. Demographics: The BOOMERS Reach 60 in ’ 05! 3. Demographics: The BOOMERS Reach 60 in ’ 05!

“NOT ACTING THEIR AGE: As Baby Boomers Zoom into Retirement, Will America Ever Be “NOT ACTING THEIR AGE: As Baby Boomers Zoom into Retirement, Will America Ever Be the Same? ” USN&WR Cover

Boomer World “From jogging to plastic surgery, from vegetarian diets to Viagra, they are Boomer World “From jogging to plastic surgery, from vegetarian diets to Viagra, they are fighting to preserve their youth and defy the effects of gravity. ” M. W. C. Howgill, “Healthcare Consumerism, the Information Revolution and Branding”

“Pick up any copy of Glamour or Men’s Health, and you’ll see pages of “Pick up any copy of Glamour or Men’s Health, and you’ll see pages of advertisements encouraging readers to enlarge their breasts, retard baldness, correct their vision, improve their smile, or relieve stress through herbs, massage therapy, acupuncture—you name it. ” Coddington, Fischer, Moore & Clarke, Beyond Managed Care

“Sixty Is the New Thirty” —Cover/AARP/11. 03 “Sixty Is the New Thirty” —Cover/AARP/11. 03

4. “Quality”: COULD IT TRULY BE THIS AWFUL? 4. “Quality”: COULD IT TRULY BE THIS AWFUL?

“Quality of care is the problem, not managed care. ” Institute of Medicine “Quality of care is the problem, not managed care. ” Institute of Medicine

“Without being disrespectful, I consider the U. S. healthcare delivery system the largest cottage “Without being disrespectful, I consider the U. S. healthcare delivery system the largest cottage industry in the world. There are virtually no performance measurements and no standards. Trying to measure performance … is the next revolution in healthcare. ” Richard Huber, former CEO, Aetna

“A healthcare delivery system characterized by idiosyncratic and often ill-informed judgments must be restructured “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 “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 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

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

1, 000 “serious medication errors per year” … “illegible handwriting, misplaced decimal points, and 1, 000 “serious medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug interactions and allergies. ” Source: Wall Street Journal / Institute of Medicine

Various studies: 1 in 3, 1 in 5, 1 in 7, 1 in 20 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

Health. Grades/Denver: 195, 000 hospital deaths per year in the U. S. , 2000 Health. Grades/Denver: 195, 000 hospital deaths per year in the U. S. , 2000 -2002 = 390 full jumbos/747 s in the drink per year. Comments: “This should give you pause when you go to the hospital. ” —Dr. Kenneth Kizer, National Quality is little evidence that patient safety has improved in the last five years. ” —Dr. Samantha Collier Forum . “There Source: Boston Globe/07. 27. 04

“This should give you pause when you go to the hospital. ” “There is “This should give you pause when you go to the hospital. ” “There is little evidence that patient safety has improved in the last five years. ”

RAND (1998): 50%, appropriate preventive care. 60%, recommended treatment, per medical studies, for chronic RAND (1998): 50%, appropriate preventive care. 60%, recommended treatment, per medical studies, for chronic conditions. 20%, chronic care treatment that is wrong. 30% acute care treatment that is wrong.

“Established state-of-theart cancer care—about which there is no longer any debate—is erratically applied. ” “Established state-of-theart cancer care—about which there is no longer any debate—is erratically applied. ” Source: Institute of Medicine’s National Cancer Policy Board

“In a disturbing 1991 study, 110 nurses of varying experience levels took a written “In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to calculate medication doses. Eight out of 10 made calculation mistakes at least 10% of the time, while four out of 10 made mistakes 30 % of the time. ” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

YE GADS! New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate 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

Geography Is Destiny “Often all one must do to acquire a disease is to Geography Is Destiny “Often all one must do to acquire a disease is to enter a country where a disease is recognized—leaving the country will either cure the malady or turn it into something else. … Blood pressure considered treatably high in the United States might be considered normal in England; and the low blood pressure treated with 85 drugs as well as hydrotherapy and spa treatments in Germany would entitle its sufferer to lower life insurance rates in the United States. ” – Lynn Payer, Medicine & Culture

Geography Is Destiny E. g. : Ft. Myers 4 X Manhattan—back surgery. Newark 2 Geography Is Destiny E. g. : Ft. Myers 4 X Manhattan—back surgery. Newark 2 X New Haven— prostatectomy. Rapid City SD 34 X Elyria OH—breast-conserving surgery. VT, ME, IA: 3 X differences in hysterectomy by age 70; 8 X tonsillectomy; 4 X prostatectomy (10 X Baton Rouge vs. Binghampton). Breast cancer screening: 4 X NE, FL, MI vs. SE, SW. (Source: various)

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

“Most physicians believe that diagnosis can’t be reduced to a set of generalizations—to a “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

Deep Blue Redux*: 2, 240 EKGs … 1, 120 heart attacks. Hans Ohlin : Deep Blue Redux*: 2, 240 EKGs … 1, 120 heart attacks. Hans Ohlin : 620. Lars Edenbrandt’s software: 738. (50 yr old chief of coronary care, Univ of Lund/SW) *Only this time it matters!

“Practice variation is not caused by ‘bad’ or ‘ignorant’ doctors. Rather, it is a “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

Genius Required? Genius Required?

Leapfrog Group: CPOE/Computerized Physician Order Entry* ICU staffing by trained intensivists** EHR/Evidence-based Hospital Referral*** Leapfrog Group: CPOE/Computerized Physician Order Entry* ICU staffing by trained intensivists** EHR/Evidence-based Hospital Referral*** *Duh I: Welcome to the computer age. **Duh II: How about using experts? ***Duh III: If you do stuff a lotta times, you tend to get/be better. Source: Health. Leaders

The Benefits of … FOCUSED EXCELLENCE Shouldice/Hernia Repair: 30 -45 min, 1% recurrence. Avg: The Benefits of … FOCUSED EXCELLENCE Shouldice/Hernia Repair: 30 -45 min, 1% recurrence. Avg: 90 min, 10%-15% recurrence. Source: Complications, Atul Gawande

IS/Web 5. The REVOLUTION IS/Web 5. The REVOLUTION

“Some grocery stores have better technology than our hospitals and clinics. ” —Tommy Thompson, “Some grocery stores have better technology than our hospitals and clinics. ” —Tommy Thompson, HHS Secretary Source: Special Report on technology in healthcare, U. S. News & World Report (07. 04)

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

Computerized Physician Order Entry/CPOE: 5% hospitals source: Health. Leaders/06. 02 of U. S. Computerized Physician Order Entry/CPOE: 5% hospitals source: Health. Leaders/06. 02 of U. S.

Want email consultation: 90% patients, 15% docs. Evidence: Patients do not pester docs. Time 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

Telemedicine … Reduces days/1000 patients and physician visits for the chronically ill Decreases costs Telemedicine … Reduces days/1000 patients and physician visits for the chronically ill Decreases costs of managing chronic disease Expands service areas for providers Reduces travel costs to and from medical ed seminars Douglas Goldstein, e-Healthcare

“Our entire facility is digital. No paper, no film, no medical records. Nothing. And “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. Leaders/12. 2002)

Detroit Med Center: $100 M IS Makeover Experiment: Surgical residents equipped with Palm IIIxe. Detroit Med Center: $100 M IS Makeover Experiment: Surgical residents equipped with Palm IIIxe. Med Director: “It’s not unusual to have a team of 5 or 6 residents responsible for the patients of 25 doctors. For each resident, that could mean seeing 40 patients spread across 10 floors and 5 buildings. ” Records work was manual; but “Now you export the list of patients to your Palm, with the room number for each patient and with lab results from the last 72 hours. ”

