AHCA/NCAL 55th Annual Convention & Expo. Miam

1
Tom PetersLeading for Excellence Surpassing
Unrealistic ExpectationsAHCA/NCAL 55th Annual
Convention ExpoMiami Beach/10.04.2004
2
AHCA is the American Healthcare
Association.NCAL is the National Center for
Assisted Living.
3
Slides at tompeters.com
4
Goals.
5
Toms Healthcare9
Goals20041. Stop killing people in acute-care
settings through negligence/lousy
management/craft mores. (THIS IS ABOUT
ATTITUDE WILL NOT .)2. Adopt
Patient-centric acute-care models (a la
Planetree).3. Embrace the Boomer Tsunami.4.
Prepare for consumer-driven healthcare.5.
Revise-Revolutionize the entire system (K-90) to
revolve around Wellness-Prevention.6. Erase
the disgrace of uninsured Americans in
Planets Wealthiest Economy.7. Re-orient
Boomer-driven Eldercare toward Optimism (The
time of your life!) (60 30 90 60).8.
Re-imagine! What an Opportunity!9. Excellence
State of Mind.
6
Musings
7
This is the most important speech Ive given
since NAESP!
8
Never felt it so keenly Problem-focused?Oppor
tunity-focused?
9
RegulationsSky-high (Unrealistic)
ExpectationsInadequate FundingStaffing
WoesEtc.Etc.Etc.
10
Growth market or Magical Opportunity to Lead
this Demographic Revolution and Re-imagine
Aging?
11
Biases.
12
95/Ginger Cove/Life Care Services
13
WHY THE HELL SHOULDNT MY EXPECTATIONS BE
TOWERING?
14
T SS 34D
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Cool? Oh Bleep?60 30 90 - 60
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Old Age A Magical Time to fully/finally
appreciate life!
17
TP/61/CR Diet Eating Habits/Philosophy
Nutrition Supplements Breathing Stretching
Meditation (Short, Long) Exercise Mini-walks
Sound Flowers Aromatherapy Baths
Labyrinthine Massage Acupuncture
Chiropractic Big CR/CR Pauses Water
(Japanese bath) Stop. Look. Listen. ...
Monitor Measure Record. New World Order
Reverse 5 decades of abuse (With damn little help
from my M.D. friends)
18
Context.Weird.
19
Uncertainty is the only thing to be sure of.
Anthony Muh,head of investment in Asia,
Citigroup Asset Management If you dont like
change, youre going to like irrelevance even
less. General Eric Shinseki, Chief of Staff,
U. S. Army
20
Its no longer enough to be a change agent.
You must be a change insurgentprovoking,
prodding, warning everyone in sight that
complacency is death. Bob Reich
21
In Toms world, its always better to try a
swan dive and deliver a colossal belly flop than
to step timidly off the board while holding your
nose. Fast Company /October2003
22
Revolution.Period.
23
It is the foremost taskand responsibilityof
our generation to re-imagine our enterprises,
private and public. from the back cover,
Re-imagine!
24
No Wiggle Room! Incrementalism is innovations
worst enemy. Nicholas Negroponte
25
Beware of the tyranny of making Small Changes
to Small Things. Rather, make Big Changes to Big
Things. Roger Enrico, former Chairman, PepsiCo
26
The greatest dangerfor most of usis not that
our aim istoo highand we miss it,but that it
istoo lowand we reach it.Michelangelo
27
Characteristics of the Also ransMinimize
riskRespect the chain of commandSupport the
bossMake budgetFortune, article on Most
Admired Global Corporations
28
IS/IT. Go for the Gold. (Or At Least Try and Get
Off the Bench.)
