LONG Tom Peters Toward Health care Excellence Michigan Health

LONG Tom Peters’ Toward Health(care) Excellence! Michigan Health & Hospital Association Annual Membership Meeting Grand Hotel/Mackinac Island/0629. 2006

Part 1

EXCELLENCE. ALWAYS.

The Irreducible 209

EXCELLENCE. THE MANDATE.

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

EXCELLENCE. THE WORD.

Synonyms Purity Transcendence Virtue Elegance Majesty Antonyms Mediocrity

EXCELLENCE. 1982.

Excellence 1982: The Bedrock “Eight Basics” 1. 2. 3. 4. 5. 6. 7. 8. A Bias for Action Close to the Customer Autonomy and Entrepreneurship Productivity Through People Hands On, Value-Driven Stick to the Knitting Simple Form, Lean Staff Simultaneous Loose-Tight Properties”

EXCELLENCE. ALWAYS.

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

The Peters Principles: Enthusiasm. Emotion. Excellence. Energy. Excitement. Service. Growth. Creativity. Imagination. Vitality. Joy. Surprise. Independence. Spirit. Community. Limitless human potential. Diversity. Profit. Innovation. Design. Quality. Entrepreneurialism. Wow.

An emotional, vital, innovative, joyful, creative, entrepreneurial endeavor that elicits maximum concerted human potential in the wholehearted service of others. *** Business* ** (*at its best): **Excellence. Always. ***Employees, Customers, Suppliers, Communities, Owners, Temporary partners

The Ultimate Business: Creative Endeavor.

The Ultimate Business: Personal Development. Growth Experience.

The Ultimate Business: Transcendent Service Opportunity.

EXCELLENCE. YOU & ME.

“This is the true joy of Life, the being used for a purpose recognized by yourself as a mighty one … the being a force of Nature instead of a feverish, selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy. ” —GB Shaw/Man and Superman

“Life is not a journey to the grave with the intention of arriving safely in a pretty and well-preserved body—but rather a skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming, ‘Wow, what a ride!’ ” —anon.

EXCELLENCE. INNOVATE. OR. DIE.

“A focus on cost-cutting and efficiency has helped many organizations weather the downturn, but this approach will ultimately Only the constant pursuit of innovation can ensure long-term success. ” render them obsolete. —Daniel Muzyka, Dean, Sauder School of Business, Univ of British Columbia (FT/09. 17. 04)

“I am often asked by would-be entrepreneurs seeking escape from life within huge corporate structures, ‘How do I build a small firm for Buy a very large one and just wait. ” myself? ’ The answer seems obvious: —Paul Ormerod, Why Most Things Fail: Evolution, Extinction and Economics

More than $$$$ #1 R&D spending, last 25 years?

GM

Innovation: The Secrets

Parallel universe!

“Venture” fund (E. g. Gerstner/Amex, Dow/Marriott, Grove/Intel, Bedbury/Starbucks)

“This is so simple it sounds stupid, but it is amazing you only find oil if you drill wells. how few oil people really understand that You may think you’re finding it when you’re drawing maps and studying logs, but you have to drill. ” Source: The Hunters, by John Masters, Canadian O & G wildcatter

“We made mistakes, of course. Most of them were omissions we didn’t think of when we initially wrote the software. We fixed them by doing it over and over, again and again. We do the same today. While our competitors are still sucking their thumbs trying to make the design perfect, we’re already on prototype version No. 5. By the time our rivals are ready with wires and screws, we are on version It gets back to planning versus acting: We act from day one; others plan how to plan— for months. ” —Bloomberg by Bloomberg No. 10.

Culture of Prototyping “Effective prototyping may be the most valuable core competence an innovative organization can hope to have. ” Michael Schrage

“Never doubt that a small group of committed people can change the world. Indeed it is the only thing that ever has. ” —Margaret Mead

EXCELLENCE. DRAMATIC. DIFFERENCE. DOABLE.

