11 tom peters’ x25* toward health(care) excellence! inova leadership institute/13 march 2007 *in...

11

Tom Peters’ X25*Tom Peters’ X25*

Toward Toward HealthHealth((carecare)) ExcellenceExcellence!!

Inova Leadership Institute/13 March 2007Inova Leadership Institute/13 March 2007

**In Search of ExcellenceIn Search of Excellence 1982-2007 1982-2007

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Part 1Part 1

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EXCELLENCE. EXCELLENCE.

ALWAYS.ALWAYS.

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EXCELLENCE. THE EXCELLENCE. THE

MANDATE.MANDATE.

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“It is It is notnot the the sstrontronggest est of the of the

species that survives, species that survives, nornor the the most most

intelliintelliggentent, but , but the the one most resone most respponsive onsive to chanto changgee.”.” —Charles Darwin—Charles Darwin

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ALWAYS.ALWAYS.EVERYWHERE.EVERYWHERE.

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“Why in the world did you go to Siberia?”

The Peters The Peters PrinciPrincipplesles:: Enthusiasm. Enthusiasm.

Emotion. Emotion. Excellence.Excellence. Energy. Energy. Excitement. Service. Growth. Excitement. Service. Growth.

Creativity. Imagination. Vitality. Creativity. Imagination. Vitality. Joy. Surprise. Independence. Joy. Surprise. Independence. Spirit. Community. Limitless Spirit. Community. Limitless human potential. Diversity. human potential. Diversity. Profit.Profit. Innovation. Design. Innovation. Design.

Quality. Entrepreneurialism. Quality. Entrepreneurialism. Wow.Wow.

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Excellence1982: The Bedrock “Eight Basics”Excellence1982: The Bedrock “Eight Basics”

1. A Bias for Action1. A Bias for Action2. Close to the Customer2. Close to the Customer3. Autonomy and 3. Autonomy and EntrepreneurshipEntrepreneurship4. Productivity Through People4. Productivity Through People5. Hands On, Value-Driven5. Hands On, Value-Driven6. Stick to the Knitting6. Stick to the Knitting7. Simple Form, Lean Staff7. Simple Form, Lean Staff8. Simultaneous Loose-Tight8. Simultaneous Loose-Tight Properties” Properties”

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Part 2Part 2

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““What’s Really Propping What’s Really Propping Up the Economy: Up the Economy:

Healthcare has added 1.7 Healthcare has added 1.7 million jobs since 2001. million jobs since 2001. The rest of the private The rest of the private

sector? sector? NoneNone.”.”

Source: Title, cover story, Source: Title, cover story, BusinessWeekBusinessWeek, 0925.2006, 0925.2006

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HEALTH(CARE).HEALTH(CARE).

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“When I climb Mount When I climb Mount Rainier I face less Rainier I face less

risk of death than I’ll risk of death than I’ll face on the face on the

operating table.”operating table.” ——Don BerwickDon Berwick, “Six Keys to Safer Hospitals: A Set of Simple Precautions , “Six Keys to Safer Hospitals: A Set of Simple Precautions Could Prevent 100,000 Needless Deaths Every Year,” Could Prevent 100,000 Needless Deaths Every Year,” Newsweek Newsweek (1212.2005)(1212.2005)

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March-June 2006: March-June 2006: Sample ofSample of

Healthcare “PR”Healthcare “PR”

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Doctors/Hospitals

53 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)

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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)

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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

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TP’s TP’s Health(care) Health(care)

Rants & Rants & PassionsPassions

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Quality!Quality!Prevention!Prevention!Wellness!Wellness!

Chronic care! Chronic care!Childhood obesity!Childhood obesity!

H5N1!H5N1!

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““Quality”:Quality”:

COULD IT TRULY BE

THIS AWFUL?

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22mm3838ss

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CDC 1998CDC 1998:: 90,00090,000 killedkilled and and 2,000,0002,000,000

injuredinjured from from hospital-caused drug hospital-caused drug

errors & infectionserrors & infections

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HealthGrades/Denver:HealthGrades/Denver:

195,000195,000 hospital deaths per hospital deaths per

year in the U.S., 2000-2002 = year in the U.S., 2000-2002 = 390 full 390 full jumbos/747s in the drink per yearjumbos/747s in the drink per year..

Comments: Comments: “This should give you pause “This should give you pause when you go to the hospital.”when you go to the hospital.” —Dr. Kenneth Kizer, —Dr. Kenneth Kizer,

National Quality ForumNational Quality Forum.. ““There is little There is little evidence that patient safety has evidence that patient safety has improved in the last five yearsimproved in the last five years.”.” —Dr. —Dr.

Samantha CollierSamantha Collier

Source: Source: Boston GlobeBoston Globe//07.27.0407.27.04

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1,000,0001,000,000

“serious medication errors per “serious medication errors per year” … “illegible handwriting, year” … “illegible handwriting, misplaced decimal points, and misplaced decimal points, and missed drug interactions and missed drug interactions and

allergies.”allergies.”

Source: Source: Wall Street Journal /Wall Street Journal /Institute of MedicineInstitute of Medicine

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YE GADS!YE GADS! New England Journal of Medicine/ New England Journal of Medicine/ Harvard Medical Practice Study: 4% error rate (1 of 4 Harvard Medical Practice Study: 4% error rate (1 of 4 negligence). negligence). “Subsequent investigations around the “Subsequent investigations around the

country have confirmed the ubiquity of error.”country have confirmed the ubiquity of error.” “In one “In one small study of how clinicians perform when patients small study of how clinicians perform when patients

have a sudden cardiac arrest,have a sudden cardiac arrest, 27 of 3027 of 30 clinicians clinicians made an error in using the defibrillator.” Mistakes in made an error in using the defibrillator.” Mistakes in administering drugs (1995 study) “average once every administering drugs (1995 study) “average once every

hospital admission.” hospital admission.” “Lucian Leape, medicine’s leading “Lucian Leape, medicine’s leading expert on error, points out that many other industries—expert on error, points out that many other industries—whether the task is manufacturing semiconductors or whether the task is manufacturing semiconductors or

serving customers at the Ritz Carlton—simply wouldn’t serving customers at the Ritz Carlton—simply wouldn’t countenance error rates like those in hospitalscountenance error rates like those in hospitals.”.”