29
Productivity!McKesson 2002-2003 Revenue 7B
Employees 500Source USA Today/06.14.04
30
Some grocery stores have better technology than
our hospitals and clinics. Tommy Thompson, HHS
SecretarySource Special Report on technology
in healthcare, U.S. News World Report (07.04)
31
Were in the Internet age, and the average
patient cant email their doctor.Donald
Berwick, Harvard Med School
32
Want email consultation 90 patients, 15
docs. Evidence Patients do not pester docs.
Time is saved. No one has sued (shows care
connectionthe absence of which is the major
cause of suits).Source New York Times
33
Computerized Physician Order Entry/CPOE 5 of
U.S. hospitalssource HealthLeaders/06.02
34
Telemedicine Reduces days/1000 patients and
physician visits for the chronically
illDecreases costs of managing chronic
diseaseExpands service areas for
providersReduces travel costs to and from
medical ed seminarsDouglas Goldstein,
e-Healthcare
35
Our entire facility is digital. No paper, no
film, no medical records. Nothing. And its all
integratedfrom the lab to X-ray to records to
physician order entry. Patients dont have to
wait for anything. The information from the
physicians office is in registration and vice
versa. The referring physician is immediately
sent an email telling him his patient has shown
up. Its wireless in-house. We have 800
notebook computers that are wireless. Physicians
can walk around with a computer thats
pre-programmed. If the physician wants, well 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
)
36
The VHA gets it! E.g. Laptop at bedside calls
up patient e-records from one of 1,300 hospitals.
Bar-coded wristband confirms meds. National
Center for Patient Safety in Ann Arbor. Docs
and researchers discuss optimal treatment
regimensresearch center in Durham NC. Doc
measures guidelines e.g., pneumonia
vaccinations from 50 to 84. Blame-free
system, modeled after airlines. Whats needed
in the U.S. is nothing short of a medical
revolution and the VHA has gone further than most
any other organization to revamp its culture and
systems.Rand/SourceWSJ 12.10.2001
37
Consumerism.
38
Amen!The Age of the Never Satisfied
CustomerRegis McKenna
39
We expect consumers to move into a position of
dominance in the early years of the new
century.Dean Coddington, Elizabeth Fischer,
Keith Moore Richard Clarke, Beyond Managed Care
40
Todays Healthcare Consumer skeptical and
demandingSource Ian Morrison, Health Care in
the New Millennium
41
Medical care has traditionally followed a
professional model, based on two assumptions
that patients are unable to become sufficiently
informed about their own care to allow them a
pivotal role, and that medical judgments are
based on science.Joseph Blumstein, Vanderbilt
Law School
42
Consumer ImperativesChoiceControl (Self-care,
Self-management)Shared Medical
Decision-makingCustomer ServiceInformationBrand
ingSource Institute for the Future
43
Savior for the Sickvs. Partner for Good
Health Source NPR
44
Quality.Whoops.Ouch.Yikes.
45
Without being disrespectful, I consider the U.S.
healthcare delivery system the largest cottage
industry in the world. There are virtually no
performance measurements and no standards. Trying
to measure performance is the next revolution
in healthcare.Richard Huber, former CEO, Aetna
46
A healthcare delivery system characterized by
idiosyncratic and often ill-informed judgments
must be restructured according to evidence-based
medical practice.Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
47
PARADOX Many, many formal case reviews failure
to systematically/ systemically/ statistically
look at and act on evidence.C.f.,
Complications, Atul Gawande
48
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
49
As unsettling as the prevalence of inappropriate
care is the enormous amount of what can only be
called ignorant care. A surprising 85 of
everyday medical treatments have never been
scientifically validated. For instance, when
family practitioners in Washington were queried
about treating a simple urinary tract infection,
82 physicians came up with an extraordinary 137
strategies.Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
50
Quality of care is the problem, not managed
care.Institute of Medicine
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CDC 1998 90,000 killed and 2,000,000 injured
from nosocomial hospital-caused drug errors
infections
52
HealthGrades/Denver 195,000 hospital deaths per
year in the U.S., 2000-2002 390 full
jumbos/747s in the drink per year. Comments
This should give you pause when you go to the
hospital. Dr. Kenneth Kizer, National Quality
Forum. There is little evidence that patient
safety has improved in the last five years. Dr.
