Archives: July 2008

Proposed Hospital "Organization Chart"

What follows is obviously hopelessly bureaucratic—hence, tongue mostly in cheek. The idea is to demonstrate the mostly missing elements at senior levels in the typical hospital, as suggested by yesterday's Post, "The Healthcare14: U.S. Healthcare Trauma in 2008." However, the post of "Deputy CEO/Patient Safety & Quality" is not bureaucratic—it is a non-negotiable "must-do-now" in "my" hospital, regardless of size.

   Director "Hands Clean" Mandate
   Director Error-free Medications Program
   Director Simple-Tools-That-Save-Lives Programs
   Director Over-treatment Evaluation & Management
   Director Evidence-based Medicine Initiatives
   Director Best-practices Program
   Director Error Reporting & Evaluation Initiative
   Director Electronic Medical Records
   Director Cross-functional IS Engagement &
      Implementation Teams
   Director Wellness & Prevention Programs
   Director Follow-up Patient Behaviors Program
   Director Public Health Initiatives
   Director Wellness Programs
   Director Kids' Education Programs
   Director Patient Experience Programs
   Director Planetree Practices Programs
   Director Patient "Home Port" & Self- & Family-
      Management Programs
   Director Teams-based Organization

   Director Patient-Treatment Teams Implementation
   Director Cross-functional Communications Initiatives

[See Tom's Healthcare Master (PPT) posted 9 April 2008.—CM]

The Healthcare14: U.S. Healthcare Trauma in 2008

I have screamed and shouted about customer service—to the point of physical and mental exhaustion and near collapse. I have screamed and shouted about our failure to embrace design as a rock-solid basis for differentiation. I have hissed and booed from on high and on low at the mis-direction of our education system in an age where creativity counts most. I have screamed and shouted and harangued and begged and cajoled and sworn like the sailor I once was on the topic of truly putting people first. I have screamed and shouted and been vicious and rude on the topic of women in leadership roles. I have insulted, with maximum verbal violence, every marketer I can find on the topic of inattention to the market power of women and boomers-geezers. I have pilloried every CEO I can lay voice on over the utter stupidity of 9 out of 9.1 major mergers. And I have begged and begged and begged some more on the topic of ... Stop talking, get on with it, whatever your "it" may be.

And now I'm engaged in another hysterical, and perhaps quixotic, campaign. This time the topic and target is American health"care." No doubt of it, I am the beneficiary of incredible care and have been aided by extraordinary medical devices and the skilled hands of exceptionally well-trained surgeons. (Just as I have gotten great service at the gazillion-dollars-a-night Four Seasons hotels in which I sometimes park my weary carcass.) Nonetheless, the American healthcare story is by and large a nightmare—and I don't just mean the un-insured. Below, after a dozen-years study, the last two of which have been rather intense, you will find my summary, shorthand List of American Healthcare Sins. Moreover, and most important, you will see that, in my opinion, most of these problems could be reversed without resort to either Mr McCain's or Mr Obama's Big Policy Initiatives. Using a simple, paper airline pilot-like checklist in ICUs can reduce infections and stays dramatically. Supplying simple compression socks to in-patients could avoid thousands upon thousands of deaths via deep-vein thrombosis. Clean hands—don't get me started. Scanners to certify accurate drug administration to in-patients—don't get me started.

As with customer-care and people practices, we have the wherewithal within to make Giant Performance Leaps. So when will we do so with the Total Determination the issue demands?

Tom Peters/The U.S. Healthcare14

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 inappropriate 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—e.g., 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.")

NB1: Many of these problems are equally applicable to other nations. But as is true with education issues, various nations use various approaches, so de facto generalization is dangerous.

NB2: This rant was triggered by a testy conversation with a client who inferred (in no uncertain terms) that I was being too hard on the healthcare folks. And to think, I thought I was letting them off too easily!

[Michael Millenson, author of Demanding Medical Excellence: Doctors and Accountability in the Information Age, which Tom has been quoting since its Y2000 publication, sent him this link to Millenson's 8-Day Health Care Diary (it mentions Tom, by the way).—CM]

Happy Birthday to Us

We started the blog before Tom joined in, so there are entries prior to four years ago today, but today is the day we consider our birthday. The official start of Tom's blogging is 28 July 2004, and today marks four years of blog posts! We'd like to thank all our readers for staying with us and contributing to the success of this blog.



Stop Telling Stories

What does it feel like to be engaged in genuine dialogue?

I have asked this question in many workshops and speeches lately. Audience members have given very rich answers. "It's like a flow." "It's learning from each other." "What I say depends on what the other person says."

