Toward Healthcare Excellence: Challenges and Solutions in the Medical Industry

1. LONGTom Peters’Toward Health(care) Excellence!Michigan Health & Hospital AssociationAnnual Membership MeetingGrand Hotel/Mackinac Island/0629.2006

2. Part 1

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

4. Docs & Hospitals

5. 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)

6. Doctors/HospitalsDr 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)

7. Big Pharma

8. Digger the Dermatophyte**Lamisil/Novartis/#4/$110M/3X in 10 to 100,000

9. 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)

10. Intractable Problems

11. 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

12. STATE OFEMERGENCY

13. Manifesto

14. “Healthcare” vs “Health”

15. TP’s Healing & Wellness Manifesto2006(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.)

16. TomRant2006 • 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. • 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, bio-medicine will soon allow us to understand and deal with individual genetic pre-dispositions. (And hooray!) But take it from this 63-year old, decades of physical and psychological self-abuse can literally be reversedin 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-white-coat-who-will-now-miraculously-dispense-fix it-pills-and-surgical-incisions-for-you-the-unwashed.”

17. BIGGEST DEAL OF ALL

18. !!!!!!!!!!!!!“Healthcare” vs “Health”

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

20. State of Play

21. Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-

22. Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-Quality: FScientific basis for action: C-/D

23. Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-Emphasis on Acute care: CDe-emphasis of WPC/Wellness-Prevention-Chronic care: F (F-??)

24. Funding …………………........... N.A.Access …………………………… N.A.Execution of chosen task … DPriorities ……………………...... FBig Pharma …………………..... D-“Me too”: D-Overcomplexity/Drug discovery: D-Disease creation: D-Hiring pretty girls: AHiring lotsa pretty girls: A

25. BONUSFunding …………………........... N.A.Access …………………………… N.A.Execution of chosen task ……... DPriorities ……………………............ FBig Pharma …………………........... D-FDA …………………………………….. D-Kill a few, save a lot: D-

26. Bust fat docs!

27. Health:Century21.Job # 1

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

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

30. “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)

31. 2m38s

32. Welcome to the Homer Simpson Hospitala/k/aThe Killing Fields

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

34. Childhood Obesity > Terrorism

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

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

37. Report Card.

38. Quality(100K+ deaths)“Evidence/Outcomes-based” medicineIS/IT-in-health(care) revolutionWellness/PreventionHealth“care” to Health “culture” transformationWash your hands!Home-care (as the population rapidly ages)Med-school re-orientation “Public health” emphasisChildhood ObesityMind-boggling (15 years?) social-moral-technological impact of life sciences (“the Singularity”?)H5N1/WMDs/Environmental degradationRisk assessment (private, public)Market opportunityPublic vs/+ Private responsibilities & partnerships Africa! (Unconscionable failure to attend to/staggering Health consequences for all)

39. 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

40. “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 Neighbor andWash Your Hands. A close third would be Move, Move, Move.”—Mark Pettus, M.D., The Savvy Patient“The most important thing you can do to keep from getting sick is to wash your hands.”—CDC/National Center for Infectious Diseases

41. Tommy Thompson: take your meds; chronic illness 75% to 80%; “curative healthcare system” to “prevention system”Source: Advertising Age, 05.08.06

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

43. Wash your hands.Apply #50 sunscreen.Banish trans fatBanish high fructose corn syrup.Exercise “30-7.”Breathe.Stockpile for H5N1.*(*not Tamiflu!)

44. Women.Women business owners.Boomers-Geezers.Single-adults (Urban)Health-Wellness-Chronic Care

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

46. “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)

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

48. 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

49. Welcome to the Homer Simpson Hospitala/k/aThe Killing Fields

50. Dear Mr. & Mrs. Smith,XYZ hospital regrets to inform you ……. …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Sincerely,A. S. Jackson, AdministratorT. D. Jones, M.D., Chief Medical OfficerL.S. Donald, CFOW.N. Arnold, CIO