tom peters’ re-ima g ine ! toward health ( care ) excellence !

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Tom Peters’

Re-Imagine2006!Business Excellence in a Disruptive Age

Aetna National Accounts 2006 Consultants Forum/Laguna Niguel/01March2006

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Tom Peters’

Re-imagine!Toward

Health(care) Excellence!

JanuaryFebruary

DukeApril

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Tom Peters’

Re-imagine!Toward

Health(care) Excellence!

Aetna National Accounts 2006 Consultants Forum/Laguna Niguel/01Duke2006/Part #1

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Re-imagine! Not Your Father’s World I.

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THREE BILLION NEW CAPITALISTS

—Clyde Prestowitz

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26m

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43h

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THE CUSTOMER IS GOD AND THE MARKET DECIDES

EVERYTHING

Source: Banner, Hua Xin Dress Co, Ltd., Rongcheng Industry Zone

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Re-imagine!

Not Your Father’s World II.

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“There is no job that

is America’s God-given

right anymore.”

—Carly Fiorina/HP/January2004

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“Income Confers No Immunity as Jobs Migrate”

—Headline/USA Today/02.2004

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No Limits?

“Short on Priests, U.S. Catholics

Outsource Prayer to Indian Clergy” —Headline,

New York Times/06.13.04 (“Special intentions,” $.90 for Indians, $5.00 for Americans)

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“In a global economy, the government

cannot give anybody a guaranteed success

story, but you can give people the tools to make the most of

their own lives.” —WJC, from

Philip Bobbitt, The Shield of Achilles: War, Peace, and the Course of History

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The General’s

Story. (And Harry’s) (And Darwin’s)

(And James Yorke’s) (And the Admiral’s.)

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“If you don’t like change,

you’re going to like irrelevance even less.” —General Eric

Shinseki, Chief of Staff. U. S. Army

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“It is not the strongest of the

species that survives, nor the most intelligent, but the one most

responsive to change.” —Charles Darwin

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Nelson’s secret:

“[Other] admirals more frightened of losing than

anxious to win”

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My Story. (And

Charles’.)

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Point of View!/Point of Dramatic Difference!

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1. Re-imagine Permanence:

The Naked Emperor Problem!

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“Forbes100” from 1917 to 1987: 39 members of the Class of ’17 were

alive in ’87; 18 in ’87 F100; 18 F100 “survivors” underperformed the

market by 20%; just 2 (2%), GE &

Kodak, outperformed the market 1917 to 1987.

S&P 500 from 1957 to 1997: 74 members of the Class of ’57 were alive in ’97; 12 (2.4%) of 500 outperformed the market from

1957 to 1997.

Source: Dick Foster & Sarah Kaplan, Creative Destruction: Why Companies That Are Built to Last Underperform the Market

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“I am often asked by would-be entrepreneurs seeking escape from life within huge corporate structures, ‘How do I build a small firm for myself?’ The

answer seems obvious: Buy a very large one and just wait.”

—Paul Ormerod, Why Most Things Fail: Evolution, Extinction and Economics

De-cent-ral-iz-a-tion!

Ex-e-cu-

tion!

Ac-count-a-bil-ity!

6:15A.M.

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2. Re-imagine:

Innovate or Die!

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No Option!

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Innovateor

Die!!

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Brilliant!

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“A focus on cost-cutting and efficiency has helped many organizations weather the

downturn, but this approach will ultimately

render them obsolete. Only the constant pursuit of

innovation can ensure long-term

success.” —Daniel Muzyka, Dean, Sauder School of Business,

Univ of British Columbia (FT/2004)

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“Under his former boss, Jack Welch, the skills GE prized above all others were cost-cutting, efficiency and deal-making. What mattered was the continual improvement of operations, and that mindset helped the $152 billion industrial and finance behemoth become a marvel of

earnings consistency. Immelt hasn’t turned his back on

the old ways. But in his GE, the new imperatives are

risk-taking, sophisticated

marketing and, above all, innovation.” —BW/2005

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Different!*

*“Dramatic Difference” (DH), “Remarkable Point of view” (SG)

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Franchise Lost!

TP: “How many of you [600] really

crave a new Chevy?”

NYC/IIR/061205

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This is not a “mature category.”

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This is an “undistinguished category.”

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My (Les’s) Dinner with Henri

JUSTWHATIZZITUMAKE?

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???????????

Millionaires/Deci-millionaires talk about “shareholder value.”*

Billionaires talk about “product.”**

*BigCo CEOs**Gates, Ellison, Jobs, Smith, Branson,

Buffett, Walton, Schultz, Murthy

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“To grow, companies need to break out of a

vicious cycle of competitive

benchmarking and imitation.” —W. Chan Kim & Renée

Mauborgne, “Think for Yourself —Stop Copying a Rival,” Financial Times/2003

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“The ‘surplus society’ has a surplus

of similar companies,

employing similar people,

with similar educational backgrounds, coming up with

similar ideas, producing

similar things, with

similar prices and

similar quality.” —Kjell Nordström and

Jonas Ridderstråle, Funky Business

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“Get better” vs

“Get different”

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Summary:

WallopWal*Mart16*

*Or: Why it’s so unbelievably easy to beat a GIANT Company

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The “Small Guys” Guide: Wallop Wal*Mart16

*Niche-aimed. (Never, ever “all things for all people,” a “mini-Wal*Mart.)

*Never attack the monsters head on! (Instead steal niche business and lukewarm customers.)

*“Dramatically Different”

(La Difference ... within our community, our industry regionally, etc … is as obvious as the end of one’s nose!) (THIS IS WHERE MOST MIDGETS COME UP SHORT.)

*Compete on value/experience/intimacy, not price. (You ain’t gonna beat the behemoths on cost-price in 9.99 out of 10 cases.)

*Emotional bond with Clients, Vendors. (BEAT THE BIGGIES ON EMOTION/CONNECTION!!)

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*Hands-on, emotional leadership. (“We are a great & cool & intimate & joyful & dramatically different team working to transform our Clients lives via Consistently Incredible Experiences!”)

*A community star! (“Sell” local-ness per se. Sell the hell out of it!)

*An incredible experience, from the first to last moment—and then in the follow-up! (“These guys are cool! They ‘get’ me! They love me!”)

*DESIGN DRIVEN! (“Design” is a premier weapon-in-pursuit-of-the sublime for small-ish enterprises, including the professional services.)

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*Employer of choice. (A very cool, well-paid place to work/learning and growth experience in at least the short term … marked by notably progressive policies.) (THIS IS EMINENTLY DO-ABLE!!)

*Sophisticated use of information technology. (Small-“ish” is no excuse for “small aims”/execution in IS/IT!)

*Web-power! (The Web can make very small very big … if the product-service is super-cool and one purposefully masters buzz/viral marketing.)

*Innovative! (Must keep renewing and expanding and revising and re-imagining “the promise” to employees, the customer, the community.)

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*Brand-Lovemark* (*Kevin Roberts) Maniacs! (“Branding” is not just for big folks with big budgets. And modest size is actually a Big Advantage in becoming a local-regional-niche “lovemark.”)

*Focus on women-as-clients. (Most don’t. How stupid.)

*Excellence! (A small player … per

me … has no right or reason to exist unless they are in Relentless Pursuit of Excellence. One earns the right—one damn day and client experience at a time!—to beat the Big Guys in your chosen niche!)

