Comments

Tom, I know you have poo-poo'ed Systems Thinking in past columns. But, this is what the Health Care SYSTEM needs - is to be treated as a system of linked messes. Clare Crawford-Mason ("If Japan Can, Why Can't We?") has put considerable effort into the Health Care dilemna. See her website at http://www.managementwisdom.com/goodnews.html

Steve Prevette
Fluor
ASQ CQE

Posted by Steve Prevette at March 31, 2008 4:23 PM

286 great slides thank you Tom. Your presentation relates to the US healthcare system but has relevance to the UK healthcare system too. I’ve spent my working life in health and healthcare and I still love it after 39 years. The saddest thing to me - and a paradox - is that millions of people working in healthcare are totally committed and dedicated folks, trying damned hard to do a great job caring for sick people.

Our new approach has to be more about self health improvement where we each take more responsibility for our own health.

We must also see brave political decisions to close big hospitals that are unnecessary and investing that money instead into positive lifestyle initiatives.

We need to give incentives to individuals to stay healthy.

Most of this health improvement stuff by the way has nothing whatsoever to do with doctors, nurses and healthcare providers.

Most health improvements in the last several centuries have come from improvements in public health like improved sanitation, better water supplies and better living standards RATHER THAN advances in medical technology. Better medical techniques come into play to fix people when they are sick and not in the prevention of illness – it is a no brainer.

We should use our wonderful front line doctors and nurses and other clinicians to fix people who are ill and we should use all other means at our disposal to stop people becoming ill. And that starts with making individual healthier lifestyle choices.

Tom – you took 10 years to develop this presentation so a few lines in response through these comments does inadequate justice to your work but heartfelt thanks from me for putting your head above the parapet to challenge the ostriches. Keep rattling the cage.

Posted by Trevor Gay at March 31, 2008 5:22 PM

This is a nice cull of points !!

I wish TP would inject and mix in audio into these slides.. !!

Posted by /pd at March 31, 2008 5:25 PM

I'm 55, reasonably healthy, self-employed and spend about $9000/year on non-group healthcare coverage with high deductibles. I haven't seen a doctor in years and the premiums rise about 15%/year.

I'd gladly spend about $1000/year for some checkups and preventive visits (out of pocket) if doing so didn't put me at risk for not being able to buy/afford future or continued coverage.

I had difficulty getting the coverage I have and the list of deal breakers when applying for coverage grows longer all the time. Things like: Have you been treated for X (you name it) in the last 10 years?

I live in fear of a medical event ruining me financially and then making me uninsurable. I've tried to be diligent in buying good coverage. My wife and I could not get the same companies to insure us both (her coverage is even more expensive). I never thought being self-employed would create such health care traps...real or imagined.

Posted by Perspective at March 31, 2008 8:10 PM

For whatever reason the attachment link is not working in either Safari 3.1 or FireFox on my Mac.

But if I view source and input it, I get the file.

Links later on in post work just fine.

Posted by Shawn Petriw at March 31, 2008 8:39 PM

Tom Congratulations!

You have done a vintage Tom Peters job with this presentation. This slide show is important in 2008 because it is about health and how NOT to organise for it today and tomorrow.

Health is about linking information to action - current models of health care around the globe do a poor job of it. Tom you have done an excellent job of exposing the reasons we all get less than we should expect from our health care providers - you have explained in graphic terms why they do not always improve our health.

There are too many good points in your slides, Tom, to cover them all here so I will try to give you all the encouragement and positive feedback I can muster on the critical ones.

So what are the problems? Why do they persist? What can we do about these problems?

Problem #1 is the patient is not use to being in control of his or her health - instead they cede control of their health to a series of health care mechanics. Warning number one - ceding your health to health care mechanics should only ever be a last resort. Allowing these mechanics to fix your body, mind, or spirit is always fraught with danger. Mechanics are good if you are smashed up and need repairs - that is you had an accident or you have neglected your health for years. Then you need the best mechanic you can get - you need them to do a bare minimum and then go rehabilitate yourself.

Problem #2 the revenue models in all health care systems - private or public - are badly flawed. Both the UK and the US health care systems suffer from the same chronic problem. Both over spend on tools for mechanics and underspend on information technology for patient health. Both revenue models are biased towards intervention not prevention - neither is focused on health improvement. Health is improved when information is freely available to all patients at all times - but this can not and will not happen in the current UK or US systems because both revenue models capture & store all the key information in the mechanics tool kit not in the patient's computer, iPod, iPhone, medicare card, etc.

Problem #3 there are simply too many mechanics in the health care system - the common perception is that more mechanics are needed to cope with a huge growth in patient needs (NB if young individuals continue to abuse their health this could become a huge problem by 2030). Supporting this call for more mechanics in 2008 is the notion that patient demand is outstripping the supply of mechanics. Both perceptions are dead wrong! The real problem is there are too many mechanics in the health care system and too few information technologists who could better provide the health information that patients need. In 2008 and beyond we need more and better health information systems and fewer, far fewer, health care mechanics. We need to automate the paper-based systems of health care services and convert them to digital systems tailored to meet each individual's need for health information storing, updating, and sharing.

Problem #4 health is a decentralised activity whereas health care servicing is a centralised activity - these two are incompatible. Emergency is the only place in the centralised institutions of health care services that is decentralised - it works effectively and efficiently while the crisis is on. Once the crisis is passed try finding the EXIT to this splendidly chaotic system - there is no obvious pathway to a patient resuming control of his or her circumstance. I believe IDEO may have done a job on this at the MAYO Clinic but I am not sure of details - I am sure that someone out there will know about it Tom. Health is always about decentralised information and care based on patient needs and use value... Health Care Systems are almost always highly centralised, over-populated with staff, over-spent on intrusive technologies, and under funded on information technologies that might save patients lives.

Problem #5 health care is a people and paper based system that could and should be ruthlessly automated - there should be a self-service and full service mode. Self-service is day surgery or the like where you book yourself in and the mechanics work you over before you get up and leave at the end of the day. Full-service is for longer stay events where the mechanics have to do major repairs - in this instance you will need a patient's advocate to help you make decisions or to make those decisions for you. Mechanics are mechanics and some are good and others not so good - they all need to be challenged on their diagnosis and prognosis.

Problem #6 health insurance is about financial risk not health risk. When health insurance is mandated by governments the industry that it creates is focused on pooled financial risks not pooled health risks. For example, if you take the 2,000 most expensive clients for a health insurance company and you pay for them to have a full time (yeah 24/7) nurse or patients advocate and other health related services - eg beepers for medicine times that are coded with colours for medications, etc - then the cost to the insurers will come down and yeah you guessed it Tom the health of the patient will go UP! Let's have a system that is all about health risks - we have a system that is attuned to financial risks due to the high cost of health care service mechanics and their over servicing.

Finally the biggest problem is most of us have been cultured into believing that we have the best health system in the world... It is an ugly urban myth - as you have pointed out in your slides Tom - none of us can have a reliable health system unless or until we are in complete control and when we can not maintain vigilance and control we have to be able to ceded it to our trusted patient advocate....

Keep up your good work Tom - you will help save lives!

Richard.

Posted by Richard Lipscombe at April 1, 2008 12:58 AM

Solution:

Free high-tech health care in India, Andhra Pradesh.

From 1991-2004 statistics:
14.309 Heart surgeries FOR FREE
14.637 Cath procedures FOR FREE
24.443 Urology surgeries FOR FREE
24.333 Opthalomology surgeries FOR FREE
3.865 CT scans FOR FREE

http://www.sathyasai.org/saihealth/safaya.htm

p.s.
That 30% American doctors in Africa is not bad idea at all:)

Posted by Ina Matijevic at April 1, 2008 1:13 AM

As Richard Lipsombe usually has much to say, as well as I, I am sorry to those who are reading our comments back to back and hope that my comment will be said succintly, though I rather doubt it. It will probably be longer rather than shorter, but I promise to return the consideration. I hope I will say something useful.

