The Challenge: To Create More Value in All Negotiations
Tom Peters Excellence. Always. The Art of the possible. Press Ganey/17 November 2009 (Slides at tompeters.com) NOTE: To
appreciate this presentation [and ensure that it is not a mess], you need Microsoft fonts: Showcard Gothic, Ravie, Chiller
and Verdana DVM/Lyme/2005-2008 **Multiple diagnoses (>5) **Specialist self-certainty **Health deterioration failed to produce urgencycommunication **Virtually no communications between specialists **Follow-up very spotty unless bugged incessantly **Lost major test results, mis-placed 3 or 4 occasions
**Near fatal drug mistake (one nurse takes charge) **Effectively, disinterest in chronic-care **Lack of curiosity The failure to pursue EXCELLENCE is incomprehensible to me.
Let us create such a building that future generations will take us for lunatics. the church hierarchs at Seville 14,000
A Excellence1982: The Bedrock Eight Basics 1. A Bias for Action 2. Close to the Customer 3. Autonomy and Entrepreneurship 4. Productivity Through People 5. Hands On, Value-Driven 6. Stick to the Knitting
7. Simple Form, Lean Staff 8. Simultaneous Loose-Tight Properties Hard Is Soft (Plans, # s) Soft Is Hard (people, customers, values, relationships)
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
it is the game. game Lou Gerstner, Who Says Elephants Cant Dance
30 - fold! When a plane crashes, they ask, What happened? In medicine they ask: Whose fault
was it? James Bagian, M.D. & former astronaut, now working with the VHA Acute Respiratory Distress Syndrome, 1st test of variation analysis and reduction; deviate as desired; re-write weekly. ARDS survival rate, 40% vs national average of 10% per MGH study. Committees (docs, nurses, administrators) for 50 clinical conditions; protocols computerized if possible. Concept: ID variation. 35 various ventilator settings; 50-page doc;
imitators. (Dont argue philosophy. Show me your morality rate, and Ill believe you.James.) Operational system plus culture change. 700-hospital study/Journal many hospitals are not even aware of what they do well and what they dont. People are very often willing to make intuitive diagnoses even when
of Health Affairs: theyre very likely to be wrong.Daniel Kahneman. The human mind can sometimes do a better job of piecing together amorphous bits of information On the other hand, human beings can be unduly influenced by just a few experiences, like the Psychological Assessment: clinical vs. data-drivenDD clear winner across numerous studies. Pronovosts checklist/s: 108 Michigan hospitals, line-infection rate approx. ZERO (New
England Journal of Medicine, 2006most still not use) [Intermountain] is the best model in the country of how you can actually change healthcare.Jack Wennberg Brent is the future.Lucian treatment of an especially memorable patient.James. Leape Primary source: Dr. James Will Make It Better, NYT/11-08-09 NYT/11-08-09
Most people think that quality of care is defined by medical interventions, such as a hip replacement, lens implant, or coronary bypass operation, but genuine quality of care is defined by action based on good information. Definitions of quality are often counterintuitive. Multiple lab tests do not constitute quality medicine. Entrepreneurial physicians have a greater stake in doing more than in doing good. Medicare,
for example, provides funding for autopsies of every hospitalized beneficiary, and good science suggests that at least 30 percent of deaths should be autopsied. Very few are.. In fact, lack of autopsy is the ultimate cover-up in medicine, and the signature of poor quality care. The whole issue of patient safety is based on honesty, and the autopsy is central in a system that finds truth, deals with it honestly, and tries to improve patient care. Source: The Search for Quality: It All Begins on the Autopsy Table, chapter title, Severed Trust: Why American Medicine Hasnt Been Fixed , George Lundberg stunning lack of
scientific knowledge about which treatments and procedures actually work Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Yours/Phillip Longman 400,000 heart bypass surgeries, 1,000,000 angioplasties per year:
Yet recent studies show that only three percent about of the patients who receive such operations benefit from them; most would be