——Complications,Complications, Atul Gawande Atul Gawande

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“In health care,In health care,

geography geography is destiny.”is destiny.”

Source: Dartmouth Medical School 1996 reportSource: Dartmouth Medical School 1996 report

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“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

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“As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called the enormous amount of what can only be called

ignorant care.ignorant care. A surprising 85% A surprising 85% of everyday medical of everyday medical

treatments have never treatments have never been scientifically been scientifically

validatedvalidated.. … For instance, when family … For instance, when family

practitioners in Washington State were queried about practitioners in Washington State were queried about treating a simple urinary tract infection, 82 physicians treating a simple urinary tract infection, 82 physicians

came up with an extraordinary 137 strategies.”came up with an extraordinary 137 strategies.”

Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

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“A healthcare delivery system characterized by A healthcare delivery system characterized by idiosyncratic and often ill-informed judgments idiosyncratic and often ill-informed judgments

must be restructured according tomust be restructured according to

evidence-based evidence-based medical medical

practicepractice.”.”Demanding Medical Excellence: Doctors and Accountability

in the Information Age, Michael Millenson

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““Most physicians believe that diagnosis can’t be reduced to a Most physicians believe that diagnosis can’t be reduced to a set of generalizations—to a ‘cookbook.’… How often does my set of generalizations—to a ‘cookbook.’… How often does my

intuition lead me astray?intuition lead me astray? The radical The radical implication of the Swedish implication of the Swedish

study is that the study is that the individualized, intuitive individualized, intuitive approach that lies at the approach that lies at the

center of modern medicine is center of modern medicine is flawed—it causes more flawed—it causes more

mistakes than it preventsmistakes than it prevents.” —Atul Gawande, Complications

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Dr Larry Weed/POMR (“problem-

oriented medical record”)/Etc: “It’s impossible to keep up with the avalanche of knowledge.

Therefore it’s essential to use a valid diagnostic-decision aid like Larry’s” —Neil de

Crescenzo, VP Global Healthcare/IBM Consulting “There is no other profession that

tries to operate in the fashion we do. We go on

hallucinating about what we can do.” —Dr Charles Burger (using Weed’s software for 20

years)

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The Necessary The Necessary

IS/WebIS/Web

REVOLUTIONREVOLUTION

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““Some grocery Some grocery stores have better stores have better technology than technology than our hospitals and our hospitals and clinics.”clinics.” —Tommy Thompson, former —Tommy Thompson, former

HHS SecretaryHHS Secretary

Source: Special Report on technology in healthcare, Source: Special Report on technology in healthcare, U.S. News & World ReportU.S. News & World Report

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“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

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Health

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TP Reccomendation* #1:

Dubai Healthcare City

to

Dubai Health City*

*Presentation at “First Middle Eastern Healthcare Summit/01.2006**Cleveland Clinic and Canyon Ranch Partnership

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Childhood Obesity > Terrorism

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““Sanitary revolution”: Sanitary revolution”: mortality in major mortality in major

citiescities downdown 5555%%

between 1850 and between 1850 and 19151915

Source: Tom Farley & Deborah Cohen, Prescription for a Healthy Nation

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Wellness

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Aging reversal!!!!**Why wasn’t I “informed”

until age 59?

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Report Card.

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Re-imagine Healthcare: Reportcard2006Re-imagine Healthcare: Reportcard2006

Evidence-based/Outcomes-based ……………….………...... DEvidence-based/Outcomes-based ……………….………...... DPay-for-performance ………………………………………….… DPay-for-performance ………………………………………….… DIS/IT (general) ………………………………..………………..…. C-IS/IT (general) ………………………………..………………..…. C-Use of information (for decisionmaking-measurement) .… C-Use of information (for decisionmaking-measurement) .… C-EMR (Electronic Medical Records) ……………………..….... C-/DEMR (Electronic Medical Records) ……………………..….... C-/DCPOE (Computerized Physician Order Entry) ……….……. C-/DCPOE (Computerized Physician Order Entry) ……….……. C-/DQuality/100K+ unnecessary deathsQuality/100K+ unnecessary deaths …………..……… D- …………..……… D-(kind)(kind)Acute care to chronic care-home care shift ………….….... D/D-Acute care to chronic care-home care shift ………….….... D/D-Acute-care to Prevention/Wellness ObsessionAcute-care to Prevention/Wellness Obsession…..… D/D-…..… D/D-Patient-centric/Patient-centric/ClientClient-centric………………………………….. D-centric………………………………….. DDocs’ acceptance of “evidence-based” …………............… D/D-Docs’ acceptance of “evidence-based” …………............… D/D-“Revolutionary”-intensity Incentives re evidence …..……. D-“Revolutionary”-intensity Incentives re evidence …..……. D-Childhood obesity epidemicChildhood obesity epidemic …………………………….. D- …………………………….. D-H5N1 preparednessH5N1 preparedness ………………………………….…….. D ………………………………….…….. D