Thank you, TP for such a touching presentation. Terribly emotional I may be, but I found myself incredibly moved by both the horror and beauty here. The stats are indeed horrific, "stunning," “flabbergasting, indeed. But there was such beauty in those who have tried and succeeded in implementing small things that have had incredible powerful positive affects. We are most grateful to these and to you for the work done to present such beauty to us. Regardless of the horror, where truth exists, there is always beauty. Thank you.

To speak a bit about your presentation style, it always strikes me as a brilliant stream of consciousness piece where connections are made in ubiquitous places throughout. Perhaps because of the seriousness of the topic, I found this presentation to be less so. Its “plot” had more of a beginning, middle and end in a more conventional way. It works, as does the others whose thoughts are connected in an unsuspected seemingly unconnected manner, albeit thoroughly readable. Thank you.

There were a few dramatic cliff hangers where answers did not come until later on in the presentation, and because of their oddity as in “5 PIANOS,” I looked for the answer with each slide, though being thoroughly in the moment of the current slide. The mind really can hold more than one thought simultaneously, especially if the proper scenario is set up, which leads the reader somewhere, even as the import of the current slide assumes its important place. This slide too will lead somewhere. But where? I waited, holding more than several thoughts simultaneously. Thank you.

With so many slides, I will try to make my comments succinctly on selected ones. At least this is my desire, though I fear not do particularly well.

Slide 12: Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs —Melody Petersen.

These quotes remind of a commercial that I’ve been seeing lately that has gotten under my skin, but I did not know all together why. Well, I had my suspicions, but when I read this quote it became obvious. The commercial deals The Partnership for Prescription Assistance (PHARMA) bus tour that goes through inner cities assisting the uninsured with free or nearly free badly "needed" prescription medicines.

As I read this slide, I thought of its spokesperson and TV host, Montel Williams, the now picture of health, although battling MS, speaking to million of TV viewers of the goodness and necessity of pharmaceutical companies. PHARMA undoubtedly pays him well.

This quote is found on the PHARMA website:

"PHARMA -- Disease is our enemy. Working to save lives is our job."

"The Partnership for Prescription Assistance's ‘Help Is Here Express’ vehicle provides the mobility to reach, inform and register at-risk patients in communities of color for benefits to help pay for life-saving medicines - enabling compliance and potentially offsetting the prevalence of disease disparities," said Gary A. Puckrein, Ph.D., executive director of the National Minority Health Month Foundation.

Noble Motives? I have my doubts. Distributing meds on a rolling tour bus could NOT by ANY MEANS describe care. Would not the focus be better spent on prevention and health matter, not pharmaceuticals? This bus tour also reminds me of...

Slide 25: “America’s elites are very good at attracting money and prestige, and they have a huge technology arsenal with which they attack death and disease. But they have no positive medical results to show for it in the aggregate and many indications that
they are providing lower-quality care than the much-maligned HMOs and assorted St. Elsewheres.”

And….

Slide 53: “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 Alzheimer’s disease.”

OK! I’m going to have to stop abruptly right here. I have taken scrupulous notes and have jotted down quite a few stories to accompany many of the slides. Although, my head is on fire, I will stop now. I fear my comments will be much too long. Anyway, thanks again, TP for this most important work. It is a work that obvious has implications in the in the US and undoubtedly in other countries of the world. Maybe a copy could be sent to the Gates Foundation. They’re doing groundbreaking work in Africa in the field of medicine. Better yet, maybe you can speak before the Foundation board and Mr. and Mrs. Gates themselves.

One more thing…as a licensed chaplain who grew up visiting senior homes as an adolescent, something my nieces and nephews still do to this day twice a month from the littlest on up, I am heartened by Plantree's work. There is not a more beautiful scene seeing seniors and young people interrelating. It often brings me to tears. Once when I was massaging the legs and feet of a senior suffering with diabetes, where here eyes were growing deem and her feet getting numb, she whispered to me, “Judith, you have healing hands.” I went home and wept.

When I look at my nieces and nephews, in the same place where I once was, I am heartened. The light in seniors’ eyes who otherwise may not have contact with sometimes rambunctious young people in such a setting, money cannot buy. And the sense of self-worth that young people receive by reading to those who can no longer read for themselves is invaluable. I am so thankful for the work that Planetree does. I wish them continued success and tremendous profits.

Posted by Judith Ellis at April 1, 2008 2:13 AM

Tom,

simply
awesome my friend,
awsome,

Patrick (shocked and amazed of the UK!)

Posted by Patrick at April 1, 2008 8:06 AM

Ina Matijevic...what a majestic structure. Thanks for the image that aligns beautifully with the aesthetic TP spoke of.

I'd also like to see a hospital designed here in America in the spirit of Frank Lloyd Wright...a Fallingwater of sorts where the aesthetic is wholly internal and external.

Wouldn't that be nice? Talk about healing? Wow!

Posted by Judith Ellis at April 1, 2008 10:06 AM

And...Ina...while the procedures listed above are "free," the question still remains of their necessity, especially in cases where the name of the patient has not been asked or checklist initiated. How does the "little stuff" stack up in your part of the world?

Posted by Judith Ellis at April 1, 2008 10:15 AM

Judith, I would not only question the necessity of the procedures but the definition of 'free'. Free to the patient involved? Or is this like corporate taxes? They just get passed through to others as a cost of business. All hospitals provide charity and indigent care. Could those also be considered free, since the patient doesn't pay?

Posted by MikeC at April 1, 2008 11:46 AM

Great point, MikeC! I was also thinking about countries with national healthcare where taxes are so incredibly high, where there is no choice for the citizen. Now, I'm all for national healthcare of some sort, but how such a program is implemented, as we will know, is up for great debate.

Perhaps, it is the debate itself that is the problem. I tend to be more for privatizing things with some sort of governmental oversight. A government run with entrepreneur-like thought, with compassion for its people, is what's needed. Red tape is a killer, systemic legacy entitlement too.

Posted by Judith Ellis at April 1, 2008 12:45 PM

I bet a look at the stats would show the US has the highest standard deviation in life expectancy in the world.
That is part of the problem. People in the upper income scale have the best health care system in the world. In fact, I would bet on all quality of life issues that can be measured quantitively, the U.S. has the highest standard deviation by a long shot.

Posted by fromAtlanta at April 1, 2008 4:57 PM

Tom
I am an entrepreneur and need to dig into this more - must be ways to bring disruptive innovation to a niche area and create better solutions for all. Scaryu thought though, given the regulatory and lobbyist protections afforded the big ship of healthcare.

Thanks.

Posted by Brian Jenkins at April 1, 2008 7:46 PM

Thank You Judithe Ellis and Mike C to ask this questions.

Andhra Pradesh is very poor part of India. Isaac Tigreet, owner of Hard Rock Caffe sold this chain and gave this money for Hospital.
This ''FOR FREE'' is part of donations worldwide.
There is no patient that paid bills, it's all come up from donations worldwide.

What is the driving force of this?

To merge with God, transcend senses and serve humanity.

