LONG Tom Peters

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LONGTom Peters EXCELLENCE.
ALWAYS.McKesson 2008 Executive Leadership
SummitThe Broadmoor/Colorado Springs/23 July
2008
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Slides at tompeters.com
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Part One A Civilian Looks at Your World
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DVM/Lyme/2005-2008Multip
le diagnoses (gt5)Specialist self-certaintyHe
alth deterioration failed to produce urgency-
communicationVirtually no communications
between specialistsFollow-up very spotty
unless bugged incessantlyLost major test
results, mis-placed 3 or 4 occasionsNear
fatal drug mistake (one nurse takes
charge)Effectively, disinterest in
chronic-careLack of curiosity
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Dartmouth Professor Elliott Fisher and his
colleagues discovered that patients who went to
hospitals that spent the most and did the most
procedures were 2 to 6 percent more likely to
die than patients that went to hospitals that
spent the least. Source Overtreated Why Too
Much Medicine Is Making Us Sicker and Poorer,
Shannon Brownlee
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The more doctors and specialists around, the
more tests and procedures performed. And the
results of all these tests and procedures? Lots
more medical bills, exposure to medical errors,
and a loss of life expectancy. It was this
last conclusion that was truly shocking, but it
became unavoidable when Dartmouths Dr. Jack
Wennberg and others broadened their studies. They
found its not just that renowned hospitals and
their specialists tend to engage in massive
overtreatment. They also tend to be poor at
providing critical but routine care. Source
Best Care Anywhere Why VA Healthcare Is Better
Than Yours/Phillip Longman
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If we sent 30 percent of the doctors in this
country to Africa, we might raise the level of
health on both continents. Dr Elliott Fisher,
Center of Evaluative Clinical Sciences,
Dartmouth Medical School (Overdose, Atlantic,
Shannon Brownlee.)
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CDC 1998 98,000 killed and 2,000,000 injured
from hospital-caused drug errors infections
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HealthGrades/Denver 195,000 hospital deaths per
year in the U.S., 2000-2002 equivalent of 390
full jumbos/747s in the drink per yearmore than
one-a-day.Comments There is little evidence
that patient safety has improved in the last five
years. Dr. Samantha CollierSource Boston
Globe/2005
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1,000,000 serious medication errors per year
illegible handwriting, misplaced decimal points,
and missed drug interactions and
allergies.Source Wall Street Journal
/Institute of Medicine
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Hospital infections kill an estimated 103,000
people in the United States a year, as many as
AIDS, breast cancer and auto accidents combined.
Today, experts estimate that more than 60
percent of staph infections are M.R.S.A. up from
2 percent in 1974. Hospitals in Denmark, Finland
and the Netherlands once faced similar rates, but
brought them down to below 1 percent. How?
Through the rigorous enforcement of rules on hand
washing, the meticulous cleaning of equipment and
hospital rooms, the use of gowns and disposable
aprons to prevent doctors and nurses from
spreading germs on clothing and the testing of
incoming patients to identify and isolate those
carrying the germ. Many hospital administrators
say they cant afford to take the necessary
precautions. Betsy McCaughey, founder of the
Committee to Reduce Infection Deaths (New York
Times/06.06.2005)
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Experts estimate that more than a hundred
thousand Americans die each year not from
illness but from their prescription drugs. Those
deaths, occurring quietly, almost without notice
in hospitals, emergency rooms, and homes, make
medicines one of the leading causes of death in
the United States. On a daily basis, prescription
pills are estimated to kill more than 270
Americans. Prescription medicines, taken
according to doctors instructions, kill more
Americans than either diabetes or Alzheimers
disease.Source Our Daily Meds How the
Pharmaceutical Companies Transformed Themselves
into Slick Marketing Machines and Hooked the
Nation on Prescription Drugs Melody Petersen
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140,000,000 illegible prescriptions per year
John Hammergren Phil Harkins, Skin in the
Game How Putting Yourself First Today Will
Revolutionize Healthcare Tomorrow
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1,500,000,000,000 claims per year30
errors15 lost25 paper-basedSource
John Hammergren Phil Harkins, Skin in the Game
How Putting Yourself First Today Will
Revolutionize Healthcare Tomorrow
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I can receive a BlackBerry message from a
colleague climbing a mountain, yet I still show
up at a doctors office and after a 45-minite
wait learn that my hospital test results have
not arrived weeks after they should have.
John Hammergren ( Phil Harkins), Skin in the
Game How Putting Yourself First Today Will
Revolutionize Healthcare Tomorrow
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stunning lack of scientific knowledge about
which treatments and procedures actually
work. Source Best Care Anywhere Why VA
Healthcare Is Better Than Yours/Phillip Longman
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Up To 500,000 Lives The medical system has
been unable to turn proven remedies into everyday
care. Half the people who need to be treated to
prevent heart attacks are not treated and half
who are treated are treated inadequately.
Patients go home with the wrong drugs or the
wrong doses or misimpressions about the
importance of taking their medications.More
55 chance of receiving the best recommended
carewhich means getting scientifically
appropriate, evidence-based medical treatment
The New York Times, from John Hammergren
Phil Harkins, Skin in the Game How Putting
Yourself First Today Will Revolutionize
Healthcare Tomorrow
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The results are deadly. In addition to the
98,000 killed by medical errors in hospitals and
the 90,000 deaths caused by hospital infections,
another 126,000 die from their doctors failure
to observe evidence-based protocols for just four
common conditions hypertension, heart attack,
pneumonia, and colorectal cancer. TP total
314,000 Source Best Care Anywhere Why VA
Healthcare Is Better Than Yours/Phillip Longman
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Bottom line 1900-1960, life expectancy grew
0.64 per year 1960-2002, 0.24 per year, half
from airbags, gun locks, service employment
Source Best Care Anywhere Why VA Healthcare
Is Better Than Yours/Phillip Longman
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Plus God alone knows how many casualties in
doctors offices, Tom Thom Mayer
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25 to 30 percent of our 2.2 trillion
goes to wasted care in the form of preventable
errors, incorrect diagnoses, redundant treatment,
unnecessary infections, and extra time spent in
the hospital. Team-based medicine, bar-code
prescription scanning, evidence-based
medicineall of these are systems and innovations
that are being put into place to eliminate waste
so that we can re-apply the money.John
Hammergren Phil Harkins, Skin in the Game How
Putting Yourself First Today Will Revolutionize
Healthcare Tomorrow
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Medical HomesClinical
MicrosystemsConvenient Care
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Clinical microsystem, linked microsystems,
patient-centric care teams Paul
Batalden/DHMCSource What System? Dartmouth
Medicine, Summer 2006 (Quality By Design A
Clinical Microsystems Approach, by Eugene C.