Corporate focus on Prevention/Wellness…………..…..…..... C-/DCorporate focus on Prevention/Wellness…………..…..…..... C-/DIndividual focus on Prevention/Wellness…………………..… DIndividual focus on Prevention/Wellness…………………..… DIndividuals’ health education/self-management …….…...…. C-Individuals’ health education/self-management …….…...…. C-

Workforce acceptance of self-responsibility ….…….…...….. C-Workforce acceptance of self-responsibility ….…….…...….. C-Workforce transition to “Brand You” attitude……..……..….. C-/DWorkforce transition to “Brand You” attitude……..……..….. C-/D

3 March 2006/Tom Peters3 March 2006/Tom Peters

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Part 2APart 2A

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PlanetreePlanetree:: A Radical Model for A Radical Model for

New New Healthcare/Healing/Healthcare/Healing/Wellness Wellness ExcellenceExcellence

Tom Peters/17 September 2006

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““It was the goal of It was the goal of the Planetree Unit to the Planetree Unit to

help patients not help patients not only get well faster only get well faster but also to stay well but also to stay well longer.”longer.” —Putting Patients First,

Susan Frampton, Laura Gilpin, Patrick Charmel

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““Much of our current Much of our current healthcare is about healthcare is about curing curing . . Curing is good. But Curing is good. But healinghealing is spiritual, and healing is is spiritual, and healing is

better, because we can heal better, because we can heal many people we cannot many people we cannot

cure.”cure.” —Leland Kaiser, “Holistic Hospitals”

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The 9 Planetree Practices

1.1. The Importance of Human InteractionThe Importance of Human Interaction2. Informing and Empowering Diverse Populations: Consumer Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information Health Libraries and Patient Information3. Healing Partnerships: The importance of Including Friends Healing Partnerships: The importance of Including Friends and Family and Family4. Nutrition: The Nurturing Aspect of Food Nutrition: The Nurturing Aspect of Food5. Spirituality: Inner Resources for Healing Spirituality: Inner Resources for Healing6.6. Human Touch: The Essentials of Communicating Human Touch: The Essentials of Communicating Caring Through Massage Caring Through Massage7.7. Healing Arts: Nutrition for the Soul Healing Arts: Nutrition for the Soul8.8. Integrating Complementary and Alternative Practices Integrating Complementary and Alternative Practices into Conventional Care into Conventional Care9.9. Healing Environments: Architecture and Design Conducive Healing Environments: Architecture and Design Conducive to Health to Health

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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1. The The Importance of Importance of

Human Human InteractionInteraction

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“There is a misconception that supportive interactions require more staff or more time and are therefore more costly. Although

labor costs are a substantial part of any hospital budget, the interactions themselves add nothing to the budget.

Kindness is Kindness is freefree.. Listening to patients or answering their

questions costs nothing. It can be argued that negative interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. …

Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring far more time than it would have taken to interact with them initially in a

positive way.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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Press Ganey Assoc: 139,380 former patients from 225 hospitals:

nonenone of THE top 15 factors of THE top 15 factors

determining determining PPatient atient SSatisfaction atisfaction referred to patient’s health referred to patient’s health outcomeoutcome

PSPS directldirectly related to y related to StaffStaff InteractionInteraction

PSPS directldirectly correlated with y correlated with Employee Employee SatisfactionSatisfaction


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““Perhaps the simplest and most Perhaps the simplest and most profound of all human interactions profound of all human interactions

is KINDNESS. … is KINDNESS. … But if it is so But if it is so simsimpple, it is surle, it is surpprising how rising how

frefreqquentluentlyy it is absent from our it is absent from our healthcare environmentshealthcare environments.. … Many … Many

staff members report verbal staff members report verbal

‘abuse‘abuse’’ by physicians, by physicians,

managers and coworkers.”managers and coworkers.” ——Putting Putting Patients FirstPatients First, Susan Frampton, Laura Gilpin, Patrick Charmel, Susan Frampton, Laura Gilpin, Patrick Charmel

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““Planetree is Planetree is about human about human

beings caring for beings caring for other human other human

beings.”beings.”

—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies

and gentlemen”—4S credo)

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2. Informing and Informing and Empowering Diverse Empowering Diverse

Populations: Populations: ConsumerConsumer Health Libraries and Health Libraries and

Patient InformationPatient Information

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Planetree Health Resources Center/1981Planetree Health Resources Center/1981Planetree Classification SystemPlanetree Classification System

Consumer Health LibrariansConsumer Health LibrariansVolunteersVolunteers

Classes, lecturesClasses, lecturesHealth FairsHealth Fairs

Griffin’s Mobile Health Resource CenterGriffin’s Mobile Health Resource CenterOpen Chart PolicyOpen Chart Policy

Patient Progress NotesPatient Progress NotesCare Coordination Conferences (Est Care Coordination Conferences (Est

goals, timetable, etc.)goals, timetable, etc.)


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3. Healing Healing Partnerships: Partnerships: The The

Importance of Importance of IncludingIncluding

Friends and Friends and FamilyFamily

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“When hospital staff members are asked to list the attributes of the ‘perfect patient

and family,’ their response is

usually a passive patient with no

family.” —Putting Patients First, Susan

Frampton, Laura Gilpin, Patrick Charmel

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The Patient-Family Experience

“Patients are stripped of Patients are stripped of control, their clothes are control, their clothes are

taken away, they have little taken away, they have little say over their schedule, and say over their schedule, and

they are deliberately they are deliberately separated from their family separated from their family

and friends. Healthcare and friends. Healthcare professionals control all of professionals control all of the information about their the information about their patients’ bodies and access patients’ bodies and access

to the people who can to the people who can answer questions and answer questions and

connect them with helpful connect them with helpful resources. Families are resources. Families are

treated more as intruders treated more as intruders than loved ones.”than loved ones.” —Putting Patients First,


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““Family members, close friends Family members, close friends and ‘significant others’ can and ‘significant others’ can

have a far greater impact on have a far greater impact on patients’ experience of illness, patients’ experience of illness, and on their long-term health and on their long-term health

and happiness, than any and happiness, than any healthcare professional.”healthcare professional.”