There are list of doctors worldwide who are waiting to serve in this hospitals for free, from Australia to USA.

http://youtube.com/watch?v=V4et4SZOX-I

Posted by Ina Matijevic at April 2, 2008 3:49 AM

Much like Perspective, I am in my mid fifties, pay my own health care, haven't filed a claim in 25 years, and do my share of triathlons. And my premiums continue to rise. So much for the preventive care argument. If we strip all the junk aside, it comes down to a question of national will. I am tired of going to fund raisers for people who can't afford to pay their medical bills. I am tired of national leaders who proclaim we have the best health care in the world (they are usually federally elected officials who may have the best health care in the world because we all pay for it). I just wonder where the national outrage and activism is around this issue? By the way, when I consult with medical groups and pharmas, I raise my fees 100%. Fighting back in my own way...:)

Posted by Mike Neiss at April 2, 2008 6:33 AM

I find this a frustrating posting from Tom because there simply is not enough time, room or space for a balanced, critical argument about a national health service versus private healthcare service or a combination of the two.

Let me say immediately I don’t feel qualified to criticise the US healthcare system. I do say however there are many unfair and untrue myths about the National Health Service in the UK. The NHS is not perfect by any stretch of the imagination. I am as big a critic as anyone as I have often made clear in my comments on Tom Peters Blog.

But the one thing I do know is that we still have a system in the UK that I am very proud to say provides universal access to free healthcare as a right.

The great Labour Party MP Aneurin Bevan who was the founder of the NHS in 1948 said ‘In Britain no longer will we have a healthcare system where wealth is an advantage and poverty a disadvantage’ – I’ll still drink to that Mr Bevan - ( a healthy option drink of course :- )

I will now put on my armour anticipating many brickbats but given a choice of private healthcare versus national health care I will go for national service every time in the interests of the WHOLE population – that WHOLE word is the key point.

Posted by Trevor Gay at April 2, 2008 7:34 AM

Ina...thank you for the video. It appears that the government itself has no fiscal responsibility in the patients' care. The funds to support the hospital seem to be provided solely from donations worldwide. It would probably be considered a non-profit in the US. But as we know here, there is a lot of profit in non-profit. They also, needless to say, have the same responsiblities and red tape as for-profits. Many hospitals and some national insurance companies here are non-profit and quite profitable...indeed. How does your hospital fair?

Is the hosiptal's work more similiar to that of Mother Teresa's? While I understand that the hospital's mission may by in large be different, there is the charity component that aligns them. I love the driving force of both missions which seems to be just as you have stated..."to merge with God, transcend senses, and serve humanity." Love and passion must be the center of these missions. These two, in fact, must be the center of any successful mission.

A few questions: does the government have any oversight at all? Do the doctors and specialsts donate their time? Are they compensated through funds given to the hospital? Are these fees comparable to other fees worldwide, though the expertise may be? How many people does the hospital serve in relation to the whole of the population? What kind of health care system currently exists for the population en masse? Is it privatized or national health care? Combination?

Posted by Judith Ellis at April 2, 2008 9:01 AM

Ina...I got the fees bit with the international waiting list and all. This is great! But are there no doctors on staff? So, there would be no recurring fees associated with their services? Who's running the hospital? How are they compensated?

Posted by Judith Ellis at April 2, 2008 9:08 AM

Trevor, as you might have suspected, there is growing sentiment for some type of universal health care here in the states. Unfortunately, it is going to be a battle between doing what seems to be the right thing for a caring nation, and the willingness to see that capitalism isn't always the right thing to do. I do suspect that in the current environment, the money folks will win, but sense a shift in the nation. I am saddened that in this nation our infant mortality rates are soaring and our elders need to choose between food or medications. Tough situation...well, gotta go check my pharma stocks to see if I can afford to make this month's health insurance premium.

Posted by Mike Neiss at April 2, 2008 9:46 AM

Thanks for that insight Mike. It is not for me to pass judgement on other nation’s priorities for healthcare. I am happy and very content that one of the fundamental principles in my country is that the poorest and frailest in our population are entitled to exactly the same free healthcare at the point of need as is the richest person in the UK. I feel at least one of the stakes in the ground to identify a caring nation must be how it treats is most frail folks. But hey Mike – I thank God I’m not a politician :-)

As a matter of interest I posted something on my own Blog several months ago that illustrates our UK National Health Service compares more than favourably with other healthcare systems world wide.

The world renowned Commonwealth Fund based in New York is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency.

In a nutshell the Commonwealth Fund report concludes the UK Health care system emerges as the top overall performer in terms of value for money in healthcare of 6 countries - Australia, Canada, Germany, New Zealand, UK and US. The US is the worst performer on 4 of the 5 headings. This is the link to my Blog and there you will find a link to the Commonwealth Fund Report

http://simplicityitk.blogspot.com/2007/05/nhs-is-top-of-league.html

As I have said many times before on Tom's Blog I fully accept we have an imperfect healthcare system in the UK but I feel our NHS also gets a lot of unfair criticism.

Posted by Trevor Gay at April 2, 2008 10:38 AM

Judith Ellis,
I live in Croatia and work in Food industry Podravka. Croatian health Care is far away from Sathy Sai health care.

These informations about Sathy Sai Free Hospitals I collect from books, internet, newsletters I receive everyday from RadioSai.

Here is the link on Swiss Med Publisher, Swiss Review for Medicin and Medical Technology on Sri Sathya Sai Super Speciality Hospitals that can give You right answers.

http://www.sssihms.org.in/pdf/SWISS_MED.pdf

It is interesting to read experience of Dr. Mitchell W. Krucoff, MD, FACC, FCCP, Duke University Medical Center, North Caroline.

Regards from Croatia, Ina

Posted by Ina Matijevic at April 2, 2008 11:04 AM

Mike...I think the right thing for a caring nation would be to good education for all of its its citizens and train them for an open global market. While we must no punish children for the failings of their parent, I believe that we must also prepare parents for their responsibility. One of the biggest problems I see here is those who hold two or three jobs and are still unable to afford healthcare for their families.

For those, who are not putting forth the effort to be responsible, I say take care of the children and let the adults fend for themselves. Then again, everyone will end up caring for these too in emergency rooms everywhere, as is now the case. I don't know the answers. But I do know that we must take care of children and parents who are putting forth every effort to be responsible. Seniors too need assistance.

Caring for children and seniors do not have to be the responsibility of the government alone. Private industry can step up and be big of heart, offering plans for those seniors and working families who cannot afford high premiums. Pharma companies are undoubtedly making a killing and they may even be able to make more by insuring a larger segment of the population. Can government, by they way, make it more attractive for these companies to have more diverse plans to cover all?

I am fully aware that these thoughts may be rather naive to the hardcore healthcare analyst.

Posted by Judith Ellis at April 2, 2008 2:22 PM

Trevor, Judith, Mike, and Ina... WOW! I hear your frustrations - you all make excellent points.

Ina I had my appendix out in a Bombay (as it was then) hospital many years ago - those doctors and nurses saved my life! They were as good as you could get anywhere in the world at that time. More generally, I have been up close and personal with the health issues in India - the gifting of free provisions to the sick must be a godsend for them and I understand your joy in seeing it happen.

Trevor most of us here on this blog site admire, applaud, and understand your position on the NHS - you are clearly and justifiably proud of it on 'social justice' grounds yet critical of its efficiency and effectiveness.

Judith I support you 100% and believe you are 'on the money' when you urge us to prepare the next generation for an open global market existence and thus to solve our health needs within an inclusive framework.

Mike the irony of health insurance playing a key role in the future development of US capitalism is indeed striking - you live with it and thus you feel the frustrations that attend a user pays health care system.

But folks Tom made the point in his slides and in his commentary that he is clearly focussed on the organisational efficiency and effectiveness of health systems not the financial issues of existing health care systems. I believe he is right to do that here.....

Tom talks about health. Tom illustrates how poorly the US health care system is at delivering 'health' and supporting 'wellness' - indeed in many respects it is counter-productive.