Nelson, Paul B. Batalden, and Marjorie M. Godfrey)
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Part Two The Last 98
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1
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it is the game.
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If I could have chosen not to tackle the IBM
culture head-on, I probably wouldnt have. My
bias coming in was toward strategy, analysis and
measurement. In comparison, changing the attitude
and behaviors of hundreds of thousands of people
is very, very hard. Yet I came to see in my
time at IBM that culture isnt just one aspect of
the game it is the game. Lou Gerstner, Who
Says Elephants Cant Dance
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30-fold!
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Ken Kizer/VA 1997 culture of cover-up that
pervades healthcare Patient Safety Event
Registry looking for systemic solutions, not
seeking to fix blame on individuals except in the
most egregious cases. The good news was a
thirty-fold increase in the number of medical
mistakes and adverse events that got reported.
National Center for Patient Safety Ann Arbor
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2
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Thank you Ike , Charlie, Ben Norm,
George, Nelson, and Ben
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Allied commands depend on mutual confidence
and this confidence is gained, above all
through the development of friendships.
General D.D. Eisenhower, Armchair General
(05.08)Perhaps his most outstanding ability
at West Point was the ease with which he made
friends and earned the trust of fellow cadets
who came from widely varied backgrounds it was
a quality that would pay great dividends during
his future coalition command.
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George Crile (Charlie Wilsons War) on Charlie
Wilson The way things normally work, if youre
not Jewish you dont get into the Jewish caucus,
but Charlie did. And if youre not black you
dont get into the black caucus. But Charlie
plays poker with the black caucus they had a
game, and hes the only white guy in it. The
House, like any human institution, is moved by
friendships, and no matter what people might
think about Wilsons antics, they tend to like
him and enjoy his company.
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Give good tea!
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In the same bitter winter of 1776 that Gen.
George Washington led his beleaguered troops
across the Delaware River to safety, Benjamin
Franklin sailed across the Atlantic to Paris to
engage in an equally crucial campaign, this one
diplomatic. A lot depended on the bespectacled
and decidedly unfashionable 70-year-old as he
entered the worlds fashion capitol sporting a
simple brown suit and a fur cap. Franklins
miracle was that armed only with his canny
personal charm and reputation as a scientist and
philosopher, he was able to cajole a wary French
government into lending the fledgling American
nation an enormous fortune. The enduring image
of Franklin in Paris tends to be that of a
flirtatious old man, too busy visiting the citys
fashionable salons to pursue affairs of state as
rigorously as John Adams. When Adams joined
Franklin in Paris in 1779, he was scandalized by
the late hours and French lifestyle his colleague
had adopted, says Stacy Schiff, in A Great
Improvisation Adams was clueless that it was
through the dropped hints and seemingly offhand
remarks at these salons that so much of French
diplomacy was conducted. Like the Beatles
arriving in America, Franklin aroused a
fervorhis face appeared on prints, teacups and
chamber pots. The extraordinary popularity served
Franklins diplomatic purposes splendidly. Not
even King Louis XVI could ignore the enthusiasm
that had won over both the nobility and the
bourgeoisie. Source In Paris, Taking the
Salons By Storm How the Canny Ben Franklin
Talked the French into Forming a Crucial
Alliance, U.S. News World Report, 0707.08
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The 95 Factor What I learned from my years as
a hostage negotiator is that we do not have to
feel powerlessand that bonding is the antidote
to the hostage situation. George Kohlrieser,
Hostage at the Table
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?
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I am a dispenser of enthusiasm. Ben Zander
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Hard Is SoftSoft Is Hard
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Hard Is Soft (Plans, s)Soft Is Hard (people,
customers, values, relationships))
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R.O.I.R.
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Return On Investment In Relationships
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Relationships (of all varieties) THERE ONCE WAS
A TIME WHEN A THREE-MINUTE PHONE CALL WOULD HAVE
AVOIDED SETTING OFF THE DOWNWARD SPIRAL THAT
RESULTED IN A COMPLETE RUPTURE.

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Courtesies of a small and trivial character are
the ones which strike deepest in the grateful and
appreciating heart. Henry Clay
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THE PROBLEM IS RARELY/NEVER THE PROBLEM. THE
RESPONSE TO THE PROBLEM INVARIABLY ENDS UP BEING
THE REAL PROBLEM.

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X XFXExcellence Cross-functional
Excellence
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Stanford/HagadornConoco/geologists-geophysici
stsSchlumberger IPM-IBM Global Services-
UPS Logistics (bet the company)GSK/CEDDChi
at/DayBatalden/DHMC/clinical
microsystems9-11 CommissionEtcEtc
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The XF-50 50 Ways to Enhance Cross-Functional
Effectiveness and Deliver Speed, Service
Excellence and Value-added Customer
SolutionsEntire XF-50 List is an
Appendix to this presentation
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Never waste a lunch!
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???? XF lunches Measure!
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CIO Question Doc lunches Last 30 days
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???????Success doesnt depend on the number of
people you know it depends on the number of
people you know in high places!or Success
doesnt depend on the number of people you know
it depends on the number of people you know in
low places!
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Loser Hes such a suck-up!Winner
Hes such a suck-down.
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George Crile (Charlie Wilsons War) on Gust
Avrakotos strategy He had become something
of a legend with these people who manned the
underbelly of the Agency CIA.
