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Slides at … tompeters

Tom Peters’ Leading for Excellence: Surpassing “Unrealistic” Expectations AHCA/NCAL 55 th Annual Convention & Expo Miami Beach/10.04.2004. AHCA is … the American Healthcare Association. NCAL is … the National Center for Assisted Living. Slides at … tompeters.com. Goals.

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Slides at … tompeters

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  1. Tom Peters’Leading for Excellence: Surpassing “Unrealistic” ExpectationsAHCA/NCAL 55th Annual Convention & ExpoMiami Beach/10.04.2004

  2. AHCA is … the American Healthcare Association.NCAL is … the National Center for Assisted Living.

  3. Slides at …tompeters.com

  4. Goals.

  5. Tom’s Healthcare9: Goals20041. Stop killing people in acute-care settings through negligence/lousy management/craft mores. (THIS IS ABOUT ATTITUDE & WILL … NOT $$$$.)2. Adopt Patient-centric acute-care models (a la Planetree).3. Embrace the Boomer Tsunami.4. Prepare for consumer-driven healthcare.5. Revise-Revolutionize the entire system (K-90) to revolve around Wellness-Prevention.6. Erase the disgrace of uninsured American’s … in Planet’s Wealthiest Economy.7. Re-orient Boomer-driven Eldercare toward Optimism (“The time of your life!”) (60 – 30 = 90 – 60).8. Re-imagine! What an Opportunity!9. Excellence = State of Mind.

  6. Musings …

  7. This is the most important speech I’ve given since NAESP!

  8. Never felt it so keenly …Problem-focused?Opportunity-focused?

  9. RegulationsSky-high (“Unrealistic”) ExpectationsInadequate FundingStaffing WoesEtc.Etc.Etc.

  10. “Growth market” or … Magical Opportunity to Lead this Demographic Revolution … and Re-imagine Aging?

  11. Biases.

  12. 95/Ginger Cove/Life Care Services

  13. WHY THE HELL SHOULDN’T MY EXPECTATIONS BE “TOWERING”?

  14. T = SS – 34D

  15. Cool? Oh Bleep?60 – 30 = 90 - 60

  16. “Old Age”: A Magical Time to fully/finally appreciate life!

  17. TP/61/CR: Diet … Eating Habits/Philosophy … Nutrition Supplements … Breathing … Stretching … Meditation (Short, Long) … Exercise … Mini-walks … Sound … Flowers … Aromatherapy … Baths … Labyrinthine … Massage … Acupuncture … Chiropractic … Big CR/“CR Pauses” … Water (Japanese bath) … “Stop. Look. Listen.” ... Monitor & Measure & Record. New World Order = Reverse 5 decades of abuse(With damn little help from my M.D. friends)

  18. Context.Weird.

  19. “Uncertainty is the only thing to be sure of.”—Anthony Muh,head of investment in Asia, Citigroup Asset Management“If you don’t like change, you’re going to like irrelevance even less.”—General Eric Shinseki, Chief of Staff, U. S. Army

  20. “It’s no longer enough to be a ‘change agent.’ You must be a changeinsurgent—provoking, prodding, warning everyone in sight that complacency is death.”—Bob Reich

  21. “In Tom’s world, it’s always better to try a swan dive and deliver a colossal belly flop than to step timidly off the board while holding your nose.” —Fast Company /October2003

  22. Revolution.Period.

  23. It is the foremost task—and responsibility—of our generation to re-imagine our enterprises, private and public.—from the back cover, Re-imagine!

  24. No Wiggle Room!“Incrementalism is innovation’s worst enemy.” Nicholas Negroponte

  25. “Beware of the tyranny of making Small Changes to Small Things. Rather, make Big Changes to Big Things.”—Roger Enrico, former Chairman, PepsiCo

  26. The greatest dangerfor most of usis not that our aim istoo highand we miss it,but that it istoo lowand we reach it.Michelangelo

  27. Characteristics of the “Also rans”*“Minimize risk”“Respect the chain of command”“Support the boss”“Make budget”*Fortune, article on “Most Admired Global Corporations”

  28. IS/IT. Go for the Gold. (Or: At Least Try and Get Off the Bench.)

  29. Productivity!McKesson 2002-2003: Revenue … +$7B Employees … +500Source: USA Today/06.14.04

  30. “Some grocery stores have better technology than our hospitals and clinics.”—Tommy Thompson, HHS SecretarySource: Special Report on technology in healthcare, U.S. News & World Report (07.04)

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

  32. 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

  33. Computerized Physician Order Entry/CPOE: 5% of U.S. hospitalssource: HealthLeaders/06.02

  34. Telemedicine …Reduces days/1000 patients and physician visits for the chronically illDecreases costs of managing chronic diseaseExpands service areas for providersReduces travel costs to and from medical ed seminarsDouglas Goldstein, e-Healthcare

  35. “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 (HealthLeaders/12.2002)

  36. The VHA gets it!E.g.: Laptop at bedside calls up patient e-records from one of 1,300 hospitals. Bar-coded 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%. Blame-free 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

  37. Consumerism.

  38. Amen!“The Age of the NeverSatisfied Customer”Regis McKenna

  39. “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

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

  41. “Medical care has traditionally followed a ‘professional’ model, based on two assumptions: that patients are unable to become sufficiently informed about their own care to allow them a pivotal role, and that medical judgments are based on science.”Joseph Blumstein, Vanderbilt Law School

  42. Consumer ImperativesChoiceControl (Self-care, Self-management)Shared Medical Decision-makingCustomer ServiceInformationBrandingSource: Institute for the Future

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

  44. Quality.Whoops.Ouch.Yikes.

  45. “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

  46. “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

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

  48. “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

  49. “As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called ignorant care. A surprising 85% of everyday medical treatments have never been scientifically validated. … For instance, when family 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

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

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