Samantha CollierSource Boston Globe/07.27.04
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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
54
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
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In a disturbing 1991 study, 110 nurses of
varying experience levels took a written test of
their ability to calculate medication doses.
Eight out of 10 made calculation mistakes at
least 10 of the time, while four out of 10 made
mistakes 30 of the time.Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
56
YE GADS! New England Journal of Medicine/
Harvard Medical Practice Study 4 error rate (1
of 4 negligence). Subsequent investigations
around the country have confirmed the ubiquity of
error. In one small study of how clinicians
perform when patients have a sudden cardiac
arrest, 27 of 30 clinicians made an error in
using the defibrillator. Mistakes in
administering drugs (1995 study) average once
every hospital admission. Lucian Leape,
medicines leading expert on error, points out
that many other industrieswhether the task is
manufacturing semiconductors or serving customers
at the Ritz Carltonsimply wouldnt countenance
error rates like those in hospitals.
Complications, Atul Gawande
57
In health care, geography is destiny.Source
Dartmouth Medical School 1996 report
58
Geography Is DestinyE.g. Ft. Myers 4X
Manhattanback surgery. Newark 2X New
Havenprostatectomy. Rapid City SD 34X Elyria
OHbreast-conserving surgery. VT, ME, IA 3X
differences in hysterectomy by age 70 8X
tonsillectomy 4X prostatectomy (10X Baton Rouge
vs. Binghamton). Breast cancer screening 4X NE,
FL, MI vs. SE, SW. (Source various)
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Geography Is DestinyOften all one must do to
acquire a disease is to enter a country where a
disease is recognizedleaving the country will
either cure the malady or turn it into something
else. Blood pressure considered treatably high
in the United States might be considered normal
in England and the low blood pressure treated
with 85 drugs as well as hydrotherapy and spa
treatments in Germany would entitle its sufferer
to lower life insurance rates in the United
States. Lynn Payer, Medicine Culture
60
Its the Experience!
61
Experiences are as distinct from services as
services are from goods.Joseph Pine James
Gilmore, The Experience Economy Work Is Theatre
Every Business a Stage
62
The Experience LadderExperiences
ServicesGoods Raw Materials
63
Club Med is more than just a resort its a
means of rediscovering oneself, of inventing an
entirely new me. Source Jean-Marie Dru,
Disruption
64
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
thats not work or home. Its the place our
customers come for refuge.Nancy Orsolini,
District Manager
65
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
66
Most executives have no idea how to add value to
a market in the metaphysical world. But that is
what the market will cry out for in the future.
There is no lack of physical products to choose
between.Jesper Kunde, Unique Now ... or Never
on the excellence of Nokia, Nike, Lego, Virgin
et al.
67
A Certain Sort of Experience Women.
68
?????????Home Furnishings 94Vacations 92
(Adventure Travel 70/ 55B travel
equipment)Houses 91D.I.Y. (major home
projects) 80Consumer Electronics 51 (66
home computers) Cars 68 (90)All consumer
purchases 83 Bank Account 89Household
investment decisions 67Small business
loans/biz starts 70Health Care 80
69
Read This Book EVEolution The Eight Truths
of Marketing to WomenFaith Popcorn Lys
Marigold
70
EVEolution Truth No. 1Connecting Your Female
Consumers to Each Other Connects Them to Your
Brand
71
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
72
Women dont buy brands. They join
them.EVEolution
73
2.6 vs. 21
74
Resting State 30, 90 A woman knows her
childrens friends, hopes, dreams, romances,
secret fears, what they are thinking, how they
are feeling. Men are vaguely aware of some short
people also living in the house.Barbara
Allan Pease, Why Men Dont Listen Women Cant
Read Maps
75
As a hunter, a man needed vision that would
allow him to zero in on targets in the distance
whereas a woman needed eyes to allow a wide arc
of vision so that she could monitor any predators
sneaking up on the nest. This is why modern men
can find their way effortlessly to a distant pub,
but can never find things in fridges, cupboards
or drawers.Barbara Allan Pease, Why Men
Dont Listen Women Cant Read Maps
76
Female hearing advantage contributes
significantly to what is called womens
intuition and is one of the reasons why a woman
can read between the lines of what people say.
Men, however, shouldnt despair. They are
excellent at imitating animal sounds.Barbara
Allan Pease, Why Men Dont Listen Women Cant
Read Maps
77
When a woman is upset, she talks emotionally to
her friends but an upset man rebuilds a motor or
fixes a leaking tap.Barbara Allan Pease, Why
Men Dont Listen Women Cant Read Maps
78
Women are more comfortable talking or thinking
about people and relationships, while men prefer
to contemplate things. research reported in the
New York Times (08.10.2003)
79
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. Womens Market Opportunity
No. 1.8. Men are (STILL) in charge.9. MEN ARE
TOTALLY, HOPELESSLY CLUELESS ABOUT WOMEN.10.
Womens Market Opportunity No. 1.
80
The Hunch of a Lifetime An
Emergent (Market) Nexus I have a sense/hunch
theres an interesting nexus among several of the
ideas about New Market Realities that I promote
namely Women-Boomers-Wellness-Green-Intangibles.
Each one drives the Fundamental (Traditional)
Economic Value Proposition toward the softer
side From facts- figures-obsessed males
toward relationship-oriented Women. From
goods-driven youth toward experiences-craving
Boomers. From quick-fix pill-popping
healthcare toward a holistically inclined
Wellness Revolution. From mindless exploitation
of the Earths resources toward increased
awareness of the fragility and preciousness of
our Environment. From goods and services
toward Design- Creativity-rich
Intangibles-Experiences-Dreams Fulfilled. This
so-called softer sideas the disparate likes of
IBMs Sam Palmisano and Harley-Davidsons Rich
Teerlink teach usis now increasingly where
the loot is, damn near all the loot. That is,
the softer side has become the Prime Driver of
tomorrows hard economic value. Furthermore,
each of the Five Key Ideas (Women-Boomers-Wellness
-Green-Intangibles) feeds off and complements the
other four. Dare I use the word synergy?
Perhaps. (Or Of course!) I can imagine an
enterprise defining its raison detre in terms of
these Five Complementary Key Ideas. (HINT DAMN
FEW DO TODAY.)
81
WomenBoomersWellnessGreenIntangibles
82
An Emergent
Nexus Men ..... Women Youth
Boomers/Geezers Fix It
Healthcare.. Wellness/Prevention Exploit-t
he-Earth ...... Preserve/Cherish the
Planet Tangibles Intangibles
83
Experience Plus Planetree.
84
If one didnt know better, one might think that
hospitals set out to design systems that provide
the most sophisticated technical care but deliver
the worst possible experience to sick people.
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
85
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
86
Much of our current healthcare is about curing.
Curing is good. But healing is spiritual, and
healing is better, because we can hewal many
people we cannot cure. Leland Kaiser, Holistic
HospitalsSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
87
The 9 Planetree
Practices1. The Importance of Human
Interaction2. Informing and Empowering Diverse
Populations Consumer Health Libraries and
Patient Information3. Healing Partnerships The
importance of Including Friends and Family4.
Nutrition The Nurturing Aspect of Food5.
Spirituality Inner Resources for Healing6.
