Some Reflections

1. NOTE:To appreciate this presentation [and ensure that it is not a mess], you need Microsoft fonts:“Showcard Gothic,”“Ravie,”“Chiller”and“Verdana”

2. Some Reflections On the sorry state of American “health,” circa 2008, and the sorry state of the “delivery of Healthcare,” and why the twain rarely meet; and how easy it would be to do a few things right, such as remind adults of a certain age to take their aspirin Tom Peters/03.31.2008

3. This presentation has taken me about 10 years to produce—some recent books took me over the top. Nonetheless, it is an amateur’s view—albeit a 65-year-old amateur with “skin in the game.”* *These gray-background slides are notes on the preceding slide. I have chosen not to use the Notes feature of PowerPoint, because so few in fact avail themselves of notes in that format—and I am optimistic that some of you will read the “notes” slides in this format.

4. 45

5. Keep this # in mind. (Throughout this presentation.)

6. Some Reflections On the sorry state of American “health,” circa 2008, and the sorry state of the “delivery of Healthcare,” and why the twain rarely meet: It’s about a whole lot more than health insurance! Tom Peters/03.31.08

7. This presentation is not about Hillarycare—or Obamacare or McCain-care. While the perverse nature of financial incentives is discussed (e.g., their bias toward “medicine” and away from “health”), this is not a treatise on financing overall or the # of uninsured. It focuses on “my turf”—the operational aspects of healthcare delivery. There is an enormous amount to do in healthcare within our grasp today, and not dependent upon new legislation.

8. Outline: 17 “Chapters”

9. Some Resources • “Bottom Line” (??): U.S. Life Expectancy • K.I.A. & Wounded: A House (Hospital) of Horrors • How “It” “Works” (And Feels) … • 5. You Must Be Your Own Boss! • 6. Over-treatment!!!!!!!!!!!! • 7. F.Y.I.: The Dominating (!) Role of Healthcare • in the American Economy • 8. Pick of the Litter: Our “Best” Hospitals? • 9. See No Evil: A Culture of Cover-up

10. 10. And “They” Call It “Science” I: The • Overwhelming Lack of Treatment Validation • 11. And “They” Call It “Science” II: Astounding • Geographic Treatment Variation • 12. Shining Star, A/The … • 13. IS/IT: The “Dark Ages” Saga Continues • K.I.S.S./Keep It Simple, Stupid: Un-sexy • “Stuff” Could Save Tens of Thousands of • Lives and Extend Hundreds of Thousands • of Others • 15. Wellness-Prevention: No Good Deed Goes • Unpunished • 16. From “Healthcare” to “Health”: • The “Oughtas” • 17. Healthcare Meets Health: The Case of • the Planetree Alliance • Bonus: Tom’s Nobels

11. 1. Some resources

12. ***Best Care Anywhere: Why VA Healthcare Is Better Than Yours—Phillip Longman***Medicine & Culture—Lynn Payer***Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs—Melody Petersen***Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer—Shannon Brownlee***Demanding Medical Excellence: Doctors and Accountability in the Information Age—Michael Millenson ***Putting Patients First—Susan Frampton, Laura Gilpin, Patrick Charmel [The Planetree story]

13. 2. “Bottom line” (??): U.S. Life Expectancy

14. 45th.**Rank of U.S. life expectancy, <Bosnia, Cuba

15. Problems notwithstanding, many-most Americans, at the end of the day, consider their-our healthcare to be the best in the world. If so, why do we rank behind the likes of Bosnia and Cuba in life expectancy? Our global life expectancy rank? Forty-five. (And falling-dropping-plummeting.)

16. “This” [life expectancy] is sorta the point, isn’t it … or am I missing something?*

17. I’d think this (life expectancy) would (obviously) be the principal point of the overall exercise—it’s not “How much healthcare do we get?” but “How healthy are we?” Right???

18. “This” [life expectancy] is sorta the point, isn’t it … or am I missing something?* *Should I, for instance, measure my health by “number of operations,” or “number of tests,” where, More = Better Health?

19. “Pay by procedure” is the operative (insane) funding algorithm in our healthcare system—there is no premium on helping us get healthy —in fact there are severe penalties for so doing.