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Easy!

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FLASH!

Innovation

is easy!

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Innovation’s Saviors-in-Waiting

Disgruntled CustomersOff-the-Scope Competitors

Rogue EmployeesFringe Suppliers

Wayne Burkan, Wide Angle Vision: Beat the Competition by Focusing on Fringe Competitors, Lost Customers, and Rogue Employees

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CUSTOMERS: “Future-defining customers

may account for only 2% to 3% of your total, but they represent a

crucial window on the future.”Adrian Slywotzky, Mercer Consultants

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“How do dominant companies lose their

position? Two-thirds of the time, they pick

the wrong competitor to worry about.” —Don Listwin, CEO, Openwave

Systems/WSJ/06.01.2004 (commenting on Nokia)

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“Don’t benchmark, futuremark!

” Impetus: “The future is already here; it’s just

not evenly distributed” —William Gibson

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Employees: “Are there enough weird people in the lab

these days?”V. Chmn., pharmaceutical house, to a lab director

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We become who we hang

out with!

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Measure “Strangeness”/Portfolio Quality

StaffConsultants

VendorsOut-sourcing Partners (#, Quality)

Innovation Alliance PartnersCustomers

Competitors (who we “benchmark” against)

Strategic Initiatives Product Portfolio (LineEx v. Leap)

IS/IT ProjectsHQ LocationLunch Mates

LanguageBoard

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Bold!

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No Wiggle Room!

“Incrementalism

is innovation’s worst enemy.”

Nicholas Negroponte

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Just Say No …

“I don’t intend to be

known as the ‘King of

the Tinkerers.’ ”CEO, large financial services company

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CI/6S/Etc Concerns

OlivesDeck ChairsCow Paths

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On a Scale of 1 to 10*

My main activity is a Deck-Chair Shuffling, Cow-Path Paving, Olive- Reducing

Project (DCSP, CPPP, ORP) ____

* 1 = No way! 10 = ’Fraid so.

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“Beware of the tyranny of making

Small Changes to Small

Things. Rather,

make Big Changes

to Big Things.”

—Roger Enrico, former Chairman, PepsiCo

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“Reward excellent failures.

Punish mediocre

successes.”Phil Daniels, Sydney exec

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Action!

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“Execution is the job of

the business leader.” —Larry Bossidy & Ram

Charan/ Execution: The Discipline of Getting Things Done

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“Execution is a

systematic process of rigorously

discussing hows and whats, tenaciously following through, and

ensuring accountability.” —Larry Bossidy & Ram Charan/ Execution: The Discipline of Getting Things Done

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P + M = G

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Measurable!

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Innovation Index: How many of your Top 5 Strategic Initiatives/Key Projects

score 8 or higher (out of 10) on a “Weirdness”/ “Profundity”/

“Wow”/ “Gasp-worthy”/ “Game-changer” Scale?

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Personal!

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Step #1: Buy a Mirror!

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“The First step in a ‘dramatic’

‘organizational change program’ is obvious—

dramatic personal change!” —RG

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3. Re-imagine Organizing I:

IS/IT as Disruptive Tool!

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We all live in

Dell-Wal*Mart-

eBay-Google World!

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“UPS used to be a trucking

company with technology. Now it’s

a technology company with

trucks.” —Forbes

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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 (HealthLeaders/12.2002)

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“Ebusiness is about rebuilding the

organization from the ground up. Most companies today

are not built to exploit the Internet. Their business processes, their approvals, their

hierarchies, the number of people they employ … all of that is wrong for running

an ebusiness.” —Ray Lane, Kleiner Perkins

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Power Tools for Power Solutions/

Strategies! —TP

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Sysco!

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Go for the Bold

*Bold/Aggressive/$$$$

* Bold/GameChanger

* Bold/Creative Destruction* Bold/“Cool” Supplier Portfolio* Bold/Web Fanaticism

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5% F500 have CIO on Board: “While

some of the world’s most admired companies—

Tesco, Wal*Mart —are transforming the business landscape by including technology experts on their boards, the vast majority are

missing out on ways to boost productivity, competitiveness and shareholder value.”

Source: Burson-Marsteller

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4. Re-imagine

Organizing II: What

Organization?

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“Organizations will still be critically important in the

world, but as ‘organizers,’ not

‘employers’!” — Charles Handy

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TP In Nagano …

Revenue: $10B

FTE: 1*

*Maybe

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Not “out sourcing”Not “off shoring”

Not “near shoring”Not “in sourcing”

but …

“Best Sourcing”

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“global innovation networks”

vs

“research in large monolithic companies”

Source: George Colony/Forrester Research

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“In the 21st century we’ll see

a rise of invention

companies [earning

licensing fees]. ” —Nathan Myhrvold, Forbes, 11.05

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5. Re-imagine Organizing III:

Welcome to a Brand You World …

Distinct or Extinct

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“One of the defining characteristics

[of the change] is that it will be less driven by countries or

corporations and more driven by real people. It will unleash

unprecedented creativity, advancement of knowledge, and economic development. But at the same time, it will tend to

undermine safety net systems and penalize the unskilled.” —Clyde

Prestowitz, Three Billion New Capitalists

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R.D.A.

Rate: 15%?, 25%?

Therefore: Formal “Investment

Strategy”/R.I.P.**Renewal Investment Plan

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Have you invested as much this year in your career as in your

car?

Source: Molly Sargent

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New Work SurvivalKit2006

1. Mastery! (Best/Absurdly Good at Something!)2. “Manage” to Legacy (All Work = “Memorable”/“Braggable”

WOW Projects!) 3. A “USP”/Unique Selling Proposition (R.POV8: Remarkable Point of View … captured in 8 or less words)

4. Rolodex Obsession (From vertical/hierarchy/“suck up” loyalty to horizontal/“colleague”/“mate” loyalty)

5. Entrepreneurial Instinct (A sleepless … Eye for Opportunity! E.g.: Small Opp for Independent Action beats faceless part of Monster Project)

6. CEO/Leader/Businessperson/Closer (CEO, Me Inc. Period! 24/7!)7. Mistress of Improv (Play a dozen parts simultaneously, from

Chief Strategist to Chief Toilet Scrubber)8. Sense of Humor (A willingness to Screw Up & Move On)

9. Comfortable with Your Skin (Bring “interesting you” to work!) 10. Intense Appetite for Technology (E.g.: How Cool-Active is your Web site? Do you Blog?) 11. Embrace “Marketing” (Your own CSO/Chief Storytelling Officer) 12. Passion for Renewal (Your own CLO/Chief Learning Officer) 13. Execution Excellence! (Show up on time! Leave last!)

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Distinct … or

… Extinct

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“It’s always

showtime.”

—David D’Alessandro, Career Warfare

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100 WAYS TO SUCCEED #35: Lovemark or Bust!

(1) Enjoy your the Holiday Season!(2) Between now and 1JAN2005, invent 10 actions, solo or with

pals, to Launch Your “Lovemark Journey2005.”(3) Focus directly—Architect or Lawyer or Realtor—on the following

“KRWs”/Kevin Roberts Words: Mystery … Magic … Sensuality … Enchantment … Intimacy … Exploration.

(3A) The words in #3 above Do Apply to You!(4) Develop a “No Bull” Action Schedule that includes 2 Hard First

Steps by 10JAN05, 5 Hard First Steps by 01FEB05.(5) Report back to this Website, tompeters.com.