$798

$415/Sq. Ft/Wal*Mart $798/Sq. Ft/Whole Foods

7 X. 730 A 800 P. F 12 A. * *’ 93 -’ 03/10 yr annual return: CB: 29%; WM: 17%; HD: 16%. Mkt Cap: 48% p. a.

“It’s simple, really, Tom. Hire for s, and, above all, promote for s. ” —Starbucks middle manager/field

#1/100 “Best Companies to Work for”/2005

Wegmans

EXCELLENCE. OPPORTUNITY.

“Women are the majority market” —Fara Warner/The Power of the Purse

“Forget China, India and the Internet: Economic Growth Is Driven by Women. ” —Headline, Economist, April 15, Leader, page 14

1. Men and women are different. 2. Very different. 3. VERY, VERY DIFFERENT. 4. Women & Men have a-b-s-o-l-u-t-e-l-y nothing in common. 5. Women buy lotsa stuff. 6. WOMEN BUY A-L-L THE STUFF. 7. Women’s Market = Opportunity No. 1. 8. Men are (STILL) in charge. 9. MEN ARE … TOTALLY, HOPELESSLY CLUELESS ABOUT WOMEN. 10. Women’s Market = Opportunity No. 1.

EXCELLENCE. EXPERIENCE IT.

“Experiences are as distinct from services as services are from goods. ” —Joe Pine & Jim Gilmore, The Experience Economy: Work Is Theatre & Every Business a Stage

“The [Starbucks] Fix” Is on … “We have identified a ‘third place. ’ And I really believe that sets us apart. The third place is that place that’s not work or home. It’s the place our customers come for refuge. ” Nancy Orsolini, District Manager

C XO* *Chief e Xperience Officer

EXCELLENCE. THE STORY.

“Storytelling is the core of culture. ” —Branded Nation: The Marketing of Megachurch, College Inc. , and Museumworld, James Twitchell

“Management has a lot to do with answers. Leadership is a function of questions. And the first question for a ‘Who do we intend to be? ’ leader always is: Not ‘What are we going to do? ’ but ‘Who do we intend to be? ’” —Max De Pree, Herman Miller

EXCELLENCE. BEDROCK.

Organizing Genius / Warren Bennis and Patricia Ward Biederman “Groups become great only when everyone in them, leaders and members alike, is free to do his or her absolute best. ” “The best thing a leader can do for a Great Group is to allow its members to discover their greatness. ”

Leadership’s Mt Everest/Mt Excellence “free to do his or her absolute best” … “allow its members to discover their greatness. ”

“The role of the Director is to create a space where the actor or actress can become more than they’ve ever been before, more than they’ve dreamed of being. ” —Robert Altman, Oscar acceptance

“In the end, management doesn’t change culture. Management invites the workforce itself to change the culture. ” —Lou Gerstner

Our Mission To develop and manage talent; to apply that talent, throughout the world, for the benefit of clients; to do so in partnership; to do so with profit. WPP

DD$21 M

A review of Jack and Suzy Welch’s Winning claims there are but two key differentiators that set GE “culture” apart from the herd: First: Separating financial forecasting and performance measurement. Performance measurement based, as it usually is, on budgeting leads to an epidemic of gaming the system. GE’s performance measurement is divorced from budgeting—and instead reflects how you do relative to your past performance and relative to competitors’ performance; ie it’s about how you actually do in the context of what happened in the real world, not as compared to a gamed-abstract plan developed last year. Second: Putting HR on a par with finance and marketing.

“Leaders ‘do’ people. Period. ” —Anon.

“AS LEADERS, WOMEN RULE: New Studies find that female managers outshine their male counterparts in almost every measure” Title, Special Report/Business. Week

EXCELLENCE. BEDROCK.

X. Step #1: Buy a Mirror!

“The First step in a ‘dramatic’ ‘organizational change program’ is obvious —dramatic personal change!” —RG

“You must be the change you wish to see in the world. ” Gandhi

EXCELLENCE. STRETCH.

The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it. Michelangelo

Kevin Roberts’ Credo 1. Ready. Fire! Aim. 2. If it ain’t broke. . . Break it! 3. Hire crazies. 4. Ask dumb questions. 5. Pursue failure. 6. Lead, follow. . . or get out of the way! 7. Spread confusion. 8. Ditch your office. 9. Read odd stuff. 10. Avoid moderation!

