McKesson_long_072308 by jianghongl



              Tom Peters’

McKesson 2008 Executive Leadership Summit
The Broadmoor/Colorado Springs/23 July 2008
   Slides at …
 Part One: A
Civilian Looks
at Your World
**Multiple diagnoses (>5)
**Specialist self-certainty
**Health deterioration failed to produce urgency-
**Virtually no communications between specialists
**Follow-up very spotty unless bugged incessantly
**Lost major test results, mis-placed 3 or 4
**Near fatal drug mistake (one nurse takes charge)
**Effectively, disinterest in chronic-care
**Lack of curiosity
“[Dartmouth Professor Elliott] Fisher and his
     colleagues discovered that
  patients who went to hospitals
   that spent the most—

   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
“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

              They found it’s not
 broadened their studies.

  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
“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
       98,000 killed
CDC 1998:

    and 2,000,000
     injured from
hospital-caused drug
 errors & infections

195,000                       hospital deaths per year
in the U.S., 2000-2002 = equivalent of 390 full
jumbos/747s in the drink per year—more than one-a-day.

        There is little
evidence that patient
safety has improved in the
last five years.”               —Dr. Samantha Collier

Source: Boston Globe/2005
“serious medication errors per
year” … “illegible handwriting,
misplaced decimal points, and
 missed drug interactions and
    Source: Wall Street Journal /Institute of Medicine
 “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)
 “Experts estimate that more
   than a hundred thousand
Americans die each year not
  from illness but from their
prescription drugs. Those deaths, occurring
 quietly, almost without notice in hospitals, emergency rooms, and
 homes, make medicines one of the leading causes of death in the
United States. On a daily basis, prescription pills are estimated to kill
     more than 270 Americans. … Prescription medicines, taken
 according to doctors’ instructions, kill more Americans than either
                  diabetes or Alzheimer’s disease.”

       Source: Our Daily Meds: How the Pharmaceutical Companies
       Transformed Themselves into Slick Marketing Machines and
       Hooked the Nation on Prescription Drugs —Melody Petersen
       per year
—John Hammergren & Phil Harkins, Skin in the Game: How
Putting Yourself First Today Will Revolutionize Healthcare
  claims per year
**30% errors
**15% lost
**25% paper-based
Source: John Hammergren & Phil Harkins, Skin in the Game:
How Putting Yourself First Today Will Revolutionize
Healthcare Tomorrow
  ”I can receive a BlackBerry
   message from a colleague
climbing a mountain, yet I still
  show up at a doctor’s 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
  “stunning lack of
scientific knowledge
     about which
   treatments and
procedures actually
Source: Best Care Anywhere: Why VA Healthcare Is Better Than Yours/Phillip Longman
 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 care—which 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
“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
          1900-1960, life
“Bottom line” :
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
 “Plus God alone
knows how many
  casualties in
 doctors’ offices,
    Tom” —Thom Mayer
“ … 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 medicine—all
 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
 “Medical Homes”
“Convenient Care”
“Clinical microsystem,”
 linked microsystems,
 patient-centric “care
   teams” —Paul Batalden/DHMC
Source: “What System?” Dartmouth Medicine, Summer 2006
 (Quality By Design: A Clinical Microsystems Approach, by
Eugene C. Nelson, Paul B. Batalden, and Marjorie M. Godfrey)
Part Two: The
 “Last 98%”
“… it is
“If I could have chosen not to tackle the IBM culture head-on, I
probably wouldn’t 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

        [Yet] I came to see in
 very, very hard.

my time at IBM that culture
isn’t just one aspect of the
         game —it is the
          game.”                   —Lou Gerstner,
             Who Says Elephants Can’t Dance
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

increase                 in the number of medical
 mistakes and adverse events that got reported.”
  “National Center for Patient Safety Ann Arbor”
    Thank you
 Ike , Charlie, Ben
  & Norm, George,
Nelson, and Ben …
“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.”
George Crile (Charlie Wilson’s War) on Charlie
Wilson: “The way things normally work,
  if you’re not Jewish you don’t get into
the Jewish caucus, but Charlie did. And
if you’re not black you don’t get into the
  black caucus. But Charlie plays poker
with the black caucus; they had a game,
   and he’s the only white guy in it. The
   House, like any human institution, is
   moved by friendships, and no matter
what people might think about Wilson’s
 antics, they tend to like him and enjoy
               his company.”
 “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 world’s fashion capitol sporting a
                      Franklin’s miracle was that armed
  simple brown suit and a fur cap. …

 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 city’s fashionable salons to pursue affairs
                             When Adams joined Franklin in
   of state as rigorously as John Adams.