Human Touch The Essentials of Communicating
Caring Through Massage7. Healing Arts Nutrition
for the Soul8. Integrating Complementary and
Alternative Practices into Conventional
Care9. Healing Environments Architecture and
Design Conducive to HealthSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
88
1. The Importance of Human Interaction
89
There is a misconception that supportive
interactions require more staff or more time and
are therefore more costly. Although labor costs
are a substantial part of any hospital budget,
the interactions themselves add nothing to the
budget. Kindness is free. Listening to patients
or answering their questions costs nothing. It
can be argued that negative interactionsalienatin
g patients, being non-responsive to their needs
or limiting their sense of controlcan be very
costly. Angry, frustrated or frightened
patients may be combative, withdrawn and less
cooperativerequiring far more time than it would
have taken to interact with them initially in a
positive way. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
90
Press Ganey Assoc/1999 139,380 former patients
from 225 hospitals0 of top 15 factors
determining Patient Satisfaction referred to
patients health outcomePS directly related to
Staff InteractionPS directly correlated with ES
(Employee Satisfaction)Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
91
Mgrs re staff wages, security, promotion
opportunitiesStaff re staff interesting work
(M5 of 10), appreciation (5 of 10), sense of
being in about whats going on (10 of 10)
Source Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
92
The Customer Comes Second Put your People First
and Watch Em Kick Butt Hal Rosenbluth (and
Diane McFerrin Peters)
93
100 Best Places to Work/RLevering/2001Get
straight answersAppreciationCollaborationInt
erest in me as a personCamaraderie (Fun place
to work)
94
Perhaps the simplest and most profound of al
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
95
Planetree is about human beings caring for other
human beings. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel (Ladies
and gentlemen serving ladies and gentlemen4S
credo)
96
2. Informing and Empowering Diverse Populations
Consumer Health Libraries and Patient
Information
97
Planetree Health Resources Center/1981Planetree
Classification SystemConsumer Health
LibrariansVolunteersClasses, lectures
(CR)Health FairsGriffins Mobile Health
Resource CenterOpen Chart PolicyPatient
Progress NotesCare Coordination Conferences (Est
goals, timetable, etc.)Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
98
3. Healing Partnerships The importance of
Including Friends and Family
99
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
100
Family members, close friends and significant
others can have a far greater impact on
patients experience of illness, and on their
long-term health and happiness, than any
healthcare professional. Through the Patients
EyesSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
101
A 7-year follow-up of women diagnosed with
breast cancer showed that those who confided in
at least one person in the 3 months after surgery
had a 7-year survival rate of 72.4, as compared
to 56.3 for those who didnt have a
confidant.Source Institute for the Future
102
The Patient-Family ExperiencePatients are
stripped of control, their clothes are taken
away, they have little say over their schedule,
and they are deliberately separated from their
family and friends. Healthcare professionals
control all of the information about their
patients bodies and access to the people who can
answer questions and connect them with helpful
resources. Families are treated more as intruders
than loved ones. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
103
Institute of Medicine/ Crossing the Quality
ChasmRespect for preferencesInvolvement in
Decision MakingAccess to careCoordination of
careInformation and educationPhysical
comfortEmotional supportInvolvement of Friends
and FamilyContinuity of careSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
104
Care Partner Programs (IDs, discount meals,
etc.)Unrestricted visits (Most Planetree
hospitals have eliminated visiting restrictions
altogether.) (ER at one hospital has a policy
of never separating the patient from the family
and there is no limitation on how many family
members may be present.)Collaborative Care
ConferencesClinical Guidelines
DiscussionsFamily SpacesPet Visits (POP
Patients Own Pets)Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
105
4. Nutrition The Nurturing Aspect of Food
106
Meals are central eventsvsThere, youre
fed.Irony Focus on nutrition has
reduced focus on food and serviceSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
107
KitchenBeautiful cutlery, plates, etc.Chef
repSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
108
Aroma therapy (e.g., smell of baking
cookies)Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
109
5. Spirituality Inner Resources for Healing
110
