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Welcome to Tom Peters “PowerPoint World”! Beyond the set of slides here, you will find at tompeters.com the last eight years of presentations, a basketful of “Special Presentations,” and, above all, Tom’s constantly updatedMaster Presentation—from which most of the slides in this presentation are drawn. There are about 3,500 slides in the 7-part “Master Presentation.” The first five “chapters” constitute the main argument: Part I is context. Part II is devoted entirely to innovation—the sine qua non, as perhaps never before, of survival. In earlier incarnations of the “master,” “innovation” “stuff” was scattered throughout the presentation—now it is front and center and a stand-alone. Part III is a variation on the innovation theme—but it is organized to examine the imperative (for most everyone in the developed-emerging world) of an ultra high value-added strategy. A “value-added ladder” (the “ladder” configuration lifted with gratitude from Joe Pine and Jim Gilmore’s Experience Economy) lays out a specific logic for necessarily leaving commodity-like goods and services in the dust. Part IV argues that in this age of “micro-marketing” there are two macro-markets of astounding size that are dramatically under-attended by all but a few; namely women and boomers-geezers. Part V underpins the overall argument with the necessary bedrock—Talent, with brief consideration of Education & Healthcare. Part VI examines Leadership for turbulent times from several angles. Part VII is a collection of a dozen Lists—such as Tom’s “Irreducible 209,” 209 “things I’ve learned along the way.” Enjoy! Download! “Steal”—that’s the whole point!
NOTE:To appreciate this presentation [and ensure that it is not a mess], you need Microsoft fonts:“Showcard Gothic,”“Ravie,”“Chiller”and“Verdana”
Tom Peters’ EXCELLENCE. ALWAYS.Kindred HealthcareLas Vegas/25 March 2008Part 1 of 2
Sticking my neck out: Reflecting on healthcare Tom Peters/03.25.2008
“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
“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
CDC 1998:90,000killed and 2,000,000injuredfrom hospital-caused drug errors & infections
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
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
“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)
“When I climb Mount Rainier I face less risk of death than I’ll face on the operating table.”—Don Berwick
“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
“Plus God knows how many in doctors’ offices, Tom”—Thom Mayer
***2003, New England Journal of Medicine publishes quality study results: 11 measures of quality compare VA and fee-for-service plans. VA “significantly better” on 11 out of 11… ***2004, Annals of Internal Medicine, RAND study: VA vs commercial managed care; VA “outperforms all other sectors of American healthcare in 294measures of quality” … ***National Committee for Quality Assurance top-rated, JHU, Mayo, Mass General; “In every single category the veterans healthcare system outperforms the highest-rated non-VA hospitals” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
K.I.S.S./Keep It Simple, Stupid:Wrong site surgery: “The most effective part of the drill is simply asking the patient, in language he can understand, to state (not confirm) who he is, his birth date or social security number, and what he’s in for.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
90K in ICU on any given day178 steps/day50% “serious complication”Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**Peter Provonost, Johns Hopkins, 2001**Checklist, line infections**1/3rd at least one error**Nurses/permission to stop procedure**1 year/10-day line-infection rate:11% to 0%(43 infections, 8 deaths, $2M saved) Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**Docs, nurses make own checklists on whatever process-procedure they choose**Within weeks, average stay in ICU down 50%Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**Replicate in Inner City Detroit (resource strapped—$$$, staff cut 1/3rd, poorest patients in USA)**Nurses QB**Project manager**Exec involvement (help with “little things”—it’s all “little things”)**Blues, small bonuses for participating**6 months, 66% decrease in infection rate; USA: bottom 25% to top 10%Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
“[Pronovost] is focused on work that is not normally considered a significant contribution in academic medicine. As a result, few others are venturing to extend his achievements.Yet his work has already saved more lives than that of any laboratory scientist in the last decade.”—Atul Gawande, “The Checklist” (New Yorker, 1210.07)
“Beware of the tyranny of making SmallChanges to SmallThings. Rather, make Big Changes to BigThings.”—Roger Enrico, former Chairman, PepsiCo
“Beware of the tyranny of making SmallChanges to SmallThings.Rather, make BigChanges to Big Things … using Small, Almost Invisible Levers with Big Systemic Impact.”—TP
“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
“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.”Source: Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson
400,000 heart bypass surgeries, 1,000,000 angioplasties per year: “Yet recent studies show that only about three percent of the patients who receive such operations benefit from them; most would be better served just taking aspirin or low-cost beta blockers.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“culture of cover-up that pervades healthcare” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“Generally, the more prestigious the hospital you check into, and the more eminent and numerous the physicians who attend you, the more likelyyou are to receive low-quality or even dangerous and unnecessary care.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“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
“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 aloss of life expectancy.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“[Dartmouth Professor Elliott] Fisher and his colleagues discovered that patients who went to hospitals that spent the most—and did the mostprocedures—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
“My most memorable brushes have been with an eminent surgeon,” Marjorie wrote in her next-to-last column for the Washington Post, “whose method is to stride into the examining room two hours late, pat your hand, pronounce your certain death if he can’t perform an operation on you, and then snap at your husband to stop taking notes, since he can’t possibly follow the complexity of the doctor’s thinking.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
VA costs up 0.8% in 10 years, Medicare up 40.4% (Note: VA patients “older, sicker, poorer and more prone to mental illness, homelessness, and substance abuse;” ½ > 65, 1/3 smoke, 1/5 diabetes vs 1/14 overall; chronic diseases, frailty—especially vulnerable to medical errors ) Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
VA/Strengths *Safety *Evidence-based medicine *Health promotion and wellness programs *“Unparalleled adoption of electronic medical records and otherinformation technologies” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“Some grocery stores have better technology than our hospitals and clinics.”—Tommy Thompson, former HHS SecretarySource: Special Report on technology in healthcare, U.S. News & World Report
Information technology: group of off-the-radar experiments, performed surreptitiously by “the Hard Hats.” Dr Kenneth Dickie, 1979, brought together, as VistA, 20,000 software protocols “originally written by individual doctors and other professionals working secretly in VA facilities all around the country” “This unique, integrated information system has dramatically reduced medical errors at the VA while also vastly improving diagnoses, quality of care, scientific understanding of the human body, and the development of medical protocols based on hard data about what drugs and procedures work best.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
Scanner: “Skunkworks” project started in Kansas, 1992, hand-held scanner, idea from nurse Sue Kinnick when she observed usage in rental-car return area.“It wound up eliminating some 549,000errors by 2001; there was a 75% decrease in errors involving the wrong medication, a 62% decrease in errors involving the wrong dosage, a 93% reduction in the wrong patients receiving medicine, and a 70% decrease in the number of times nurses simply forgot or didn’t get around to giving patients their meds.” Source:Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
“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