 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 fervor—his
   face appeared on prints, teacups and chamber pots. The extraordinary popularity served
Franklin’s 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
            “What I learned
  The 95% Factor:

 from my years as a hostage
 negotiator is that we do not
 have to feel powerless—and
    that bonding is the
   antidote to the hostage
situation.” —George Kohlrieser, Hostage at the Table
  “I am a
dispenser of
    —Ben Zander
Hard Is Soft
Soft Is Hard
Hard Is Soft (Plans, #s)

Soft Is Hard (people,
 customers, values,
 Return On
Investment In
 Relationships   (of all varieties):

“Courtesies of a small and
trivial character are the
    ones which strike
 deepest in the grateful
and appreciating heart.”
          —Henry Clay
*Excellence = Cross-functional Excellence
**Schlumberger IPM-IBM Global Services-
  UPS Logistics (“bet the company”)
**Batalden/DHMC/“clinical microsystems”
**9-11 Commission
   The “XF-50”: 50 Ways to
Enhance Cross-Functional
 Effectiveness and Deliver
Speed, “Service Excellence”
     and “Value-added
  Customer ‘Solutions’”*
*Entire “XF-50” List is an Appendix to this presentation
waste a
  % XF
  CIO Question:

  % Doc
   *Last 30 days

“Success doesn’t depend on the number of
people you know; it depends on the number

of people you know in    high places!”

“Success doesn’t depend on the number of
people you know; it depends on the number

of people you know in    low     places!”
Loser:   “He’s such a
Winner:   “He’s such a
 George Crile (Charlie Wilson’s War) on Gust

             “He had
   Avrakotos’ strategy:

become something of a
   legend with these
people who manned the
    underbelly of the
     Agency [CIA].”
 William Easterly, The White Man’s Burden:
 Why the West’s 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.”
Lesson: Show up.
Lesson: Listen to the
Lesson: Hear the
Lesson: Engage the
Lesson: Try a lot of stuff.
“Ninety percent
   of success is
  showing up.”
     —Woody Allen
Source: How Doctors Think, Jerome Groopman
 ing is
     “Buy in”-
Authorial bragging
rights-“Born again”
 Champion = One
Line of Code!
      Nothing is “scalable”!*

*Every replication must
exude the perception of
 uniqueness—even if it
   means a half-step
backwards. (“It wouldn’t
have worked if we hadn’t done
        it our way.”)
Easterly, maligned by many, is the arch-enemy

of the   Big Plan     [his capital letters, not mine—for 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” …
   “We made mistakes, of course. Most of them were
omissions we didn’t 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, we’re already on prototype version
                the time our rivals are
                                              #5.     By

    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 plan—
  for months.” —Bloomberg by Bloomberg
      Culture of Prototyping

“Effective prototyping may
       the most
    valuable core
    competence an
innovative organization can
  hope to have.” —Michael Schrage
Source: BW0821.06, Type A Organization Strategies/
   “How to Hit a Moving Target”—Tactic #1
“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 you’re finding it
           when you’re drawing maps and
         studying logs, but you have to drill.”
Source: The Hunters, by John Masters, Canadian O & G wildcatter
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.”
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.
   “Forget China,
    India and the
Internet: Economic
 Growth Is Driven
by   Women.”                                 —Headline,
     Economist, April 15, 2006, Leader, page 14
“Women are
the majority
—Fara Warner/The Power of the Purse
“Themost significant
  variable in every
      sales situation is the
gender     of the buyer, and
more importantly, how the
salesperson communicates
  to the buyer’s gender.”
—Jeffery Tobias Halter, Selling to Men, Selling to Women
 The Perfect Answer

Jill and Jack buy
   slacks in black…
RULE:             New Studies find that
 female managers outshine their male
counterparts in almost every measure”

 TITLE/ Special Report/ BusinessWeek
 “One thing is certain: Women’s 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

              For a number of
boys in the school system.