Spirituality Meaning and Connectedness in
Life1. Connected to supportive and caring
group2. Sense of mastery and control3. Make
meaning out of disease/find meaning in
sufferingSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
111
Spiritualitybody-mind-spiritprayer-meditation-
visualizationSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
112
Griffin redesign chapel (waterfall, quiet music,
open prayer book)Other music, flowers,
portable labyrinthSource Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
113
6. Human Touch The Essentials of Communicating
Caring Through Massage
114
Massage is a powerful way to communicate
caring. Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
115
Mid-Columbia Medical Center/Center for Mind and
BodyMassage for every patient scheduled for
ambulatory surgery (Go into surgery with a good
attitude) Infant massageStaff massage (caring
for the caregivers)Healing environments
chemo!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
116
7. Healing Arts Nutrition for the Soul
117
Florence Nightingale/Notes on Nursing/patients
need for beauty, windows, flowers People say
the effect is only on the mind. It is no such
thing. The effect is on the body, tooSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
118
Planetree Environment conducive to
healingColor!Light!Brilliance!Form!Art!Mu
sic!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
119
Griffin Music in the parking lot professional
musicians in the lobby (7/week, 3-4hrs/day) 5
pianos volunteers (120-140 hrs arts
entertainment per month). Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
120
8. Integrating Complementary and Alternative
Practices into Conventional Care
121
CAM (Complementary Alternative Medicine) 83M
in US (42)CAM visits 243M greater than to PCP
(Primary Care Physician) (With min insurance
coverage)W-F-Educated-Hi incDont tell PCP
(40)OTA lt30 procedures used in conv med have
undergone RCTs (randomized clinical trials)
Source Putting Patients First, Susan Frampton,
Laura Gilpin, Patrick Charmel
122
Griffin IMC/Integrative Medicine
CenterMassageAcupunctureMeditationChiropracti
cNutritional supplementsAroma therapySource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
123
9. Healing Environments Architecture and Design
Conducive to Health
124
Planetree LookWoods and natural
materialsIndirect lightingHomelike
settingsGoals Welcome patients, friends and
family Value humans over technology .. Enable
patients to participate in their care Provide
flexibility to personalize the care of each
patient Encourage caregivers to be responsive
to patients Foster a connection to nature and
beautySource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
125
SoundTextureLightingColorSmellTasteSacred
spaceSource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
126
Access to nurses stationHappen
tovsHappen withSource Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
127
The Eden Alternative
128
The Ten Principals of the Eden
Alternative1. The three plagues of loneliness,
helplessness, and boredom account for the bulk of
suffering among Elders.2. Life in an
Elder-centered community revolves around close
and continuing contact with children, plants, and
animals. These ancient relationships provide
young and old alike with a pathway to a life
worth living.3. Companionship is the antidote to
loneliness. In an Elder-centered community we
must provide easy access to human and animal
companionship.4. A healthy Elder-centered
community seeks to balance the care that is being
given with the care that is being received.
Elders need opportunity to give care and
caregivers need opportunities need opportunities
to receive care.Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
129
The Eden paradigm allows elders to care for
animals, birds, and children as well each other.
Susan Eaton, Harvard/JFK schoolSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
130
The Ten Principals of the Eden
Alternative5. Variety and Spontaneity are the
antidotes to boredom. The Elder-centered
community is rich is rich in opportunities to
sample these ancient pleasures.6. An
Elder-centered community understands that passive
entertainment cannot fill a human life.7. The
Elder-centered community takes medical treatment
down from its pedestal and places it into the
service of genuine human caring.Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
131
The Ten Principals of the Eden
Alternative8. In an Elder-centered community,
decisions should be made by the Elders or those
as close to the Elders as possible.9. An
Elder-centered community understands human growth
cannot be separated from human life.10. Wise
leadership is the lifeblood of any struggle
against the Three Plagues. For it, there can be
no substitute.Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
132
Conclusion Caring/Growth Experience
133
Care!Control!Connect! Engage!Grow!
De-stress!
134
The most basic question we need to pose in
caring for others is this Is this a loving act?