The VHA gets it! E. g. : Laptop at bedside calls up patient e-records The VHA gets it! E. g. : Laptop at bedside calls up patient e-records from one of 1, 300 hospitals. Barcoded wristband confirms meds. National Center for Patient Safety in Ann Arbor. Docs and researchers discuss optimal treatment regimens—research center in Durham NC. Doc measures & guidelines; e. g. , pneumonia vaccinations from 50% to 84%. Blamefree system, modeled after airlines. “What’s needed in the U. S. is nothing short of a medical revolution and the VHA has gone further than most any other organization to revamp its culture and systems. ”— Rand/Source: WSJ 12. 10. 2001

“Patient by patient, problem by problem—drug reactions, hospital caused infections—Salt Lake City’s LDS Hospital “Patient by patient, problem by problem—drug reactions, hospital caused infections—Salt Lake City’s LDS Hospital has attacked treatmentcaused injuries and deaths. One of the secrets of LDS’s success is a custombuilt clinical computer system that may serve as a national model for how to save patient lives. ” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

Info Revolution Consumerism (research, consultation, B 2 C, etc. ) Clinical Info Systems (guidelines Info Revolution Consumerism (research, consultation, B 2 C, etc. ) Clinical Info Systems (guidelines and outcome measurement, etc. ) 100% Web-based (internal) Systems Electronic Medical Records Patient-physician email-consultation Telehealth-Remote Monitoring (biosensors, home testing, etc. ) Telemedicine (consultation, invasive treatment, “global medical village, ” etc. )

6. Conclusion. 6. Conclusion.

Golden American Age of Patient-centric, Genetics-driven Healthcare Looms! Current status: $1. 3 T+. 30 Golden American Age of Patient-centric, Genetics-driven Healthcare Looms! Current status: $1. 3 T+. 30 M-70 M uninsured. 100 K killed and 2 M injured p. a. in hospitals. 85% treatments unproven. Cure depends on locale in which treated. 50% prescriptions do not work. 2 X docs. 2 X hospitals. IS primitive. Accountability & measurement nil. And … EVERYBODY’S MAD-AS-HELL AND FEELS POWERLESS: DOCS, PATIENTS, NURSES, INSURERS, EMPLOYERS, PHARMA & DEVICE COS, HOSPITAL ADMINISTRATORS AND STAFF.

7. Health. Care 21 7. Health. Care 21

Health. Care 21: 21 Ideas for Century 21 1. Hospitals kill people. (And many Health. Care 21: 21 Ideas for Century 21 1. Hospitals kill people. (And many of those they don’t kill, they wound. ) (And they deny it. ) (ERRORS RULE!) And: Hustling ambulances kill pedestrians—and don’t save patients. 2. Doctors are spoiled brats—who don’t like measurements. Or any form of “interference. ” Docs are also cover-up artists. The REAL Hippocritic [sic? ] 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 Gen. X docs arrive.

Health. Care 21 (Cont. ) 8. IS/IT in hospitals is primitive (despite smart people Health. Care 21 (Cont. ) 8. IS/IT in hospitals is primitive (despite smart people and enormous expenditures—think Sears). 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. ) 12. 80 M 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 … 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.

Health. Care 21 (Cont. ) 15. The number of U. S. un-insured is the Health. Care 21 (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. ) * *

Health. Care 21 (Cont. ) ALL THIS = ENORMOUS OPPORTUNITY. 21. The Opportunity of Health. Care 21 (Cont. ) ALL THIS = ENORMOUS OPPORTUNITY. 21. The Opportunity of Several Lifetimes. (For the Bold & Brave. ) H’Care WILL be … TOTALLY … re-invented in the next two decades. (And, hey, it is our largest “industry. ”)

8. Doing It Right Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence 8. Doing It Right Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence

“It was the goal of the Planetree Unit to help patients not only get “It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer. ” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Much of our current healthcare is about curing. Curing is good. But healing is “Much of our current healthcare is about curing. Curing is good. But healing is spiritual, and healing is better, because we can heal many people we cannot cure. ” —Leland Kaiser, “Holistic Hospitals” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Source: Institute for the Future

The 9 Planetree Practices 1. The Importance of Human Interaction 2. Informing and Empowering 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 1. The Importance of Human Interaction