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William Easterly, The White Mans Burden Why the
Wests Effort to Aid the Rest Have Done So Much
Ill and so Little Good The West spent 2.3
trillion on foreign aid over the last five
decades and still has not managed to get
twelve-cent medicines to children to prevent half
of all malaria deaths. The West spent 2.3
trillion and still not managed to get three
dollars to each new mother to prevent five
million child deaths. But I and many other
like-minded people keep trying, not to abandon
aid to the poor, but to make sure it reaches
them.
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Lesson Show up. Lesson Listen to the
locals. Lesson Hear the locals. Lesson
Engage the locals. Lesson Try a lot of
stuff.
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Ninety percent of success is showing up.
Woody Allen
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MBWA
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18 Source How Doctors Think, Jerome Groopman
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Noth-ing is scalable!
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Buy in- Ownership-Authorial bragging
rights-Born again Champion One Line of Code!
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Nothing is scalable!Every replication must
exude the perception of uniquenesseven if it
means a half-step backwards. (It wouldnt have
worked if we hadnt done it our way.)
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Easterly, maligned by many, is the arch-enemy of
the Big Plan his capital letters, not minefor
once sent from afar and the vociferous fan of
practical activities of those he calls
Searchers who learn the ins and outs of the
culture, politics and local conditions on the
ground in order to use local levers and local
players, and get those 12- cent medicines to
community members. Read on, Planners vs
Searchers
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We made mistakes, of course. Most of them were
omissions we didnt think of when we initially
wrote the software. We fixed them by doing it
over and over, again and again. We do the same
today. While our competitors are still sucking
their thumbs trying to make the design perfect,
were already on prototype version 5. By the
time our rivals are ready with wires and screws,
we are on version 10. It gets back to planning
versus acting We act from day one others plan
how to planfor months. Bloomberg by Bloomberg
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1/40
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Culture of PrototypingEffective prototyping
may be the most valuable core competence an
innovative organization can hope to have.
Michael Schrage

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Experiment fearlesslySource BW0821.06, Type
A Organization Strategies/ How to Hit a Moving
TargetTactic 1
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This is so simple it sounds stupid, but it is
amazing how few oil people really understand that
you only find oil if you drill wells. You may
think youre finding it when youre drawing maps
and studying logs, but you have to drill.
Source The Hunters, by John Masters, Canadian
O G wildcatter
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Lesson Talk to the locals. Lesson Listen to
the locals. Lesson Hear the locals. Lesson
Listen to the locals. Lesson Hear the
locals. Lesson Listen to the
locals. Lesson Hear the locals. Lesson
Listen to the locals. Lesson Hear to the
locals. Lesson Listen to the
locals. Lesson Hear to the locals. Lesson
Respect the locals. Lesson Empathize with the
locals.
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For projects involving children or health or
education or community development or sustainable
small-business growth (most projects), women are
by far the most reliable and most central and
most indirectly powerful local players even in
the most chauvinist settings.
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Forget China, India and the Internet Economic
Growth Is Driven by Women. Headline, Economist,
April 15, 2006, Leader, page 14
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Women are the majority market Fara
Warner/The Power of the Purse
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The most significant variable in every sales
situation is the gender of the buyer, and more
importantly, how the salesperson communicates to
the buyers gender. Jeffery Tobias Halter,
Selling to Men, Selling to Women
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The Perfect Answer
Jill and Jack buy slacks in black
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(No Transcript)
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AS LEADERS, WOMEN RULE New Studies find that
female managers outshine their male counterparts
in almost every measure TITLE/ Special
Report/ BusinessWeek
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One thing is certain Womens rise to power,
which is linked to the increase in wealth per
capita, is happening in all domains and at all
levels of society. Women are no longer content to
provide efficient labor or to be consumers with
rising budgets and more autonomy to spend.
This is just the beginning. The phenomenon will
only grow as girls prove to be more successful
than boys in the school system. For a number of
observers, we have already entered the age of
womenomics, the economy as thought out and
practiced by a woman. Aude Zieseniss de Thuin,
Financial Times, 10.03.2006
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10 UNASSAILABLE REASONS WOMEN
RULE Women make all the financial
decisions.Women control all the wealth. Women
substantially outlive men. Women start most of
the new businesses. Womens work force
participation rates have soared
worldwide. Women are closing in on same pay for
same job. Women are penetrating senior
ranks rapidly even if the pace is slow for
the corner office per se. Womens
leadership strengths are exceptionally well
aligned with new organizational effectiveness
imperatives. Women are better salespersons than
men. Women buy almost everythingcommercial
as well as consumer goods. So what exactly is
the point of men?
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TP How to flush 500,000 down the toilet in
one easy lesson!!
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lt CAPEXgt People!
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no less than Cathedrals in which the full and
awesome power of the Imagination and Spirit and
native Entrepreneurial flair of diverse
individuals is unleashed in passionate pursuit of
Excellence.
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You have to treat your employees like
customers. Herb Kelleher, upon being asked his
secret to successSource Joe Nocera, NYT,
Parting Words of an Airline Pioneer, on the
occasion of Herb Kellehers retirement after 37
years at Southwest Airlines (SWAs pilots union
took out a full-page ad in USA Today thanking HK
for all he had done across the way in Dallas
American Airlines pilots were picketing the
Annual Meeting)
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1 cause ofDis-satisfaction?
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Employee retention satisfaction
Overwhelmingly, based on their immediate
manager!Source Marcus Buckingham Curt
Coffman, First, Break All the Rules What the
Worlds Greatest Managers Do Differently
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EXCELLENCE. BEDROCK.LEADERSHIP. THE 10Ps.
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PURPOSE.PASSION.Potential.Presence.Personal.P
ERSISTENCE.PEOPLE. Promotion.
Potent.Positive.