Pronunciamento: I HEREBY DESIGNATE, IN ACCORDANCE WITH THE POWERS GRANTED TO ME (the Inalienable Right To Blog)

THAT 2005 IS PROCLAIMED AS “THE YEAR OF THE PROFESSIONAL SERVICE LOVEMARK.”

Welcome aboard!

Source: TPBlog/12.17.2004

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6. Re-imagine Organizing IV:

The Talent Obsession.

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“The Creative Age is a

wide-open game.”

—Richard Florida, The Rise of the Creative Class

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Brand =

Talent.

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From “1, 2 or you’re out” [JW] to …

“Best Talent in each industry segment

to build best proprietary intangibles” [EM]

Source: Ed Michaels, War for Talent

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Our Mission

To develop and manage talent;

to apply that talent,throughout the world,

for the benefit of clients;to do so in partnership;

to do so with profit.WPP

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7. Re-imagine Organizing V: The Power of

“We”

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“THE POWER OF US: Mass Collaboration on THE INTERNET

Is Shaking Up Business” —Cover/BusinessWeek/06.20.05

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“The fluidity of information will bring about a

radically democratized society where

consumers enjoy

unprecedented power.” —Fast Company/10th anniversary

issue/March2006

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Globalization1.0: Countries globalizing (1492-1800)

Globalization2.0: Companies globalizing (1800-2000)

Globalization3.0 (2000+): Individuals collaborating & competing globally

Source: Tom Friedman/The World Is Flat

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“The nearly 1 billion people online worldwide—along with their shared knowledge, social contacts, online reputations, computing power, and

more—are rapidly becoming a collective force of unprecedented power. For the first time in human history, mass cooperation across

time and space is suddenly economical.” —BW/06.20.05

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“There’s a fundamental shift

in power happening. Everywhere, people are getting together and,

using the Internet, disrupting whatever

activities they’re involved in.” —Pierre Omidyar, founder,

eBay

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“The architecture

of participation”—Tim O’Reilly/Tech-book publisher

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“Blogging made my year!” —TP

Portal!Conversations!Collaboration!

New value!

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8. Re-imagine Organizing VI: The White-Collar Tsunami and the Professional Service Firm (“PSF”) Imperative.

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Re-imagine:

Up, Up, Up,

Up

the Value-added Ladder.

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“ ‘Disintermediation’ is overrated. Those who fear disintermediation should in fact be afraid of

irrelevance—disintermediation is just another way

of saying that … you’ve become

irrelevant to your customers.”

—John Battelle/Point/Advertising Age/07.05

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Answer:

PSF

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The

“PSF35”: Thirty-Five

Professional Service Firm Marks of Excellence

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The PSF35: The Work & The Legacy

1. CRYSTAL CLEAR POINT OF VIEW (Every Practice Group: “If you can’t explain your position in eight words or less, you don’t have a position”—Seth Godin)2. DRAMATIC DIFFERENCE (“We are the only ones who do what we do”—Jerry Garcia)3. Stretch Is Routine (“Never bite off less than you can chew”—anon.)4. Eye-Appetite for Game-changer Projects (Excellence at Assembling “Best Team”—Fast) 5. “Playful” Clients (Adventurous folks who unfailingly Aim to Change the World)6. Small “Uneconomic” Clients with Big Aims7. Life Is Too Short to Work with Jerks (Fire lousy clients)8. OBSESSED WITH LEGACY (Practice Group and Individual: “Dent the Universe”—Steve Jobs)9. Fire-on-the-spot Anyone Who Says, “Law/Architecture/Consulting/ I-banking/ Accounting/PR/Etc. has become a ‘commodity’ ”10. Consistent with #9 above … DO NOT SHY AWAY FROM THE WORD (IDEA) “RADICAL”

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Best is not good

enough!

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?????

Do good (excellent?!) work

Make a lot of money

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Point of

View!

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“Gasp-worthy!

”

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The PSF35: The Client Experience

11. Always team with client: “full partners in achieving memorable results” (Wanted: “Chimeras of Moonstruck Minds”!)12. We will seek assistance Anywhere to assemble the Best-in- Planet Team for the Project13. Client Team Members routinely declare that working with us was “the Peak Experience of my Career”14. The job’s not done until implementation is “100.00% complete” (Those who don’t “get it” must go)15. IMPLEMENTATION IS NOT COMPLETE UNTIL THE CLIENT HAS EXPERIENCED “CULTURE CHANGE”16. IMPLEMENTATION IS NOT COMPLETE UNTIL SIGNIFICANT “TECHNOLOGY TRANSFER” HAS TAKEN PLACE-ROOT (“Teach a man to fish …”)17. The Final Exam: DID WE MAKE A DRAMATIC, LASTING, GAME-CHANGING DIFFERENCE?

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“The business of selling is not just about matching viable solutions to the customers that require

them. It’s equally about managing the change process the customer

will need to go through to implement the solution and

achieve the value promised by the solution.”* (*E.g.: CRM failure rate/Gartner: 70%)

—Jeff Thull, The Prime Solution: Close the Value Gap, Increase Margins, and Win the Complex Sale

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The PSF35: The People & The Leadership

18. TALENT FANATICS (“Best-Coolest place to work”) (PERIOD)19. EYE FOR THE PECULIAR (Hiring: Go beyond “same old, same old”) 20. Early Opportunities (vs. “Wait your turn”) 21. Up or Out (Based on “Legacy”/Mentoring as much as “Billings”/“Rainmaking”)22. Slide the Old Aside/Make Room for Youth (Find oldsters new roles?)23. TALENT IS OBSESSED WITH RENEWAL FROM DAY #1 TO DAY #“R” [R = Retirement]24. Office/Practice Leaders Evaluated Primarily on Mentoring-Team Building Skills25. A “PROPRIETARY” TALENT DEVELOPMENT PROCESS (GE)26. Team Leadership Skills Valued Early27. Partner with B.I.W. [Best In World] Outsiders as Needed and to Infuse Different Views

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The PSF35: The Firm & The Brand

28. EAT-SLEEP-BREATHE-OOZE INTEGRITY (“My life is my message”—Gandhi)29. Excellence+ in EXECUTION … 100.00% of the Time (No such thing as a “small sins”/World Series Ring to the Batboy!) 30. “Drop everything”/“Swarm” to Support a Harried-On The Verge Team31. SPEND AS AGGRESSIVELY ON R&D AS A TECH FIRM OR CIRQUE DU SOLEIL32. A PROPRIETARY METHODOLOGY (FBR, McKinsey, Chiat Day, IDEO, old EDS)33. Web (Technology) Obsession34. BRAND/“LOVEMARK” MANIACS (Organize Around a Point of View Worth BROADCASTING: “You must be the change you wish to see in the world”—Gandhi)35. PASSION! ENTHUSIASM! (Passion & Enthusiasm have as much a place at the Head Table in a “PSF” as in a widgets factory: “You can’t behave in a calm, rational manner. You’ve got to be out there on the lunatic fringe”—Jack Welch)

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Static/Imitative

Integrity.Quality.

Excellence.Continuous Improvement.

Superior Service (Exceeds Expectations.)

Completely Satisfactory Transaction.Smooth Evolution.

Market Share.