 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
Women make [all] the financial decisions.
Women control [all] the wealth.
Women [substantially] outlive men.
Women start most of the new businesses.
Women’s work force participation rates have
  soared worldwide.
Women are closing in on “same pay for same
Women are penetrating senior ranks rapidly
  [even if the pace is slow for the corner
  office per se].
Women’s leadership strengths are exceptionally well
  aligned with new organizational effectiveness
Women are better salespersons than men.
Women buy [almost] everything—commercial
  as well as consumer goods.
So what exactly is the point of men?
TP: “How to flush
$500,000 down
the toilet in one
  easy lesson!!”
> People!
… 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.
  “You have to
   treat your
 employees like
customers.”                                   —Herb Kelleher,
           upon being asked his “secret to success”

Source: Joe Nocera, NYT, “Parting Words of an Airline Pioneer,”
 on the occasion of Herb Kelleher’s retirement after 37 years
 at Southwest Airlines (SWA’s 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)
  #1 cause of
  Employee retention & satisfaction:

   based on their
immediate manager!
Source: Marcus Buckingham & Curt Coffman, First, Break All
                       the Rules:
    What the World’s Greatest Managers Do Differently
 THE 10Ps.
 “I am a …
 Dispenser of
    —Ben Zander
 “You must       be
 the change you
wish to see in the
Relentless: “One of
my superstitions had always been
when I started to go anywhere or

       not to
  to do anything,

turn back , or stop,
  until the thing intended was
     accomplished.” —Grant
                 Kevin Roberts’ Credo

1. Ready. Fire! Aim.
2. If it ain’t 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!

 admirals more
 frightened of
  losing than
anxious to win”
  2 per Year/
20 per Decade =
 Excellence +
90K in U.S.A. ICUs on any
given day; 178 steps/day
          in ICU.

50%                                 stays result
in “serious complication”
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**Peter Pronovost, Johns Hopkins,
**Checklist, line infections
**1/3rd at least one error when he started
**Nurses/permission to stop procedure
if doc, other not following checklist
**In 1 year, 10-day line-infection rate:

11% to …            0%
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
**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)
**Replicate in Inner City Detroit
 (resource strapped—$$$, staff cut 1/3rd, poorest patients in USA)
**Nurses QB the process
**Project manager for overall process implementation
**Exec involvement (help with “little things”—it’s all “little things”)
**Blue Cross/insurers, small bonuses for participating

**6 months,      66%
                  decrease in infection rate; USA:
bottom 25% in hospital rankings to …

top 10%
Source: Atul Gawande, “The Checklist” (New Yorker, 1210.07)
 “[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

        Yet his work has
his achievements.

already saved more lives
    than that of any
 laboratory scientist in
 the last decade.”                               —Atul Gawande,
              “The Checklist” (New Yorker, 1210.07)
 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,
         , March 2008
         “Everything matters”

  Source: Nudge, Richard Thaler and Cass
   Sunstein, etching of fly in the urinal
reduces “spillage” by 80%, Schiphol Airport
  are as distinct
 from services as
services are from
goods.”                  —Joe Pine & Jim Gilmore, The
Experience Economy: Work Is Theatre & Every Business a
   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