“It’s always showtime. ” —David D’Alessandro, Career Warfare

EXCELLE ALWAYS

Part 2

EXCELLENCE. HEALTH(CARE).

March-June 2006: Sample of Healthcare “PR”

Docs & Hospitals

Doctors/Hospitals 53 autopsy studies … 24% misdiagnosis rate (The Independent, 06. 27) “Medical Guesswork: From heart surgery to prostate care, the health industry knows little about which common treatments really work” (Cover, Business. Week, 0529) Dr David Eddy/Kaiser Permanente Care Management Institute: “The problem is we do not know what we are doing. ” Eddy: 15% of what doctors do is “backed by hard evidence” (BW); in general, 20% to 25%. “What Doctors Hate About Hospitals” (Cover, Time, 05. 01) “It remains almost a stroke of luck to enter a U. S. hospital and receive precisely the right treatment. ” (Time) “No day passed—not one— without a medication error. The errors were not rare; they were the norm” (Don Berwick, on his wife’s treatment) “One medication was discontinued by a physician’s order on the first day of admission [Berwick’s wife] and yet was brought by a nurse every single evening fo 14 days straight. ” (Time) Harvard Public Health, 2002 study: “More than 1 in 3 doctors reported errors in their own or a family member’s medical care. ” (Time)

Doctors/Hospitals Dr Robert Wachter, Chief of Medical Service, UCSF Medical Center: Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (Time) Dr Niteesh Choudry, Harvard Med School: “More than half the studies [reviewed] found decreasing performance with increasing years of practice for all outcomes assessed; only 4% found increasing performance with increasing age … one study found that for heart attack patients, mortality increased 0. 5% for every year the physician had been out of medical school. ” (Time) “My pizza parlor is more thoroughly computerized than most of healthcare. ” (Don Berwick, Time) “Teaching Doctors to Care” (feature, Time, 05. 29)

Big Pharma

Big Pharma “Pushing Pills: How Big Pharma Got Addicted To Marketing” (Cover, Forbes, 05. 08) Novartis: #4 best seller, Lamisil, toe fungus, $850 for 3 -month treatment, “Digger Dermatopphyte” (Forbes) $42 billion on R&D, $46 billion on marketing and admin. Salespeople: up 100, 000 in last 10 years, 1 per 9 docs vs 1 per 18 docs. (Forbes) Clinical trials favor sponsor’s drug 90% of the time. “The comparative studies are a joke. ” —Dr Jack Rosenblatt (Forbes) “Psychiatric Drugs Fare Favorably When Companies Pay for Studies” (headline, USA Today. 05. 25) 57% of studies paid by drug companies, up from 25% in 1992. Favorable outcome for sponsor: 78%. Sponsored by neutral: 48%. Sponsored by competitor: 28%. USA Today /American Psychiatric Association) “Hey, You Don’t Look So Good: As diagnoses ofr once-rare illnesses soar, doctors say drugmakers are ‘disease-mongering’ to boost sales” (feature, Business. Week, 05. 08)

Intractable Problems

Other “Hazardous To Your Health” (New York Times Op-ed on High Fructose Corn Syrup, 04. 11); 112, 000 deaths/year, $75 billion/per year associated with too much fat; 2/3 rd of Americans over-weight, 1/3 rd 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 3 X in 25 years

STATE OF EMERGENCY

Funding …………………. . . N. A. Access ……………… N. A. Execution of chosen task … D Priorities …………. . . F Big Pharma …………………. . . D-

Funding …………………. . . N. A. Access ……………… N. A. Execution of chosen task … D Priorities …………. . . F Big Pharma …………………. . . DQuality: F Scientific basis for action: C-/D

Funding …………………. . . N. A. Access ……………… N. A. Execution of chosen task … D Priorities …………. . . F Big Pharma …………………. . . DEmphasis on Acute care: C De-emphasis of WPC/Wellness. Prevention-Chronic care: F (F-? ? )