Dynamic/Different

Dramatic Difference!Disruptive!

Insanely Great! (Quality++++)

Life-(Industry-)changing Experience!Game-changing!

WOW!Surprise!Delight!

Breathtaking!Punctuated Equilibrium!

Market Creation!

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Big Idea:

“Corporation” as “Mega-PSF”*

* “Virtual” Collection of Entrepreneurially-minded Professionals (“Talent”/“Roster”) Creating/ Applying

Intellectual Capital (“Work Product”)

Game-changing Solutions: Core Mechanism

PSF (Professional Service Firm “model”)

+

Wow Projects (“Different” vs “Better”)

+

Brand You(“Distinct” or “Extinct”)

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The

WOW! Project.

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Your Current Project?

1. Another day’s work/Pays the rent.4. Of value.7. Pretty Damn Cool/Definitely subversive.10. WE AIM TO CHANGE THE WORLD.

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“Insanely Great”

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9. Re-imagine Business’s

Fundamental Value Proposition: PSFs

Unbound, or Fighting “Inevitable Commoditization”

via “The ‘Gamechanging Solutions’ Imperative.”

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Re-imagine:

Up, Up, Up,

Up

the Value-added Ladder.

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$55B

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And the “M” Stands for … ?

Gerstner’s IBM: “Systems Integrator of choice.”/BW (“Lou, help us turn ‘all this’ into that long-

promised ‘revolution.’ ” )

IBM Global Services*

(*Integrated Systems Services Corp.): $55B

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Planetary Rainmaker-in-Chief!

“Palmisano’s strategy is to expand tech’s borders by pushing

users—and entire industries—toward radically different business

models. The payoff for IBM would be access to an ocean of revenue—Palmisano estimates it at $500 billion a year—that technology companies have

never been able to touch.” —Fortune

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“By making the Global Delivery Model both legitimate and mainstream, we have brought the battle to our territory. That is, after all, the purpose of strategy. We have become the leaders, and incumbents [IBM, Accenture]

are followers, forever playing catch-up. … However, creating a new business innovation is not enough for rules to be changed. The

innovation must impact clients, competitors, investors, and society. We have seen all this in spades. Clients have embraced the model and are

demanding it in even greater measure. The acuteness of their circumstance, coupled with the capability and value of our solution, has made the choice not a choice. Competitors have been dragged kicking

and screaming to replicate what we do. They face trauma and disruption,

but the game has changed forever. Investors have grasped that this is not a passing fancy, but a potential restructuring of the way

the world operates and how value will be created in the future.” —Narayana Murthy, chairman’s

letter, Infosys Annual Report

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“Big Brown’s New Bag: UPS

Aims to Be the Traffic Manager for Corporate

America” —Headline/BW/2004

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And …

MasterCard Advisors

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“Customer Satisfaction” to “Customer Success”

“We’re getting better at [Six Sigma] every day. But we really need to

think about the customer’s

profitability. Are customers’ bottom

lines really benefiting from what we provide

them?” —Bob Nardelli, GE Power Systems

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Bear In Mind: Customer Satisfaction versus Customer

Success

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The Value-added Ladder/Stuff ‘n’ Things

Goods Raw Materials

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The Value-added Ladder/Stuff & Transactions

ServicesGoods

Raw Materials

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The Value-added Ladder/Opportunity-seeking

Gamechanging Solutions/

Business AdvantageServicesGoods

Raw Materials

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$55B

“Game-changing Solutions”: Core Mechanism

PSF (Professional Service Firm “model”)

+

Wow Projects (“Different” vs “Better”)

+

Brand You(“Distinct” or “Extinct”)

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Era #1/Obvious Value:“Our ‘it’ works, is delivered on time” (“Close”)

Era #2/Augmented Value: “How our ‘it’ can add value—a ‘useful it’ ” (“Solve”)

Era #3/Complex Value Networks: “How our ‘system’ can change you and deliver

‘business advantage’ ” (“Culture-Strategic change”)

Source: Jeff Thull, The Prime Solution: Close the Value Gap, Increase Margins, and Win the Complex Sale

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10. Re-imagine Enterprise as

Theater I: A World of Scintillating “Experiences.”

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$798

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$415/SqFt/Wal*Mart$798/SqFt/Whole Foods

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7X. 730A-800P.

F12A.**’93-’03/10 yr annual return: CB: 29%; WM: 17%; HD: 16%. Mkt Cap: 48% p.a.

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“The [Starbucks] Fix” Is on …

“We have identified a

‘third place.’ And I

really believe that sets us apart. The third place is that place that’s not work or home. It’s the place our customers

come for refuge.”

Nancy Orsolini, District Manager

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Experience: “Rebel Lifestyle!”

“What we sell is the ability for a 43-year-old accountant to dress in

black leather, ride through small towns and have people be

afraid of him.”Harley exec, quoted in Results-Based Leadership

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“Experiences are as distinct

from services as services are from

goods.” —Joe Pine & Jim Gilmore, The Experience Economy:

Work Is Theatre & Every Business a Stage

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The Value-added Ladder/Memorable Connection

Scintillating Experiences

Gamechanging Solutions/Business Advantage

ServicesGoods

Raw Materials

1

11. Re-imagine Enterprise as

Theater II: Embracing the “Dream

Business.”

1

DREAM: “A dream is a complete moment in the life

of a client. Important experiences that tempt the client to commit substantial resources. The essence of

the desires of the consumer. The opportunity to help

clients become what they want to be.”

—Gian Luigi Longinotti-Buitoni

1

The Value-added Ladder/Emotion

Dreams Come True

Scintillating Experiences Gamechanging Solutions/

Business AdvantageServicesGoods

Raw Materials

1

“The Ritz-Carlton experience enlivens the senses, instills

well-being, and fulfills even the unexpressed wishes and needs of

our guests.” — from the Ritz-Carlton Credo

1

Six Market Profiles

1. Adventures for Sale2. The Market for Togetherness, Friendship and Love3. The Market for Care4. The Who-Am-I Market5. The Market for Peace of Mind6. The Market for Convictions

Rolf Jensen/The Dream Society: How the Coming Shift from Information to Imagination Will Transform Your Business

1

Six Market Profiles

1. Adventures for Sale/IBM-UPS-GE2. The Market for Togetherness, Friendship and Love/IBM-UPS-GE3. The Market for Care/IBM-UPS-GE4. The Who-Am-I Market/IBM-UPS-GE5. The Market for Peace of Mind/IBM-UPS-GE6. The Market for Convictions/IBM-UPS-GE

Rolf Jensen/The Dream Society: How the Coming Shift from Information to Imagination Will Transform Your Business

1

IBM, UPS, GE …

Dream Merchants

!

1

The Power Is the Story

1

Story > Brand

1

“Storytelling

is the core of culture.”

—Branded Nation: The Marketing of Megachurch, College Inc., and Museumworld, James Twitchell

1

“The branding of cultural capital may be the next

step in the evolution of

community.” — “When All

Business Is Show Business, What’s Next,” Branded Nation: The Marketing of Megachurch, College Inc., and

Museumworld, James Twitchell

1

Market Power = Story Power

= Dream Power

1

12. Re-imagine the Customer: A Trend Worth Trillion$$$ …

Women Roar.

1

“Women are the

majority market”

—Fara Warner/The Power of the Purse

1

?????????