Part Three:
Five Pianos
A Radical Model for New
  Wellness Excellence
        Tom Peters
 “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 community—nurses, doctors, pharmacists
    and specialists—work together seamlessly on your
    behalf. When their combined efforts are tracked,
      measured, and reported on—and 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
                     The 9 Planetree Practices
1. The Importance of Human Interaction
2. Informing and Empowering Diverse Populations: Consumer
  Health Libraries and Patient Information
3. Healing Partnerships: The importance of Including Friends
  and Family
4. Nutrition: The Nurturing Aspect of Food
5. Spirituality: Inner Resources for Healing
6. Human Touch: The Essentials of Communicating
  Caring Through Massage
7. Healing Arts: Nutrition for the Soul
8. Integrating Complementary and Alternative Practices
  into Conventional Care
9. Healing Environments: Architecture and Design Conducive
  to Health
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
1. The Importance
      of Human
                             139,380 former
             Press Ganey Assoc:
               patients from 225 hospitals:

      none               of THE top 15 factors
 determining Patient Satisfaction
referred to patient’s health outcome

PS directly related to Staff Interaction
 PS directly correlated with Employee
 Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
“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
   2. Informing and
 Empowering Diverse
Populations: Consumer
 Health Libraries and
 Patient Information
Planetree Health Resources Center/1981
    Planetree Classification System
       Consumer Health Librarians
             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
    3. Healing
Partnerships: The
  Importance of
Friends and Family
“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
         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
 4. Nutrition:
The Nurturing
Aspect of Food
Beautiful cutlery,
    plates, etc
 Chef reputation
Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
  Aroma therapy
      (e.g., “smell of baking cookies”—from kitchenettes in each ward)

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
 5. Spirituality:
Inner Resources
    for Healing
    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
Griffin:         redesign chapel (waterfall,
                 quiet music, open prayer book)

Other:          music, flowers, portable

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
6. Human Touch:
The Essentials of
 Caring Through
 “Massage is a
powerful way to
caring.”                    —Putting Patients First,

 Susan Frampton, Laura Gilpin, Patrick Charmel
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
7. Healing Arts:
 Nutrition for
    the Soul
     Planetree: “Environment conducive to healing”

Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
 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
    8. Integrating
 Complementary and
Alternative Practices
into Conventional Care
       Griffin IMC/Integrative Medicine Center

Nutritional supplements
    Aroma therapy
 Source: Putting Patients First, Susan Frampton, Laura Gilpin, Patrick Charmel
   9. Healing
Architecture and
Design Conducive
   to Health
                       “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
F.Y.I.: It
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)
   9 July 2008/HealthLeaders

     2008 Top
Leadership Team in
Healthcare: Griffin
 Tom peters on
   The Lists
      “Never forget
implementation , boys. In
  our work, it’s 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
The “Have
you …” 50
“Mapping your

    or …
  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 D’Aveni. His work is uniformly
 good—and I have said as much publicly on several occasions
dating back 15 years. I’m sure this article is good, too—though
   I didn’t read it. In fact it triggered a furious negative “Tom
  reaction” as my wife calls it. Of course I believe you should
                               But instead of
worry about your “competitive position.”
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.
   “Unfortunately many
     leaders of major
 companies believe their
    job is to create the
  strategy, organization
     and organization
  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)
1. Have you in the last 10 days … visited a
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
customer’s 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 recognized—publicly—one of your folks for a small act of
cross-functional co-operation?
8. Have you in the last week recognized—publicly—one 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 true—in your mind—then you’re more out of touch than I dared
1. Have you in the
last 10 days … visited
a customer?
2. Have you called a
customer … TODAY?

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 > 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!!!
    I posted this at on New
   Year’s Eve 2007.
11. Have you in the last two days had a chat with someone (a couple of levels down?) about specific deadlines
concerning a project’s 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 project’s 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”
13. Have you celebrated in the last week a “small” (or large!) milestone reached? (I.e., are you a milestone
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
across—away from your industry or function—at a Web site, in a product or its packaging?
19. Have you in the last two weeks had an informal meeting—at least an hour long—with 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?
           UniCredit Group/
          UniCredito Italiano* **
—3rd party measurement
—Primary $$$$ incentives
—Primary Corporate Initiative
 The director of staff services
at the giant financial services
    firm, UniCredit Group,
 installed the most thorough
internal customer satisfaction
   measures scheme I have
    seen—with exceptional
 rewards for those who make
 the grade with their internal
21. Have you had in the last year a one-day, intense offsite with each (?) of your
internal customers—followed 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” situation—
restaurant, 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”
You = Your
*Calendars   never lie
 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?
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
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 public—and 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?