The issue all around the globe today comes down to one simple question - "who should pay for the health care system?" For me this leads us away from the provision of 'health and wellness' and into financial matters - we start asking a series of wrong minded questions. Should the health care system be funded by taxpayers? Should it be a mixture of taxpayers (general revenue funds) and individual families (household budgets) who contribute to a health insurance fund? Should it be employees and employers who contribute to a health insurance fund? No one has come up with the right answer to these questions BUT I believe once we focus on finance not health we will always end up asking a series of wrong questions.

The issue is health. We need a new approach to health. We need a new culture, set of social mores, mindset within individuals, habits by individuals, and frameworks within workplaces & communities if we are to deliver better health outcomes. Tom's evidence is stark - Tom's documented outcomes should not be acceptable!

Health is an individual, communal, national, and international responsibility. Poor health outcomes reflect badly on all of us no matter what system we have delivering them.

Richard.

Posted by Richard Lipscombe at April 2, 2008 5:10 PM

What a terrific discussion this thread is on matters close to my heart.

Well said Richard – you are spot on. As you know my friend you won’t find me disagreeing with you on the wellness agenda. I said in my opening comment three days ago that the new priority has to be ‘health’ and not ‘sickness.’ It starts with self healthy lifestyles and you are absolutely right to add communal, national, and international responsibilities for health.

I think Judith hit on a brilliant point about education which is at the root of many of the health debate. As I said earlier the health improvement agenda is actually not the prime responsibility of doctors, nurses and health professionals – and it never has been. It is a public health agenda and a responsibility for all of us.

Ina – your comments are precious – I love your language. I am in the early stages of discussions with healthcare colleagues about UK patients travelling to India for healthcare treatments and your positive words about the quality of services in India are consistent with my research to date.

Posted by Trevor Gay at April 2, 2008 6:03 PM

Tom, I'm smitten with your point of view and your passion for this topic. I've spent time in the trenches of both standard allopathic medicine and complementary therapies and it's hard not to notice: they're both rackets. The healthcare industry depends on illness for its income. While there are many conscientious individuals working in the industry, the racket as a whole depends on people being ill. This is why it's never truly become HEALTH-care but remains mired in disease-care strategies. The disease-care mindset has set us up to pursue the wrong questions: how can I fight this disease or suppress these symptoms? rather than how can I activate the body's innate intelligence and learn to work with it? Fortunately, this is beginning to shift in certain areas: it's reassuring, for example, to see research on stents that dissolve over time, allowing the heart to repair itself with minimal intervention. But the reigning trend is geared toward keeping the market going by promoting disease-care scenarios. It's not in the hospital's, big pharma's or the insurance scene's best interest to promote health, self-sustained well-being and common sense prevention strategies. As long as that's the case, we're caught in our own laces, racing toward the cure.

Posted by Laurie Perez at April 2, 2008 8:02 PM

Richard...thank you for your thoughtful comments. While I agree with the spirit of your letter (your precision of thought on issues), I do no agree with the letter itself. By this I mean, it is virtually impossible within a captialistic system not to discuss capital. After all, health is a major component of this system. Capitalism is most preferable to the other 'isms.

Ayn Rand has always impressed me (for her pure intellectual prowess alone), though I do not align myself with her completely. I do, however, agree with much of what she advises, especially when it comes to the necessity of a free and open market. (Coupled with this, also, has to be the education and/or skills trade for all citizens in order to compete in the global market. Funny thing, though, when I lived in Europe there were many highly educated people, but there were no jobs.) Rand's father, by the way, just so happened to have been a prosperous pharmacist before being driven out by the Bolsheviks.

Yes! We should most certainly concentrate of education and wellness, but it will be ludicrous in a captialist system not to talk about capital. Even when we focus on health and wellness, wealth enters into the picture. My weekly bill at a speciality food market is usually quite expensive because the organic market demand is there. Because I want certain things for my health, not considering wealth, I frequent such stores often to buy organic products. There is no way in such a system to get around discussing capital.

What the discussion can come to, however, is a general sense of what we need to do to better be our brother's keep. Americans, en masse, give billions annually to charity. This is indeed good. Perhaps the discussion within such charities can be on health and wellness. I am not trying to exclude government (its important), but I am most certainly trying to lessen it.

People can be trusted when aided by their government (i.e., less taxes, more personal responsibility, and individual leadership in our local, national and global responsibility to each other) within a system that rewards giving and accountability. Government has a very important role in the security and education of its people. But perhaps on some issues, business should lead. (Does business have to be about profit alone? Are there no companies with hearts? I think not. But I must admit, however, that business cannot have its cake and eat it to. It cannot, for example, give low wages and no healthcare, or vice versa.) Governments are typically entities of massive red tape; people with entreprenurial ideas often do much better.

Posted by Judith Ellis at April 2, 2008 8:22 PM

Judith

It is great that you disagree with me - discussion, debate, intense disagreement, and counter-point are what we need in the health system debate.

Ann Rand bless her soul - she made me want to become an architect when I read Fountainhead (what powerful stuff it was for an idealistic youth to read!).

For my sins, by the time I got to University I took far too many classes in economics - I loved Labour Economics and all those theories about Human Capital (Becker?). It is all good stuff - it all added to my psychic health. I thank you for reminding me of it because alas I do not think about such matters from day to day - I am a simple case of wasted human capital I guess.

I should say up front that I prefer to use the term finance rather than capital these days - for me the term finance is a much better fit with a global networked economy where quants live and work simply to create the likes of the sub-prime derivatives because they have to find commercial uses for their maths filled heads.

My only point about Capital is a simple one - the way it is used within the health care system has led us all to some really adverse 'unintended consequences'. Tom has listed many of these in his slide show.

I contend that Capital (ie human, land, and technology) is being used to institutionalise the 'sick role' within our societies. I contend too that too much of the human capital of doctors, specialists, nurses, medical researchers, etc is being wasted, misplaced, and largely mis-directed in both our private and public funded health care systems.

Of course there are notable exceptions - eg there are people who have saved lives with good health outcomes because they invented a new procedure for say prostate cancer removal while retaining full male bodily functions (thanks Dr Patrick Walsh of John Hopkins who did so more than 20 years ago). But the main use of Capital in the health care systems around the globe today is to entrench not to alleviate the 'sick role'. I honestly believe that if we escape the 'sick role' we generally have better health outcomes and thus live a better quality of life.

Richard.

Posted by Richard Lipscombe at April 2, 2008 10:50 PM

Richard and Judith – congrats on a fascinating exchange.

I am not really able to argue either way on economic theory grounds as it has never been my best or favourite subject. As I read your comments my mind wandered way back almost 20 years to 1989 when I was a hospital and primary care manager in the NHS responsible for an annual budget of £1million ($2million). At the time I can tell you it seemed like a lot of money for this farmer’s boy from East Anglia to manage. In my own amateurish way I did some detailed analysis of that ‘budget’ and I found in fact that 90% of that money was flesh and blood – i.e. salaries of the healthcare staff employees. What it illustrated vividly to me then - and remains my belief now - that our most fabulous asset in healthcare is our employee. Money equals people. Yes of course the 10% ‘non people’ money was important too but effectiveness in healthcare is mainly about how people work.

So when I see any discussion in healthcare about ‘finance’ or ‘capital’ or any other such term it is actually for me about how we encourage our staff to do a fabulous job with patients. It is about quality.

I am not sure which ‘ism’ my comment fits into but if you look behind the headlines of what Tom Peters points us to at Plaintree for instance we see great results through people and I believe caring people hold the answers to both the health issues and the healthcare issues. We see the same behind the wonderful words of Ina. Healthcare is about people first and money second.

Talking of money - That’s my 2 cents as you guys would say.

