1. Welcome to Tom Peters “PowerPoint World”! Beyond the set of slides here, you will find at tompeters.com the last eight years of presentations, a basketful of “Special Presentations,” and, above all, Tom’s constantly updated Master Presentation—from which most of the slides in this presentation are drawn. There are about 3,500 slides in the 7-part “Master Presentation.” The first five “chapters” constitute the main argument: Part I is context. Part II is devoted entirely to innovation—the sine qua non, as perhaps never before, of survival. In earlier incarnations of the “master,” “innovation” “stuff” was scattered throughout the presentation— now it is front and center and a stand-alone. Part III is a variation on the innovation theme—but it is organized to examine the imperative (for most everyone in the developed-emerging world) of an ultra high value-added strategy. A “value-added ladder” (the “ladder” configuration lifted with gratitude from Joe Pine and Jim Gilmore’s Experience Economy) lays out a specific logic for necessarily leaving commodity-like goods and services in the dust. Part IV argues that in this age of “micro-marketing” there are two macro-markets of astounding size that are dramatically under- attended by all but a few; namely women and boomers-geezers. Part V underpins the overall argument with the necessary bedrock—Talent, with brief consideration of Education & Healthcare. Part VI examines Leadership for turbulent times from several angles. Part VII is a collection of a dozen Lists—such as Tom’s “Irreducible 209,” 209 “things I’ve learned along the way.” Enjoy! Download! “Steal”—that’s the whole point!

2. NOTE: To appreciate this presentation [and ensure that it is not a mess ], you need Microsoft fonts: “Showcard Gothic,” “Ravie,” “Chiller” and “Verdana”

3. Tom Peters’ EXCELLENCE. ALWAYS. Kindred Healthcare Las Vegas/25 March 2008 Part 1 of 2

4. tompeters.com Slides at … tompeters.com

5. Sticking my neck out: Reflecting on healthcare Tom Peters/03.25.2008

6. U.S. Life Expectancy

7. 45. * *Rank of U.S. life expectancy, <Bosnia, Cuba 45. * *Rank of U.S. life expectancy, <Bosnia, Cuba

8. “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

9. “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.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

10. KIA & Wounded

11. CDC 1998: 90,000 killed and 2,000,000 injured from hospital-caused drug errors & infections

12. HealthGrades/Denver: 195,000 hospital deaths per year in the U.S., 2000-2002 = 390 full jumbos/747s in the drink per year. Comments: “This should give you pause when you go to the hospital.” —Dr. Kenneth Kizer, National Quality Forum “ There is little evidence that patient safety has improved in the last five years.” —Dr. Samantha Collier Source: Boston Globe/07.27.04

13. 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

14. “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 can’t afford to take the necessary precautions. ” —Betsy McCaughey, founder of the Committee to Reduce Infection Deaths (New York Times/06.06.2005)

15. When I climb Mount Rainier I face less risk of death than I’ll face on the operating table.” — Don Berwick “When I climb Mount Rainier I face less risk of death than I’ll face on the operating table.” — Don Berwick

16. “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 doctor’s 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

17. 1 m 42 s

18. 59

19. “Plus God knows how many in doctors’ offices, Tom” —Thom Mayer

20. ***2003, New England Journal of Medicine publishes quality study results: 11 measures of quality compare VA and fee-for-service plans. VA “significantly better” on 11 out of 11 … ***2004, Annals of Internal Medicine, RAND study: VA vs commercial managed care; VA “outperforms all other sectors of American healthcare in 294 measures of quality” … ***National Committee for Quality Assurance top- rated, JHU, Mayo, Mass General; “In every single category the veterans healthcare system outperforms the highest-rated non- VA hospitals” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

21. k.i.s.s.