better served just taking aspirin or low-cost beta blockers. Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Yours/Phillip Longman 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 loss of
life expectancy. to medical errors, and a Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Yours/Phillip Longman 2007 Siberia
Why in the World did An emotional, vital, innovative, joyful, creative, entrepreneurial endeavor that elicits maximum Enterprise* ** (*at its best):
concerted human potential in the wholehearted service of others.** others **Employees, Customers, Suppliers, Communities, Owners, Temporary partners 2007 Sydne
y 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. Thank you Peter Drucker/AIM Our goal is to serve our customers brilliantly and profitably over the long haul. Serving our customers brilliantly and profitably over the long haul is a product of brilliantly serving, over the long haul, the people who
serve the customer. Hence, our job as leadersthe alpha and the omega and everything in betweenis abetting the sustained growth and success and engagement and enthusiasm and commitment to Excellence of those, one at a time, who directly or indirectly serve the ultimate customer. Source: The Little BIG Things: 163 Ways to Pursue EXCELLENCE
Weleaders of every stripeare in the Human Growth and Development and Success and Aspiration to Excellence business. We [leaders] only grow when they [each and every one of our colleagues] are growing. We [leaders] only succeed when they [each and every one of our colleagues] are succeeding. We [leaders] only energetically march toward Excellence when they [each and every one of our colleagues] are energetically
marching toward Excellence. Period. Source: The Little BIG Things: 163 Ways to Pursue EXCELLENCE You have to treat your employees like customers. Herb Kelleher,
complete answer, upon being asked his secrets to success Source: 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) The doctor
interrupts after * *Source: Jerome Groopman, How Doctors Think 18 seconds [An obsession with] Listening is ... the ultimate mark of Respect. Listening is ... the heart and soul of Engagement.
Listening is ... the heart and soul of Kindness. Listening is ... the heart and soul of Thoughtfulness. Listening is ... the basis for true Collaboration. Listening is ... the basis for true Partnership. Listening is ... a Team Sport. Listening is ... a Developable Individual Skill.* (*Though women are far better at it than men.) Listening is ... Listening is ...
Listening is ... Listening is ... the basis for Community. the bedrock of Joint Ventures that work. the bedrock of Joint Ventures that last. the core of effective Cross-functional Communication* (*Which is in turn Attribute #1 of organizational effectiveness.)
[cont.] Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... Listening is ...
Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... Listening is ... the engine of superior EXECUTION.
the key to making the Sale. the key to Keeping the Customers Business. the engine of Network development. the engine of Network maintenance. the engine of Network expansion. Social Networkings secret weapon. Learning. the sine qua non of Renewal. the sine qua non of Creativity. the sine qua non of Innovation.
the core of taking Diverse opinions aboard. Strategy. Source #1 of Value-added. Differentiator #1. Profitable.* (*The R.O.I. from listening is higher than from any other single activity.) Listening is the bedrock which underpins a Commitment to EXCELLENCE
*Listening is of the utmost strategic importance! *Listening is a proper core value ! *Listening is trainable !
*Listening is a ! profession Listen = Profession = Study = practice = evaluation = Enterprise value:
"We listen intently to and fully engage all with whom we work." The four most important words in any organization are
The four most important words in any organization are What do you think? Source: courtesy Dave Wheeler, posted at tompeters.com
The deepest human need is the need to be appreciated. William James *appreciation is of the utmost strategic importance!
*appreciation is a proper core value ! *appreciation is trainable ! *appreciation is a !