  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
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 style”—and 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 someone’s (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 listen—and
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 conversation—and 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 it—with all presentations by relatively junior
folks, including front-line folks? (And with a determined effort to keep the conversation
restricted to “real world” “small” cases—not 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)
 Relationships   (of all varieties):

 Return On
Investment In
  Melvin Zais
“Courtesies of a small and
trivial character are the
    ones which strike
 deepest in the grateful
and appreciating heart.”
          —Henry Clay
The magic number 25.
Calendars never lie.
    Tom Peters/0709.07
*5,000 miles for a 5-minute face-to
  -face meeting (courtesy super-
      agent Mark McCormick)
    When Bob Waterman and I wrote In Search of
      Excellence in 1982, business was “by the
  numbers”—and 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

         (Managing By
   for this … MBWA.

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 cherish—enterprises 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.
     —Craig Johnson/30 yrs
  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.
*Hank Paulson, China visits, Fortune 1127.06
  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
 Paulson’s SEVENTY TRIPS to
  China while at Goldman Sachs.
“I call 60 CEOs                               [in

     the first week of the year]

wish them happy
 New Year. …”
—Hank Paulson, former CEO, Goldman Sachs
 Source: Fortune, “Secrets of Greatness,” 0320.05
             MBWA, Grameen Style!
 “Conventional banks ask their clients to come to their
office. It’s 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
 “You must       be
 the change you
wish to see in the
“It’s always
 —David D’Alessandro, Career Warfare
“… a blinding
 flash of the
obvious”—Manny Garcia
   “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 day’s 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 R&D labs, without the equivalent to
Hank Paulsen’s “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 won’t be insulted when I
    say this was the best seminar I’ve ever been to—and 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-alike—instinctively in the field. The
other was an in the office “leader.” The one produced. The other
    didn’t. At age 24 I learned an incredible life lesson, though I
couldn’t describe it well until tripping over HP’s MBWA/Managing
                        By Wandering Around.
The “XF-50”: 50 Ways to
    Enhance Cross-
  Effectiveness and
Deliver Speed, “Service
Excellence” and “Value-
   added Customer
*Excellence = Cross-functional Excellence
      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
  vision’s promise was more multi-disciplinary research,
 aimed at solving some of the world’s complex systemic
 problems. (2) The chief of GlaxoSmithKline, a few years
   ago, announced a “revolutionary” new drug discovery
    process—human-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 industry’s exploration
sector, I came across a particularly successful firm—one
key to that success was their physical and organizational
 mingling of formerly warring (two sets of prima donnas)
               geologists and geophysicists.
(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 world’s most
  viscous turf wars, talking to one another—we 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 One—some 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!
     our organization to make work—or not. It’s not “them,” the
1. It’s
outside world that’s the problem. The enemy is us. Period.
2. Friction-free! Dump 90% of “middle managers”—most are advertent or inadvertent “power
freaks.” We are all—every one of us—in 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 question—that
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 that’s “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 d’etre, 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 works—the new “it” is
pure and simple a product of XF co-operation; “the product is the co-operation” is not much of a
“We have met
 the enemy
and he is us.”
    Walt Kelly/“Pogo”
  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. (China’s 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 IBM’s Global Services and UPS’
integrated logistics’ experts and even Best Buy’s 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
production”—that is, as BusinessWeek put it, “[IPM] strays from [Schlumberger’s]
      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.)
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
watchword—and true Professionalism rise above turf wars. You are your projects,
your legacy is your projects—and 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 don’t blame others for screw-ups—the Clint doesn’t care. Good
salespeople are “quarterbacks” who make the system work-deliver.