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I am a Dispenser of Enthusiasm!Ben Zander
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You must be the change you wish to see in the
world.Gandhi
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Relentless One of my superstitions had always
been when I started to go anywhere or to do
anything, not to turn back , or stop, until the
thing intended was accomplished. Grant
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MBWA
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Kevin Roberts Credo1.
Ready. Fire! Aim.2. If it aint broke ... Break
it!3. Hire crazies.4. Ask dumb questions.5.
Pursue failure.6. Lead, follow ... or get out of
the way!7. Spread confusion.8. Ditch your
office.9. Read odd stuff.10. Avoid moderation!
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Leaders do people. Period. Anon.
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On NELSON other admirals more frightened of
losing than anxious to win
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2 per Year/ 20 per Decade Excellence Legacy
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9
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Nudge.Sway.K.I.S.S.Keep It Simple, Stupid
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90K in U.S.A. ICUs on any given day 178
steps/day in ICU.50 stays result in serious
complicationSource Atul Gawande, The
Checklist (New Yorker, 1210.07)
105
Peter Pronovost, Johns Hopkins,
2001Checklist, line infections1/3rd at
least one error when he startedNurses/permissio
n to stop procedure if doc, other not following
checklistIn 1 year, 10-day line-infection
rate 11 to 0 Source Atul Gawande, The
Checklist (New Yorker, 1210.07)
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Docs, nurses make own checklists on whatever
process-procedure they chooseWithin weeks,
average stay in ICU down 50Source Atul
Gawande, The Checklist (New Yorker, 1210.07)
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Replicate in Inner City Detroit (resource
strapped, staff cut 1/3rd, poorest patients
in USA)Nurses QB the processProject manager
for overall process implementationExec
involvement (help with little thingsits all
little things)Blue Cross/insurers, small
bonuses for participating6 months, 66
decrease in infection rate USA bottom 25 in
hospital rankings to top 10Source Atul
Gawande, The Checklist (New Yorker, 1210.07)
108
Pronovost is focused on work that is not
normally considered a significant contribution in
academic medicine. As a result, few others are
venturing to extend his achievements. Yet his
work has already saved more lives than that of
any laboratory scientist in the last decade.
Atul Gawande, The Checklist (New Yorker,
1210.07)
109
Compression hose would mostly fix the
hospital 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
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Everything matters -80 Source Nudge,
Richard Thaler and Cass Sunstein, etching of fly
in the urinal reduces spillage by 80,
Schiphol Airport
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10
112
Experiences are as distinct from services as
services are from goods. Joe Pine Jim
Gilmore, The Experience Economy Work Is Theatre
Every Business a Stage
113
Experience Rebel Lifestyle!What we sell is
the ability for a 43-year-old accountant to dress
in black leather, ride through small towns and
have people be afraid of him.Harley exec,
quoted in Results-Based Leadership
114
ltTGWvs. gtTGR
115
2-cent candy
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Part Three Five Pianos
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Fivepianos
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Planetree A Radical Model for New
Healthcare/Healing/Wellness ExcellenceTom
Peters
119
How will you know when the healthcare industry
has finally entered the 21st century? When
error rates at hospitals are close to zero. When
doctors and nurses use evidence-based protocols
in your treatment. When you can decide how much
to spend on treatment, and you have the
information and the opportunity to determine the
best value. When your primary care physician is
in charge of your extended care team, operating
as your command central. When all members of
the medical communitynurses, doctors,
pharmacists and specialistswork together
seamlessly on your behalf. When their combined
efforts are tracked, measured, and reported
onand the insurance reimbursements awarded to
them are based on performance. When you see
that hospitals, pharmacies and doctors are
working harder in all aspects to make sure you
are an informed consumer who has trust and
confidence in the services they offer and the
prices they charge. John Hammergren Phil
Harkins, Skin in the Game How Putting Yourself
First Today Will Revolutionize Healthcare
Tomorrow
120
The 9 Planetree
Practices1. The Importance of Human
Interaction2. Informing and Empowering Diverse
Populations Consumer Health Libraries and
Patient Information3. Healing Partnerships The
importance of Including Friends and Family4.
Nutrition The Nurturing Aspect of Food5.
Spirituality Inner Resources for Healing6.
Human Touch The Essentials of Communicating
Caring Through Massage7. Healing Arts Nutrition
for the Soul8. Integrating Complementary and
Alternative Practices into Conventional
Care9. Healing Environments Architecture and
Design Conducive to HealthSource Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
121
1. The Importance of Human Interaction
122
Press Ganey Assoc 139,380 former patients from
225 hospitalsnone of THE top 15 factors
determining Patient Satisfaction referred to
patients health outcomePS directly related to
Staff InteractionPS directly correlated with
Employee Satisfaction Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
123
There is a misconception that supportive
interactions require more staff or more time and
are therefore more costly. Although labor costs
are a substantial part of any hospital budget,
the interactions themselves add nothing to the
budget. Kindness is free. Listening to patients
or answering their questions costs nothing. It
can be argued that negative interactionsalienatin
g patients, being non-responsive to their needs
or limiting their sense of controlcan be very
costly. Angry, frustrated or frightened
patients may be combative, withdrawn and less
cooperativerequiring far more time than it
would have taken to interact with them initially
in a positive way. Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
124
2. Informing and Empowering Diverse Populations
Consumer Health Libraries and Patient
Information
125
Planetree Health Resources Center/1981Planetree
Classification SystemConsumer Health
LibrariansVolunteersClasses, lecturesHealth
FairsGriffins Mobile Health Resource
CenterOpen Chart PolicyPatient Progress
NotesCare Coordination Conferences (Est goals,
timetable, etc.)Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
126
3. Healing Partnerships The Importance of
