( Again, the doctors are among the biggest sinners n

1
HealthcareThe RantTom Peters/10.30.2004
2
There are many problems with Healthcare. I am
not aiming to provide a comprehensive diagnosis
or a comprehensive Rx. I am instead
cherrypicking two, and only two, Core Issues (1)
The wretched (Damning!) quality problem (2) and
the almost 100 emphasis on after-the-fact-fixes,
rather than Wellness-Prevention-Healing-Care.Wit
h respect, Tom Peters
3

• 
  Healthcares 1-2 Punch
• 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 yearand wound many times that number.
  Finally, they are getting around to dealing
  with the issue. Well, thanks. And what is it
  weve been buying for our Trillion or so bucks a
  year? The fix is eminently do-able which makes
  the condition even more intolerable. (Disgrace
  is far too kind a label for the condition.
  Whos to blame? Just about everybody, starting
  with the docs who consider oversight from anyone
  other than fellow clan members to be
  unacceptable.)
• 2. The systemtraining, docs, insurance
  incentives, culture, patients themselvesis
  hopelessly-mindlessly-insanely (as I see it)
  skewed toward fixing things (e.g. Me) that are
  brokennot 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 61-year old,
  decades of physical and psychological self-abuse
  can literally be reversed in relatively short
  order by an encompassing approach to life that
  can only be described as a Passion for Wellness
  (and Well-being). Patientslike meare catching
  on in record numbers but the system is highly
  resistant. (Again, the doctors are among the
  biggest sinnersno surprise, following years of
  acculturation as the man-with-the-white-coat-who-
  will-now-miraculously-dispense-fix
  it-pills-for-you-the-unwashed. (Come to think of
  it, maybe Ill start wearing a White Coat to my
  doctors officeafter all, I am the
  Professional-in-Charge when it comes to my Body
  Soul. Right?)

4
Toms RantPatient Safety(Curb the Killing
Fields!)Planetree Alliance/Griffin
Hospital(Put the Care back in
Healthcare!)Canyon Ranch(Re-imagine
Wellness-Prevention!)
5
Welcome to the Homer Simpson Hospitala/k/a
The Killing Fields
6
XYZ Corp Complete Vision ValuesAny Service
or Product of ours is yours for absolutely NO
CHARGE if any employee saysor impliesto you
at any point Its Not My Fault.V. Big
Cheese, Founder, CEO Dictator
7
Toms Cold Fury at Healthcare
Professionals, Especially Acute Care
Operatives1. You are killers Quality remains
a bad joke.2. Pick off bunches of Low-hanging
Fruit. (E.g., Toms 1st Executive order as Your
Next President Providing a Handwritten
Prescription is punishable by not less than 60
days of Hard Time.)3. The science in
medicine is often fanciful Most scientific
treatments are unverified. (So quit the
kneejerk denigration of alternative
therapiestrust me, Breathing Meditation
beats Univasc Good Nutrition beats Lipitor
Regular Exercise beats bypass surgery.) 4. You
continue to obsess only on after-the-act fixes,
the automatic resort to Chemicals and Knives,
rather than P-W-H-C Prevention-Wellness-
Healing-Care.5. Your Mindful Lifelong (mine)
Failure to focus on P-W-H-C will probably cost me
a decade of longevity, Canyon Ranch/Lenox not
withstanding. THAT PISSES ME OFF. (For one
thing, I need those 10 years to spread the
P-W-H-C Credo to healthcare
professionals.)6. You are hereby ordered to
stop using the term healthcare You havent
earned the right to utter the word care!7.
Are Not the Issue/Excuse I Quality is
free!!! (There are MANY who are Getting This
Right without Buckets of .)8. Are
Not the Issue/Excuse II Planetree
Alliance/Griffin Hospital Models The Way
on P-W-H-C Every Day. IT CAN BE DONE!9. ALL
THESE PROBLEMS CAN BE FIXED! WE KNOW HOW! THERE
ARE NO EXCUSES EXCEPT LACK OF GUTS WILL!
Its Attitude, Baby!10. All members of
staffregardless of professional
disciplineare Healing Arts Practitioners.
OR TURN IN YOUR EMPLOYEE BADGE.
NOW.10.27.2004/La Jolla
8
Rule 1. Attend the Duh Factor! Model The Way!
DO NOT SERVE BOUNTIFUL BASKETFULS OF
FATTY-SUGARY CRAP BUCKETSFUL OF HIGH-OCTANE
COFFEE AT BREAKS DURING HEALTHCARE MEETINGS.
Think Fruit! Think Tea! Think Duh!
9
TP to Healthcare CIOs You are not CIOs. You
are Executive Members of an Integrated
Healing Services Team (Healing Arts Team?)
with a specialization in IS/IT.
10
Dear Mr. Mrs. Smith,XYZ hospital regrets to
inform you .