22. K.I.S.S./Keep It Simple, Stupid: Wrong site surgery: “The most effective part of the drill is simply asking the patient, in language he can understand, to state (not confirm) who he is, his birth date or social security number, and what he’s in for.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

23. The Checklist!

24. 90K in ICU on any given day 178 steps/day 50% “serious complication” Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)

25. **Peter Provonost, Johns Hopkins, 2001 **Checklist, line infections **1/3 rd at least one error **Nurses/permission to stop procedure **1 year/10-day line-infection rate: 11% to 0% (43 infections, 8 deaths, $2M saved) Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)

26. **Docs, nurses make own checklists on whatever process-procedure they choose **Within weeks, average stay in ICU down 50% Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)

27. **Replicate in Inner City Detroit (resource strapped—$$$, staff cut 1/3 rd, poorest patients in USA) **Nurses QB **Project manager **Exec involvement (help with “little things”—it’s all “little things”) **Blues, small bonuses for participating **6 months, 66% decrease in infection rate; USA: bottom 25% to top 10% Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)

28. “[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)

29. Beware of the tyranny of making Small Changes to Small Things. Rather, make Big Changes to Big Things.” —Roger Enrico, former Chairman, PepsiCo “ Beware of the tyranny of making Small Changes to Small Things. Rather, make Big Changes to Big Things.” —Roger Enrico, former Chairman, PepsiCo

30. “Beware of the tyranny of making S mall Changes to Small Things. Rather, make Big Changes to Big Things … using Small, Almost Invisible Levers with Big Systemic Impact.” —TP

31. And “they” call it “science”

32. “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

33. “As unsettling as the prevalence of inappropriate care is the enormous amount of what can only be called ignorant care. A surprising 85% of everyday medical treatments have never been scientifically validated. … For instance, when family practitioners in Washington were queried about treating a simple urinary tract infection, 82 physicians came up with an extraordinary 137 strategies.” Source: Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

34. 400,000 heart bypass surgeries, 1,000,000 angioplasties per year: “Yet recent studies show that only about three percent 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 Longman

35. See no evil....

36. “culture of cover-up that pervades healthcare” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

37. Pick of the litter????

38. “Generally, the more prestigious the hospital you check into, and the more eminent and numerous the physicians who attend you, the more likely you are to receive low-quality or even dangerous and unnecessary care.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

39. “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 [Dartmouth’s Dr. Jack] Wennberg and others broadened their studies. They found it’s 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

40. “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.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

41. “[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

42. “My most memorable brushes have been with an eminent surgeon,” Marjorie wrote in her next-to-last column for the Washington Post, “whose method is to stride into the examining room two hours late, pat your hand, pronounce your certain death if he can’t perform an operation on you, and then snap at your husband to stop taking notes, since he can’t possibly follow the complexity of the doctor’s thinking.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

43. VA costs up 0.8% in 10 years, Medicare up 40.4% (Note: VA patients “older, sicker, poorer and more prone to mental illness, homelessness, and substance abuse;” ½ > 65, 1/3 smoke, 1/5 diabetes vs 1/14 overall; chronic diseases, frailty—especially vulnerable to medical errors ) Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

44. VA/Strengths *Safety *Evidence-based medicine *Health promotion and wellness programs programs *“Unparalleled adoption of electronic medical records electronic medical records and other information and other information technologies” technologies” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

45. IS/IT

46. “Some grocery stores have better technology than our hospitals and clinics.” —Tommy Thompson, former HHS Secretary Source: Special Report on technology in healthcare, U.S. News & World Report

47. Information technology: group of off-the- radar experiments, performed surreptitiously by “the Hard Hats.” “the Hard Hats.” Dr Kenneth Dickie, 1979, brought together, as VistA, 20,000 software protocols “originally written by individual doctors and other professionals working secretly in VA facilities all around the country” “This unique, integrated information system has dramatically reduced medical errors at the VA while also vastly improving diagnoses, quality of care, scientific understanding of the human body, and the development of medical protocols based on hard data about what drugs and procedures work best.” “This unique, integrated information system has dramatically reduced medical errors at the VA while also vastly improving diagnoses, quality of care, scientific understanding of the human body, and the development of medical protocols based on hard data about what drugs and procedures work best.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