Funding …………………. . . N. A. Access ……………… N. A. Execution of chosen task … D Priorities …………. . . F Big Pharma …………………. . . D“Me too”: DOvercomplexity/Drug discovery: DDisease creation: DHiring pretty girls: A Hiring lotsa pretty girls: A

BONUS Funding …………………. . . N. A. Access ……………… N. A. Execution of chosen task ……. . . D Priorities …………. . . F Big Pharma …………………. . . DFDA …………………. . DKill a few, save a lot: D-

Manifesto

“Healthcare” vs “Health”

TP Recce #1: Dubai Healthcare City to Dubai Health City* *Cleveland Clinic and Canyon Ranch

TP’s Healing & Wellness Manifesto 2006 (1) Acute-care facilities are “killing fields. ” (WE KNOW WHAT TO DO. ) (2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it. ” (WE KNOW WHAT TO DO. ) (3) There are three primary aims for “all this”: Wellness-Healing-Health. (WE KNOW WHAT TO DO. ) (4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO. )

Health: Century 21. Job # 1

Quality! Prevention! Wellness! Chronic care! Childhood obesity! H 5 N 1!

Quality! Prevention! Wellness! Chronic care! Childhood obesity! H 5 N 1!

“When I climb Mount Rainier I face less risk of death than I’ll face on the operating table. ” —Don Berwick, “Six Keys to Safer Hospitals: A Set of Simple Precautions Could Prevent 100, 000 Needless Deaths Every Year, ” Newsweek (1212. 2005)

2 38 m s

Welcome to the Homer Simpson Hospital a/k/a The Killing Fields

Quality! Prevention! Wellness! Chronic care! Childhood obesity! H 5 N 1!

Childhood Obesity > Terrorism

Bust fat docs!

Quality! Prevention! Wellness! Chronic care! Childhood obesity! H 5 N 1!

The Ultimate “Culture Change” “Healthcare” vs. “Health”

“If God spoke to me by saying, ‘Mark, you’re down to your last three words: What would you want to say to your fellow humans that would make the most positive impact? ’ It would be a close call between Love Thy Wash Your Hands. Neighbor and A close third would be Move, Move. ” —Mark Pettus, M. D. , The Savvy Patient “The most important thing you can do to keep from getting sick is to hands. ” wash your —CDC/National Center for Infectious Diseases

Quality! Prevention! Wellness! Chronic care! Childhood obesity! H 5 N 1!

Report Card.

Re-imagine Healthcare: Reportcard 2006 Evidence-based/Outcomes-based ………………. . . . D Pay-for-performance ……………………. … D IS/IT (general) ………………. . …. CUse of information (for decisionmaking-measurement). … CEMR (Electronic Medical Records) …………. . C-/D CPOE (Computerized Physician Order Entry) ………. C-/D Quality/100 K+ unnecessary deaths …………. . ……… D-(kind) Acute care to chronic care-home care shift …………. …. . D/DAcute-care to Prevention/Wellness Obsession…. . … D/DPatient-centric/Client-centric…………………. . D Docs’ acceptance of “evidence-based” …………. . . … D/D“Revolutionary”-intensity Incentives re evidence …. . ……. DChildhood obesity epidemic ………………. . DH 5 N 1 preparedness …………………. ……. . D Corporate focus on Prevention/Wellness…………. . . C-/D Individual focus on Prevention/Wellness…………………. . … D Individuals’ health education/self-management ……. …. CWorkforce acceptance of self-responsibility …. …. . CWorkforce transition to “Brand You” attitude……. . C-/D 3 March 2006/Tom Peters

Wash your hands. Apply #50 sunscreen. Banish trans fat Banish high fructose corn syrup. Exercise “ 30 -7. ” Breathe. Stockpile for H 5 N 1. * (*not Tamiflu!)