Home Furnishings … 94%Vacations … 92% (Adventure Travel … 70%/ $55B travel equipment)

Houses … 91%D.I.Y. (major “home projects”) … 80%

Consumer Electronics … 51% (66% home computers)

Cars … 68% (90%)All consumer purchases … 83%

Bank Account … 89%Household investment decisions … 67%Small business loans/biz starts … 70%

Health Care … 80%

1

Editorial/Men: Tables, rankings.*

Editorial/Women:

Narratives that cohere.*

*Redwood (UK)

1

Initiate Purchase

Men: Study “facts & features.”

Women: Ask lots of people for input.

Source: Martha Barletta, Marketing to Women

1

Thanks, Marti

Barletta!

The Perfect Answer

Jill and Jack buy slacks in black…

1

Read This Book …

EVEolution: The Eight

Truths of Marketing

to WomenFaith Popcorn & Lys Marigold

1

EVEolution: Truth No. 1

Connecting Your Female Consumers to Each Other Connects Them to Your Brand

1

“The ‘Connection Proclivity’ in women starts early. When asked, ‘How was

school today?’ a girl usually tells her mother every

detail of what happened, while a boy might grunt,

‘Fine.’ ”

EVEolution

1

“Women don’t buy

brands. They join them.”

EVEolution

1

2.6 vs. 21

1

1. Men and women are different.2. Very different.3. VERY, VERY DIFFERENT.4. Women & Men have a-b-s-o-l-u-t-e-l-y nothing in common.5. Women buy lotsa stuff.

6. WOMEN BUY A-L-L THE STUFF.7. Women’s Market = Opportunity No. 1.8. Men are (STILL) in charge.9. MEN ARE … TOTALLY, HOPELESSLY CLUELESS ABOUT WOMEN.10. Women’s Market = Opportunity No. 1.

1

10. Women’s Market =

Opportunity No. 1.

1

Why?

1

Good Thinking, Guys!

“Kodak Sharpens Digital Focus

On Its Best Customers:

Women”

—Page 1 Headline/WSJ/0705

1

2005

1

Duh!

“More Hotels Try to Offer What Women

Want” —Headline, USA Today, 11.08.05

1

Fastest growing demographic:

Single-person Households (>50% in the likes of London, Stockholm)

Source: Richard Scase

1

“If I could have chosen not to tackle the IBM culture head-on, I probably wouldn’t

have. My bias coming in was toward strategy, analysis and measurement. In comparison, changing the attitude and behaviors of hundreds of thousands of

people is very, very hard. [Yet] I came to see in my time at IBM that

culture isn’t just one aspect of the game—it is the game.” —Lou Gerstner, Who

Says Elephants Can’t Dance

1

12. Re-imagine Leadership for Totally

Screwed-Up Times: The

Passion Imperative.

1

Lead It … Loud!

1

Create a Cause!

1

G.H.: “Create a ‘cause,’ not a ‘business.’

”

1

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

first question for a leader always

is: ‘Who do we intend to be?’ Not ‘What are we going to do?’

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

1

“the wildest chimera of a moonstruck

mind” —The Federalist on TJ’s Louisiana

Purchase

1

Make It a Grand

Adventure!

1

Quests!

1

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 her absolute best.”

“The best thing a leader can do for a

Great Group is to allow its members to discover their

greatness.”

1

Yes!!!!!!!!!!!!!!!!!

“free to do his or her absolute best” …

“allow its members to discover their

greatness.”

1

“In the end, management doesn’t

change culture. Management invites the workforce itself

to change the culture.”

—Lou Gerstner

1

Trumpet an Exhilarating

Story!

1

“Leaders don’t just make products and make

decisions. Leaders make

meaning.” – John Seely Brown

1

“A key – perhaps the key – to leadership is

the effective communication

of a story.”—Howard Gardner/Leading Minds:

An Anatomy of Leadership

1

Wow!

1

Live Your

Story!

1

“To change minds effectively, leaders make

particular use of two tools: the stories

that they tell and the lives that they lead.” —

Howard Gardner, Changing Minds

1

“It is necessary for the President to be the

nation’s …

No. 1 actor.”FDR

1

“You must

be the

change you wish to see in the

world.”Gandhi

1

Try It!

1

Sam’s

Secret #1!

1

“Reward excellent failures.

Punish mediocre

successes.”Phil Daniels, Sydney exec

1

Insist on

Speed!

1

“If things seem under control, you’re just not

going fast enough.” —Mario Andretti

1

Eat Change!

1

“We eat change for breakfast!”

—Harry Quadracci, QuadGraphics

1

Dispense Enthusiasm!

1

BZ: “I am a … Dispenser of Enthusiasm!”

1

“Nothing is so contagious as enthusiasm.”

—Samuel Taylor Coleridge

1

“Most important,

he upped the energy level at Motorola.” —Fortune on Ed Zander/08.05

1

“A man without a smiling face must

not open a shop.” —Chinese Proverb*

*Courtesy Tom Morris, The Art of Achievement

1

Excellence. Always.

1

Leader Job No.1

Paint Portraits of

Excellence!

1

Avoid … Moderation!

1

Kevin Roberts’ Credo

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

10. Avoid moderation!

1

Stay Hungry.

Stay Foolish.

Steve Jobs

1

Free the Lunatic Within!

1

The greatest dangerfor most of us

is not that our aim istoo high

and we miss it,but that it is

too lowand we reach it.

Michelangelo

1

“You can’t behave in a calm, rational manner. You’ve got to be out there on

the lunatic fringe.” — Jack Welch

1

Tom Peters’

Toward Health(care) Excellence!

Aetna/Laguna Niguel/Part #2

Tom Peters’ Re-Imagine!

Toward Client-driven, CustomerExperience-animated, QUALITY-OBSESSED, OutcomeAccountability-focused,

InformationMeasurement-intensive, EMR-determined, Science-aware, PreventionWellness-centric,

Healing-aimed, ChronicCare-oriented, HomeCare-based, Boomer-sensitive,

Women’sHealth-directed, Revolution-insistent

HEALTH(CARE) EXCELLENCE Aetna/Laguna Niguel/Part #2

1

Health(care): Seven Main Messages

1. Quality (Error reduction/ Evidence-based Medicine)2. “Healthcare” vs. “Health” (Wellness + Prevention)3. “Models of Excellence” available4. Life sciences (“Singularity”)5. Avian flu

1

Health:Century21.Job # 1

(HC21.J1)

Tom Peters/0206.2006

1

!!!!!!!!!!!!!

“Healthcare” vs “Health”

1

Quality!Prevention!Wellness!

1

Go Bubba!

WASHINGTON (Feb. 28) - Former President Clinton, a reformed overeater, urged state governors on Tuesday to embrace a long-term effort to changethe nation's culture of too much foodand too little exercise. (AOL.0301.0338am, re NGA)

1

“When I climb Mount Rainier I face less risk of death than I’ll

face on the operating table.” —Don

Berwick, “Six Keys to Safer Hospitals: A Set of Simple Precautions Could Prevent 100,000 Needless Deaths Every Year,” Newsweek (12.12.2005)

1

Quality (100K deaths)

“Evidence/Outcomes-based” medicineIS/IT-in-health(care) revolution

Wellness/PreventionHealth“care” to Health transformation

Wash your hands!Home-care (as the population rapidly ages)

Med-school re-orientation “Public health” emphasis

Mind-boggling (15 years?) social-moral-technological impact of life sciences (“the Singularity”?)