—Through the Patient’s Eyes

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Institute of Medicine/ “Crossing the Quality Chasm”

Respect for preferencesRespect for preferencesInvolvement in Decision MakingInvolvement in Decision Making

Access to careAccess to careCoordination of careCoordination of care

Information and educationInformation and educationPhysical comfortPhysical comfort

Emotional supportEmotional supportInvolvement of Friends and FamilyInvolvement of Friends and Family

Continuity of careContinuity of care


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Care Partner ProgramsCare Partner Programs (IDs, discount meals, etc.)

Unrestricted visitsUnrestricted visits (“Most Planetree hospitals have eliminated visiting restrictions altogether.”) (ER at one

hospital “has a policy of never separating the patient from the family, and there is no limitation on how many family members

may be present.”)

Collaborative Care ConferencesCollaborative Care ConferencesClinical Guidelines DiscussionsClinical Guidelines Discussions

Family SpacesFamily SpacesPet VisitsPet Visits (POP: Patients’ Own Pets)


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4. Nutrition: Nutrition: The Nurturing The Nurturing Aspect of FoodAspect of Food

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Meals are central Meals are central eventsevents

vs

“There, you’re fed.” *

*Irony: Focus on “nutrition” has reduced focus on “food” and “service”


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KitchenKitchen

Beautiful cutlery,Beautiful cutlery, plates, etc plates, etc

Chef reputationChef reputation


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Aroma therapyAroma therapy (eg “smell of baking cookies”)


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5. Spirituality: Spirituality: Inner Resources Inner Resources

for Healingfor Healing

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Spirituality: Meaning and Connectedness in Life

1. Connected to supportive and1. Connected to supportive and caring group caring group2. Sense of mastery and control2. Sense of mastery and control3. 3. Make meaning out of Make meaning out of disease/disease/ find meaning in suffering find meaning in suffering


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Griffin: redesign chapelredesign chapel (waterfall, quiet music, open prayer book)

Other: music, flowers, portablemusic, flowers, portable labyrinth labyrinth


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6. Human Touch: Human Touch: The Essentials of The Essentials of CommunicatingCommunicating

Caring Through Caring Through MassageMassage

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“Massage is a Massage is a powerful way to powerful way to

communicate communicate caring.”caring.” —Putting Patients First,


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Mid-Columbia Medical Center/Center for Mind and Body

Massage for every patient scheduled for Massage for every patient scheduled for ambulatory surgery ambulatory surgery (“Go into surgery with(“Go into surgery witha good attitude”) a good attitude”) Infant massageInfant massageStaff massage Staff massage (“caring for the caregivers”)(“caring for the caregivers”)Healing environments: chemo!Healing environments: chemo!


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7.7. Healing Arts: Healing Arts: Nutrition forNutrition for

the Soul the Soul

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Planetree: “Environment conducive to healing”

Color!Color!Light!Light!

Brilliance!Brilliance!Form!Form!Art!Art!

Music!Music!


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Florence Nightingale/Notes on Nursing/patient’s need for beauty,

windows, flowers: “People People say the effect is only say the effect is only on the mind. It is no on the mind. It is no

such thing. The effect such thing. The effect is on the body, too.”is on the body, too.”


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Griffin: Music in the parking Music in the parking lot; professional musicians in lot; professional musicians in

the lobbythe lobby (7/week, 3-4hrs/day) ;

5 pianos5 pianos ;

volunteersvolunteers (120-140 hrs arts &

entertainment per month).


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8. Integrating Integrating Complementary and Complementary and

Alternative Practices Alternative Practices into Conventional into Conventional

CareCare

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CAM (Complementary & Alternative Medicine):

83M in US83M in US (42%)(42%)

CAM visits 243M, greater than to PCPCAM visits 243M, greater than to PCP (Primary (Primary Care Physician) (With min insurance coverage)Care Physician) (With min insurance coverage)

W-Educated-Hi incW-Educated-Hi incDon’t tell PCP Don’t tell PCP (40%)(40%)

OTA: <30% procedures used in OTA: <30% procedures used in conventional medicine have undergone conventional medicine have undergone

RCTsRCTs (randomized clinical trials)(randomized clinical trials)


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Griffin IMC/Integrative Medicine Center

MassageMassageAcupunctureAcupunctureMeditationMeditation

ChiropracticChiropracticNutritional supplementsNutritional supplements

Aroma therapyAroma therapy


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9. Healing Healing Environments: Environments:

Architecture andArchitecture and Design ConduciveDesign Conducive

to Healthto Health

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“Planetree Look”

Woods and natural materialsWoods and natural materialsIndirect lightingIndirect lighting

Homelike settingsHomelike settings

Goals: Goals: Welcome patients, friends and Welcome patients, friends and family … Value humans over technology .. family … Value humans over technology .. Enable patients to participate in their care Enable patients to participate in their care

… Provide flexibility to personalize the … Provide flexibility to personalize the care of each patient … Encourage care of each patient … Encourage

caregivers to be responsive to patients … caregivers to be responsive to patients … Foster a connection to nature and beautyFoster a connection to nature and beauty


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SoundSoundTextureTextureLightingLighting

ColorColorSmellSmellTasteTaste

Sacred spaceSacred spaceSource: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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Access to nurses station:

“Happen to”“Happen to”vs

“Happen with”“Happen with”Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

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Conclusion: Conclusion: Caring/Growth Caring/Growth “Experience“Experience””

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Care!/Love!/Spirit!Care!/Love!/Spirit!