Leland Kaiser, Holistic HospitalsSource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
135
Learn more about Planetree/The Planetree Alliance
www.planetree.org
136
Talent I.
137
The leaders of Great Groups love talent and
know where to find it. They revel in the talent
of others.Warren Bennis Patricia Ward
Biederman, Organizing Genius
138
PARCs Bob Taylor Connoisseur of Talent
139
Brand Talent.
140
Whats your companys EVP?Employee Value
Proposition, per Ed Michaels et al., The War for
Talent IBP/Internal Brand Promise per TP
141
EVP Challenge, professional growth, respect,
satisfaction, opportunity, rewardSource Ed
Michaels et al., The War for Talent
142
High T/O Is Not Inevitable! CostCo vs.
WalMart
143
Talent II.
144
AS LEADERS, WOMEN RULE New Studies find that
female managers outshine their male counterparts
in almost every measureTitle, Special Report,
BusinessWeek, 11.20.00
145
Womens Strengths Match New Economy Imperatives
Link rather than rank workers favor
interactive-collaborative leadership style
empowerment beats top-down decision making
sustain fruitful collaborations comfortable with
sharing information see redistribution of power
as victory, not surrender favor
multi-dimensional feedback value technical
interpersonal skills, individual group
contributions equally readily accept ambiguity
honor intuition as well as pure rationality
inherently flexible appreciate cultural
diversity.Source Judy B. Rosener, Americas
Competitive Secret Women Managers
146
Lead.
147
Ninety percent of what we call management
consists of making it difficult for people to get
things done. P.D.
148
G.H. Create a cause, not a business.
149
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
150
BZ I am a Dispenser of Enthusiasm!
151
Make it fun to work at your agency. Encourage
exuberance. Get rid of sad dogs who spread
gloom. David Ogilvy
152

• It was much later that I realized Dads secret.
  He gained respect by giving it. He talked and
  listened to the fourth-grade kids in Spring
  Valley who shined shoes the same way he talked
  and listened to a bishop or a college president.
  He was seriously interested in who you were and
  what you had to say.
• Sara Lawrence-Lightfoot, Respect

153
The two most powerful things in existence a
kind word and a thoughtful gesture.Ken
Langone, CEO, Invemed Associates from Ronna
Lichtenberg, Its Not Business, Its Personal
154
The deepest human need is the need to be
appreciated.William James
155
We look for ...... listening, caring,
smiling, saying Thank you, being warm.
Colleen Barrett, President, Southwest Airlines
156
Soft Is Hard- ISOE
157
Message Leadership is all about love! Passion,
Enthusiasms, Appetite for Life, Engagement,
Commitment, Great Causes Determination to Make
a Damn Difference, Shared Adventures, Bizarre
Failures, Growth, Insatiable Appetite for
Change. Otherwise, why bother? Just read
Dilbert. TPs final words CYNICISM SUCKS.
158
A key perhaps the key to leadership is
the effective communication of a story.Howard
Gardner Leading Minds An Anatomy of Leadership
159
Leaders dont just make products and make
decisions. Leaders make meaning. John Seely
Brown
160
You must be the change you wish to see in the
world.Gandhi
161
The single best way to predict the future is to
create it. anon
162
Appendix IHealthCare21
163
HealthCare21 21 Ideas for Century211.
Hospitals kill people. (And many of those they
dont kill, they wound.) (And they deny it.)
(ERRORS RULE!) And Hustling ambulances kill
pedestriansand dont save patients.2. Doctors
are spoiled bratswho dont like measurements.
Or any form of interference. Docs are also
cover-up artists. The REAL Hippocratic Oath
DONT RAT ON A FELLOW DOC. 3. Most
prescription drugs dont workfor a PARTICULAR
patient. Current drugs Blunderbusses.4. THINK
WELLNESS. THINK PREVENTION.5. THERE IS
LITTLE SCIENCE IN MEDICINE. (See state to
state variations country to country variations
the general lack of agreed-upon
treatments.)6. You could save thousands of lives
(think Schindler)if you just outlawed
handwritten prescriptions.7. Detailers will
disappear when GenX docs arrive.