48. Scanner: “Skunkworks” project started in Kansas, 1992, hand-held scanner, idea from nurse Sue Kinnick when she observed usage in rental-car return area. “It wound up eliminating some 549,000 errors by 2001; there was a 75% decrease in errors involving the wrong medication, a 62% decrease in errors involving the wrong dosage, a 93% reduction in the wrong patients receiving medicine, and a 70% decrease in the number of times nurses simply forgot or didn’t get around to giving patients their meds.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

49. “ Our entire facility is digital. No paper, no film, no medical records. Nothing. And it’s all integrated—from the lab to X-ray to records to physician order entry. Patients don’t have to wait for anything. The information from the physician’s office is in registration and vice versa. The referring physician is immediately sent an email telling him his patient has shown up. … It’s wireless in-house. We have 800 notebook computers that are wireless. Physicians can walk around with a computer that’s pre-programmed. If the physician wants, we’ll go out and wire their house so they can sit on the couch and connect to the network. They can review a chart from 100 miles away.” — David Veillette, CEO, Indiana Heart Hospital

50. No good deed goes unpunished

51. “Every $1.00 spent on its wellness program ended up saving [Citigroup] $4.70, according to an academic study.” —WSJ/0329.07

52. “Quality doesn’t pay”: 1995, Duke Medical Center, “Nurses regularly called patients [with congestive heart failure] at home to monitor their well-being and to make sure they took their medications. Nutritionists offered heart-healthy diets. Doctors shared data about their patients and developed evidence for what treatments and dosages had the best results. And it worked—at least in the sense that patients became healthier. The number of hospital admissions declined and patients spent less time in the hospital. Problem: “By 2000, the hospital was taking a 37% hit in its revenue due to the decline in admissions and the absence of complications. Ten hospitals in Utah had a similar experience after implementing integrated care for pneumonia.” “No investment in quality goes unpunished.” “But there is a problem: Who will pay for it? … An idealistic commitment to best practices doesn’t pay the bills.” Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman

53. Planetree: A Radical Model for New Healthcare/Healing/ Wellness Excellence Tom Peters

54. “It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.” “It was the goal of the Planetree Unit to help patients not only get well faster but also to stay well longer.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

55. “Much of our current healthcare is about curing. Curing is good. But healing is spiritual, and healing is better, because we can heal many people we cannot cure.” “Much of our current healthcare is about curing. Curing is good. But healing is spiritual, and healing is better, because we can heal many people we cannot cure.” —Leland Kaiser, “Holistic Hospitals”

56. “The most basic question we need to pose in caring for others is this: Is this a loving act?” “The most basic question we need to pose in caring for others is this: Is this a loving act?” —Leland Kaiser, “Holistic Hospitals” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

57. Determinants of Health Access to care: 10% Genetics: 20% Environment: 20% Health Behaviors: 50% Source: Institute for the Future

58. 1. The Importance of Human Interaction Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information Healing Partnerships: The importance of Including Friends and Family Nutrition: The Nurturing Aspect of Food 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 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

59. The Importance of Human Interaction 1. The Importance of Human Interaction

60. none of THE top 15 factors determining P atient S atisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with Employee Satisfaction Press Ganey Assoc: 139,380 former patients from 225 hospitals: none of THE top 15 factors determining P atient S atisfaction referred to patient’s health outcome PS directly related to Staff Interaction PS directly correlated with Employee Satisfaction Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

61. Kindness is free. “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 interactions—alienating patients, being non-responsive to their needs or limiting their sense of control—can be very costly. … Angry, frustrated or frightened patients may be combative, withdrawn and less cooperative—requiring 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

62. But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. ‘abuse ’ “ Perhaps the simplest and most profound of all human interactions is KINDNESS. … But if it is so simple, it is surprising how frequently it is absent from our healthcare environments. … Many staff members report verbal ‘abuse ’ by physicians, managers and coworkers.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

63. “Planetree is about human beings caring for other human beings.” “Planetree is about human beings caring for other human beings.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel (“Ladies and gentlemen serving ladies and gentlemen”—4S credo)

64. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information 2. Informing and Empowering Diverse Populations: Consumer Health Libraries and Patient Information

65. Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures Health Fairs Griffin’s Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est. goals, timetable, etc.) Planetree Health Resources Center/1981 Planetree Classification System Consumer Health Librarians Volunteers Classes, lectures Health Fairs Griffin’s Mobile Health Resource Center Open Chart Policy Patient Progress Notes Care Coordination Conferences (Est. goals, timetable, etc.) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

66. Healing Partnerships: The Importance of Including Friends and Family 3. Healing Partnerships: The Importance of Including Friends and Family

67. “When hospital staff members are asked to list the attributes of the ‘perfect patient and family,’ their response is usually a passive patient with no family.” — Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

68. Patients are stripped of control, their clothes are taken away, they have little say over their schedule, and they are deliberately separated from their family and friends. Healthcare professionals control all of the information about their patients’ bodies and access to the people who can answer questions and connect them with helpful resources. Families are treated more as intruders than loved ones.” The Patient-Family Experience “Patients are stripped of control, their clothes are taken away, they have little say over their schedule, and they are deliberately separated from their family and friends. Healthcare professionals control all of the information about their patients’ bodies and access to the people who can answer questions and connect them with helpful resources. Families are treated more as intruders than loved ones.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

69. “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.” “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 Patient’s Eyes

70. confided in at least one person 72.4%, 56.3% “A 7-year follow-up of women diagnosed with breast cancer showed that those who confided in at least one person in the 3 months after surgery had a 7-year survival rate of 72.4%, as compared to 56.3% for those who didn’t have a confidant.” —Institute for the Future

71. Care Partner Programs Unrestricted visits Collaborative Care Conferences Clinical Guidelines Discussions Family Spaces Pet Visits 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 Conferences Clinical Guidelines Discussions Family Spaces Pet Visits (POP: Patients’ Own Pets) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

72. Nutrition: The Nurturing Aspect of Food 4. Nutrition: The Nurturing Aspect of Food

73. Meals are central events Meals are central events vs “There, you’re fed.” * *Irony: Focus on “nutrition” has reduced focus on “food” and “service” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

74. Kitchen Beautiful cutlery, plates, etc Chef reputation Kitchen Beautiful cutlery, plates, etc Chef reputation Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

75. Aroma therapy Aroma therapy (e.g., “smell of baking cookies”) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

76. Spirituality: Inner Resources for Healing 5. Spirituality: Inner Resources for Healing

77. 1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/ find meaning in suffering Spirituality: Meaning and Connectedness in Life 1. Connected to supportive and caring group 2. Sense of mastery and control 3. Make meaning out of disease/ find meaning in suffering Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

78. redesign chapel music, flowers, portable labyrinth Griffin: redesign chapel (waterfall, quiet music, open prayer book) Other : music, flowers, portable labyrinth Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

79. Human Touch: The Essentials of Communicating Caring Through Massage 6. Human Touch: The Essentials of Communicating Caring Through Massage

80. Massage is a powerful way to communicate caring.” “Massage is a powerful way to communicate caring.” —Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

81. Massage for every patient scheduled for ambulatory surgery (“Go into surgery with a good attitude”) Infant massage Staff massage (“caring for the caregivers”) Healing environments: chemo! Mid-Columbia Medical Center/Center for Mind and Body Massage for every patient scheduled for ambulatory surgery (“Go into surgery with a good attitude”) Infant massage Staff massage (“caring for the caregivers”) Healing environments: chemo! Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

82. 7. Healing Arts: Nutrition for the Soul

83. Color! Light! Brilliance! Form! Art! Music! Planetree: “Environment conducive to healing” Color! Light! Brilliance! Form! Art! Music! Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

84. People say the effect is only on the mind. It is no such thing. The effect is on the body, too.” Florence Nightingale/Notes on Nursing/patient’s need for beauty, windows, flowers: “People say the effect is only on the mind. It is no such thing. The effect is on the body, too.” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