In his 1930 essay, "Dialogue," Martin Buber distinguished between genuine dialogue and "monologue disguised as dialogue," which he as "characterized ... solely by the desire to have one's own self-reliance confirmed by marking the impression that is made."


Everything Matters …

I have grown a little frustrated with business's current love affair with cost cutting. Increasingly, little thought is being given to the impact on the brand. Just this week, I observed four examples that come to mind.

First, a restaurant I frequent that earned a deserved reputation for its wine list was out of several popular reds. The manager's directive to the employees? "It doesn't matter, they [customers] will just order something else." My note: It does matter, and maybe they will order their wine somewhere else.

Second, my health club started using a cheaper detergent and the towels are scratchy. And they lowered the temperature of the pool by five degrees. Since the people who made those decision don't actually work out at the facility, or overhear the talk in the locker room, I can understand their belief that "it doesn't matter."

Third, standing at the counter of a premium-priced golf course, I overheard a customer complaining to the pro that the round was excessively slow and the rangers (whose job it is to police the pace of play on the course) didn't seem to feel they could do anything about it. The customer said he wouldn't be back. The pro just said, "Oh well, nothing we can do about that," as if losing one customer doesn't matter. But, it doesn't matter only if there is an endless supply of golfers waiting to get on this course. There aren't. By the way, don't expect to see that golfer's buddies at your course, either.

Lastly, perhaps a small thing, but it is a case of the disappearing amenities at hotels. Sure, I can carry my own Q-tips, and if I want more than one cup of coffee, I can call room service. But I notice they haven't lowered the price of the room. And pardon my cynicism, but I have to believe that the option they offer of not changing the linens every day is based more on a desire to cut costs rather than saving the earth.

In my mind, a brand is built on a historic value proposition that builds a certain loyalty. If you start messing with the perceived benefits, those adjustments can't do anything but hurt the long-term interest of the business. I understand the need to be frugal, but I wish decision-makers had a better sense of what matters in the customers' eyes.

Am I just feeling a little grouchy today? Or have you noticed this as well? At what point is the brand compromised?

Event: McKesson

Tom is speaking for McKesson Provider Technologies at the 2008 Executive Leadership Summit in Colorado Springs at The Broadmoor. According to the McKesson website, they are "a healthcare IT company, dedicated to delivering comprehensive solutions with the power to make a difference in how you provide healthcare." If you went to the event, we'd like to hear from you. If you'd like to download the slides, the links are here:
McKesson Provider Technologies, 2008 Executive Leadership Summit, Final Version
McKesson Provider Technologies, 2008 Executive Leadership Summit, Long Version

Believe It or Not: An Original Take on Leadership

LeadershipHardWay.jpgDov Frohman is a pioneer in the semiconductor industry. Among (many) other things, he started Intel Israel and was largely responsible for the growth of Israel's potent high-tech sector. With Robert Howard, he has written a truly original book on leadership, Leadership the Hard Way: Why Leadership Can't Be Taught—and How You Can Learn It Anyway.

A few of the provocative chapter titles are: "Insisting on Survival," "Leadership Under Fire" (literally, Israel remember), "Leveraging Random Opportunities." In a chapter titled "The Soft Skills of Hard Leadership," Frohman astonishes as he insists that the leader-manager must free up no less than 50% of his-her time from routine tasks. To wit:

"Most managers spend a great deal of time thinking about what they plan to do, but relatively little time thinking about what they plan not to do ... As a result, they become so caught up ... in fighting the fires of the moment that they cannot really attend to the longterm threats and risks facing the organization. So the first soft skill of leadership the hard way is to cultivate the perspective of Marcus Aurelius: avoid busyness, free up your time, stay focused on what really matters. Let me put it bluntly: every leader should routinely keep a substantial portion of his or her time—I would say as much as 50 percent—unscheduled. ... Only when you have substantial 'slop' in your schedule—unscheduled time—will you have the space to reflect on what you are doing, learn from experience, and recover from your inevitable mistakes. Leaders without such free time end up tackling issues only when there is an immediate or visible problem. Managers' typical response to my argument about free time is, 'That's all well and good, but there are things I have to do.' Yet we waste so much time in unproductive activity—it takes an enormous effort on the part of the leader to keep free time for the truly important things."

