Reflections on the State of American Healthcare

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

2. Part 9Tom Peters’ EXCELLENCE. ALWAYS.New Master/21 August 2008

3. Slides at …tompeters.com

4. Ten PartsP1.1, P1.2, P1.3, P1.4/GenericP2/LeadershipP3/TalentP4/“Value-added Ladder”P5/“New” Markets P6/“The Equations”P7.1/ImplementationP7.2/ActionP8/13 “Guru Gaffes”P9/Health“care”P10/“The Lists”

5. Part nine

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; 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/08.21.2008

7. 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.

8. 45

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

10. 37

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

12. 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/08.21.08

13. 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.

14. Outline: 22 “Chapters”

15. “Bottom Line” (??): U.S. Life Expectancy • My Take • John Hammergren’s Take • K.I.A. & Wounded: A House (Hospital) of Horrors • How “It” “Works” (And Feels) … • 6. You Must Be Your Own Boss! • 7. Over-treatment!!!!!!!!!!!! • 8. F.Y.I.: The Dominating (!) Role of Healthcare • in the American Economy • 9. Pick of the Litter: Our “Best” Hospitals? • 10. See No Evil: A Culture of Cover-up • 11. And “They” Call It “Science” I: The • Overwhelming Lack of Treatment Validation • 12. And “They” Call It “Science” II: Astounding • Geographic Treatment Variation

16. 13. Shining Star, A/The … • 14. IS/IT: The “Dark Ages” Saga Continues • 15. 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 • “Organizational effectiveness” “Tools” that would put the focus on the patient • Wellness-Prevention: No Good Deed Goes • Unpunished • 18. From “Healthcare” to “Health”: • The “Oughtas” • 19. Healthcare Meets Health: The Case of • the Planetree Alliance • 20. My concerns, My Ideal • 21.TP’s Nobels • 22. Some Resources

17. 1. “Bottom line” (??): U.S. Life Expectancy

18. 45th.**Rank of U.S. life expectancy, <Bosnia, Cuba

19. 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.)

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

21. 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???

22. “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?

23. “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.

24. “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

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

26. 37th.* World Health Organization/WHO rank of U.S. health system performance

27. More.

28. 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

29. 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

30. Stunning.

31. “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

32. Stunning.

33. 2. My Take

34. The Healthcare14: U.S. Healthcare Trauma in 2008 U.S. Life expectancy rank: #45. WHO, overall American healthcare system performance: #37 (#1 in cost). Access: Denied to 10s of millions un/underinsured. Unnecessary annual health-system deaths: 200,000-400,000 or more.* Performance/top med centers: Problematic re quality of care and follow-up.* Over-treatment (meds, tests, procedures): Pandemic.* Use of hard evidence in medical decision-making: Spotty at best.* Collection of evidence based on reported treatment errors: Low.* Use of S.O.P.s in treatment regimes: Spotty.* Incentives for appropriate care: Low.* Incentives for in-appropriate care: High.* Emphasis on prevention and wellness: Low.* Emphasis on chronic-care: Low.* State-of-the-art IS/IT: Rare.* *Fixable without legislation or major societal change—eg can by and large be improved dramatically without some form of mandated universal access to care and in the absence of, say, a full-fledged War on Obesity. (Evidence in support of this proposition is the fact that in every category starred above there are Pockets of Excellence—hospitals and other health-service organizations, facing the same realities as their peers, that really “get it.”)

35. Data to follow.

36. 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, and mis-placed 3 or 4 occasions**Near fatal drug mistake (one nurse takes charge)**Effectively, disinterest in chronic-care**Lack of curiosity in general

37. Home in Vermont, I happened to run into a vet (Doctor of Veterinary Medicine), who has dealt with Lyme disease for years. In the course of a half-hour conversation, these points arose. Alas, none were in the least surprising—and, of course, they are the observations of an expert.

38. 3. John Hammergren’s Take

39. Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow—John Hammergren (CEO, McKesson) & Phil Harkins

40. John Hammergren is the CEO of $100 billion+ McKesson Corp. In a 2008 book, he paints a bleak picture of U.S. healthcare systemic performance—but als sees steps that would improve things dramatically.

41. “ … 25 to 30 percent of our $2.2 trillion goes to wasted care* in the form of preventable errors, incorrect diagnoses, redundant treatment, unnecessary infections, and extra time spent in the hospital.*and another 20% to paperworkSource: John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow

42. Stunning.

43. 140,000,000 illegible prescriptions per year—John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow

44. **1,500,000,000,000 claims per year**30% errors**15% lost**25% paper-basedSource: John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow

45. Stunning.

46. ”I can receive a BlackBerry message from a colleague climbing a mountain, yet I still show up at a doctor’s office [and after a 45-minite wait] learn that my hospital test results have not arrived weeks after they should have.”—John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow

47. Stunning.

48. Up To 500,000 Lives:“The medical system has been unable to turn proven remedies into everyday care.* Half the people who need to be treated to prevent heart attacks are not treated and half who are treated are treated inadequately. Patients go home with the wrong drugs or the wrong doses or misimpressions about the importance of taking their medications.”*More: 55% chance of “receiving the best recommended care—which means getting scientifically appropriate, evidence-based medical treatment”—The New York Times, from John Hammergren & Phil Harkins, Skin in the Game:How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow

49. Stunning.

50. “The private insurance industry has little incentive to see people live healthy lives beyond 65 when their customers automatically drop out of the employer-based system and enter the government-based system.”—John Hammergren & Phil Harkins, Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow