Tom Peters

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Tom Peters EXCELLENCE. ALWAYS.McKesso
n 2008 Executive Leadership SummitThe
Broadmoor/Colorado Springs/23 July 2008
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Slides at tompeters.comAlso Long
version
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Part One A Civilian Looks at Your World
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DVM/Lyme/2005-2008Multip
le diagnoses (gt5)Specialist self-certaintyHe
alth deterioration failed to produce urgency-
communicationVirtually no communications
between specialistsFollow-up very spotty
unless bugged incessantlyLost major test
results, mis-placed 3 or 4 occasionsNear
fatal drug mistake (one nurse takes
charge)Effectively, disinterest in
chronic-careLack of curiosity
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Bottom line 1900-1960, life expectancy grew
0.64 per year 1960-2002, 0.24 per year, half
from airbags, gun locks, service employment
Source Best Care Anywhere Why VA Healthcare
Is Better Than Yours/Phillip Longman
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The more doctors and specialists around, the
more tests and procedures performed. And the
results of all these tests and procedures? Lots
more medical bills, exposure to medical errors,
and a loss of life expectancy. It was this
last conclusion that was truly shocking, but it
became unavoidable when Dartmouths Dr. Jack
Wennberg and others broadened their studies. They
found its not just that renowned hospitals and
their specialists tend to engage in massive
overtreatment. They also tend to be poor at
providing critical but routine care. Source
Best Care Anywhere Why VA Healthcare Is Better
Than Yours/Phillip Longman
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If we sent 30 percent of the doctors in this
country to Africa, we might raise the level of
health on both continents. Dr Elliott Fisher,
Center of Evaluative Clinical Sciences,
Dartmouth Medical School (Overdose, Atlantic,
Shannon Brownlee.)
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CDC 1998 98,000 killed and 2,000,000 injured
from hospital-caused drug errors infections
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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
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Hospital infections kill an estimated 103,000
people in the United States a year, as many as
AIDS, breast cancer and auto accidents combined.
Today, experts estimate that more than 60
percent of staph infections are M.R.S.A. up from
2 percent in 1974. Hospitals in Denmark, Finland
and the Netherlands once faced similar rates, but
brought them down to below 1 percent. How?
Through the rigorous enforcement of rules on hand
washing, the meticulous cleaning of equipment and
hospital rooms, the use of gowns and disposable
aprons to prevent doctors and nurses from
spreading germs on clothing and the testing of
incoming patients to identify and isolate those
carrying the germ. Many hospital administrators
say they cant afford to take the necessary
precautions. Betsy McCaughey, founder of the
Committee to Reduce Infection Deaths (New York
Times/06.06.2005)
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Experts estimate that more than a hundred
thousand Americans die each year not from
illness but from their prescription drugs. Those
deaths, occurring quietly, almost without notice
in hospitals, emergency rooms, and homes, make
medicines one of the leading causes of death in
the United States. On a daily basis, prescription
pills are estimated to kill more than 270
Americans. Prescription medicines, taken
according to doctors instructions, kill more
Americans than either diabetes or Alzheimers
disease.Source Our Daily Meds How the
Pharmaceutical Companies Transformed Themselves
into Slick Marketing Machines and Hooked the
Nation on Prescription Drugs Melody Petersen
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140,000,000 illegible prescriptions per year
John Hammergren Phil Harkins, Skin in the
Game How Putting Yourself First Today Will
Revolutionize Healthcare Tomorrow
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1,500,000,000,000 claims per year30
errors15 lost25 paper-basedSource
John Hammergren Phil Harkins, Skin in the Game
How Putting Yourself First Today Will
Revolutionize Healthcare Tomorrow
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stunning lack of scientific knowledge about
which treatments and procedures actually
work Source Best Care Anywhere Why VA
Healthcare Is Better Than Yours/Phillip Longman
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The results are deadly. In addition to the
98,000 killed by medical errors in hospitals and
the 90,000 deaths caused by hospital infections,
another 126,000 die from their doctors failure
to observe evidence-based protocols for just four
common conditions hypertension, heart attack,
pneumonia, and colorectal cancer. TP total
314,000 Source Best Care Anywhere Why VA
Healthcare Is Better Than Yours/Phillip Longman
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Plus God alone knows how many casualties in
doctors offices, Tom Thom Mayer
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Part Two The Last 98
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1
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it is the game.
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If I could have chosen not to tackle the IBM
culture head-on, I probably wouldnt 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 isnt just one aspect of
the game it is the game. Lou Gerstner, Who
Says Elephants Cant Dance
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30-fold!
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Ken Kizer/VA 1997 culture of cover-up that
pervades healthcare Patient Safety Event
Registry looking for systemic solutions, not
seeking to fix blame on individuals except in the
most egregious cases. The good news was a
thirty-fold increase in the number of medical
mistakes and adverse events that got reported.
National Center for Patient Safety Ann Arbor
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2
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Thank you Ike , Charlie, Ben Norm,
George, Nelson, and Ben
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Allied commands depend on mutual confidence
and this confidence is gained, above all
through the development of friendships.
General D.D. Eisenhower, Armchair General
(05.08)Perhaps his most outstanding ability
at West Point was the ease with which he made
friends and earned the trust of fellow cadets
who came from widely varied backgrounds it was
a quality that would pay great dividends during
his future coalition command.
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George Crile (Charlie Wilsons War) on Charlie
Wilson The way things normally work, if youre
not Jewish you dont get into the Jewish caucus,
but Charlie did. And if youre not black you
dont get into the black caucus. But Charlie
plays poker with the black caucus they had a
game, and hes the only white guy in it. The
House, like any human institution, is moved by
friendships, and no matter what people might
think about Wilsons antics, they tend to like
him and enjoy his company.
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Give good tea!
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The 95 Factor What I learned from my years as
a hostage negotiator is that we do not have to
feel powerlessand that bonding is the antidote
to the hostage situation. George Kohlrieser,
Hostage at the Table
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?
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I am a dispenser of enthusiasm. Ben Zander
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3
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Hard Is SoftSoft Is Hard
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Hard Is Soft (Plans, s)Soft Is Hard (people,
customers, values, relationships))
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R.O.I.R.
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Return On Investment In Relationships
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Relationships (of all varieties) THERE ONCE WAS
A TIME WHEN A THREE-MINUTE PHONE CALL WOULD HAVE
AVOIDED SETTING OFF THE DOWNWARD SPIRAL THAT
RESULTED IN A COMPLETE RUPTURE.

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Courtesies of a small and trivial character are
the ones which strike deepest in the grateful and
appreciating heart. Henry Clay
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4
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X XFXExcellence Cross-functional
Excellence
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The XF-50 50 Ways to Enhance Cross-Functional
Effectiveness and Deliver Speed, Service
Excellence and Value-added Customer
SolutionsEntire XF-50 List is an
Appendix to the LONG version of this
presentation, posted at tompeters.com
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Never waste a lunch!
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???? XF lunches Measure!
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CIO Question Doc lunches Last 30 days
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???????Success doesnt depend on the number of
people you know it depends on the number of
people you know in high places!or Success
doesnt depend on the number of people you know
it depends on the number of people you know in
low places!
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Loser Hes such a suck-up!Winner
Hes such a suck-down.
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George Crile (Charlie Wilsons War) on Gust
Avrakotos strategy He had become something
of a legend with these people who manned the
underbelly of the Agency CIA.
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5
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William Easterly, The White Mans Burden Why the
Wests Effort to Aid the Rest Have Done So Much
Ill and so Little Good The West spent 2.3
trillion on foreign aid over the last five
decades and still has not managed to get
twelve-cent medicines to children to prevent half
of all malaria deaths. The West spent 2.3
trillion and still not managed to get three
dollars to each new mother to prevent five
million child deaths. But I and many other
like-minded people keep trying, not to abandon
aid to the poor, but to make sure it reaches
them.
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Lesson Show up. Lesson Listen to the
locals. Lesson Hear the locals. Lesson
Engage the locals. Lesson Try a lot of
stuff.
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MBWA
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18 Source How Doctors Think, Jerome Groopman
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Buy in- Ownership-Authorial bragging
rights-Born again Champion One Line of Code!
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We made mistakes, of course. Most of them were
omissions we didnt think of when we initially
wrote the software. We fixed them by doing it
over and over, again and again. We do the same
today. While our competitors are still sucking
their thumbs trying to make the design perfect,
were already on prototype version 5. By the
time our rivals are ready with wires and screws,
we are on version 10. It gets back to planning
versus acting We act from day one others plan
how to planfor months. Bloomberg by Bloomberg
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For projects involving children or health or
education or community development or sustainable
small-business growth (most projects), women are
by far the most reliable and most central and
most indirectly powerful local players even in
the most chauvinist settings.
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Forget China, India and the Internet Economic
Growth Is Driven by Women. Headline, Economist,
April 15, 2006, Leader, page 14
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10 UNASSAILABLE REASONS WOMEN
RULE Women make all the financial
decisions.Women control all the wealth. Women
substantially outlive men. Women start most of
the new businesses. Womens work force
participation rates have soared
worldwide. Women are closing in on same pay for
same job. Women are penetrating senior
ranks rapidly even if the pace is slow for
the corner office per se. Womens
leadership strengths are exceptionally well
aligned with new organizational effectiveness
imperatives. Women are better salespersons than
men. Women buy almost everythingcommercial
as well as consumer goods. So what exactly is
the point of men?