profession And the answer is . otis 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 interactionsalienating 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 Courtesies of a small and trivial character are the ones which strike deepest in the grateful
and appreciating heart. Henry Clay I regard apologizing as the most magical, healing, restorative gesture human beings can make. It is the centerpiece of my work with executives who want to get better. Marshall Goldsmith, What Got You
Here Wont Get You There: How Successful People Become Even More Successful THE PROBLEM IS RARELY/NEVER THE PROBLEM. THE RESPONSE TO THE PROBLEM INVARIABLY ENDS UP BEING THE REAL PROBLEM.*
PROBLEM *PERCEPTION IS ALL THERE IS! 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. BI
Big carts = 1.5X Source: Wal*Mart Socks = 10K/UK (DVT)
Compression hose would mostly fix the problem: According to the American Heart Association, up to two million Americans are affected annually by deep vein thrombosis. Of those who develop pulmonary embolism, up to 300,000 will die each year. ... Deep vein thrombosis also is among the leading causes of preventable hospital death. Even more disturbing is the fact that, according to a U.S. multi-center study published by two of ClotCare's editorial board members,
58% of patients who developed a DVT while in the hospital received no preventive treatment despite the presence of multiple risk factors and overwhelming data that prophylaxis is very effective at reducing these events. Marie B. Walker, clotcare.com, March 2008
Wash Your Hands! *14 different traces in a bowl of peanuts at a pub *Dispensers with handwashing solution all 20% 43% over the place, less illness,
fewer absences from class *Moist 500X dry *Warm-air dryer (110-206) >> No wash (117-47) *45% forgot/alone vs. 9% peers present Source: Wash Your Hands, Dr Frederic Saldmann The simplest treatments often
making sure a patient knows how to use an asthma inhaler, for instance. fall through the cracks And when doctors and hospitals try to deliver the right kind of care, such as keeping track of a heart patients weight gain , they lose money.
Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee 90K in U.S.A. ICUs on any given day; 178 steps/day in ICU. 50% stays result
in serious complication Source: Atul Gawande, The Checklist (New Yorker, 1210.07) **Peter Pronovost, Johns Hopkins, 2001 **Checklist, line infections **1/3rd at least one error when he started **Nurses/permission to stop procedure if doc, other not following checklist
**In 1 year, 10-day line-infection rate: 11% to 0% Source: Atul Gawande, The Checklist (New Yorker, 1210.07) (1) Amenable to rapid experimentation/failure
free (No bad PR, No $$) (2) Quick to implement/Quick to Roll out (3) Inexpensive to implement/ Roll out (4) Huge multiplier (5) An Attitude (6) Does not by and large require a power position from which
to launch experiments. #12 TGR [Things Gone WRONG-Things Gone RIGHT]
May I clean your glasses, sir? Perception is all there is
M.M.M.T. = Manage to Memorable Moments of Truth* *with thanks to Jan Carlzon, SAS XO* C
Xperience Officer *Chief e Music in the parking lot; professional musicians in the lobby (7/week, 3-4hrs/day) ; Griffin:
5 pianos volunteers (120-140 hrs arts & entertainment per month). ; The 9 Planetree Practices 1. The Importance of Human Interaction
2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 3. Healing Partnerships: The importance of Including Friends and Family 4. Nutrition: The Nurturing Aspect of Food 5. Spirituality: Inner Resources for Healing 6. Human Touch: The Essentials of Communicating Caring Through Massage 7. Healing Arts: Nutrition for the Soul 8. Integrating Complementary and Alternative Practices
into Conventional Care 9. Healing Environments: Architecture and Design Conducive to Health Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel 1/40 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 We ground up
more pig brains: 100% Mad Scientists! TPs 1/40/We ground up more pig brains Experiment fearlessly Its all about attitude! One Big Innovation Lab!
Let 1,000 flowers bloom (Chief Gardener?) Micro-experiment budget Hyper-quick approval process Hyper-quick prototyping (Measure mean time to prototype) Mini-project teams born in a flash Do everything at once No bad ideas except inaction Transparency/Publish everything
TPs 1/40/We ground up more pig brains Get it right the 79th time Reward clever/excellent failures Celebrate constantly/ Wee rewards/Recognition/ Mad scientist club Master nudgery Encourage/Reward cross-functional
excellence (A special category!) Take the lid off the best practices travel budget/Visit Excellence Steal excellence everywhere! LEARN from best practices/ Allow 100% variation TPs 1/40/We ground up more pig brains Coalition of Fearless Experimenters
Ask for help in Wikiworld Social networking with peers (Board game?) What do you think? Listen!!!! 100% participation 100% leaders Patient participation Process ideas from all Map everything
Measure but dont stifle! Training in process improvement for 100% Training in prototyping/100% Let us create such a building that future generations will take us for
lunatics. the church hierarchs at Seville Excellence can be obtained if you: ... care more than others think is wise; ... risk more than others think is safe; ... dream more than others think is practical; ... expect more than others think
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