And as regards Ayn Rand – I was given ‘Atlas Shrugged’ by a doctor friend of mine 4 years ago and he told me very assertively I should read it. Unfortunately it is still on my bookshelf untouched – 1079 pages with tiny print is a big challenge for someone like me but in view of the fact both of you recommend her so highly maybe I need to make a start on that book on my shelf :-)

Posted by Trevor Gay at April 3, 2008 1:40 AM

Trevor/Tom

Morning

Understand this, privitisation in the Uk does not bring a better service or it won't.

A man who has worked over 40 years in the NHS in the labs, working his heart out, and his department will be shipped 50 miles away?

So the weekend call outs for yourng childrens tests will now be put in a Taxi and sent? SOme service? Hardly cheaper, hardly the quality they have and are dismantling? This is just one county hospital in the UK? Some of these solutions forget why we do what we do when we work in healthcare?

Simply Fix the whole person.

But do it with the person in mind!

This as you rightly say Tom beggars belief and buggers the mind (I was shocked by this quote from you? but loved its impact!)

Sorry I can't get my head around all this.

Patrick

Posted by Patrick at April 3, 2008 2:39 AM

Richard and Trevor...thank you both for your astute comments. I loved reading them. And Trevor...thank you especially for your simple beautiful lines of remembrance. And you too... Richard...for your Remembrance of Things Past. That said…I must say a few things in opposition.

While I LOVE Ayn Rand, I must vehemently disagree to the sense here of objectifying of people. Ontology (the study of being) and objectification do not mix, save to say that objects are extensions of being, but they are not being itself. This is one of things I oppose in Rand's theory. Objectifying people is to take the soul out of being, which I ardently oppose. People are not capital.

I do not believe that it is good to speak of people in terms of capital, even though, in business, the term could fit because of the all-important role people play in profit. Talent is the center of the Gyroscope; it is the axis that turns the whole mechanism of business, hence our greatest asset.

Talent here, though referring to people, best refer to the effort of people and not to people themselves. (Hence, all employees are not, in the specific sense, talent.) There is a notable exception. I oppose the objectification of people, while fully embracing talent so expressed in our daily work and outcomes. overnight viagra delivery without prescription

Regarding, changing the term capital to finance, it's sort of like taking apple out of apple pie. Capitalism is as American as apple pie, but it is a global as universality itself. It can be argued that even other 'isms have veiled capitalistic tendencies though perhaps misaligned.

Capital is the heart of capitalism. Period. I do, however, appreciate redefining words for global understanding. But in a more direct sense, why redefine the word at all? Why not assist others in understanding its best purest essence, that within the American system and within others, veiled or otherwise?

While not being opposed to redefinition in general, I am opposed to obfuscation, muddying, tiptoeing, stonewalling, or of not calling a spade a spade. To redefine a term for the sake of not dealing directly with the term itself or its grand developing implications, is not advisable.

Capitalism is about capital; it is not socialism, or other ‘isms, Trevor. Now, what it can be, however, is greater than it has ever been before, driven by talent with the heart of the people in mind.

Posted by Judith Ellis at April 3, 2008 5:41 AM

This is an amazing pres - Thank you Tom. After all that doom and gloom I want to put a positive note in! - Especially as you mentioned environment in the pres

At the moment I am at a technical service conference in Paris (how Technical support etc can work better).

Yesterday I attended a presentation from a leading Medical equipment maker (MRI scanners etc) One the the most interesting developments they had in their services portfolio wasn't technology oriented at all - it was room design! They are increasingly asked to help design the environment that their equipment sits in so it is more calming and less intimidating - So it is starting to happen Tom!!!

I must admit I thought that was vaguely interesting (I hadn't read your pres until today)until he said something that blew me away - on exceptional, very stressed patients they can save 15 minutes on the scan visit time BECAUSE THEY DON'T HAVE TO SEDATE THEM!! Not only is the hospital making better use of the equipment but less drugs are pumped into human bodies.

Now you can argue that this company obviously makes a shed load of money in doing this and perhaps the story is biased. but to me it shows a much more holistic thinking works and makes hard economic as well as caring benefit. over the life of the machine the hospital makes the money back in more efficient use of the machine.

So patient calmer and scanned faster. Hospital more efficient (and saving money in the long term). Equipment company more profitable - Result all round!

Posted by PaulH at April 3, 2008 6:00 AM

Beautiful, PaulH. Thank you for sharing this. A "shed load of money" is not inherently bad.

Posted by Judith Ellis at April 3, 2008 6:21 AM

I feel great energy here. 10 years of making this awasome presentation of mr. Peters trigers avalanche.

Trevor , I hope You will visit Bangalore or Prasanthi Nilayam In India and share some insights here.My opinion is that we already have blueprint and solution. It is working.
I like Your language too!

My personal experience: Croatian health care system...two operations of head, there was no enough anestetic in hospital , doctors choose ''brave'' to go on local.I was one of them.

After that, they gave me 5 years of life beacuse of hematoms in head.

Only deep, deep motivation for Life saved me.

Regards, Ina

Posted by Ina Matijevic at April 3, 2008 7:49 AM

This morning I put in an offer to buy the cutest little 1950s brick bungalow with loads of light, hard wood floors, lots of eaves, coved ceillings, retro bathroom tile etc. It's darling! What I really like about the house is that it's 300 feet deep, a small football field of sorts that a wee kids soceer team could run around on for days. You've seen them, eh? Cute.

There could be many uses for this land. But I will use my little patch of land to plant my own organic vegetables (is this possible with soil in the city?) and loads of wild flowers. Perhaps the cost of seeds would then increase if everyone considered their health and planted such a garden en masse. Nice! Plant! Grow! Do it for your health and wealth. You gotta love it!

Posted by Judith Ellis at April 3, 2008 10:37 AM viagra 50mg dosage online

Thank you, Ina, for the information above. I will read it thoroughly when time affords. Blessings...

Posted by Judith Ellis at April 3, 2008 11:03 AM

Patrick - I am with you 100%.

Privatisation will not improve the NHS. I am committed to a National Health Service. I hope I have made my position crystal clear on Tom Peters Blog for the last three years but let me repeat some of my thoughts:

*I love the NHS with all its warts and wrinkles
*I am proud, as a citizen of the UK, that we retain our UNIVERSAL health system where my mum, who is 78 years old, gets free treatment when she needs it and my 6 month old grandson also gets free treatment when he needs it. They and their families shouldn’t have to worry about whether they can ‘afford’ to be treated when they are ill.
*I will fight to retain the concept that the frailest of our UK citizens get free treatment when they need it.
*I’ve never believed privatisation of NHS services equals better patient care for all. It’s just not true.
*I want best value for tax-payers money from the NHS. We achieve this by involving patients and front line staff as well as managers and politicians in decisions

As mentioned in my earlier comment if one looks at the world renowned Commonwealth Fund (New York)report of less than one year ago the UK healthcare system comes out well ahead when compared with the US, Australia, Canada, Germany and New Zealand.

I sometimes think we need to remind ourselves here in the UK that in the NHS we have a very special and unique UNIVERSAL system. I say we must fight to protect the principles like EQUALITY OF ACCESS regardless of status or wealth and free treatment at the time of need for all our citizens.

That is worth fighting for and I will continue to argue that Patrick rest assured.

At the same time I am not saying we should turn away from opportunities to make better use of money in the NHS – but privatisation alone simply does not achieve that.

In my 39 years of work in the world of health and healthcare I have yet to see a report from anyone that proves any country in the world has a BETTER healthcare service for ALL ITS CITIZENS than our UK National Health Service. Of course there are pockets of healthcare excellence in every country. But that is not the full picture - I suggest we have to approach this debate from a ‘whole population’ perspective not from a narrow viewpoint about particular areas of expertise. Otherwise we are comparing apples with pears.