H5N1/WMDs/Environmental degradationRisk assessment (private, public)

Market opportunityPublic vs/+ Private responsibilities & partnerships

Africa! (Unconscionable failure to attend to/staggering Health consequences for all)

1

“If God spoke to me by saying, ‘Mark, you’re down to your last three words: What would you want to say to your fellow humans that would make the most positive impact?’ It would be a close

call between Love Thy Neighbor and Wash Your Hands. A close third

would be Move, Move, Move.” —Mark Pettus, M.D.,The Savvy Patient

“The most important thing you can do to keep from getting

sick is to wash your hands.” —CDC/National Center for Infectious

Diseases

1

Manifesto(s)

1

!!!!!!!!!!!!!


1

TP’s Healing & Wellness Manifesto2006

(1) Acute-care facilities are “killing fields.” (WE KNOW WHAT TO DO.)

(2) Shift the “community” focus 90 degrees (not 180, but not 25) from “fix it” to “prevent it.” (WE KNOW WHAT TO DO.)

(3) There are three primary aims for “all this”: Wellness-Healing-Health. (WE KNOW WHAT TO DO.)

(4) I’m mad as hell and I’m not going to take it anymore. (I KNOW WHAT TO DO.)

1

Tom’s Rant2006

1. 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 year—and wound many times that number. Finally, “they” are “getting around to” dealing with the issue. Well, thanks. And what is it we’ve 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.” Who’s to blame? Just about everybody, starting with the docs who consider oversight from anyone other than fellow clan members to be unacceptable.)

2. The “system”—training, docs, insurance incentives, “culture,” “patients” themselves—is hopelessly-mindlessly-insanely (as I see it) skewed toward fixing things (e.g. me) that are broken—not 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 63-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).” Patients—like me—are catching on in record numbers; but “the system” is highly resistant. (Again, the doctors are among the biggest sinners—no surprise, following years of acculturation as the “man-with-the-white-coat-who-will-now-miraculously-dispense-fix it-pills-and-surgical-incisions-for-you-the-unwashed.” (Come to think of it, maybe I’ll start wearing a White Coat to my doctor’s office—after all, I am the Professional-in-Charge when it comes to my Body & Soul. Right?)

1

BIGGEST DEAL OF

ALL

1

!!!!!!!!!!!!!


1

“Quality”:

COULD IT TRULY BE

THIS AWFUL?

1

Thomas PetersThomas Peters

He Went To The He Went To The

HospitalHospital

1

CDC 1998: 90,000

killed and 2,000,000

injured from hospital-caused drug

errors & infections

1

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 Collier

Source: Boston Globe/07.27.04

1

“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.”

1

22mm3838ss

1

“Silence surrounds this issue.”

Source: To Err Is Human: Building a Safer Health System, by the Institute of Medicine (Subject: 44,000 to 98,000 preventable

hospital deaths per year in the U.S.)

1

Welcome to the Homer Simpson Hospital

a/k/a

The Killing Fields

1

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

1

Mistakes: 100,000 deaths—“minor fraction of the total deaths caused

by modern medicine.” Hopkins: 225,000 iatrogenic deaths (people

killed by docs); (Institute for Medicine higher)

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

1

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, medicine’s leading expert on error, points out that many other industries—whether the task is manufacturing semiconductors or

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

—Complications, Atul Gawande

1

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.

1

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

1

“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


1

20%: not get prescriptions filled

50%: use meds inconsistently


1

“In health care,

geography is destiny.”

Source: Dartmouth Medical School

1

Geography Is Destiny

“Often all one must do to acquire a disease is to enter a country where a disease is recognized—leaving 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

1

Geography Is Destiny

E.g.: Ft. Myers 4X Manhattan—back surgery. Newark 2X New Haven—

prostatectomy. Rapid City SD 34X Elyria OH—breast-conserving surgery. VT,

ME, IA: 3X differences in hysterectomy by age 70; 8X tonsillectomy; 4X

prostatectomy Breast cancer screening:

4X NE, FL, MI vs. SE, SW. (Source: various)

1

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

restructured according to

evidence-based medical

practice.”Demanding Medical Excellence: Doctors and Accountability


1

“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

1

“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 State 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

1

“Most physicians believe that diagnosis can’t be reduced to a set of generalizations—to 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 flawed—it causes more mistakes than it prevents.” —Atul

Gawande, Complications

1

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 Edenbrandt’s

software: 738.

*Only this time it matters!

1

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)

1

Probable parole violations: Simple model (age, # of previous offenses, type of crime) beats

M.D. shrinks.

100 studies: Statistical formulas > Human

judgment. “In virtually all cases, statistical

thinking equaled or surpassed human

judgment.” —Atul Gawande, Complications

1

PARADOX: Many, many formal case reviews … failure to systematically/ systemically/ statistically

look at and act on evidence.

Source: Complications, Atul Gawande

1

Genius Required?

1

Leapfrog Group:

CPOE/Computerized Physician Order Entry*ICU staffing by trained intensivists**EHR/Evidence-based Hospital Referral***

Source: HealthLeaders

1

The Benefits of … FOCUSED EXCELLENCE

Shouldice/Hernia Repair:

30-45 min, 1% recurrence. Avg: 90 min,

10%-15% recurrence.

Source: Complications, Atul Gawande

1

About Time!

100,000 Lives Campaign*

*Don Berwick/Institute for Healthcare Improvement

1

“What’s your name?

When’s your birthday?”

1

Hospitals Pay Appropriate Attention To Medical Errors

Yes ………………………………. 1%Aware and Trying Hard ……... 8%Aware But Tepid Response … 22%No ………………………………... 25%An Inexcusable Tragedy …….. 44%

Source: 12.2005 Poll/tompeters.com

1

Attention/ “Being There”:

Job One!

1

You = Your

Calendar

1

“You must be the change you wish to see in the world.”

Gandhi

1

The Necessary

IS/Web REVOLUTION

1

We all live in Dell-

Wal*Mart-eBay-Google

World!

1

We

[almost] all live in Dell -Wal*Mart-eBay-Google World!

1

“Some grocery stores have

better technology than our hospitals and clinics.” —Tommy Thompson, HHS Secretary

Source: Special Report on technology in healthcare, U.S. News & World Report (07.04)

1

Computerized Physician Order

Entry/CPOE: 5% of U.S.

hospitals

source: HealthLeaders/06.02

1

Henry Lowe, U. of Pitt. School of

Medicine: “Broadband, Internet-based,

‘multimedia’ electronic medical records”

1

Telemedicine: E.g. …

HANC* [Home Assisted

Nursing Care]

*BP, ECG, pulse, temp, etc

1

Telemedicine …

Reduces days/1000 patients and physician visits for the chronically ill

Decreases costs of managing chronic disease

Expands service areas for providers

Reduces travel costs to and from medical ed seminars

Source: Douglas Goldstein, e-Healthcare

1

“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 (HealthLeaders/12.2002)

1

“Information therapy … is the prescription of specific, evidenced-based medical

information to a specific patient, caregiver or consumer at just the right time to help him or her

make a specific health decision or behavior change.”

“As we try to refocus our medical resources from acute care to chronic care we must gain full value

from what the patient and the family can do for themselves. Without integrating the self-management of the family no system of chronic care can be either

economically or medically successful.”