Including Friends and Family
127
Family members, close friends and significant
others can have a far greater impact on
patients experience of illness, and on their
long-term health and happiness, than any
healthcare professional. Through the
Patients Eyes
128
Care Partner Programs (IDs, discount meals,
etc.)Unrestricted visits (Most Planetree
hospitals have eliminated visiting restrictions
altogether.) (ER at one hospital has a policy
of never separating the patient from the family,
and there is no limitation on how many family
members may be present.)Collaborative Care
ConferencesClinical Guidelines
DiscussionsFamily SpacesPet Visits (POP
Patients Own Pets)Source Putting Patients
First, Susan Frampton, Laura Gilpin, Patrick
Charmel
129
4. Nutrition The Nurturing Aspect of Food
130
KitchenBeautiful cutlery, plates, etcChef
reputation Source Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
131
Aroma therapy (e.g., smell of baking
cookiesfrom kitchenettes in each
ward)Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
132
5. Spirituality Inner Resources for Healing
133
Spirituality Meaning and Connectedness in
Life1. Connected to supportive and caring
group2. Sense of mastery and control3. Make
meaning out of disease/ find meaning in
sufferingSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
134
Griffin redesign chapel (waterfall,
quiet music, open prayer book)Other music,
flowers, portable
labyrinthSource Putting Patients First,
Susan Frampton, Laura Gilpin, Patrick Charmel
135
6. Human Touch The Essentials of Communicating
Caring Through Massage
136
Massage is a powerful way to communicate
caring. Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
137
Mid-Columbia Medical Center/Center for Mind and
BodyMassage for every patient scheduled for
ambulatory surgery (Go into surgery witha good
attitude) Infant massageStaff massage (caring
for the caregivers)Healing environments
chemo!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
138
7. Healing Arts Nutrition for the Soul
139
Planetree Environment conducive to
healingColor!Light!Brilliance!Form!Art!Mu
sic!Source Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
140
Griffin Music in the parking lot professional
musicians in the lobby (7/week, 3-4hrs/day) 5
pianos volunteers (120-140 hrs arts
entertainment per month). Source Putting
Patients First, Susan Frampton, Laura Gilpin,
Patrick Charmel
141
8. Integrating Complementary and Alternative
Practices into Conventional Care
142
Griffin IMC/Integrative Medicine
CenterMassageAcupunctureMeditationChiropracti
cNutritional supplementsAroma therapySource
Putting Patients First, Susan Frampton, Laura
Gilpin, Patrick Charmel
143
9. Healing Environments Architecture and Design
Conduciveto Health
144
Planetree LookWoods and natural
materialsIndirect lightingHomelike
settingsGoals Welcome patients, friends and
family Value humans over technology .. Enable
patients to participate in their care Provide
flexibility to personalize the care of each
patient Encourage caregivers to be responsive
to patients Foster a connection to nature and
beautySource Putting Patients First, Susan
Frampton, Laura Gilpin, Patrick Charmel
145
F.Y.I. It works!
146
Griffin Hospital/Derby CT (Planetree Alliance
HQ) Results Financially successful.
Expanding programs-physically. Growing market
share. Only hospital in 100 Best Cos to Work
for7 consecutive years, currently 6.
Five-Star Hospitals, Joe Flower,
strategybusiness (42)
147
9 July 2008/HealthLeaders 2008 Top
Leadership Team in Healthcare Griffin Hospital
148
AppendixTom peters on implementation The
Lists
149
Never forget implementation , boys. In our work,
its what I call the last 98 percent of the
client puzzle. Al McDonald, former Managing
Director, McKinsey Co, to a project team,
reported by subsequent McKinsey MD, Ron Daniel
150
The Have you 50
151
Mapping your competitive position or
152
While waiting last week early December 2007 in
the Albany airport to board a Southwest Airlines
flight to Reagan, I happened across the latest
Harvard Business Review, on the cover of which
was a yellow sticker. The sticker had on it the
words Mapping your competitive position. It
referred to a feature article by my friend Rich
DAveni. His work is uniformly goodand I have
said as much publicly on several occasions dating
back 15 years. Im sure this article is good,
toothough I didnt read it. In fact it triggered
a furious negative Tom reaction as my wife
calls it. Of course I believe you should worry
about your competitive position. But instead of
obsessing on competitive position and other
abstractions, as the B-schools and consultants
would always have us do, I instead wondered about
some practical stuff which I believe is more
important to the short- and long-term health of
the enterprise, tiny or enormous.
153
Unfortunately many leaders of major companies
believe their job is to create the strategy,
organization and organization processesremaining
aloof from the people doing the work. George
Kohlrieser, Hostage at the Table (GK is, among
other things, a hostage negotiator with a 95
success rate)
154
1. Have you in the last 10 days visited a
customer? 2. Have you called a customer
TODAY? 3. Have you in the last 60-90 days had
a seminar in which several folks from the
customers operation (different levels, different
functions, different divisions) interacted, via
facilitator, with various of your folks? 4. Have
you thanked a front-line employee for a small act
of helpfulness in the last three days? 5. Have
you thanked a front-line employee for a small act
of helpfulness in the last three hours? 6.
Have you thanked a frontline employee for
carrying around a great attitude today? 7. Have
you in the last week recognizedpubliclyone of
your folks for a small act of cross-functional
co-operation? 8. Have you in the last week
recognizedpubliclyone of their folks (another
function) for a small act of cross-functional
co-operation? 9. Have you invited in the last
month a leader of another function to your weekly
team priorities meeting? 10. Have you personally
in the last week-month called-visited an internal
or external customer to sort out, inquire, or
apologize for some little or big thing that went
awry? (No reason for doing so? If truein your
mindthen youre more out of touch than I dared
imagine.)
155
1. Have you in the last 10 days visited a
customer?2. Have you called a customer TODAY?
156
Blog1231.07 FLASH! FLASH! FLASH! FOR IMMEDIATE
ACTION! FOR IMMEDIATE ACTION! FOR IMMEDIATE
ACTION! OLD YEARS RESOLUTION! Call (C-A-L-L!)
(NOT E-MAIL!) 25-50 (NO LESS THAN 25) people
TODAY to thank them for their support this
year (2007) and wish them and their families
and colleagues a Happy 2008!
Today TODAY N-O-W (not within the
hour) Remember ROIR gt ROI. ROIR Return On
Investment in Relationships. Success
ƒ(Relationships). This is the most important
piece of advice I have provided this
year. This is Not Optional. Trust me
This is fun!!!! Trust me This
works. Happy 2008!!!