Self-Control!Self-Control!

Connect!/learn!/Connect!/learn!/involve!/Engage!involve!/Engage!

Understanding!/Growth! Understanding!/Growth!

De-stress!/heal! De-stress!/heal!

Whole patient & family Whole patient & family & friends! & friends!

be well!/stay well!be well!/stay well!

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F.Y.I.F.Y.I.

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Griffin Hospital/Derby CT (Planetree Alliance “HQ”) Results:

Financially successful. Financially successful. Expanding programs-Expanding programs-

physically.physically. Growing market Growing market share. share. Only hospital in Only hospital in

“100 Best Cos to Work for”—“100 Best Cos to Work for”—7 consecutive years, 7 consecutive years,

currently #6.currently #6.

—“Five-Star Hospitals,” Joe Flower, strategy+business (#42)

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Learn more about Planetree/ Learn more about Planetree/ The Planetree Alliance:The Planetree Alliance:

www.planetree.orgwww.planetree.org

1

Part 3Part 3

881

Tom Peters’ X25*Tom Peters’ X25*

EXCELLENCEXCELLENCE. ALWAYS.E. ALWAYS.XAlways.XAlways.Motivational Stuff+Motivational Stuff+.12 March 2007.12 March 2007

**In Search of ExcellenceIn Search of Excellence 1982-2007 1982-2007

891

EXCELLENCE.EXCELLENCE.MOTIVATIONAL MOTIVATIONAL

STUFF.STUFF.

901

““Little Little Stuff”: The Stuff”: The

True True “Basics”“Basics”

1

The older I The older I get the get the lessless boring the boring the “basics” “basics” become!become!

921

Thank Thank You!You!

931

FFLLOOWWEERRPPOOWWEERR

1

““Courtesies of a small Courtesies of a small and trivial character are and trivial character are

the ones which strike the ones which strike deepest in the grateful deepest in the grateful

and appreciating heart.”and appreciating heart.”

—Henry Clay

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Axiom #3,359:Axiom #3,359: (1)(1) It’s It’s alwaysalways about about relationships.relationships. (2)(2) Sweat the small Sweat the small

stuff—and the big stuff—and the big stuff will take care stuff will take care

of itself.of itself.

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The Manager’s Book of The Manager’s Book of Decencies: How Small gestures Decencies: How Small gestures Build Great Companies.Build Great Companies. —Steve Harrison, Adecco

Servant LeadershipServant Leadership —Robert Greenleaf

One: The Art and Practice of One: The Art and Practice of Conscious LeadershipConscious Leadership —Lance Secretan, founder of Manpower, Inc. (“What would happen if we (“What would happen if we

looked at a customer and saw the face of God in them?”)looked at a customer and saw the face of God in them?”)

981

““Leaders Leaders

‘‘SERVESERVE’’ people. people.

Period.”Period.” —Anon.

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Servant LeadershipServant Leadership/Robert Greenleaf/Robert Greenleaf

1. 1. Do those served grow asDo those served grow as persons?persons? 2. 2. Do they, while being served, Do they, while being served,

become healthier wiser, freer, become healthier wiser, freer, more autonomous, more likely more autonomous, more likely themselves to become servants?themselves to become servants?

1

The Manager’s Book of The Manager’s Book of Decencies: How Small gestures Decencies: How Small gestures Build Great Companies.Build Great Companies. —Steve Harrison, Adecco

Servant LeadershipServant Leadership —Robert Greenleaf

One: The Art and Practice of One: The Art and Practice of Conscious LeadershipConscious Leadership —Lance Secretan, founder of Manpower, Inc. (“What would happen if we (“What would happen if we

looked at a customer and saw the face of God in them?”)looked at a customer and saw the face of God in them?”)

1

““What would happen if we looked at a What would happen if we looked at a customer and saw the face of God in customer and saw the face of God in

them? To most people it sounds like a them? To most people it sounds like a lofty idea. But if you see the face of lofty idea. But if you see the face of

God in a flower, why wouldn’t you see God in a flower, why wouldn’t you see it in the face of a customer? If we it in the face of a customer? If we

treated customers and honored the treated customers and honored the God within them— God within them— if we loved themif we loved them — —

we would not need a ‘quality we would not need a ‘quality program’.”program’.” —Lance Secretan, founder of Manpower, Inc. and most

recently author of One: The Art and Practice of Conscious Leadership

1021

THE PROBLEMTHE PROBLEM IS RARELY THE IS RARELY THE

PROBLEM.PROBLEM.

1031

THE PROBLEM IS THE PROBLEM IS RARELY/NEVER THE RARELY/NEVER THE

PROBLEM. THE PROBLEM. THE RESPONSERESPONSE TO THE TO THE

PROBLEM INVARIABLY PROBLEM INVARIABLY ENDS UP BEING THE ENDS UP BEING THE REAL PROBLEMREAL PROBLEM.* **

*Watergate, M Stewart, BR, “Scooter” Libby**And: PERCEPTION IS ALL THERE IS!PERCEPTION IS ALL THERE IS!

1041

OFTEN AS OFTEN AS NOT/MORE OFTEN NOT/MORE OFTEN

THAN NOT THE THAN NOT THE UNDERLYING UNDERLYING

PROBLEM IS NOT PROBLEM IS NOT MUCH OF A MUCH OF A PROBLEM.PROBLEM.