When someone points me to a credible and fully researched report that proves the UK is not the best universal healthcare system, I will gladly eat humble pie and reach for my passport. Until then I await evidence that anywhere in the world has a more effective health service for ALL ITS CITIZENS.

Phew … I feel better now... :- )

Posted by Trevor Gay at April 3, 2008 11:14 AM

Trevor...I utterly defer to your expertise on such matters in the UK. I also applaud your desire for fairness and equality. There remains a question of how and the responsibility of all here in America. Thank you for your words. They matter.

Posted by Judith Ellis at April 3, 2008 11:45 AM

Hi Judith – thank you for that feedback and good luck in your new bungalow – sounds great!!

I don't envy the US politicians and citizens in trying to grapple with this hot potato – the health care debate is clearly a matter of growing concern and I wish you all well as you explore a growing crisis. We have identical challenges in the UK. This is not a new problem – we have had the same problem in the UK since the NHS was formed by the radical, reforming Labour Government 60 years ago in 1948 - infinite demand and finite supply in a nutshell.

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It is extremely kind of you to refer to my 'expertise' – and I value that. However I assure you I am no ‘expert.’ I’m much more comfortable with words like commonsense, pragmatism, simplicity, reality and grounded in defining my input to such debates on health and healthcare. I am an eternal optimist and non cynical but I do agree with my late beloved Dad who always told me to be very wary of ‘experts’ :-)

Posted by Trevor Gay at April 3, 2008 12:20 PM

Trevor..if you are not an expert after 39 years in this industry, I'm sure that you are most certainly, sir, a professional. In any event, your experience is far greater than mine in healthcare. This is my deference.

All the best.

Posted by Judith Ellis at April 3, 2008 1:53 PM

Tom

You use 'life expectancy' as a key indicator... It is an interesting one because the TABLE you point to shows movement both down and up in 2007.

As you say the US is now at 45 down from 29 while the UK is at 36 down from 25. Incidentally my place of birth (Australia) is at 9 down from 6 - these rankings are all based on 'life expectancy at birth' for both males and females. As you would expect the females have on average about a five year gap in their favour over males.

Mind you Tom all these life expectancy indicators are at very 'healthy' levels. So as we are all more healthy (due in large part to improvements in public health and sanitation measures - as Trevor points out above) thus we all stay out of the health care system more and so we live longer - it is makes a good 'cause and effect' story to me!

What was most interesting to me Tom is who is moving up the TABLE - there were some surprises here! Macua has jumped in at 2 from off the TABLE and Hong Kong has come into the TABLE at 6....

I am no statistician and I know even less about morbidity or mortality statistics BUT seeing who is improving their life expectancy rankings is interesting. As you go down the TABLE it is often small island communities that are improving - it could be they are merely rising with the tide of new 'public health measures' but then again perhaps there is something else going on within smaller communities.

In the emerging flat world of the internet most people will work local. Jobs will be shed from big organisations - including big health care systems like the NHS - at an increasing rate as information technology automates processes. I know that the trends for employment in health care at present suggests the opposite (health care employment is currently seen as a recession proof job for US workers).

in 2008 and beyond I sense that more and more people will look for work in and around their local digs. They will work from home (travel to works sites as and when required not as a routine) or in a local workspace. They will live more as my parents and grand parent did - that is within their local community not the broader community.

Health and wellness systems in future will perhaps best serve these workers and their families if they are local. One part of an answer to the current health care system issues is to have health become much more a communal activity - a communal activity that stretches across a nation and across the world.

Maybe, just maybe, the life expectancy rankings in the TABLE support such a proposition... eh Tom?

Richard.

Posted by Richard Lipscombe at April 3, 2008 5:19 PM

Richard... I often feel rather intrusive when you address, TP, as if the comments of others are not particularly welcomed. But I will venture to add my two cents anyway. I really appreciate your local communal workforce analysis of a possible trend aligning workers back to their communities as in times past. I see this workforce as the force (the innate passion) of work emanating from talent (knowledge workers who are forever aiming for greater knowledge whose actions are so properly in sync) in communal spaces that are globally aligned through technology. These could be the small huddles we often speak about here out of which prototyping and innovation can perhaps be best initiated. I really like it. This is no doubt happening already all over the world but its implementation on a larger scale may have greater local, national and global significance.

Your idea is communal and universal, as we are all driven by the same basic needs and desires. We are also all experiencing the same growth of rapid technology simultaneously. Your idea also aligns with my idea that people know what's best for them more so than than any government system belabored with massive red tape, cronism and pork barrel spending. The business of the country is moved back into the hands of the people while government protects and educates its people, preparing them for an increasingly global market infused with the responsiblity of all (being our brother's keeper) from issues ranging from health care to global warming. Let the people lead! This is a great plan for governments and will probably occur whether we like it or not. Governments need to find better ways to protect, educate and serve. It also needs to find ways of cutting red tape and rooting out cronism. These things slow the process of work that matters. Perhaps giving the power back to the people through such an idea is a start. Our constituition begins with "We the people..." I hear a negative voice in my head shouting, "FAT CHANCE!" I will, nonetheless, believe that all things are possible to those who believe. I BELIEVE! YES WE CAN!

Posted by Judith Ellis at April 4, 2008 8:01 AM

Judith – I’m with you 100% on your comment 'people know what's best for them.' As you know I actively promote that concept in my commitment to front line employees in business. My view is front line employees know ‘what is best for them’ rather than managers. In healthcare I do think the government has a role –even if only providing principles and the ‘stakes in the ground’ that ensures the most frail, the poorest and those who - for whatever reason - find it hard to express ‘what’s best for them.’ I am totally in favour of self-healthy lifestyle as the driver for change. Thanks for your excellent contributions to this discussion.

Posted by Trevor Gay at April 4, 2008 9:55 AM

Trevor...If I know anything about you from reading this blog, it is your belief in "front line employees." Bravo! This is a belief, however, that must be aligned with the goals and objectives of the company and owners. No disruptive employees, though fully supporting disruptive ideas. I also thank you for your thoughtful contributions.

Posted by Judith Ellis at April 4, 2008 11:04 AM

Thanks Judith – I always enjoy our exchanges. Whilst I see what you are saying, do you not agree ‘disruptive’ employees are often the people who lead and drive change because they are just not content with the status quo? If they do not get the change they want to see they leave anyway to become disruptive somewhere else. I guess disruptive employees are not great to have around in very stable situations - but hey – what the heck is ‘stability’ in 2008? I love working with people who are considered disruptive. Actually I would like to see more disruptive goals and objectives of the company and owners too :-) … but that is a whole new discussion …..

Posted by Trevor Gay at April 4, 2008 11:20 AM

Trevor...I refer you back to the last extensive discussion here, "So, Work Really Does Matter." No need to re-do that one.

Posted by Judith Ellis at April 4, 2008 11:47 AM

You too, Trevor. Enjoy!

Posted by Judith Ellis at April 4, 2008 3:23 PM

I look forward to spending some extended time reflecting on this visual manifesto. Absolutely fascinating as I just finished assisting my dad who was in the hospital for cancer surgery. He was in for two and a half weeks. Either one of my sisters, dad's wife or me would be present in the room 24 hours a day. It was more to monitor what was going on. Dad had three different issues going on at once, so it required three different doctors involved. As it stood, there should have been a fourth. We were satisfied with the care he received, but I attribute that to our being very engaging with the nursing staff. There were some errors in judgment of his care that complicated certain aspects of his recovery. That is to be expected, but as a total novice, I could see that the procedure was the wrong one. What I found is a system of genuinely caring people who are overwhelmed by the system. As with any large system, the problem in many respects is the kind of training people receive. They are knowledgeable and skilled, but lack skills in observation and assessment of what is happening at the human level, whether it is with the patient or their family. Caring overcomes some of those deficiencies, but not all of them. I look forward to go into your presentation with greater depth. Thank you.