20. “Bottom line” :1900-1960, life expectancy grew 0.64 % per year; 1960-2002, 0.24% per year, half from airbags, gun locks, service employment … Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

21. Historically, much-most of the gain in life-expectancy comes from non-health system factors—especially cleanliness and nutrition in the past.

22. State of Healthcare/U.S.A.*Spend more per capita*Overall system performance/WHO: 37th*Relatively low life expectancy*High # of uninsuredSource: Consulting, 07-08.06

23. State of Healthcare/U.S.A.*Spend more per capita*Overall system performance/WHO: 37th*Relatively low life expectancy*High # of uninsuredSource: Consulting, 07-08.06

24. Stunning.

25. “America’s elites are very good at attracting money and prestige, and they have a huge technology arsenal with which they attack death and disease.But they have no positive medical results to show for it in the aggregate and many indications that they are providing lower-quality care than the much-maligned HMOs and assorted St. Elsewheres.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

26. Stunning.

27. 3. K.I.A. & Wounded: A house (hospital) of horrors

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

29. “Quality of care is the problem, not managed care.”Source: Institute of Medicine (from Michael Millenson, Demanding Medical Excellence)

30. “Study: Medical Errors Affect 20 Percent of Patients”—headline, Boston Herald

31. RAND: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.

32. Typical stats—more to come.

33. Welcome to the Homer Simpson Hospital, a/k/a …The Killing Fields

34. American life expectancy is relatively low—and the delivery of healthcare in the U.S. is notoriously unsafe.

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

36. This 1998 report was a shocker —and bitterly contested by the “healthcare establishment.” Now it’s taken for granted, and perhaps understates—significantly. More grim estimates follow.

37. HealthGrades/Denver:195,000hospital deaths per year in the U.S., 2000-2002 = equivalent of 390 full jumbos/747s in the drink per year—more than one-a-day.Comments: There is little evidence that patient safety has improved in the last five years.”—Dr. Samantha CollierSource: Boston Globe/2005

38. 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

39. Throughout, we will see that much of this horrorshow is the product of “simple” problems—e.g., bad handwriting.

40. “The Institute of Medicine calculated that drug errors [on average, one per patient per visit—various sources; some estimates go as high as one-per-patient-per-day, on average] alone add on average nearly $5,000 to the cost of every hospital visit.”Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee

41. “Hospital infections kill an estimated 103,000 people in the United States a year, as many as AIDS, breast cancer and auto accidents combined.… Today, experts estimate that more than 60 percent of staph infections are M.R.S.A. [up from 2 percent in 1974]. Hospitals in Denmark, Finland and the Netherlands once faced similar rates, but brought them down to below 1 percent. How? Through the rigorous enforcement of rules on hand washing, the meticulous cleaning of equipment and hospital rooms, the use of gowns and disposable aprons to prevent doctors and nurses from spreading germs on clothing and the testing of incoming patients to identify and isolate those carrying the germ. … Many hospital administrators say they can’t afford to take the necessary precautions.”—Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (New York Times/06.06.2005)

42. “When I climb Mount Rainier I face less risk of death than I’ll face on the operating table.”—Don Berwick

43. Berwick is the uber-guru of the patient safety movement.

44. “The results are deadly. In addition to the 98,000 killed by medical errors in hospitals and the 90,000 deaths caused by hospital infections, another 126,000 die from their doctor’s failure to observe evidence-based protocols for justfour common conditions: hypertension, heart attack, pneumonia, and colorectal cancer.” [TP: total 314,000] Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

45. 1m42s

46. The 314K per year, very conservative, translates into an unnecessary death every one-minute-and-forty-two seconds. ....

47. 59

48. ... which in turn translates into 59 unnecessary deaths in the course of a healthcare presentation, a little over an hour long, that I recently made.

49. “Plus God alone knows how many casualties in doctors’ offices, Tom”—Thom Mayer

50. Thom Mayer, renown ER doc and consultant on patient-centric care, reminded me that the grim stats above leave out the likes what goes on in docs’ offices all over the land. (Arguably a staggering number in its own right.)