Slides at … tompeters

1. Tom Peters’ EXCELLENCE. ALWAYS.Healthcare Financial Management AssociationLas Vegas/26 June 2008

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

3. Slides at …tompeters.com

4. Part One: A Civilian Looks at Your World

5. 45

6. “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

7. DVM/Lyme/2005-2008**Multiple diagnoses (>5)**Specialist self-certainty**Health deterioration failed to produce urgency- communication**Virtually no communications between specialists**Follow-up very spotty unless bugged incessantly**Lost major test results, mis-placed 3 or 4 occasions**Near fatal drug mistake (one nurse takes charge)**Effectively, disinterest in chronic-care**Lack of curiosity

8. “[Dartmouth Professor Elliott] Fisher and his colleagues discovered that patients who went to hospitals that spent the most— and did the most procedures—were 2 to 6 percent more likely to die than patients that went to hospitals that spent the least.” Source:Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee

9. “The more doctors and specialists around, the more tests and procedures performed. And the results of all these tests and procedures? Lots more medical bills, exposure to medical errors, and a loss of life expectancy. “It was this last conclusion that was truly shocking, but it became unavoidable when [Dartmouth’s Dr. Jack] Wennberg and others broadened their studies.They found it’s not just that renowned hospitals and their specialists tend to engage in massive overtreatment. They also tend to be poor at providing critical but routine care.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

10. Journalist Tim Noah writes about his wife’s cancer treatment in a high-rep private med center: “Much of our effort involved retrieving information from one source and sending it to another. This wasn’t something we could count on happening on its own. Very expensive blood test results, we observed, had perhaps a 50% chance of being misplaced under a pile of faxes and therefore not finding their way into Marjorie [William’s] medical chart. So we made a habit of getting the labs to fax to our house. Films of CT scans would be misfiled perhaps 30% of the time and thus become permanently irretrievable. So I took my checkbook to all of Marjorie’s CT scans and purchased my own spare copy on the spot.” Source: Foreword to Best Care Any where: Why VA Healthcare Is Better Than Yours, Phillip Longman

11. “stunning lack of scientific knowledge about which treatments and procedures actually work.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

12. CDC 1998:98,000killed and 2,000,000injuredfrom hospital-caused drug errors & infections

13. 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

14. 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

15. “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

16. 1m41s

17. 47

18. “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)

19. “Experts estimate that more than a hundred thousand Americans die each year not from illness but from their prescription drugs.Those deaths, occurring quietly, almost without notice in hospitals, emergency rooms, and homes, make medicines one of the leading causes of death in the United States. On a daily basis, prescription pills are estimated to kill more than 270 Americans. … Prescription medicines, taken according to doctors’ instructions, kill more Americans than either diabetes or Alzheimer’s disease.”Source: Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs —Melody Petersen

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

21. “Can’t you Put a muzzle on him?”

22. Part Two: Some Stuff, a 40 Year Journey

23. Thank you Ike and Ben

24. “Allied commands depend on mutual confidence [and this confidence] is gained, above all through the development of friendships.” —General D.D. Eisenhower, Armchair General* (05.08)*“Perhaps his most outstanding ability [at West Point] was the ease with which he made friends and earned the trust of fellow cadets who came from widely varied backgrounds; it was a quality that would pay great dividends during his future coalition command

25. Give good tea!

26. Thank you ,Herb

27. “You have to treat your employees like customers.”—Herb Kelleher, upon being asked his “secret to success”Source: Joe Nocera, NYT, “Parting Words of an Airline Pioneer,” on the occasion of Herb Kelleher’s retirement after 37 years at Southwest Airlines (SWA’s pilots union took out a full-page ad in USA Today thanking HK for all he had done; across the way in Dallas American Airlines’ pilots were picketing the Annual Meeting)

28. Thank you Sheik Mohammad

29. 24%

30. Single greatest act of pure imagination

31. dubai

32. Thank you Bob

33. 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”

34. “Breakthrough” 82* People! Customers! Action! Values! *In Search of Excellence

35. #1

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

37. Dick Kovacevich:You don’t get better by being bigger. You get worse.”

38. #4 Japan#3 USA#2 China#1 Germany

39. Reason!!!Mittelstand

40. Basement Systems Inc.

41. *Basement Systems Inc.*Larry Janesky*Dry Basement Science(115,000!)*1990: $0; 2003: $13M; 2007: $62,000,000

42. #2

43. The black swan

44. 1982 (-) = 200 Years (+)

45. 1982/Default Latin America = 200 years[Total historical earnings] The Black Swan: The Impact of the Highly Improbable, Nassim Nicholas Taleb

46. Career =1 or 2 black swans

47. #3

48. 25

49. #4

50. Conrad Hilton, at a gala celebrating his life, was asked, “What was the most important lesson you’ve learned in your long and distinguished career?” His immediate answer …