“Information Therapy”: not “about” healthcare; “essential part” of healthcare

Source: Donald Kemper, CEO, Healthwise

1

Health**vs Healthcare

1

Health

*vs Healthcare

1

“Sanitary revolution”: mortality in major cities

down 55%

between 1850 and 1915


1

“Gwen [former healthcare exec] has wonderful health insurance and an abundance of healthcare. What Gwen does not have is

health. And there is nothing our health system can do to give it to

her.” “The battle cry is always health, but in fact the struggle has always been over healthcare.” “For all its inspiring, high-tech cures, medicine is just not very effective at

curing our era’s major killers.” “Medicine doesn’t do much chronic

disease.” “When the most common killers of our

era are mostly incurable and our preventive treatments pretty feeble, you have to wonder about medical care as a whole.”

“There is a widely held view that medical care contributes little to

health.” (John Bunker/ Journal of the Royal College of Physicians)


1

Smoking, excess

drinking, lack of

exercise, shitty diet:

40% of deaths


1

“Our mistake is not that we value

medical care—but that we have

misunderstood what it can and cannot

do.”


1

“Curve Shifting”Source: Tom Farley & Deborah Cohen,

Prescription for a Healthy Nation

1

“Bump into factor”: Extra-size portions, eat more. Higher %

shelf space snacks, more obesity. More liquor stores, more crime. High vs low fat: Japanese who

emigrate to U.S. suffer 3X increase in heart disease.


1

Context Change: The Most Powerful Force (??)

Wastebaskets: Japan v U.S.; Christchurch NZ v

Sydney AUS*

*“Broken windows”

1

+10: Sardinians, Adventists, Okinawans

Don’t smoke. Put family first. Be active every day. Keep socially engaged. Eat fruits, vegetables,

whole grains. [Other: nuts, red wine, pecorino cheese, small portions.]

Source: National Geographic (National Institute on Aging), November 2005

1

“An estimated 60 to 90 percent of doctor visits involve stress-related complaints.”

—Newsweek/09.27.2004

1

“Our focus can no longer be on cost containment.

Rather, we must emphasize education, disease management

programs, and wellness and prevention far more strongly than we have in

the past.” —Chad Holliday/DuPont

1

Wellness

1

“The ‘curative model’ narrowly focuses on the goal of cure. …

From many quarters comes evidence that the view of health

should be expanded to encompass mental, social and

spiritual well-being.” Institute for the Future

1

“Ontario To Split Health Ministry”

—Headline/Globe And Mail /06.05 (New ministry will focus on

Prevention/ Wellness/Eldercare)

1

“Savior for the Sick”

vs.

“Partner for Good Health”

Source: NPR

1

“Companies Step Up Wellness Efforts: Rising

health costs provide incentive to promote healthier employee

lifestyles” —headline/USA Today/08.05

1

“Prevention Program At Dow

Chemical Aims To Save Money” —IBD/08.05

1

Sprint/Overland Park KS: Slow elevators, distant

parking lots with infrequent buses, “food court” as

“poorly” placed as possible, etc.

Source: New York Times

1

Tom’s Story

1

Obesity/-79(-36); BP (140-85 to 90-60); Blood sugar (180-

87); Blood chemistry (normal+); Cholesterol (140-

58); Metabolic rate/RMR (+250); Mental state

(dramatic improvement*)

1

CR

07.03: 60/264/180/145-85/140

10.04: 61/195/092/097-60/058

1

“Fixes”

Diet (eg small portions, slow down)

Extreme exercise!Meditation

Dietary supplementsNo alcohol

(Psychotropic meds/others reduced)

(No work reduction)

1

Aging reversal!!!!

**Why wasn’t I

“informed” until age 59?

1

Determinants of Health

Access to care: 10%Genetics: 20%

Environment: 20%

Health Behaviors: 50%Source: Institute for the Future

1

Planetree: A Radical Model for New

Healthcare/Healing/Health/Wellness Excellence*

* “It” can be done!

1

“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

1

“Much of our current healthcare is about

curing. Curing is good. But healing is spiritual, and healing is better, because we can heal

many people we cannot cure.” —Leland Kaiser, “Holistic Hospitals”

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

1

The Nine Planetree Practices

1. 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 Health


1

1. The Importance of Human Interaction

1

“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 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

1

Press Ganey Assoc/1999: 139,380 former patients from 225 hospitals

0 of top 15 factors determining Patient

Satisfaction referred to patient’s health outcome

PS directly related to Staff Interaction

PS directly correlated with ES (Employee Satisfaction)


1

“Perhaps the simplest and most profound of all human interactions is KINDNESS. …

But if it is so simple, it is surprising how frequently it is

absent from our healthcare environments. … Many staff

members report verbal

‘abuse’ by physicians, managers and coworkers.” —Putting

Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

1

“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 gentlemen”—4S credo)

1

2. Informing and Empowering Diverse

Populations: Consumer Health Libraries and

Patient Information

1

Planetree Health Resources Center/1981Planetree Classification System

Consumer Health LibrariansVolunteers

Classes, lecturesHealth Fairs

Griffin’s Mobile Health Resource CenterOpen Chart Policy

Patient Progress NotesCare Coordination Conferences (Est goals, timetable, etc.)


1

3. Healing Partnerships: The

Importance of Including

Friends and Family

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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

1

The Patient-Family Experience

“Patients 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

1

“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 Patient’s Eyes

1

“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 didn’t have a confidant.” —Institute for the Future

1

Institute of Medicine/ “Crossing the Quality Chasm”

Respect for preferencesInvolvement in Decision Making

Access to careCoordination of care

Information and educationPhysical comfort

Emotional supportInvolvement of Friends and Family

Continuity of care


1

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 Discussions

Family SpacesPet Visits (POP: Patients’ Own Pets)


1

4. Nutrition: The Nurturing Aspect

of Food

1

Meals are central events

vs

“There, you’re fed.” *

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


1

KitchenBeautiful cutlery, plates, etc

Chef rep


1

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


1

5. Spirituality: Inner Resources for

Healing

1

Spirituality: Meaning and Connectedness in Life

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


1

6. Human Touch: The Essentials of Communicating

Caring Through Massage

1

“Massage is a powerful way to

communicate caring.”

—Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

1

Mid-Columbia Medical Center/Center for Mind and Body

Massage for every patient scheduled for ambulatory surgery (“Go into surgery with a good attitude”)

Infant massageStaff massage (“caring for the caregivers”)

Healing environments: chemo!


1

7. Healing Arts: Nutrition for the

Soul

1

Planetree: “Environment conducive to healing”

Color!Light!

Brilliance!Form!Art!

Music!


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8. Integrating Complementary and

Alternative Practices into Conventional

Care

1

Griffin IMC/Integrative Medicine Center

MassageAcupunctureMeditation

ChiropracticNutritional supplements

Aroma therapy


1

CAM (Complementary & Alternative Medicine):

83M in US (42%)CAM visits 243M, greater than to PCP (Primary Care Physician) (With min insurance coverage)

W-Educated-Hi incDon’t tell PCP (40%)

And: <30% procedures used in conventional medicine have undergone RCTs (randomized

clinical trials)


1

9. Healing Environments:

Architecture and Design Conducive

to Health

1

“Planetree Look”

Woods and natural materialsIndirect lighting

Homelike settings

Goals: 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 beauty


1

Access to nurses station:

“Happen to”vs

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

1

Conclusion: Caring/Growth “Experience”

1

Care!Control!Connect! Engage!Grow!