Posted by Ed Brenegar at April 4, 2008 3:30 PM

With all the discussion this has generated I would love to attend the HFMA (Healthcare Financial Management Association) Annual National Institute this year. The Thursday key-note is from Tom Peters. Here is the bio they have for him.

Since co-authoring the best seller, In Search of Excellence, Tom Peters has been regarded as a business guru and a highly sought-after consultant, credited with launching the management revolution. Today, Peters' ideas— and more than a dozen of his books—are considered standard operating procedure in businesses around the world. During Thursday’s keynote, he will draw on his experience as an author, consultant, veteran, former White House advisor and business world iconoclast and provide his thoughts on how to achieve excellence through leadership in the healthcare arena.

http://www.hfma.org/ani/2008/keynotespeakers.htm

Posted by MikeC at April 4, 2008 3:32 PM

Ed – thanks so much for sharing your powerful story. I hope your Dad is now recovering.

I think you are spot on with your comments. There is nothing as powerful as patient’s stories or family care-givers stories to illustrate the good stuff and the problems in healthcare delivery. Staff at the front line in healthcare are often hamstrung by unnecessarily complex processes that add no value to patient care.

On the subject of healthcare and patient’s stories may I ask anyone reading this to offer a prayer for little Lucy Johnson who is 8 months old. Lucy is fighting for her life at this moment and is the Grand daughter of a good friend in the US.

It is an incredible story - see this link http://www.simplicityitk.blogspot.com/

Thank you in advance.

Posted by Trevor Gay at April 4, 2008 5:59 PM

Judith

Tom asked for feedback on his new slide show and I give it to him freely - BUT I do not expect what I have to say to be either relevant or remarkable for anyone else. When responding to comments I address them to the person who made them - I guess that is how I work!

You and I seem to agree on the developing momentum towards local workforces and to a new emphasis on community. I see this as a positive development in my life time.

Tom is the Management Guru (that is he is famous and he has worked hard to achieve that status) BUT there is a hell of lot that he says that I totally disagree with and I would suggest that the current trends and/or evidence around the world does not support. I am not on this site to push a cause - I am here as most of us are (including Tom Peters I imagine) to learn about what we have a passion in life for - in my case that is doing things better and smarter.

I write my riffs here because, just like Tom, I have a need to say the things that bug me and otherwise keep buzzing around in my brain. I put them out in cyberspace and the mere act of doing that helps me to better organise my mindsets on things. I do not want or expect people to agree with me but rather I like to think that I might stimulate them to think again about what they are doing in their lives to improve things.

I currently have a passion to fix a broken health care system - I want it to be about people not money, I want it to be about health not illness, I want it to be generally affordable not cripplingly expensive, I want it to be inclusive not exclusive.... I know I want too much but better to aim high and fail than aim low and succeed (is that the quote Tom uses?)....

Health care system around the world are people and paper based and in my opinion this borders on being a crime against the sick. Technology is being deployed on diagnosis and prognosis rather than information sharing. I believe that if we were to spend more on information sharing we would help the great majority of patients to become more accountable for their health outcomes. In such circumstances we could slash (I mean really slash) the cost of health delivery. We have a costly, inefficient, and largely ineffective health delivery system - it has way too many people employed in it. I believe that staffing numbers (while currently increasing) can and will be starkly reduced as automation takes over from manual/paper processing of our information trail.

The Google Health Team and Cleveland Clinic are working on information systems that will enable a better informed patient to become his or her own best advocate. This is where the health system must go - we need to get to system wherein health carers can work their 'healing magic' within local communities.

Thanks for your time and your comments Judith...

Richard.

Posted by Richard Lipscombe at April 4, 2008 6:00 PM

What a terrific discussion! I have followed it with great interest over the past few days because there is definitely much to consider and think about. I see many parrallels with healthcare and another major issue with our remaining a competative and prosperous nation...education. The changes of the past decades be they societal, technological, socio-economic etc, have not been integrated into the "products, services, amd delivery methods" in either of these critical services resulting in failed performance, billions in wasted resources, and lose of lives and futures. We have probably all heard the negatives of "nationalized" health care...no choice, long waiting lists for care and critical services, incompetent and untrained physicians...the list is endless. To me, Judith is absolutely correct when she states " Governments need to find better ways to protect, educate and serve" and "Let the people lead". All to often the critical issues that need to be addressed and resolved at the community level...on the frontline if you will...get lost in the politics. Let the People Lead...sweet! The focus on improving organizational efficiency and effectiveness is another "must do" Tom's "Liberation Management" highligthed Lakeland Regional Medical Center's innovative "Care Pairs" ...a nurse and crosstrained technician...that achieved terrific results like doubling the time spent with patients, test turn-around times decreased by more than 100% and monster increases in "customer" satisfaction. As usual, Trevor's faith in the frontline is right on the mark. The 17 March edition of Workforce Management has an article "Healing from the Inside" told the story of how Crouse Hospital, a 560 bed/2600 employee hospital in Syracruse New York came out of bankruptcy and changed it's culture by engaging their folks in identifying and fixing it's issues...a model that any organization could follow and use. Again, a topic I never really thought about but have now become interested in thanks to this forum. Great stuff indeed!

Posted by Dave Wheeler at April 4, 2008 6:44 PM

Richard...you work awfully well and I appreciate your astute comments. Thank you again and again. With regards to your "riffs" (I like the term), I would assume that many also express themselves here for the same purpose and without agenda, but perhaps, as you suggested, with cause. I value your words.

By the way, Richard, I lived in Mt Isa for about a year. I taught Aborignial youth and loved every minute of it. I also enjoyed flying over this vast country in a single engine plane for hundreds of miles and seeing no sign of human life, save a tribe here and there. It was amazingly stark, incredibly barren. I was in awe of the rugged beauty of the Outback and the lushness of Syndey. Australia's one of my favorite places.

Posted by Judith Ellis at April 4, 2008 9:07 PM

Thanks,Trevor, for your kind thoughts.

Posted by Ed Brenegar at April 4, 2008 9:26 PM

Judith

Thanks for that... I worked for around six months, on a political assignment, with Aborigines who live in Kakadu (some might know it from the outback scenes featured in the Crocodile Dundee movies)... I experienced a completely different type of life from these tribal people who live in extended communities and yet are essentially nomads - they have a consensual organisation and decision making process that is unique. BUT most of all they have such a great sense of humour and the kids have such a zest for life!

Richard.

Posted by Richard Lipscombe at April 4, 2008 10:38 PM

Having read more carefully the whole presentation, here are some comments based on my father's recent experience. Communication is the key ingredient in improving healthcare. For example, my father's surgery was intestinal. After a week, his surgeon left town for three days, and his partner took call. His medical judgment was sound in a general sense, but his intuitive sense of where Dad was in his progress was missing. The day before the partner came, the stomach tube was removed, and they began to give him a liquid diet. The next day the surgeon gave orders that regular food could begin to be brought. Dad's digestive system couldn't handle it, and the stomach tube had to be reinserted, where it remained for another five days. The issue isn't just having better communication technology. This hospital had the up-to-date computerized patient tracking system that the VA has. What is needed is better training in how to identify the intangibles that are taking place in the room. And then being able to communicate them. In my experience, I kept thinking of John Boyd's OODA loop as an apt game plan for families dealing with the system. Most of the nurses were skilled at this intuitive sense of what's happening. Knowing the physicians would come by between 5:30 and 7:30 am, meant that I had to be ready to ask questions that forced greater clarity of perspective on Dad's care. Patients and their family's have to be in control, and they have to be informed. I was grateful for in-room wifi, so I could check WebMD for information when I heard something I did not understand. I also made it a practice to talk informally with the nurses. Communication is how we control the environment of care.
Tom, thank you for this great presentation. I wish a video version was available. There many people, family, friends, clients and myself who need to take your message seriously. Thank you again. And good health to you and all your readers. Oh, yes, and the hospital had a player grand piano in the lobby. Very nice.

