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Live From the AHA Summit: Tom Peters' 14 Steps to Prevent the Awful Hospital Experience

Jim Molpus, for HealthLeaders Media, July 24, 2009

Management guru-visionary-grump Tom Peters told the assembled leaders of the American Hospital Association's annual Leadership Forum Thursday that they have no more excuses for poor performance. He had personal evidence. He spent 5.5 hours recently waiting in an emergency room while his wife suffered from a broken ankle.

While referring to the facility only as "a top hospital you will just have to figure out on your own," he recalled the four-minute interactions with a variety of physicians, and the terse, unsympathetic "no" he got when he asked if his wife could have some water. Peters said he understood that emergency rooms had to prioritize based on the acuity of patients brought in, but that alone could not justify why the visit was so poor.

"It was not a great experience. It was an awful experience," Peters said.

Peters—who describes himself alternately as a German engineer and a statistician hobbyist—said that the nationwide variations in hospital performance were not justified based on circumstances, singling our performance leaders such as Geisinger and Griffin Health as examples of health systems that have excelled in service and outcomes despite having the same constraints facing most of the nation's hospitals. "You just can't explain it away," he said.

So Peters offered his own list of "Principal Management and Leadership (as opposed to policy) Issues":

  1. Should we be doing what we are doing? Will it work? How do we know?
  2. Are we doing what we decided to do safely?
  3. Do we do too much—are we in the overuse category as determined by agreed-upon standards measures?
  4. Are we doing what we are engaged in doing effectively by local standards, by global standards (as determined by best practices, best hard evidence and minimal internal variation) in terms of quality, safety, and cost?
  5. Is the situation systematically organized to very consistently deliver the goods in more or less optimal fashion (low variation)?
  6. Do all the bits talk to-engage-consult obsessively with the other bits? Is the delivery turnkey?
  7. Are the patient and the patient's family at the epicenter of the universe?
  8. Is the institution acknowledged as a best place to work?
  9. Do we acknowledge that the people issues-capabilities involving the entire staff affect the outcomes far more than capital-technology issues?
  10. Is sustained follow-up at least as important as the event itself? "Do you want your tombstone to read 'He could have saved lives but instead wanted to get reimbursed.'"
  11. Are we successful in terms of outcomes-quality of life-patient satisfaction with the overall experience?
  12. Are all connected via an effective electronic network that extends the EMR to social networking?
  13. Do we acknowledge that most of the choices involved in executing No. 1 through No. 12 are mostly within our discretion regardless of the nature of Obamacare?
  14. Do we acknowledge that throughout the system there is today enormous variation in outcomes concerning every one of the above issues that can mostly be explained in terms of institutional leadership effectiveness?

Other kernels flowing from Peters:

"The CEO is not supposed to be the top strategist. The CEO is supposed to hire the top strategist."

"Leaders do people. It's the only damn thing they do."

"Excel at sucking down." (Covet relationships with people who do hard, often unrecognized jobs)

"Be astonishingly careful of who the hell you promote."

"Everyone has bad days. When 18 out of 22 days are crappy, there is a message."


Jim Molpus is Leadership Programs Director of HealthLeaders Media.
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