157
I posted this at tompeters.com on New Years Eve
2007.
158
11. Have you in the last two days had a chat with
someone (a couple of levels down?) about specific
deadlines concerning a projects next steps? 12.
Have you in the last two days had a chat with
someone (a couple of levels down?) about specific
deadlines concerning a projects next steps and
what specifically you can do to remove a hurdle?
(Ninety percent of what we call management
consists of making it difficult for people to get
things done.Peter His eminence Drucker.) 13.
Have you celebrated in the last week a small
(or large!) milestone reached? (I.e., are you a
milestone fanatic?) 14. Have you in the last week
or month revised some estimate in the wrong
direction and apologized for making a lousy
estimate? (Somehow you must publicly reward the
telling of difficult truths.) 15. Have you
installed in your tenure a very comprehensive
customer satisfaction scheme for all internal
customers? (With major consequences for hitting
or missing the mark.) 16. Have you in the last
six months had a week-long, visible, very
intensive visit-tour of external customers? 17.
Have you in the last 60 days called an abrupt
halt to a meeting and ordered everyone to get
out of the office, and into the field and in
the next eight hours, after asking those
involved, fixed (f-i-x-e-d!) a nagging small
problem through practical action? 18. Have you in
the last week had a rather thorough discussion of
a cool design thing someone has come
acrossaway from your industry or functionat a
Web site, in a product or its packaging? 19.
Have you in the last two weeks had an informal
meetingat least an hour longwith a frontline
employee to discuss things we do right, things we
do wrong, what it would take to meet your mid- to
long-term aspirations? 20. Have you had in the
last 60 days had a general meeting to discuss
things we do wrong that we can fix in the
next fourteen days?
159
UniCredit Group/
UniCredito Italiano 3rd party
measurementCustomer-initiated
measurementPrimary incentivesFactories
Primary Corporate InitiativeEtc13TP/1
160
The director of staff services at the giant
financial services firm, UniCredit Group,
installed the most thorough internal customer
satisfaction measures scheme I have seenwith
exceptional rewards for those who make the grade
with their internal customers.
161
21. Have you had in the last year a one-day,
intense offsite with each (?) of your internal
customersfollowed by a big celebration of
things gone right? 22. Have you in the last
week pushed someone to do some family thing that
you fear might be overwhelmed by deadline
pressure? 23. Have you learned the names of the
children of everyone who reports to you? (If not,
you have six months to fix it.) 24. Have you
taken in the last month an interesting-weird
outsider to lunch? 25. Have you in the last month
invited an interesting-weird outsider to sit in
on an important meeting? 26. Have you in the last
three days discussed something interesting,
beyond your industry, that you ran across in a
meeting, reading, etc? 27. Have you in the last
24 hours injected into a meeting I ran across
this interesting idea in strange place? 28.
Have you in the last two weeks asked someone to
report on something, anything that constitutes an
act of brilliant service rendered in a trivial
situationrestaurant, car wash, etc? (And then
discussed the relevance to your work.) 29. Have
you in the last 30 days examined in detail (hour
by hour) your calendar to evaluate the degree
time actually spent mirrors your espoused
priorities? (And repeated this exercise with
everyone on team.) 30. Have you in the last two
months had a presentation to the group by a
weird outsider?
162
You Your calendarCalendars never lie
163
All we have is our time. The way we spend our
time is our priorities, is our strategy.
Your calendar knows what you really care about.
Do you?
164
31. Have you in the last two months had a
presentation to the group by a customer, internal
customer, vendor featuring working folks 3 or 4
levels down in the vendor organization? 32. Have
you in the last two months had a presentation to
the group of a cool, beyond-our-industry ideas by
two of your folks? 33. Have you at every meeting
today (and forever more) re-directed the
conversation to the practicalities of
implementation concerning some issue before the
group? 34. Have you at every meeting today (and
forever more) had an end-of-meeting discussion on
action items to be dealt with in the next 4, 48
hours? (And then made this list publicand
followed up in 48 hours.) And made sure everyone
has at least one such item.) 35. Have you had a
discussion in the last six months about what it
would take to get recognition in local-national
poll of best places to work? 36. Have you in
the last month approved a cool-different training
course for one of your folks? 37. Have you in
the last month taught a front-line training
course? 38. Have you in the last week discussed
the idea of Excellence? (What it means, how to
get there.) 39. Have you in the last week
discussed the idea of Wow? (What it means,
how to inject it into an ongoing routine
project.) 40. Have you in the last 45 days
assessed some major process in terms of the
details of the experience, as well as results,
it provides to its external or internal customers?
165
41. Have you in the last month had one of your
folks attend a meeting you were supposed to go to
which gives them unusual exposure to senior
folks? 42. Have you in the last 60 (30?) days sat
with a trusted friend or coach to discuss your
management styleand its long- and short-term
impact on the group? 43. Have you in the last
three days considered a professional relationship
that was a little rocky and made a call to the
person involved to discuss issues and smooth the
waters? (Taking the blame, fully deserved or
not, for letting the thing-issue fester.) 44.
Have you in the last two hours stopped by
someones (two-levels down") office-workspace
for 5 minutes to ask What do you think? about
an issue that arose at a more or less just
completed meeting? (And then stuck around for 10
or so minutes to listenand visibly taken
notes.) 45. Have you in the last day looked
around you to assess whether the diversity pretty
accurately maps the diversity of the market being
served? (And ) 46. Have you in the last day at
some meeting gone out of your way to make sure
that a normally reticent person was engaged in a
conversationand then thanked him or her, perhaps
privately, for their contribution? 47. Have you
during your tenure instituted very public
(visible) presentations of performance? 48. Have
you in the last four months had a session
specifically aimed at checking on the corporate
culture and the degree we are true to itwith
all presentations by relatively junior folks,
including front-line folks? (And with a
determined effort to keep the conversation
restricted to real world small casesnot
theory.) 49. Have you in the last six months
talked about the Internal Brand Promise? 50. Have
you in the last year had a full-day off site to
talk about individual (and group) aspirations?