Posted by Ed Brenegar at April 4, 2008 10:54 PM

Indeed...Richard. The kids were amazing! I also found that there was not a great push to assimilate, on the part of the parents, at least. They did seem, however, to want a different life for their children.

The Aborigines are a remarkable people that seemed to have some of the same problems as the Amerian Indians here in the US. Perhaps it is, in part, due to the legacy of displacement. There also seemed to be many health issues among Aborigines, physical and psychological.

We've talked a lot here about physical health and wellness, but I don't think we have even touched on psychological wellness. As a matter of fact, as I read the slides, I did not even think of mental health. Nothing about the slides lead me there, Hmmm? Is it just assumed that when we speak of health and wellness that it physical health mainly?

I really enjoyed my time in the Outback.

Posted by Judith Ellis at April 4, 2008 11:28 PM

WOW! - Well said Judith and how the heck could we overlook mental health? I spent 6 years of my career working in mental health services and it is the most misunderstood of all health services. Mental Illness remains stigmatised and marginalised in the UK despite the best efforts of dedicated staff working in those services. You are so right to raise that issue. We all walk a very fine line between good and poor mental heath.

The well respected Mental Health Foundation tells us 1 in 4 people will experience some kind of mental health problem in the course of a year. I therefore feel I am in good company saying I’ve suffered clinical depression in my lifetime. I would say there is as much - if not more to do - in promoting positive mental health images as the huge task of promoting positive physical health. Good emotional health can also be a contributory factor to physical good health. Thanks for reminding us Judith- and what a terrific challenge that is.

Tom Peters put me on to a fantastic article a couple of years ago which I reviewed – the article is wonderfully entitled ‘On Being Sane In Insane Places’ by David L Rosenhan.

In a nutshell the article describes a research project of 30 years ago and how people who are perfectly healthy emotionally can be diagnosed ‘mentally ill’ in a mental hospital. The participants in the research programme ‘pretended’ to be mentally ill.

This is a powerful illustration of how easily we can become diagnosed as mentally ill. I would love to believe that sort of 'lottery' could not possibly happen in our enlightened society of 2008 …… Mmmmmm I’m not sure ….

Posted by Trevor Gay at April 5, 2008 3:30 AM

Those who have had some form of mental instability are among truly brilliant company. There should be no shame in this game.

Many of our greatest artists, scientists, pastors, entrepreneurs, CEOs, philosophers, and literary figures have all experienced some form of mental illness. Maintaining health and wellness, physcially and psychologically, is a part of the human condition.

TP’s “Implementation” Slide 58 constantly reminds me of the importance of kindness. It reads: “Be kind, for everyone you meet is fighting a great battle-Philo of Alexandria.”

Posted by Judith Ellis at April 5, 2008 8:34 AM

Just came across a very interesting comment by JG posted here on TP's "Simply the Best" post. Its truthfulness is hard and inviting. It is relative to our discussion here. Below are the main points:

1) You (Americans) are all dying young because you are fat. Ridiculously fat. Bizarrely fat. Every time I go stateside it's like being in some sort of carnival freakshow hall of mirrors. The USA is the only country in the world where a major famine would actually reduce the number of people dying from malnutrition.

2) You pay stupid money for healthcare because of private insurance. A bunch of parasites have inserted themselves between the patients and the doctors. They are expensive and unnecessary for delivering healthcare.

Check it out!

Posted by Judith Ellis at April 5, 2008 10:30 AM

The worry is that the UK is fast catching up the US in stats relating to Judiths point #1

Posted by PaulH at April 7, 2008 2:46 AM

This seems to be one of the issues with capital as it relates to health and wellness. For example, when fast food chains are exported worldwide, where these brands are bought and their products consumed at an alarming rate, there will most certainly be problems of obesity.

Where is personal responsiblity? We all have choices in such matters. We can insist that things be different i.e., insist upon certain healthy standards. Or, we can simply not buy such products. We have to reclaim our lives, reclaim personal responsibility, and not blame business for our bad choices.

Business can also have a conscious and better consider the health and wealth of its customers-more like consumers here. But even if they don't, customers can still lead, insisting change.

Posted by Judith Ellis at April 7, 2008 4:15 AM

Personal responsibility is a key part of this Judith.

One of the things I have learned through coaching is how badly we are at looking at long term consequences and goal setting. We simply don't equip our children with the skills to do this effectively. Unless people have immediate feedack that something is bad it's very difficult to visualise what the outcome could be.

As well the normal life skills. I think this stuff needs to be part of every child's education along with decision making skills and the ability to think in different ways

Posted by PaulH at April 7, 2008 4:40 AM

PaulH...RIGHT ON, BROTHER! (Throw back, eh? I think this saying from the 60s went across the pond.) I find that it is so easy to blame others and past situations for our present problems and not seek in the now to find solutions for right now and the future.

This blaming and not seeking, needless to say, is often the reason for our current situation...now. I have heard it said that now is between 1 and 5 seconds. I try to make my nows count through my daily actions, being fully aware of the future. Some days I fail miserably, many days I succeed.

Posted by Judith Ellis at April 7, 2008 11:17 AM

Watching an esteem panel of scientists on Charlie Rose tonight got me to thinking about our conversation here. Nobel Laureate Harold Varmus beautifully addresses PaulH's comment about teaching children the importance of "decision making skills and the ability to think in different ways." Varmus said, "science is a process; you have an idea, you test it out, and you draw conclusions." What is science? Science is a process of discovery; it is problem-solving. Science encourges curiosity. Perhaps we need to teach children and re-teach adults the process of science. In work environments this process is one of prototyping.

Physicist Shirley Ann Jackson, President of Rensselaer Polytechnic Institute, also made great points on the program. When asked about how the present political environment and science, she did not lead with science but with leadership. "National leaders, talking about global leadership" is essential. "Science and technology is siminal to our global leadership." Dr. Jackson spoke of science as life being imperative to all disciplines and to all industries. This essence is curiosity.

While watching Charlie Rose, I was reminded of Ina's comment about the "great energy" being generated here by this work of TP, causing an "avalanche" after 10 years in the making. Curiosity engenders more curisoity. It produces in others various ways of looking at things, means of testing them, and drawing conclusions. Thank you, TP.

Posted by Judith Ellis at April 8, 2008 12:07 AM

It really is sad (actually, infuriating... or "flabbergasting"!!!) that so many patients are harmed or die because of PREVENTABLE medical errors.

We have to move beyond blaming individuals, working toward systemic process improvements. This is a leadership and culture problem. I agree that the "Good News" DVD is incredibly enlightening, with its examples of systems thinking and Toyota-based methods.

Many hospitals around the world are using Toyota Production System (a.k.a. "lean" methods) for improving quality AND efficiency.

I have a book coming out that helps highlight these lean principles and methods, along with examples of hospitals that are doing great things with lean ("Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction," Productivity Press).

The "checklists" approach is perfect example of basic blocking and tackling, management 101 approaches. Not sexy stuff.... but it's saving many lives.

Posted by Mark Graban at April 22, 2008 11:04 AM