85. Music in the parking lot; professional musicians in the lobby 5 pianos volunteers 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

86. Integrating Complementary and Alternative Practices into Conventional Care 8. Integrating Complementary and Alternative Practices into Conventional Care

87. Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Griffin IMC/Integrative Medicine Center Massage Acupuncture Meditation Chiropractic Nutritional supplements Aroma therapy Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

88. 83M in US (42%) CAM visits 243M, greater than to PCP (Primary Care Physician) (With min insurance coverage) W-Educated-Hi inc Don’t tell PCP (40%) OTA: <30% procedures used in conventional medicine have undergone RCTs (randomized clinical trials) CAM (Complementary & Alternative Medicine): 83M in US (42%) CAM visits 243M, greater than to PCP (Primary Care Physician) (With min insurance coverage) W-Educated-Hi inc Don’t tell PCP (40%) OTA: <30% procedures used in conventional medicine have undergone RCTs (randomized clinical trials) Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

89. 9. Healing Environments: Architecture and Design Conducive to Health

90. Woods and natural materials Indirect lighting Homelike settings Goals: 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 beauty “Planetree Look” Woods and natural materials Indirect lighting Homelike settings Goals: 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 beauty Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

91. Sound Texture Lighting Color Smell Taste Sacred space Sound Texture Lighting Color Smell Taste Sacred space Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

92. “Happen to” “Happen with” Access to nurses station: “Happen to” vs “Happen with” Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

93. The Eden Alternative* The Eden Alternative* *ElderCare

94. The Ten Principals of the Eden Alternative 1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among Elders. 2. Life in an Elder-centered community revolves around close and continuing contact with children, plants, and animals. These ancient relationships provide young and old alike with a pathway to a life worth living. 3. Companionship is the antidote to loneliness. In an Elder- centered community we must provide easy access to human and animal companionship. 4. A healthy Elder-centered community seeks to balance the care that is being given with the care that is being received. Elders need opportunities to give care and caregivers need opportunities to receive care. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

95. “The Eden paradigm allows elders to care for animals, birds, and children as well as each other.” —Susan Eaton, Harvard/JFK school Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

96. The Ten Principals of the Eden Alternative 5. Variety and Spontaneity are the antidotes to boredom. The Elder-centered community is rich in opportunities to sample these ancient pleasures. 6. An Elder-centered community understands that passive entertainment cannot fill a human life. 7. The Elder-centered community takes medical treatment down from its pedestal and and places it into the service of genuine human caring. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

97. The Ten Principals of the Eden Alternative 8. In an Elder-centered community, decisions should be made by the Elders or those as close to the Elders as possible. 9. An Elder-centered community understands human growth cannot be separated from human life. 10. Wise leadership is the lifeblood of any struggle against the Three Plagues. For it, there can be no substitute. Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel

98. Conclusion: Caring/Growth “Experience”

99. Care!/Love!/Spirit! Self-Control! Connect!/learn!/ involve!/Engage! Understanding!/Growth! De-stress!/heal! Whole patient & family & friends! be well!/stay well!

100. F.Y.I.

101. Financially successful. Expanding programs- physically. Growing market share. Only hospital in “100 Best Cos to Work for”— 7 consecutive years, currently #6. Griffin Hospital/Derby CT (Planetree Alliance “HQ”) Results: Financially successful. Expanding programs- physically. Growing market share. Only hospital in “100 Best Cos to Work for”— 7 consecutive years, currently #6. —“Five-Star Hospitals,” Joe Flower, strategy+business (#42)

102. Learn more about Planetree/ The Planetree Alliance: www.planetree.org

103. resources

104. ***Best Care Anywhere: Why VA Healthcare Is Better Than Yours —Phillip Longman *** Medicine & Culture —Lynn Payer *** Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs —Melody Petersen *** Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer —Shannon Brownlee *** Demanding Medical Excellence: Doctors and Accountability in the Information Age —Michael Millenson *** Putting Patients First —Susan Frampton, Laura Gilpin, Patrick Charmel [The Planetree story]