Yet another surprising idea from the same chapter is "daydreaming":

"The Discipline Of Daydreaming": "Nearly every major decision of my business career was, to some degree, the result of daydreaming. ... To be sure, in every case I had to collect a lot of data, do detailed analysis, and make a data-based argument to convince superiors, colleagues and business partners. But that all came later. In the beginning, there was the daydream. By daydreaming, I mean loose, unstructured thinking with no particular goal in mind. ... In fact, I think daydreaming is a distinctive mode of cognition especially well suited to the complex, 'fuzzy' problems that characterize a more turbulent business environment. ... Daydreaming is an effective way of coping with complexity. When a problem has a high degree of complexity, the level of detail can be overwhelming. The more one focuses on the details, the more one risks being lost in them. ... Every child knows how to daydream. But many, perhaps most, lose the capacity as they grow up. ..."

And so on. I admit to having some quarrels with Frohman, yet every idea in the book performed that most valuable of services: challenged my long-held and thence hard-and-fast views.

Two Thumbs Up.

Our "Flirtatious Old Man" in Paris

You well know my bias, especially of late, that it's the nuts and bolts of relationship development and maintenance that make all the difference in outcomes of issues of tactical and strategic importance. Nothing has been of greater importance in American history than acquiring an ally in the Revolutionary War. That essential ally was France, and one can say in this rare instance that the efforts of Ben Franklin in Paris are almost single-handedly responsible for bringing the French on board. In its Independence Day issue, U.S. News & World Report reviewed Franklin's masterful performance, and a performance it was. The following is extracted from the article "In Paris, Taking the Salons by Storm: How the Canny Ben Franklin Talked the French into Forming a Crucial Alliance":

"In the same bitter winter of 1776 that Gen. George Washington led his beleaguered troops across the Delaware River to safety, Benjamin Franklin sailed across the Atlantic to Paris to engage in an equally crucial campaign, this one diplomatic. A lot depended on the bespectacled and decidedly unfashionable 70-year-old as he entered the world's fashion capitol sporting a simple brown suit and a fur cap. ... Franklin's miracle was that armed only with his canny personal charm and reputation as a scientist and philosopher, he was able to cajole a wary French government into lending the fledgling American nation an enormous fortune. ... The enduring image of Franklin in Paris tends to be that of a flirtatious old man, too busy visiting the city's fashionable salons to pursue affairs of state as rigorously as John Adams. When Adams joined Franklin in Paris in 1779, he was scandalized by the late hours and French lifestyle his colleague had adopted, says [Stacy Schiff, in A Great Improvisation]. Adams was clueless that it was through the dropped hints and seemingly offhand remarks at these salons that so much of French diplomacy was conducted. ... Like the Beatles arriving in America, Franklin aroused fervor—his face appeared on prints, teacups and even chamber pots. The extraordinary popularity served Franklin's diplomatic purposes splendidly. Not even King Louis XVI could ignore the enthusiasm that had won over both the nobility and the bourgeoisie. ..."

I guess this makes it less surprising that in the current issue of Time, in the cover story on Nelson Mandela's leadership "secrets," one was the great man's smile!

Grand Strategy may be of significant importance to an earthshaking success, but the likes of skill in the salon and a great smile often as not are the key ingredients of that "last 98%," persuasion and implementation.

Dear God, I'm Tired

I performed a brutal brush cutting-landscaping chore this morning in 90-degree heat. I truly pushed my ancient body to the limit and beyond.

But I got it done.
Or did I?

As I packed up my tools, I took a final look at what I'd done. Fine and dandy, but it was still a tiny-tiny-bit ragged here and there. Problem was, in the literal sense I didn't have an ounce of energy left. "F%^# it, I'll get it later" I said to myself and turned on the engine of my 4-wheel-drive Kubota.

I sat there a minute, dripping with sweat, and then I turned off the engine. With every muscle screaming in agony (I do not exaggerate—or so it feels), I got out of the Kubota, gathered a couple of tools, and spent the next 20 minutes doing that final touch on the job—and then just a little more, and a little more.

While the vignette is unmistakably self-serving, it is also one of those "reminders of the obvious" worth reminding you of. Namely, one cannot overestimate, in, say, our project work "the last two-percenter." That person who, at 2 a.m. takes one final look at the presentation to the Board tomorrow, and discovers that two key numbers are transposed on the footnote on Slide 47—and then looks "one last time" when she returns at 5:45 a.m. The carpenter who, finished, adds one final touch that alters the character of the cabinet he's spent two weeks building, and then hauls the piece back to his shop for a significant (to him) revision. Etc.

Sometimes we call the last two-percenter a "pain in the ass." True, but no one is of greater importance to the success of what we do. Funny thing, I felt less tired and achy after my "last two percent" drill than when I started it.

100 Ways to Succeed #131:

Cherish the "Pain in the Ass."

Reward the "last two-percenter/s" as if she/they were the Ultimate Gift from The Gods! They are!