166
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.

167
R.O.I.R.
168
Return On Investment In Relationships
169
Job One.
170
You must care. General Melvin Zais
171
Courtesies of a small and trivial character are
the ones which strike deepest in the grateful and
appreciating heart. Henry Clay
172
The magic number 25.Mbwa.Calendars never
lie.Excellence.Always.Tom Peters/0709.07
173
MBWA5,000 miles for a 5-minute face-to-face
meeting (courtesy super-agent Mark McCormick)
174
When Bob Waterman and I wrote In Search of
Excellence in 1982, business was by the
numbersand the Americans were struggling (to
put it mildly) with hands on, tactile stuff, like
Japanese quality. Then, at Hewlett Packard, we
were introduced to the famed HP Way, the
centerpiece of which was in-touch management. HP
had a term for this MBWA. (Managing By
Wandering Around.) Bob and I fell in immediate
love. Not only was the idea per se important and
cool, but it symbolized everything we were coming
to cherishenterprises where bosses-leaders were
in immediate touch with and emotionally attached
to workers, customers, the product. The idea is
as important or more important in fast-paced 2007
as it was in 1982.
175
20-minute rule Craig Johnson/30 yrs
176
Craig Johnson, a famed Venture Capitalist for
three decades refuses to invest in companies
that are more than a 20-minute drive from his
office. To guide them through the serpentine path
ahead, he insists that he must be in constant
touch as banker, advisor, friend.
177
gt70Hank Paulson, China visits, Fortune 1127.06
178
China is clearly our most important economic
partner. Our dialog with China was not what it
might have been when Hank Paulson took over as
Secretary of the Treasury. Immediate improvement
occurred for numerous reasons, not least of which
were Paulsons SEVENTY TRIPS to China while at
Goldman Sachs.
179
I call 60 CEOs in the first week of the year
to wish them happy New Year. Hank Paulson,
former CEO, Goldman SachsSource Fortune,
Secrets of Greatness, 0320.05
180
MBWA, Grameen Style!Conventional banks ask
their clients to come to their office. Its a
terrifying place for the poor and illiterate.
The entire Grameen Bank system runs on the
principle that people should not come to the
bank, the bank should go to the people. If any
staff member is seen in the office, it should be
taken as a violation of the rules of the Grameen
Bank. It is essential that those setting up a
new village Branch have no office and no place
to stay. The reason is to make us as different as
possible from government officials. Source
Muhammad Yunus, Banker to the Poor
181
You must be the change you wish to see in the
world.Gandhi
182
Its always showtime. David DAlessandro,
Career Warfare
183
a blinding flash of the obvious Manny Garcia
184
All this this little riff is indeed, as
seminar participant and leading Burger King
franchisee Many Garcia once said to me,
obvious. But observation over four decades
suggests that amidst the hubbub and travails of a
typical days work, the so-called obvious is
often-usually left unattended. For perfectly good
reasons, another week passes without a visit to
our equivalent of the Starbucks shops or HP RD
labs, without the equivalent to Hank Paulsens
How ya doin? call to a key customer. My Tom
Peters Job One in life? Remind busy folks of the
obvious!Manny Garcia/1983 Tom, I hope you
wont be insulted when I say this was the best
seminar Ive ever been toand it was a blinding
flash of the obvious.I had two commanding
officers during my two Vietnam tours in U.S.
Naval Mobile Construction Battalion NINE
(1966-1968). One was a Howard Shultz
look-alikeinstinctively in the field. The other
was an in the office leader. The one produced.
The other didnt. At age 24 I learned an
incredible life lesson, though I couldnt
describe it well until tripping over HPs
MBWA/Managing By Wandering Around.
185
The XF-50 50 Ways to Enhance Cross-Functional
Effectiveness and Deliver Speed, Service
Excellence and Value-added Customer Solutions
186
X XFXExcellence Cross-functional
Excellence
187
A 2007 letter from John Hennessy, president of
(1) Stanford University, to alumni laid out his
long-term vision for that esteemed institution.
The core of the visions promise was more
multi-disciplinary research, aimed at solving
some of the worlds complex systemic problems.
(2) The chief of GlaxoSmithKline, a few years
ago, announced a revolutionary new drug
discovery processhuman-scale centers of
interdisciplinary excellence, called Centers of
Excellence in Drug Discovery. (It worked.) (3)
Likewise, amidst a study of organization
effectiveness in the oil industrys exploration
sector, I came across a particularly successful
firmone key to that success was their physical
and organizational mingling of formerly warring
(two sets of prima donnas) geologists and
geophysicists.
188
(4) The cover story in Dartmouth Medicine, the
Dartmouth med school magazine, featured a
revolutionary approach, microsystems, as the
big idea that might save U.S. healthcare. The
nub is providing successful patient outcomes in
hospitals by forming multi-function patient-care
teams, including docs, nurses, labtechs and
others. (Co-operating doc may top the oxymoron
scale.) (5) One of the central responses to 911
is an effort to get intelligence services, home
to some of the worlds most viscous turf wars,
talking to one anotherwe may have seen some of
the fruits of that effort in the recently
released National Intelligence Estimate. And in
the military, inter-service co-operation has
increased by an order of magnitude since Gulf War
Onesome of the services communication systems
can actually be linked to those of other
services, a miracle almost the equal of the
Christmas miracle in my book!
189
1. Its our organization to make workor not.
Its not them, the outside world thats the
problem. The enemy is us. Period. 2.
Friction-free! Dump 90 of middle managersmost
are advertent or inadvertent power freaks. We
are allevery one of usin the Friction Removal
Business, one moment at a time, now and
forevermore. 3. No stovepipes! Stove-piping,
Silo-ing is an Automatic Firing Offense.