.Sincerely,A. S.
Jackson, AdministratorT. D. Jones, M.D.L.S.
Donald, CFOW.N. Arnold, CIO
11
You want implementation tips.I want
Ownership, Accountability Attitude!
12
Excerpt from Tom Peters Presentation to
Healthcare CIOs Quality COULD IT TRULY BE
THIS AWFUL?
13
Quality of care is the problem, not managed
care.Institute of Medicine
14
CDC 1998 90,000 killed and 2,000,000 injured
from nosocomial hospital-caused drug errors
infections
15
HealthGrades/Denver 195,000 hospital 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
16
This should give you pause when you go to the
hospital. There is little evidence that
patient safety has improved in the last five
years.
17
2m38s
18
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
19
Various studies 1 in 3, 1 in 5, 1 in 7, 1 in 20
patients harmed by treatment Demanding
Medical Excellence Doctors and Accountability
in the Information Age, Michael Millenson
20
RAND (1998) 50, appropriate preventive care.
60, recommended treatment, per medical studies,
for chronic conditions. 20, chronic care
treatment that is wrong. 30 acute care treatment
that is wrong.
21
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
22
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
23
In a disturbing 1991 study, 110 nurses of
varying experience levels took a written test of
their ability to calculate medication doses.
Eight out of 10 made calculation mistakes at
least 10 of the time, while four out of 10 made
mistakes 30 of the time.Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
24
YE GADS! New England Journal of Medicine/
Harvard Medical Practice Study 4 error rate (1
of 4 negligence). Subsequent investigations
around the country have confirmed the ubiquity of
error. In one small study of how clinicians
perform when patients have a sudden cardiac
arrest, 27 of 30 clinicians made an error in
using the defibrillator. Mistakes in
administering drugs (1995 study) average once
every hospital admission. Lucian Leape,
medicines leading expert on error, points out
that many other industrieswhether the task is
manufacturing semiconductors or serving customers
at the Ritz Carltonsimply wouldnt countenance
error rates like those in hospitals.Complication
s, Atul Gawande
25
In health care, geography is destiny.Source
Dartmouth Medical School 1996 report
26
Geography Is DestinyOften all one must do to
acquire a disease is to enter a country where a
disease is recognizedleaving the country will
either cure the malady or turn it into something
else. Blood pressure considered treatably high
in the United States might be considered normal
in England and the low blood pressure treated
with 85 drugs as well as hydrotherapy and spa
treatments in Germany would entitle its sufferer
to lower life insurance rates in the United
States. Lynn Payer, Medicine Culture
27
Geography Is DestinyE.g. Ft. Myers 4X
Manhattanback surgery. Newark 2X New
Havenprostatectomy. Rapid City SD 34X Elyria
OHbreast-conserving surgery. VT, ME, IA 3X
differences in hysterectomy by age 70 8X
tonsillectomy 4X prostatectomy (10X Baton Rouge
vs. Binghampton). Breast cancer screening 4X NE,
FL, MI vs. SE, SW. (Source various)
28
PARADOX Many, many formal case reviews failure
to systematically/ systemically/ statistically
look at and act on evidence.C.f.,
Complications, Atul Gawande
29
Deep Blue Redux 2,240 EKGs 1,120 heart
attacks. Hans Ohlin (50 yr old chief of coronary
care, Univ of Lund/SW) 620. Lars Edenbrandts
software 738.Only this time it matters!
30
Most physicians believe that diagnosis cant be
reduced to a set of generalizationsto a
cookbook. How often does my intuition lead
me astray? The radical implication of the Swedish
study is that the individualized, intuitive
approach that lies at the center of modern
medicine is flawedit causes more mistakes than
it prevents. Atul Gawande, Complications
31
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
32
Genius Required?
33
Leapfrog Group
CPOE/Computerized Physician Order
EntryICU staffing by trained
intensivistsEHR/Evidence-based Hospital
ReferralDuh I Welcome to the computer
age.Duh II How about using experts?Duh
III If you do stuff a lotta times, you tend to
get/be better.
Source HealthLeaders
34
The Benefits of FOCUSED EXCELLENCE
Shouldice/Hernia Repair 30-45 min, 1
recurrence. Avg 90 min, 10-15
recurrence.Source Complications, Atul Gawande
35
Doing It Right!Planetree A Radical Model for
New Healthcare/Healing/Wellness Excellence
36
It was the goal of the Planetree Unit to help
patients not only get well faster but also to
stay well longer. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
37
Determinants of HealthAccess to care
10Genetics 20Environment 20Health
Behaviors 50Source Institute for the Future
38
The 9 Planetree
Practices1. The Importance of Human
Interaction2. Informing and Empowering Diverse
Populations Consumer Health Libraries and
Patient Information3. Healing Partnerships The
Importance of Including Friends and Family4.