De-stress!

1

Griffin/flagship …

On the verge of closing in ’80sFinancially sound

ProfitableAdding programs

Growing Market ShareOnly hospital on the “100 Best Companies To Work For” list

(7 consecutive years; #4 in 2006)

1

Learn more about Planetree/

The Planetree Alliance:

www.planetree.org

1

Life Sciences Revo Rocks Our World*

*Coming soon to a …

1

“On February 12, 2001, anyone with access to the Internet …

Could suddenly look at a new atlas …

One containing the whole human

genome.”

Source: Juan Enriquez, As The Future Catches You

1

“WE ARE BEGINNING TO ACQUIRE … DIRECT AND DELIBERATE CONTROL …

OVER THE EVOLUTION OF ALL LIFE FORMS …

ON THE PLANET.”Source: Juan Enriquez, As The Future Catches You

1

GRIN: Genetics, Robotics (nanotech),

Information, Nanotech

Source: Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies—and What It Means to Be Human, Joel Garreau

1

“We face the biggest change in tens of thousands of years in what it

means to be human.” … “In just 20 years the boundary

between fantasy and reality will be rent asunder.” (Rodney

Brooks, AIL/MIT) … “We are at an inflection point in history.” … “It is about the

defining cultural, social, and political issue of our age. It is about

human transformation.”


1

Ray Kurzweil: “Singularity”

1

415-page doc, Department of Commerce/NSF:

Converging Technologies for Increasing Human

Performance Source: Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies—and What It Means to Be Human, Joel Garreau

1

“Soldiers having no physical, physiological, or cognitive limitations will be key to survival

and operational dominance in the

future.” —Michael Goldblatt, Director,

Defense Sciences Office/DARPA


1

“Singularity”/“Bionic Tom,” circa 2006: Medtronic pacemaker (heart micro-

management) ; psychotropics (mental micro-

management) ; Google (mind-extension—smart-

beyond-measure) ; Samsung cell phone (instant-permanent planetary connectedness) ; Orvis

shirt with UV protection (“smart skin”)

1

“The four most dangerous words in medicine may be ‘First, do

no harm.’ ” —Fortune

“Simply put, the need for certainty in

drug approval is killing people.” —Fortune

“We take harms of action to be worse

than harms of inaction.” —Jonathon Barron/

U Penn

Source: “DEADLY CAUTION: How Our National Obsession With drug Safety Is Killing People—and What We Can Do about It”/Fortune

(02.20.06)

1

“If you don’t like change,

you’re going to like irrelevance even less.” —General Eric

Shinseki, Chief of Staff. U. S. Army

1

H5N1

1

Kroll/SARS: “don’t over-react”Kroll/H5N1:

“devastating”Source: Newsweek/10.24.05

1

Healthcare27

02.28.2006

1

Healthcare27

1. Fully utilize Physician’s Assistants to do routine work in a timely fashion. (“Doc in a Kiosk” at Wal*Mart is great!)

2. Maximize Outpatient services!3. Short hospital stays work! 4. Support home care to the max. (E.g., “Declaration of Independents”—Beacon Hill/Boston)

5. STOP THE 100K+ NEEDLESS DEATHS—much/most of the “quality stuff” is eminently fixable. (Don Berwick for President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!)

6. FLIP HC 177 DEGREES TO EMPHASIZE PREVENTION & WELLNESS. (“Steps” are being taken but not enough. Med schools: Awful! Insurers: Little better. Support for appropriate-proven alternative therapies is an important part.) (HUGE INCENTIVES FOR EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)

1

Healthcare27

7. “Boomers” will determine HC’s (very different?) future. (They are from a different & demanding planet compared to yesterday’s Oldsters.)

8. “Focus on Women.” (It’s my generic—and correct—rallying cry, and it applies to HC in spades, women-as-patients-with different-woes-than-men; women-as-HC decision makers at the “consumer”—and commercial—level.)

9. “Patient/Consumer-driven” may be a buzz phrase bandied about all to easily … but it is true. (And changes the game.)

10. Reduce incentives for unnecessary tests. (Malpractice caps would help, though the issue is complex. Insurers-HMOs doing so-so on this.)

11. OUTCOME-BASED MEDICINE IS A MUST! (There is a long, long way to go!) (Measure until you’re blue in the face!)

12. Science-based medicine is a terrific idea!! (Many “therapies” unproven scientifically, uneven in application when proven.)

1

Healthcare27

13. Over the next 5-25 years, the Life Sciences Revolution will make the likes of the “info revolution” look like small beer. (Get ready.)

14. Radical increase in “best practices” utilization—inculcate in Med school!15. Med school “revolution” imperative—outcome-based medicine, abiding emphasis on Wellness & Prevention, etc.16. Get info to Patients! (HIPAA mostly good.—“I wanna see my records!”) (Detailed hospital-by-hospital, disease-by-disease, doc-by-doc success records a must despite controversy.)

17. Upgrade IS-IT in the entire system, starting with acute-care institutions. (Current grade: D-.) (Winners include: Indiana Heart Hospital; Inova Fairfax Heart Institute.)

18. Healtheon WebMD-like (if it had worked) mega-, integrated-info network will-should emerge. (A healthcare Google+?)

1

Healthcare27

19. MOVE HEAVEN & EARTH TO IMPLEMENT ELECTRONIC MEDICAL RECORDS. NOW. 20. By hook or by crook, something approximating basic universal care, starting with kids—50 state partial experiments is a help; some are quite far along. (“Market-based” as much as possible—but this is far from a “perfect market.”)

21. Deal with the enormous HMO “I want my doc” perception problem. (Fact: MARCUS WELBY, STATISTICALLY, AIN’T THAT GREAT A HEALER IN TODAY’S “HIGH SCIENCE” WORLD! Incidentally, same perception problem re Congress, schools. “My Congressman is great, Congress has 434 other crook-clowns.” “My kids’ school is good, the system is awful.”)

22. Blitzkrieg of Patient/Customer/Citizen education (eg re “outcomes-based HC”; “Get the most for your HC dollar”). (Corporate cuts should motivate this.)

23. “Healing-centric” care supported. (E.g., Planetree model—reduces future problems.)

1

Healthcare27

24. Emphasize front-to-back “customer care” practices—cuts waaaaay down on malpractice claims among other things.25. Specialization in acute care works wonders, regardless of howls! (E.g., Shouldice/hernia repair.)

26.Shorten the FDA approval process. (Tom, age 63, wants the good new stuff and will accept associated risk; so will most boomers-geezers.)

27.DON’T MESS AROUND WITH H5N1/AVIAN FLU!

1

“If God spoke to me by saying, ‘Mark, you’re down to your last three words: What would you want to say to your fellow humans that would make the most positive impact?’ It would be a close

call between Love Thy Neighbor and Wash Your Hands. A close third

would be Move, Move, Move.” —Mark Pettus, M.D.,The Savvy Patient

“The most important thing you can do to keep from getting

sick is to wash your hands.” —CDC/National Center for Infectious

Diseases

1

Wash Your

Hands.

tom peters’ re-ima g ine ! toward health ( care ) excellence !

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