Period. No appeals. (Within the limits of
civility, somewhat public firings are not out
of the questionthat is, make one and all aware
why the axe fell.) 4. Everything on the Web. This
helps. A lot. (Everything Big word.) 5. Open
access. All available to all. Transparency,
beyond a level thats sensible, is a de facto
imperative in a Burn-the-Silos strategy. 6.
Project managers rule!! Project managers running
XF (cross-functional) projects are the Elite of
the organization, and seen as such and treated as
such. (The likes of construction companies have
practiced this more or less forever.) 7.
Value-added Proposition Application of
integrated resources. (From the entire
supply-chain.) To deliver on our emergent
business raison detre, and compete with the
likes of our Chinese and Indian brethren, we must
co-operate with anybody and everybody 24/7.
IBM, UPS and many, many others are selling far
more than a product or service that worksthe new
it is pure and simple a product of XF
co-operation the product is the co-operation
is not much of a stretch.
190
We have met the enemy and he is us. Walt
Kelly/Pogo
191
Schlumberger!
192
A January 2008 BusinessWeek cover story informed
us that Schlumberger may well take over the
world THE GIANT STALKING BIG OIL How
Schlumberger Is Rewriting the Rules of the Energy
Game. In short, Schlumberger knows how to
create and run oilfields, anywhere, from drilling
to fullscale production to distribution. And the
nugget is hardcore, relatively small, technically
accomplished, highly autonomous teams. As China
and Russia, among others, make their move in
energy, state run companies are eclipsing the
major independents. (Chinas state oil company
just surpassed Exxon in market value.) At the
center of it all, abetting these new players who
are edging out the Exxons and BPs, the Kings of
Large-scale, Long-term Project Management wear
Schlumberger overalls. (The pictures in the
article from Siberia alone are worth the cover
price.) At the center of the center of the
Schlumberger empire is a relatively newly
configured outfit, reminiscent of IBMs Global
Services and UPS integrated logistics experts
and even Best Buys now ubiquitous Geek Squads.
The Schlumberger version is simply called IPM,
for Integrated Project Management. It lives in a
nondescript building near Gatwick Airport, and
its chief says it will do just about anything an
oilfield owner would want, from drilling to
productionthat is, as BusinessWeek put it,
IPM strays from Schlumbergers traditional
role as a service provider and moves deeper into
areas once dominated by the majors. (My old pal
was solo on remote offshore platforms
interpreting geophysical logs and the like.)
193
8. XF work is the direct work of leaders! 9.
Integrated solutions Our Culture.
(Therefore XF Our culture.) 10. Partner with
best-in-class only. Their pursuit of Excellence
helps us get beyond petty bickering. An all-star
team has little time for anything other than
delivering on the (big) Client promise. 11. All
functions are created equal! All functions
contribute equally! All All. 12. All functions
are PSFs, Professional Service Firms.
Professionalism is the watchwordand true
Professionalism rise above turf wars. You are
your projects, your legacy is your projectsand
the legacy will be skimpy indeed unless you pass,
with flying colors, the works well with others
exam! 13. We are all in sales! We all (a-l-l)
sell those Integrated Client Solutions. Good
salespeople dont blame others for screw-upsthe
Clint doesnt care. Good salespeople are
quarterbacks who make the system
work-deliver. 14. We all invest in wiring the
Client organizationwe develop comprehensive
relationships in every part (function, level) of
the Clients organization. We pay special
attention to the so-called lower levels, short
on glamour, long on the ability to make things
happen at the coalface. 15. We all live the
Brandwhich is Delivery of Matchless Integrated
Solutions which transform the Clients
organization. To live the brand is to become a
raving fan of XF co-operation.
194
C(I)gtC(E)Internal customer relations C(I)
are perhaps-often more important than external
relationships C(E). That is, if you Internal
Relationships are excellent, youll have your
whole company working for you to get your jobs to
the head of the queue.
195
16. We use the word partner until we want to
barf! (Words matter! A lot!) 17. We use the word
team until we want to barf. (Words matter! A
lot!) 18. We use the word us until we want to
barf. (Words matter! A lot!) 19. We obsessively
seek Inclusionand abhor exclusion. We want more
people from more places (internal, externalthe
whole supply chain) aboard in order to maximize
systemic benefits. 20. Buttons Badges matterwe
work relentlessly at team (XF team) identity and
solidarity. (Corny? Get over it.) 21. All
(almost all) rewards are team rewards. 22. We
keep base pay rather lowand give whopping
bonuses for excellent team delivery of seriously
cool cross-functional Client benefits. 23. WE
NEVER BLAME OTHER PARTS OF THE ORGANIZATION FOR
SCREWUPS. 24. WE TAKE THE HEATTHE WHOLE TEAM.
(For anything and everything.) (Losing, like
winning, is a team affair.) 25. BLAMING IS AN
AUTOMATIC FIRING OFFENSE. 26. Women rule.
Women are simply better at the XF communications
stuffless power obsessed, less hierarchically
inclined, more group-team oriented.
196
Womens Negotiating
StrengthsAbility to put themselves in their
counterparties shoesComprehensive, attentive
and detailed communication styleEmpathy that
facilitates trust-buildingCurious and attentive
listeningLess competitive attitudeStrong
sense of fairness and ability to
persuadeProactive risk managerCollaborative
decision-makingSource Horacio Falcao, Cover
story/May 2006, World Business, Say It Like a
Woman Why the 21st-century negotiator will need
the female touch
197
Womens Strengths Match New Economy Imperatives
Link rather than rank workers favor
interactive-collaborative leadership style
empowerment beats top-down decision making
sustain fruitful collaborations comfortable with
sharing information see redistribution of power
as victory, not surrender favor
multi-dimensional feedback value technical
interpersonal skills, individual group
contributions equally readily accept ambiguity
honor intuition as well as pure rationality
inherently flexible appreciate cultural
diversity. Judy B. Rosener, Americas
Competitive Secret Women Managers
198
TAKE THIS QUICK QUIZ Who manages more things
at once? Who puts more effort into their
appearance? Who usually takes care of the
details? Who finds it easier to meet new
peo