164
HealthCare21
(Cont.)8. IS/IT in hospitals is sub-primitive
(despite enormous expenditures).9. Systemic
IS/IT is worselinks between docs, insurers,
providers, patients.10. ELECTRONIC MEDICAL
RECORDS TO UNIFORM STANDARDS. (NOW.)
(PLEASE.) 11. THE WEB WILL LIBERATE. (Info
Power.) (BELIEVE IT.) 12. 80M BOOMERS RULE.
(. Desire for c-o-m-p-l-e-t-e
CONTROL. NOW. LEADERSHIP OF AGING
PROCESS.)13. Drug Discovery processes at Big
Pharma are hopelessly over-complicated.
(??? Bye Bye Big Pharma.)14. 90 of the
healthcare fix HARVEST THE LOW-HANGING
FRUIT. They are NOT the Enemy. I have
seen the enemy and it am me. Damn it.
165
HealthCare21 (Cont.)15. The
number of U.S. un-insured is the nations 1
disgrace. That said, insured consumers
are spoiled brats. They/we/me act as if
healthcare were a free good and believe
that an incipient hangnail calls for at least a
CAT scan or two. ANSWER MAKE US FEEL
THE PAIN.16. Genetic engineering biotech
change EVERYTHING. (Within 15
years.)17. New Medical Devices change
EVERYTHING. (Within 15 years.)18. IS/IT
changes EVERYTHING. (Within 10 years.)19. New
Docs change EVERYTHING. (Within 10 years.)20.
New Patients change EVERYTHING. (Within 5
years.)


166
HealthCare21 (Cont.)21.
ALL THIS ENORMOUS OPPORTUNITY. The
Opportunity of Several Lifetimes. (For the Bold
Brave.) HCare WILL be TOTALLY re-invented
in the next two decades. (And, hey, it is our
largest industry.)
167
Appendix IIHealthCare2
168

• 
  Healthcares 1-2 Punch
• Hospital quality control, at least in the
  U.S.A., is a bad, bad joke. Depending on whose
  stats you believe, hospitals kill 100,000 or so
  of us a yearand wound many times that number.
  Finally, they are getting around to dealing
  with the issue. Well, thanks. And what is it
  weve been buying for our Trillion or so bucks a
  year? The fix is eminently do-able which makes
  the condition even more intolerable. (Disgrace
  is far too kind a label for the condition.
  Whos to blame? Just about everybody, starting
  with the docs who consider oversight from anyone
  other than fellow clan members to be
  unacceptable.)
• 2. The systemtraining, docs, insurance
  incentives, culture, patients themselvesis
  hopelessly-mindlessly-insanely (as I see it)
  skewed toward fixing things (e.g. Me) that are
  brokennot preventing the problem in the first
  place and providing the Maintenance Tools
  necessary for a healthy lifestyle. Sure,
  bio-medicine will soon allow us to understand and
  deal with individual genetic pre-dispositions.
  (And hooray!) But take it from this 61-year old,
  decades of physical and psychological self-abuse
  can literally be reversed in relatively short
  order by an encompassing approach to life that
  can only be described as a Passion for Wellness
  (and Well-being). Patientslike meare catching
  on in record numbers but the system is highly
  resistant. (Again, the doctors are among the
  biggest sinnersno surprise, following years of
  acculturation as the man-with-the-white-coat-who-
  will-now-miraculously-dispense-fix
  it-pills-for-you-the-unwashed. (Come to think of
  it, maybe Ill start wearing a White Coat to my
  doctors officeafter all, I am the
  Professional-in-Charge when it comes to my Body
  Soul. Right?)