“There is a misconception that supportive interactions require more staff or more time and “There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget. Kindness is free. Listening to patients or answering their questions costs nothing. It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control —can be very costly. … Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring far more time than it would have taken to interact with them initially in a positive way. ” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Press Ganey Assoc/1999: 139, 380 former patients from 225 hospitals 0 of top 15 Press Ganey Assoc/1999: 139, 380 former patients from 225 hospitals 0 of top 15 factors determining Patient Satisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with ES (Employee Satisfaction) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Mgrs re staff: wages, security, promotion opportunities Staff re staff: interesting work (M: 5 Mgrs re staff: wages, security, promotion opportunities Staff re staff: interesting work (M: 5 of 10), appreciation (5 of 10), sense of being “in” about what’s going on (10 of 10) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Customer Comes Second: Put your People First and Watch ’Em Kick Butt, Hal The Customer Comes Second: Put your People First and Watch ’Em Kick Butt, Hal Rosenbluth (and Diane Mc. Ferrin Peters)

“ 100 Best Places to Work”/RLevering/2001 Get straight answers Appreciation Collaboration Interest in me “ 100 Best Places to Work”/RLevering/2001 Get straight answers Appreciation Collaboration Interest in me as a person Camaraderie (“Fun place to work”)

“Perhaps the simplest and most profound of all human interactions is kindness. … But “Perhaps the simplest and most profound of all human interactions is kindness. … But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. … Many staff members report verbal ‘abuse’ by physicians, managers and coworkers. ” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“Planetree is about human beings caring for other human beings. ” —Putting Patients First, “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”— 4 S 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

Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures (CR) Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures (CR) Health Fairs Griffin’s Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est goals, timetable, etc. ) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

“When hospital staff members are asked to list the attributes of the ‘perfect patient “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

The Patient-Family Experience “Patients are stripped of control, their clothes are taken away, they 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

“Family members, close friends and ‘significant others’ can have a far greater impact on “Family members, close friends and ‘significant others’ can have a far greater impact on patients’ experience of illness, and on their long-term health and happiness, than any healthcare professional. ” —Through the Patient’s Eyes Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“A 7 -year follow-up of women diagnosed with breast cancer showed that those who “A 7 -year follow-up of women diagnosed with breast cancer showed that those who confided in at least one person in the 3 months after surgery had a 7 -year survival rate of 72. 4%, as compared to 56. 3% for those who didn’t have a confidant. ” Institute for the Future

Institute of Medicine/ “Crossing the Quality Chasm” Respect for preferences Involvement in Decision Making Institute of Medicine/ “Crossing the Quality Chasm” Respect for preferences Involvement in Decision Making Access to care Coordination of care Information and education Physical comfort Emotional support Involvement of Friends and Family Continuity of care Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Care Partner Programs (IDs, discount meals, etc. ) Unrestricted visits (“Most Planetree hospitals have 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 4. Nutrition: The Nurturing Aspect of Food

Meals are central events vs “There, you’re fed. ”* *Irony: Focus on “nutrition” has 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 Kitchen Beautiful cutlery, plates, etc Chef rep Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

Spirituality: Meaning and Connectedness in Life 1. Connected to supportive and caring group 2. 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 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 6. Human Touch: The Essentials of Communicating Caring Through Massage

“Massage is a powerful way to communicate caring. ” —Putting Patients First, Susan Frampton, “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 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 7. Healing Arts: Nutrition for the Soul

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

Florence Nightingale/Notes on Nursing/patient’s need for beauty, windows, flowers: “People say the effect is 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

Griffin: Music in the parking lot; professional musicians in the lobby (7/week, 3 -4 Griffin: Music in the parking lot; professional musicians in the lobby (7/week, 3 -4 hrs/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

CAM (Complementary & Alternative Medicine): 83 M in US (42%) CAM visits 243 M CAM (Complementary & Alternative Medicine): 83 M in US (42%) CAM visits 243 M greater than to PCP (Primary Care Physician) (With min insurance coverage) W-F-Educated-Hi inc Don’t tell PCP (40%) OTA: <30% procedures used in conv med have undergone RCTs (randomized clinical trials) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting 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 9. Healing Environments: Architecture and Design Conducive to Health