1051

PERCEPTIOPERCEPTION IS ALL N IS ALL

THERE IS. THERE IS. PERIODPERIOD.*

*From Whole Foods to IBM to the corner deli

1061

Relationships (of all varieties): THERE THERE ONCE WAS A TIME WHEN ONCE WAS A TIME WHEN A A THREETHREE--MINUTEMINUTE PHONEPHONE

CALLCALL WOULD HAVE WOULD HAVE AVOIDED SETTING OFF AVOIDED SETTING OFF

THE DOWNWARD SPIRAL THE DOWNWARD SPIRAL THAT RESULTED IN A THAT RESULTED IN A COMPLETE RUPTURE.COMPLETE RUPTURE.

1

““WHY NOT WHY NOT JUST TELL JUST TELL

THE THE TRUTH?”TRUTH?”

—Raymond Carver

1081

POWER WORDS!POWER WORDS!

““I’m sorry.”I’m sorry.”

1

The … Jim Jim Jeffords Jeffords oversighoversigh

t!t!

1

bedrock bedrock behaviorsbehaviors

1

Home Run

Being there!Being there! * ** *** ****

*No more, no less**“A body can pretend to care, but they can’t

pretend to be there.” — Texas Bix Bender*** GEN Melvin Zais on COs and inspections

****Silence is golden! [Utter silence is golden-er.]

1

Period+!

Shake handsShake handsSmileSmile

Eye contactEye contactThank youThank youFFLLOOWWEERRSSOpen poseOpen pose

ROIRROIR

1

““Be kind, for Be kind, for everyone you everyone you

meet is fighting a meet is fighting a great battle.”great battle.” —Philo of —Philo of

AlexandriaAlexandria

1

Grant+Grant+RespectRespect

1151

““The The [Union senior][Union senior] officers rode past the officers rode past the Confederates smugly without any sign Confederates smugly without any sign of recognition except by one. ‘When of recognition except by one. ‘When

GeneralGeneral GrantGrant reached the line of reached the line of ragged, filthy, bloody, despairing ragged, filthy, bloody, despairing

prisoners strung out on each side of prisoners strung out on each side of the bridge, he lifted his hat and held it the bridge, he lifted his hat and held it over his head until he passed the last over his head until he passed the last man of that living funeral cortege. He man of that living funeral cortege. He was the only officer in that whole train was the only officer in that whole train

who recognized us as being on the who recognized us as being on the face of the earth.’*”face of the earth.’*”

*quote within a quote from diary of a Confederate soldier

1

““It was much later that I realized It was much later that I realized Dad’s secret. He gained respect by Dad’s secret. He gained respect by giving it. He talked and listened to giving it. He talked and listened to

the fourth-grade kids in Spring Valley the fourth-grade kids in Spring Valley who shined shoes the same way he who shined shoes the same way he talked and listened to a bishop or a talked and listened to a bishop or a

college president.college president. He was He was seriously interested in seriously interested in

who you were and what who you were and what you had to say.”you had to say.”Sara Lawrence-Lightfoot, Respect

1

““I wasn’t bowled over by I wasn’t bowled over by [David Boies][David Boies] intelligence. … What impressed me was intelligence. … What impressed me was

that when he asked a question, he waited that when he asked a question, he waited

for an answer.for an answer. He not onlHe not onlyy listened, he made me feel listened, he made me feel like I was the onllike I was the onlyy person person in the roomin the room.”.” —Lawyer Kevin _____, on his —Lawyer Kevin _____, on his

first, inadvertent meeting with David Boies, from Marshallfirst, inadvertent meeting with David Boies, from Marshall Goldsmith, “The Goldsmith, “The One SkillOne Skill That Separates,” That Separates,” Fast CompanyFast Company, 07.05, 07.05

1

““The deepest The deepest human need is human need is

the need to the need to beappreciated.beappreciated.

””William JamesWilliam James

1

““Don’t Don’t belittle!”belittle!”

—OD Consultant—OD Consultant

1

““Ph.D. in leadership. Short Ph.D. in leadership. Short course: Make a short list of course: Make a short list of all things done to you that all things done to you that

you abhorred. Don’t do them you abhorred. Don’t do them to others. Ever. Make to others. Ever. Make

another list of things done to another list of things done to you that you loved. Do them you that you loved. Do them to others. Always.”to others. Always.” — Dee Hock

1211

Marcus Marcus Buckingham: Buckingham:

The One Thing You The One Thing You Need to KnowNeed to Know

1221

“No matter what the No matter what the situation, situation, [the great manager’s][the great manager’s]

first response is always to first response is always to think about the individual think about the individual concerned and how things concerned and how things can be arranged to help can be arranged to help

that individual experience that individual experience success.”success.” —Marcus Buckingham,

The One Thing You Need to Know

1231

“The key difference between checkers and chess is that in checkers the pieces

all move the same way, whereas in

chess all the pieces move differently. … Discover what is unique Discover what is unique about each person and about each person and

capitalize capitalize on iton it.”.” —Marcus Buckingham, The One Thing You Need to

Know

1241

“The mediocre manager believes that most things are learnable and

therefore that the essence of management is to identify ach

person’s weaker areas and eradicate them. The great manager believes the opposite. He believes that the He believes that the

most influential qualities of a person most influential qualities of a person are innate and therefore that the are innate and therefore that the

essence of management is to deploy essence of management is to deploy these innate qualities as effectively these innate qualities as effectively

as possible and so drive as possible and so drive performance.”performance.” —Marcus Buckingham, The One

Thing You Need to Know

1251

Stop Stop Doing Doing

It!It!

1261

““The The oneone thinthing you g you need to know about need to know about sustained individual sustained individual

success: Discover success: Discover what you don’t like what you don’t like

doing and doing and stopstop doing it.”doing it.”

—Marcus Buckingham, The One Thing You Need to Know

1271

Start Start Doing Doing

It!It!