COULD IT TRULY BE THIS AWFUL? “Quality”:

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

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, . “There is little evidence that patient safety has improved in the last five years. ” —Dr. Samantha Collier National Quality Forum Source: Boston Globe/07. 27. 04

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

Dear Mr. & Mrs. Smith, XYZ hospital regrets to inform you ……. …………………………………………………………………… ……………. Sincerely, A. S. Jackson, Administrator T. D. Jones, M. D. , Chief Medical Officer L. S. Donald, CFO W. N. Arnold, CIO

Cost (at All Costs*) Minimization Professional? Or/to: Full Partner- “Purchasing Officer” Thrust #1: Leader in Lifetime Value-added Maximization? (*Lopez: “Arguably ‘Villain #1’ in GM tragedy”/Anon VSE-Spain)

YE GADS! New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). “Subsequent investigations around the country have confirmed the ubiquity of error. ” “In one small study of how clinicians perform when patients have a sudden cardiac arrest, 27 of 30 clinicians made an error in using the defibrillator. ” Mistakes in administering drugs (1995 study) “average once every hospital admission. ” “Lucian Leape, medicine’s leading expert on error, points out that many other industries— whether the task is manufacturing semiconductors or serving customers at the Ritz Carlton—simply wouldn’t countenance error rates like those in hospitals. ” —Complications, Atul Gawande

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

20%: not get prescriptions filled 50%: use meds inconsistently Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

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

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

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

“As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called A surprising 85% of everyday medical treatments have never been scientifically validated. … For instance, when family ignorant care. practitioners in Washington State were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies. ” Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

“Most physicians believe that diagnosis can’t be reduced to a set of generalizations—to a ‘cookbook. ’ … How often does my intuition lead me astray? The radical implication of the Swedish study is that the individualized, intuitive approach that lies at the center of modern medicine is flawed—it causes more mistakes than it prevents. ” —Atul Gawande, Complications

Dr Larry Weed/POMR (“problem-oriented medical record”)/Etc: “It’s impossible to keep up with the avalanche of knowledge. Therefore it’s essential to use a valid diagnostic-decision aid like Larry’s” —Neil de “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 Crescenzo, VP Global Healthcare/IBM Consulting Burger (using Weed’s software for 20 years)

About Time! 100, 000 Lives Campaign* *Don Berwick/Institute for Healthcare Improvement

be “You must the change you wish to see in the world. ” Gandhi

You = Your Calendar

The Necessary IS/Web REVOLUTION

We all live in Dell-Wal*Marte. Bay-Google World!

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

“Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s office is in registration and vice versa. The referring physician is immediately sent an email telling him his patient has shown up. … It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer that’s pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the network. They can review a chart from 100 miles away. ” —David Veillette, CEO, Indiana Heart Hospital

Health

“Sanitary revolution”: mortality in major cities down 55% between 1850 and 1915 Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

“Our mistake is not that we value medical care— but that we have misunderstood what it can and cannot do. ” Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

“Gwen [former healthcare exec] has wonderful health insurance and an abundance of healthcare. What Gwen does not have is health. And there is nothing our health system can do to give it to her. ” “The battle cry is always health, but in fact the struggle has always been over healthcare. ” “For all its inspiring, high-tech cures, medicine is just not very effective at curing our era’s major “Medicine doesn’t do much chronic disease. ” killers. ” “When the most common killers of our era are mostly incurable and our preventive treatments pretty feeble, you have to wonder about medical care as a whole. ” “There is a widely held view that medical care contributes little to health. ” (John Bunker/ Journal of the Royal College of Physicians) Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

“Curve Shifting” Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

“Bump into factor”: Extra-size portions, eat more. Higher % shelf space snacks, more obesity. More liquor stores, more crime. High vs low fat: Japanese who emigrate to U. S. suffer 3 X increase in heart disease. Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

Sprint/Overland Park KS: Slow elevators, distant parking lots with infrequent buses, “food court” as “poorly” placed as possible, etc. Source: New York Times

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

Wellness

Obesity/-79(-36); BP (140 -85 to 90 -60); Blood sugar (180 -87); Blood chemistry (normal+); Cholesterol (140 -58); Metabolic rate/RMR (+250); Mental state (dramatic improvement*)

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

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

“Fixes” Diet Extreme exercise Meditation Supplements Eliminate all alcohol (Meds)

Planetree: A Radical Model for New Healthcare/Healing/Health/ Wellness Excellence

