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]