1281

““A year from A year from nownow

you may wish you may wish You had You had

started today.”started today.” —Karen Lamb

1291

SWEET SPOT: THE SWEET SPOT: THE DISCOMFORT DISCOMFORT

ZONE.ZONE.

1

““Do one Do one thing every thing every

day that day that scares you.”scares you.”

—Eleanor Roosevelt

““Every time we come to a Every time we come to a comfort zone, we will find a comfort zone, we will find a

way out.” “No Cloning.” way out.” “No Cloning.” “‘Reinvent the brand’ with “‘Reinvent the brand’ with each new show.” “A typical each new show.” “A typical

day at the office for me day at the office for me begins by asking, begins by asking, ‘‘What is What is impossible that I am going impossible that I am going to do todayto do today?’”?’” —Daniel Lamarre, —Daniel Lamarre,

president,president, Cirque du SoleilCirque du Soleil

1321

““I’m not comfortable I’m not comfortable unless I’m unless I’m

uncomfortable.”uncomfortable.”—Jay Chiat

1

““If if feels If if feels painful and painful and

scary—that’s scary—that’s realreal delegation”delegation”

—Caspian Woods, small biz owner

1341


BEDROCK.BEDROCK.LEADERSHIP.LEADERSHIP.

9Ps. 9Ps.

1351

PURPOSEPURPOSE..PASSIONPASSION..PotentialPotential..PresencePresence..PersonalPersonal..

PERSISTENCEPERSISTENCE..PEOPLEPEOPLE. . PotentPotent..

PositivePositive..

1361



PositivePositive..

1371

““People want to be part People want to be part of something larger than of something larger than themselvesthemselves.. They want to They want to

be part of something they’re be part of something they’re really really proudproud of, that they’ll of, that they’ll

fight fight forfor,, sacrifice sacrifice forfor , , trusttrust.”.” —Howard Schultz, Starbucks (IBD/09.05)

1381

“Management has a lot to do with answers. Leadership is a function of questions. And the

first question for a leader always

is: ‘‘WhoWho dodo wewe iintendntend toto bebe?’?’ Not ‘What are we going to do?’

but ‘Who do we intend to be?’” —Max De Pree, Herman Miller

1391

Ah, kids: “What is your vision “What is your vision for the future?” for the future?” “What have “What have you accomplished since your you accomplished since your first book?”first book?” “Close your eyes “Close your eyes and imagine me immediately and imagine me immediately doing something about what doing something about what

you’ve just said. What would it you’ve just said. What would it be?” be?” “Do you feel you have an “Do you feel you have an obligation to ‘Make the world a obligation to ‘Make the world a

better place’?”better place’?”

1401

PURPOSEPURPOSE..

PASSIONPASSION..PotentialPotential..PresencePresence..PersonalPersonal..


PositivePositive..

1411

““Nothing is so Nothing is so contagious as contagious as enthusiasm.”enthusiasm.”

—Samuel Taylor Coleridge

1421

““Whenever anything is Whenever anything is being accomplished, I being accomplished, I

have learned, it is have learned, it is being done by a being done by a

monomaniac with a monomaniac with a mission.”mission.” —Peter Drucker

1

““Great leaders move us. They Great leaders move us. They ignite our passion and inspire ignite our passion and inspire the best in us. When we try to the best in us. When we try to

explain why they are so explain why they are so effective, we speak of strategy, effective, we speak of strategy, vision or powerful ideas. vision or powerful ideas. But the But the

reality is much more primalreality is much more primal: : Great leadership works through Great leadership works through

the emotionsthe emotions.”.” —Daniel Goleman,—Daniel Goleman,

The New LeadersThe New Leaders

1441

PURPOSEPURPOSE..PASSIONPASSION..

PotentialPotential..PresencePresence..PersonalPersonal..


PositivePositive..

1451

“In the end, management doesn’t

change culture. Management

invitesinvites the workforce itself to change the culture.”

—Lou Gerstner

1461

“The role of the Director is to create a space where the actors

and actresses can become become more than they’ve ever more than they’ve ever been before, more than been before, more than

they’ve dreamed of they’ve dreamed of beingbeing.”.” —Robert Altman, Oscar acceptance speech

1471

Organizing Genius / Warren Bennis and Patricia Ward Biederman

“Groups become great only when everyone in them, leaders and

members alike, is free to do his or is free to do his or her absolute besther absolute best.”.”

“The best thing a leader can do for a

Great Group is to allow its allow its members to discover their members to discover their

ggreatnessreatness.”.”

1481

Leadership’s Mt Everest/Mt ExcellenceLeadership’s Mt Everest/Mt Excellence

“freefree to do his or her to do his or her absoluteabsolute best” … best” …

“allow its members to “allow its members to discover their discover their greatnessgreatness.”.”

1491

PURPOSEPURPOSE..PASSIONPASSION..PotentialPotential..

PresencePresence..PersonalPersonal..


PositivePositive..

1501

2255

1511

MBWAMBWA**5,000 miles for a 5-minute face-to

-face meeting (courtesy super-agent Mark McCormick)

1521

PURPOSEPURPOSE..PASSIONPASSION..PotentialPotential..PresencePresence..

PersonalPersonal..PERSISTENCEPERSISTENCE..

PEOPLEPEOPLE. . PotentPotent..

PositivePositive..

1531

“The The FirstFirst stepstep in a in a ‘dramatic’ ‘dramatic’

‘organizational change ‘organizational change program’ is obvious—program’ is obvious—

dramaticdramatic personal personal changechange!”!” —RG

1541

““You must You must bebe the change you the change you

wish to see in the wish to see in the world.”world.”

Gandhi

1551

““It’s It’s alwaalwayyss showtime.”showtime.”

—David D’Alessandro, Career Warfare

1561



PositivePositive..