Nutrition The Nurturing Aspect of Food5.
Spirituality Inner Resources for Healing6.
Human Touch The Essentials of Communicating
Caring Through Massage7. Healing Arts Nutrition
for the Soul8. Integrating Complementary and
Alternative Practices into Conventional
Care9. Healing Environments Architecture and
Design Conducive to HealthSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
39
1. The Importance of Human Interaction
40
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 free. Listening to patients
or answering their questions costs nothing. It
can be argued that negative interactionsalienatin
g patients, being non-responsive to their needs
or limiting their sense of controlcan be very
costly. Angry, frustrated or frightened
patients may be combative, withdrawn and less
cooperativerequiring 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
41
Press Ganey Assoc/1999 139,380 former patients
from 225 hospitals0 of top 15 factors
determining Patient Satisfaction referred to
patients health outcomePS directly related to
Staff InteractionPS directly correlated with ES
(Employee Satisfaction)Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
42
Mgrs re staff wages, security, promotion
opportunitiesStaff re staff interesting work
(M5 of 10), appreciation (5 of 10), sense of
being in about whats going on (10 of 10)
Source Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
43
Planetree is about human beings caring for other
human beings. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel (Ladies
and gentlemen serving ladies and gentlemen4S
credo)
44
2. Informing and Empowering Diverse Populations
Consumer Health Libraries and Patient
Information
45
Planetree Health Resources Center/1981Planetree
Classification SystemConsumer Health
LibrariansVolunteersClasses, lectures
(CR)Health FairsGriffins Mobile Health
Resource CenterOpen Chart PolicyPatient
Progress NotesCare Coordination Conferences
(Est. goals, timetable, etc.)Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
46
3. Healing Partnerships The Importance of
Including Friends and Family
47
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
48
The Patient-Family ExperiencePatients are
stripped of control, their clothes are taken
away, they have little say over their schedule,
and they are deliberately separated from their
family and friends. Healthcare professionals
control all of the information about their
patients bodies and access to the people who can
answer questions and connect them with helpful
resources. Families are treated more as intruders
than loved ones. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
49
Family members, close friends and significant
others can have a far greater impact on
patients experience of illness, and on their
long-term health and happiness, than any
healthcare professional. Through the Patients
EyesSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
50
A 7-year follow-up of women diagnosed with
breast cancer showed that those who confided in
at least one person in the 3 months after surgery
had a 7-year survival rate of 72.4, as compared
to 56.3 for those who didnt have a
confidant.Institute for the Future
51
Care Partner Programs (IDs, discount meals,
etc)Unrestricted 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
ConferencesClinical Guidelines
DiscussionsFamily SpacesPet Visits (POP
Patients Own Pets)Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
52
4. Nutrition The Nurturing Aspect of Food
53
Meals are central eventsvsThere, youre
fed.Irony Focus on nutrition has
reduced focus on food and serviceSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
54
Aroma therapy (e.g., smell of baking
cookies)Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
55
5. Spirituality Inner Resources for Healing
56
Spirituality Meaning and Connectedness in
Life1. Connected to supportive and caring
group2. Sense of mastery and control3. Make
meaning out of disease/find meaning in
sufferingSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
57
Griffin redesign chapel (waterfall, quiet music,
open prayer book)Other music, flowers,
portable labyrinthSource Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
58
6. Human Touch The Essentials of Communicating
Caring Through Massage
59
Massage is a powerful way to communicate
caring. Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
60
7. Healing Arts Nutrition for the Soul
61
Planetree Environment conducive to
healingColor!Light!Brilliance!Form!Art!Mu
sic!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
62
Griffin Music in the parking lot professional
musicians in the lobby (7/week, 3-4hrs/day) 5
pianos volunteers (120-140 hrs arts
entertainment per month). Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
63
8. Integrating Complementary and Alternative
Practices into Conventional Care
64
Griffin IMC/Integrative Medicine
CenterMassageAcupunctureMeditationChiropracti
cNutritional supplementsAroma therapySource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
65
9. Healing Environments Architecture and Design
Conducive to Health
66
Planetree LookWoods and natural
materialsIndirect lightingHomelike
settingsGoals Welcome patients, friends and
family Value humans over technology .. Enable
patients to participate in their care Provide
flexibility to personalize the care of each
patient Encourage caregivers to be responsive
to patients Foster a connection to nature and
beautySource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
67
Access to nurses stationHappen
tovs.Happen withSource Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
68
Conclusion Caring/Growth Experience
69
Care!Control!Connect! Engage!Grow!
De-stress!
70
An estimated 60 to 90 percent of doctor visits
involve stress-related complaints.
Newsweek/09.27.2004
71
CR07.03 60/264/180/145-85/14010.04
61/195/092/097-60/058
72
Univasc (lt1/2)BextraLipitorToprolPropranolol