1. 2. 3. 4. 5. 6. 7. 8. 9. The Nine Planetree Practices The Importance of Human Interaction Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information Healing Partnerships: The importance of Including Friends and Family Nutrition: The Nurturing Aspect of Food Spirituality: Inner Resources for Healing Human Touch: The Essentials of Communicating Caring Through Massage Healing Arts: Nutrition for the Soul Integrating Complementary and Alternative Practices into Conventional Care Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

1. The Importance of Human Interaction

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

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

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

“When hospital staff members are asked to list the attributes of the ‘perfect patient and family, ’ their response is usually a passive patient with no family. ” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

4. Nutrition: The Nurturing Aspect of Food

Meals are central events vs “There, you’re fed. ” * *Irony: Focus on “nutrition” has reduced focus on “food” and “service” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

Kitchen Beautiful cutlery, plates, etc Chef rep Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

8. Integrating Complementary and Alternative Practices into Conventional Care

Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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

Conclusion: Caring/Growth “Experience”

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

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

T. T. D. / Healthcare 27

Healthcare 27 1. Fully utilize Physician’s Assistants to do routine work in a timely fashion. (“Doc in a Kiosk” at Wal*Mart is great!) 2. Maximize Outpatient services! 3. Short hospital stays work! 4. Support home care to the max. (E. g. , “Declaration of Independents”—Beacon Hill/Boston) 5. STOP THE 100 K+ NEEDLESS DEATHS—much/most of the “quality stuff” is eminently fixable. (Don Berwick for President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!) 6. FLIP HC 177 DEGREES TO EMPHASIZE PREVENTION & WELLNESS. (“Steps” are being taken but not enough. Med schools: Awful! Insurers: Little better. Support for appropriateproven alternative therapies is an important part. ) (HUGE INCENTIVES FOR EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES. )

T. T. D. / ACTION. NOW.

Visible Signs/Measures (Creech) TRAIN. (P. S. ) Med school, Nursing school cirriculum (P. S. ) BOLD!/Big change EASIER than modest change (P. S. , etc. ) EXCELLENCE. ONLY. ALWAYS. DAMN IT. EVP/Patient Safety P. S. O. s Fund the living hell out of it (P. S. ) CEO (etc): REFLECT IT IN CALENDAR EMERGENCY STATUS H. M. O. s: Big/Enormous (+/-) incentives for docs, hospitals, etc BOARD: Patient Safety Committee BOARD: WPCC Committee Patient Safety BALDRIDGE (POTUS? ) CERTIFICATION/RE-CERTIFICATION for One & All (P. S. , etc)

WPOCC Rules!!!!!!! (Wellness/Prevention/ Obesity/Chronic. Care) WPOCC: N. G. A. (AK) Dramatically higher involvement in WPOCC INSURANCE COMPANY VISIBILITY/SPONSORSHIP/ MEGA-INCENTIVES Awards Galore P. S. /WPOCC) BOARD Committee: H 5 N 1 Govt HHS: Split HC & PWO (Ontario) Write off ½ of med school loan if “pay” with 3 -5 years service in Public Health Glamorize Family Practice, Public Health Service, etc FAT legislation? ? (Almost certainly) (Density, HFCS, Trasfats, etc) (A FIRST FOR TP) SUE the hell out of One & All re Obesity (Cigarettes II)

Research LEAP @ N. I. H. (Etc, ETC) INCENTIVES @ SCHOOLS (BIG!!) EMR: Intensify!!!!!!! No leadership position in AHA (AMA? ) (DEANs? ) (Etc? ) without “Safety tour” No Medical Chief (>150 beds? ) without “Safety tour”) FORGET ABOUT ME!!! (Except Wellness, Chroni. Care) VIGOROUSLYSUPPORT Home Care American OBESITY = African AIDs (? ? ) ELIMINATE/OBLITERATE HIGH FRUCTOSE CORN SYRUP! ELIMINATE/OBLITERATE TRANSFATS! (HFTC/TF = The Real “WMDs”) FDA: Kill! (Please)

STATE OF EMERGENCY

EXCELLENCE. ALWAYS.