1571

RelentlessRelentless:: “One of “One of

my superstitions had always been my superstitions had always been when I started to go anywhere or when I started to go anywhere or

to do anything,to do anything, notnot to to turnturn backback ,, or stop, or stop,

until the thing intended was until the thing intended was accomplished.”accomplished.” —Grant

1581

“This [adolescent] incident [of getting from point A to point B] is notable not only because it underlines Grant’s fearless horsemanship and his

determination, but also it is the first known example of a very important

peculiarity of his character: Grant had an Grant had an extreme, almost extreme, almost pphobic hobic dislike of turnindislike of turningg back back

and retracinand retracingg his ste his steppss.. If he

set out for somewhere, he would get there somehow, whatever the difficulties that lay in his way. This idiosyncrasy would turn out to be one the factors that made him such a formidable general. Grant would always,

always press on—turning back was not an option for him.”

—Michael Korda, Ulysses Grant

1591

““People want to be part People want to be part of something larger than of something larger than themselvesthemselves.. They want to They want to

be part of something they’re be part of something they’re really really proudproud of, that they’ll of, that they’ll

fight fight forfor,, sacrifice sacrifice forfor , , trusttrust.”.” —Howard Schultz, Starbucks (IBD/09.05)

1601

““It is no use It is no use saying ‘We are saying ‘We are doing our best.’doing our best.’ You have got to You have got to succeed in doing succeed in doing

what is what is necessary.”necessary.” —WSC

1611

"The reasonable man adapts The reasonable man adapts himself to the world. The himself to the world. The

unreasonable one persists in unreasonable one persists in trying to adapt the world to trying to adapt the world to

himself. Therefore, all himself. Therefore, all progress depends upon the progress depends upon the unreasonable man.”unreasonable man.” —GB Shaw,

Man and Superman: The Revolutionists' Handbook.

1

““Success seems to Success seems to be largely a be largely a

mattermatter

of of hanginghanging onon after others after others have let go.”have let go.” —William —William

Feather, authorFeather, author

1631

““The most The most successful successful

people are those people are those who who

are good at plan are good at plan B.”B.”

—James Yorke, mathematician, on chaos theory, in The New Scientist

1641


PERSISTENCEPERSISTENCE..

PEOPLEPEOPLE. . PotentPotent..

PositivePositive..

1651

““Leaders Leaders

‘‘dodo’’ people. people.

Period.”Period.” —Anon.

1661

PARC’s Bob Taylor:

“Connoisseu“Connoisseur r

of Talent”of Talent”

1671

A review of Jack and Suzy Welch’s Winning claims there are but two key differentiators that set GE “culture” apart from the herd:

First: Separating financial forecasting and performance measurement. Performance measurement based, as it usually is, on budgeting leads to an epidemic of gaming the system. GE’s performance measurement is divorced from budgeting—and instead reflects how you do relative to your past performance and relative to competitors’ performance; i.e., it’s about how you actually do in the context of what happened in the real world, not as compared to a gamed-abstract plan developed last year.

Second: Putting Putting HRHR on a par with on a par with finance and finance and marketing.marketing.

1

< CAPEX< CAPEX> People!> People!

1691


PERSISTENCEPERSISTENCE..PEOPLEPEOPLE. .

PotentPotent..PositivePositive..

1701

“Beware of the tyranny of making

Small Changes to Small

Things. Rather,

make BigBig Changes

to BigBig Things.”

—Roger Enrico, former Chairman, PepsiCo

1711

Kevin Roberts’ Credo

11. Ready. Fire! Aim.. Ready. Fire! Aim.2. If it ain’t broke ... Break it!2. If it ain’t broke ... Break it!3. Hire crazies.3. Hire crazies.4. Ask dumb questions.4. Ask dumb questions.5. Pursue failure.5. Pursue failure.6. Lead, follow ... or get out of the way!6. Lead, follow ... or get out of the way!7. Spread confusion.7. Spread confusion.8. Ditch your office.8. Ditch your office.9. Read odd stuff.9. Read odd stuff.

10. Avoid moderationAvoid moderation!!

1721

““ARE YOU BEING ARE YOU BEING REASONABLE? Most REASONABLE? Most

people are reasonable; people are reasonable; that’s why they only do that’s why they only do

reasonably well.”reasonably well.”

Source: Paul Arden, Whatever You Think Think the Opposite

1731



PositivePositive..

1741

On NELSON: “[other] “[other] admirals more admirals more frightened of frightened of losing than losing than

anxious to win”anxious to win”

1751

The greatest dangerThe greatest dangerfor most of usfor most of us

is not that our aim isis not that our aim istoo hightoo high

and we miss it,and we miss it,but that it isbut that it is

too lowtoo lowand we reach it.and we reach it.

Michelangelo

1761



PositivePositive..

1

““Excellence can be obtained if you:Excellence can be obtained if you: ... care more than others think is wise; ... care more than others think is wise; ... risk more than others think is safe; ... risk more than others think is safe; ... dream more than others think ... dream more than others think is practical;is practical; ... expect more than others think ... expect more than others think is possible.”is possible.”

Source: Anon. (Posted @ tompeters.com by K.Sriram, November 27, 2006 1:17 AM)

1781

"Life is not a journey to the grave with the intention of arriving safely in one pretty

and well preserved piece, but to skid across the line

broadside, thoroughly used up, worn out, leaking oil,

shouting ‘GERONIMO!’GERONIMO!’ ” —Bill McKenna, professional motorcycle racer

(Cycle magazine 02.1982)

1791

EXEXCELLE CELLE ALWALWAYSAYS..

11 tom peters’ x25* toward health(care) excellence! inova leadership institute/13 march 2007 *in...

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