“Planetree Look” Woods and natural materials Indirect lighting Homelike settings Goals: Welcome patients, friends “Planetree Look” Woods and natural materials Indirect lighting Homelike settings Goals: Welcome patients, friends and family … Value humans over technology. . Enable patients to participate in their care … Provide flexibility to personalize the care of each patient … Encourage caregivers to be responsive to patients … Foster a connection to nature and beauty Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Sound Texture Lighting Color Smell Taste Sacred space Source: Putting Patients First, Susan Frampton, Sound Texture Lighting Color Smell Taste Sacred space Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Access to nurses station: “Happen to” vs “Happen with” Source: Putting Patients First, Susan 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

The Ten Principals of the Eden Alternative 1. The three plagues of loneliness, helplessness, The Ten Principals of the Eden Alternative 1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders. 2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living. 3. Companionship is the antidote to loneliness. In an Eldercentered community we must provide easy access to human and animal companionship. 4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunities to give care and caregivers need opportunities to receive care. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

The Ten Principals of the Eden Alternative 5. Variety and Spontaneity are the antidotes The Ten Principals of the Eden Alternative 5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures. 6. An Elder-centered community understands that passive entertainment cannot fill a human life. 7. The Elder-centered community takes medical treatment down from its pedestal and places it into the service of genuine human caring. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

The Ten Principals of the Eden Alternative 8. In an Elder-centered community, decisions should The Ten Principals of the Eden Alternative 8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible. 9. An Elder-centered community understands human growth cannot be separated from human life. 10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

“The most basic question we need to pose in caring for others is this: “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

Conclusion: Caring/Growth “Experience” Conclusion: Caring/Growth “Experience”

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

“An estimated 60 to 90 percent of doctor visits involve stress -related complaints. ” “An estimated 60 to 90 percent of doctor visits involve stress -related complaints. ” —Newsweek/ “Health for Life”/09. 27. 2004

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

9. Tom’s Health. Care 2 9. Tom’s Health. Care 2

Healthcare’s 1 -2 Punch 1. Hospital “quality control, ” at least in the U. Healthcare’s 1 -2 Punch 1. Hospital “quality control, ” at least in the U. S. A. , is a bad, bad joke. Depending on whose stats you believe, hospitals kill 100, 000 or so of us a year—and wound many times that number. Finally, “they” are “getting around to” dealing with the issue. Well, thanks. And what is it we’ve been buying for our Trillion or so bucks a year? The fix is eminently do-able … which makes the condition even more intolerable. (“Disgrace” is far too kind a label for the “condition. ” Who’s to blame? Just about everybody, starting with the docs who consider oversight from anyone other than fellow clan members to be unacceptable. ) 2. The “system”—training, docs, insurance incentives, “culture, ” “patients” themselves—is hopelessly-mindlessly-insanely (as I see it) skewed toward fixing things (e. g. Me) that are broken—not preventing the problem in the first place and providing the Maintenance Tools necessary for a healthy lifestyle. Sure, biomedicine will soon allow us to understand deal with individual genetic predispositions. (And hooray!) But take it from this 61 -year old, decades of physical and psychological self-abuse can literally be reversed in relatively short order by an encompassing approach to life that can only be described as a “Passion for Wellness (and Well-being). ” Patients—like me—are catching on in record numbers; but “the system” is highly resistant. (Again, the doctors are among the biggest sinners—no surprise, following years of acculturation as the “man-with-the-whitecoat-who-will-now-miraculously-dispense-fix it-pills-for-you-the-unwashed. ” (Come to think of it, maybe I’ll start wearing a White Coat to my doctor’s office—after all, I am the Professional-in-Charge when it comes to my Body & Soul. Right? )

CR 07. 03: 60/264/180/145 -85/140 10. 04: 61/195/092/097 -60/058 CR 07. 03: 60/264/180/145 -85/140 10. 04: 61/195/092/097 -60/058

Off … Univasc (<1/2) Bextra Lipitor Toprol Propranolol Off … Univasc (<1/2) Bextra Lipitor Toprol Propranolol