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You have to treat your employees like
customers. Herb Kelleher, upon being asked his
secret to successSource Joe Nocera, NYT,
Parting Words of an Airline Pioneer, on the
occasion of Herb Kellehers retirement after 37
years at Southwest Airlines (SWAs pilots union
took out a full-page ad in USA Today thanking HK
for all he had done across the way in Dallas
American Airlines pilots were picketing the
Annual Meeting)
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no less than Cathedrals in which the full and
awesome power of the Imagination and Spirit and
native Entrepreneurial flair of diverse
individuals is unleashed in passionate pursuit of
Excellence.
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1 cause ofDis-satisfaction?
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2 per Year Excellence Legacy
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Nudge.Sway.K.I.S.S.Keep It Simple, Stupid
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90K in U.S.A. ICUs on any given day 178
steps/day in ICU.50 stays result in serious
complicationSource Atul Gawande, The
Checklist (New Yorker, 1210.07)
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Peter Pronovost, Johns Hopkins,
2001Checklist, line infections1/3rd at
least one error when he startedNurses/permissio
n to stop procedure if doc, other not following
checklistIn 1 year, 10-day line-infection
rate 11 to 0 Source Atul Gawande, The
Checklist (New Yorker, 1210.07)
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Docs, nurses make own checklists on whatever
process-procedure they chooseWithin weeks,
average stay in ICU down 50Source Atul
Gawande, The Checklist (New Yorker, 1210.07)
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Everything matters -80 Source Nudge,
Richard Thaler and Cass Sunstein, etching of fly
in the urinal reduces spillage by 80,
Schiphol Airport
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10
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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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ltTGWvs. gtTGR
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2-cent candy
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Part Three Five Pianos
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Planetree A Radical Model for New
Healthcare/Healing/Wellness ExcellenceTom
Peters
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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
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1. The Importance of Human Interaction
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Press Ganey Assoc 139,380 former patients from
225 hospitalsnone of THE top 15 factors
determining Patient Satisfaction referred to
patients health outcomePS directly related to
Staff InteractionPS directly correlated with
Employee Satisfaction Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
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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
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2. Informing and Empowering Diverse Populations
Consumer Health Libraries and Patient
Information
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Planetree Health Resources Center/1981Planetree
Classification SystemConsumer Health
LibrariansVolunteersClasses, lecturesHealth
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
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3. Healing Partnerships The Importance of
Including Friends and Family
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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
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4. Nutrition The Nurturing Aspect of Food
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KitchenBeautiful cutlery, plates, etcChef
reputation Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
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5. Spirituality Inner Resources for Healing
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Griffin redesign chapel (waterfall,
quiet music, open prayer book)Other music,
flowers, portable
labyrinthSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
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6. Human Touch The Essentials of Communicating
Caring Through Massage
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Mid-Columbia Medical Center/Center for Mind and
BodyMassage for every patient scheduled for
ambulatory surgery (Go into surgery witha good
attitude) Infant massageStaff massage (caring
for the caregivers)Healing environments
chemo!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
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7. Healing Arts Nutrition for the Soul
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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
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8. Integrating Complementary and Alternative
Practices into Conventional Care
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Griffin IMC/Integrative Medicine
CenterMassageAcupunctureMeditationChiropracti
cNutritional supplementsAroma therapySource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
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9. Healing Environments Architecture and Design
Conduciveto Health
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F.Y.I. It works!
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Griffin Hospital/Derby CT (Planetree Alliance
HQ) Results Financially successful.
Expanding programs-physically. Growing market
share. Only hospital in 100 Best Cos to Work
for7 consecutive years, currently 6.
Five-Star Hospitals, Joe Flower,
strategybusiness (42)
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9 July 2008/HealthLeaders Media 2008 Top
Leadership Team in Healthcare Griffin Hospital
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How will you know when the healthcare industry
has finally entered the 21st century? When
error rates at hospitals are close to zero. When
doctors and nurses use evidence-based protocols
in your treatment. When you can decide how much
to spend on treatment, and you have the
information and the opportunity to determine the
best value. When your primary care physician is
in charge of your extended care team, operating
as your command central. When all members of
the medical communitynurses, doctors,
pharmacists and specialistswork together
seamlessly on your behalf. When their combined
efforts are tracked, measured, and reported
onand the insurance reimbursements awarded to
them are based on performance. When you see
that hospitals, pharmacies and doctors are
working harder in all aspects to make sure you
are an informed consumer who has trust and
confidence in the services they offer and the
prices they charge. John Hammergren Phil
Harkins, Skin in the Game How Putting Yourself
First Today Will Revolutionize Healthcare
Tomorrow