14. We all invest in “wiring” the Client organization—we
develop comprehensive relationships in every part
(function, level) of the Client’s 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 Brand”—which is Delivery of Matchless Integrated Solutions
which transform the Client’s organization. To “live the brand” is to become a raving
fan of XF co-operation.
   *Internal customer relations [C(I)] are perhaps-often more important than external
relationships [C(E)]. That is, if you Internal Relationships are excellent, you’ll have your
        whole company working for you to get your jobs to the head of the queue.
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 Inclusion—and abhor exclusion. We want more
people from more places (internal, external—the whole “supply chain”)
aboard in order to maximize systemic benefits.
20. Buttons & Badges matter—we 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 low—and give whopping bonuses for excellent
team delivery of “seriously cool” cross-functional Client benefits.

anything and everything.) (Losing, like winning, is a
team affair.)

26. “Women rule.” Women are simply better at the XF communications
stuff—less power obsessed, less hierarchically inclined, more group-team
             Women’s Negotiating Strengths
*Ability to put themselves in their
 counterparties’ shoes
*Comprehensive, attentive and detailed
 communication style
*Empathy that facilitates trust-building
*Curious and attentive listening
*Less competitive attitude
*Strong sense of fairness and ability to persuade
*Proactive risk manager
*Collaborative decision-making

Source: Horacio Falcao, Cover story/May 2006, World Business, “Say It
Like a Woman: Why the 21st-century negotiator will need the female touch”
   Women’s 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,
   America’s Competitive Secret: Women Managers
“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
     people? Who asks more questions in a
conversation? Who is a better listener? Who
   has more interest in communication skills?
  Who is more inclined to get involved? Who
encourages harmony and agreement? Who has
 better intuition? Who works with a longer ‘to
    do’ list? Who enjoys a recap to the day’s
   events? Who is better at keeping in touch
                  with others?”
    Source: Selling Is a Woman’s Game: 15 Powerful Reasons Why
      Women Can Outsell Men, Nicki Joy & Susan Kane-Benson
27. Every member of our team is an honored contributor. “XF project Excellence”
is an “all hands” affair.
28. We are our XF Teams! XF project teams are how we get things done.
29. “Wow Projects” rule, large or small—Wow projects demand by definition XF
30. We routinely attempt to unearth and then reward “small gestures” of XF co-
31. We invite Functional Bigwigs to our XF project team reviews.
32. We insist on Client team participation—from all functions of the Client
33. An “Open talent market” helps make the projects “silo-free.” People want in on
the project because of the opportunity to do something memorable—no one will
tolerate delays based on traditional functional squabbling.
34. Flat! Flat = Flattened Silos. Flat = Excellence based on XF project outcomes,
not power-hoarding within functional boundaries.
35. New “C-level”? We more or less need a “C-level” job titled Chief Bullshit
Removal Officer. That is, some kind of formal watchdog whose role in life is to
make cross-functionality work, and I.D. those who don’t get with the program.

36. Huge (H-U-G-E) co-operation bonuses. Senior team
members who conspicuously shine in the “working
together” bit are rewarded or punished Big Time. (A
million bucks in one case I know—and a non-
cooperating very senior was sacked.)
        James Robinson III:

$500K (on the spot,

Alan Puckett:   Fire the best!
     (failure to collaborate)
37. Get physical!! “Co-location” is the most powerful “culture changer. Physical
X-functional proximity is almost a guarantee (yup!) of remarkably improved co-
operation—to aid this one needs flexible workspaces that can be mobilized for a
team in a flash.
38. Ad hoc. To improve the new “X-functional Culture,” little XF teams should be
formed on the spot to deal with an urgent issue—they may live for but ten days,
but it helps the XF habit, making it normal to be “working the XF way.”
39. “Deep dip.” Dive three levels down in the organization to fill a senior role
with some one who has been pro-active on the XF dimension.
40. Formalevaluations. Everyone, starting with the receptionist,
should have an important XF rating component in their
41. Demand XF experience for, especially, senior jobs. The military requires all
would-be generals and admirals to have served a full tour in a job whose only
goals were cross-functional. Great idea!
42. Early project “management” experience. Within days, literally, of coming
aboard folks should be “running” some bit of a project, working with folks from
other functions—hence, “all this” becomes as natural as breathing.
43. “Get ’em out with the customer.” Rarely does the accountant or bench
scientist call one the customer. Reverse that. Give everyone more or less
regular “customer-facing experiences.” One learns quickly that the customer is
not interested in our in-house turf battles!
44. Put “it” on the–every agenda. XF “issues to be resolved” should be on every
agenda—morning project team review, weekly exec team meeting, etc. A “next
step” within 24 hours (4?) ought to be part of the resolution.
45. XF “honest broker” or ombudsman. The ombudsman examines XF “friction
events” and acts as Conflict Resolution Counselor. (Perhaps a formal conflict
resolution agreement?)
46. Lock it in! XF co-operation, central to any value-added mission, should be an
explicit part of the “Vision Statement.”
47. Promotions. Every promotion, no exceptions, should put XF Excellence in the
top 5 (3?) evaluation criteria.
48. Pick partners based on their “co-operation proclivity.” Everyone must be on
board if “this thing” is going to work; hence every vendor, among others, should
be formally evaluated on their commitment to XF transparency—e.g., can we
access anyone at any level in any function of their organization without
bureaucratic barriers?
49. Fire vendors who don’t “get it”—more than “get it,” welcome “it” with
open arms.”
50. Jaw. Jaw. Jaw. Talk XF cooperation-value-added at every opportunity. Become
a relentless bore!

51.Excellence! There is a state of XF
Excellence per se. Talk about it. Pursue
it. Aspire to nothing less.
*Excellence = Cross-functional Excellence
 “C-levels” to Abet Cross-functional Excellence

      CGRO/Chief Grunge Removal Officer
CXFCO/Chief Cross-functional Communication Officer
  CIS-CDO/Chief Information Sharing & Common
                 Database Officer
CHRO(PL) /Chief Human resources Officer (Project
            Managers, Love and Care of)
 CPMFO/Chief Project Management Finance Officer
   CTAO/Chief Team-space Assignments Officer
  CE(XFNC) /Chief Executioner (Cross-functional
  CXFBPO/Chief Cross-functional Brownie-points
  In We have “C-level” officers for any damn
 thing you can mention. So I thought I’d add
 my voice to the fray. If XF (Cross-functional)
  performance is a/the paramount issue for
modern enterprise effectiveness (where one
  is bringing to bear the wherewithal of the
    entire enterprise to provide high-value,
  systemic “solutions” for customers), then
      XFX/Cross-functional excellence is
necessarily priority #1. And we need an exec
to lead the charge—try these job titles on for
         The “XF Bible”
  Building a Knowledge-
   driven Organization:
 Overcome Resistance to
  the Free Flow of Ideas.
Turn Knowledge into New
  Products and Services.
  Move to a Knowledge-
 based Strategy —Robert Buckman
  The 180-degree “Middle Manager Flip”
          @ Buckman Labs …

From:   “information choke points”

    To:   “knowledge transfer
facilitators,” with 100% (!!!)
   of their rewards based on
 spurring co-operation across
         former barriers.
 Bob Buckman runs Buckman Labs, a half-billion dollar, Memphis-based specialty
   chemicals company. You might well roll your eyes at the overused “customer
   solutions” moniker—but Buckman does just that with panache and for profit,
    creating and applying chemical compounds in customized ways to deal with
  production and cleanup issues for specific customer facilities in the likes of the
  paper and leather-making industries. The devotion to custom “solutions” is the
bedrock, the alpha to omega, of the firm’s extraordinary new-product and financial
record. Those closer to the intellectual fray than me claim that Bob gets “inventor”
  rights in the now ubiquitous “knowledge management” arena. In any event,
 this book is the Buckman Labs saga in extraordinary detail—it is
particularly valuable because it moves so far beyond the relatively
 easy software-technology bit and emphasizes the way in which a
company’s culture must be jerked around 180-degrees to destroy
former functional barriers. E.g., middle managers, typically choke
 points guarding information and access to their domain, became
 “knowledge transfer facilitators,” with 100% (!!!) of their rewards
      based on spurring co-operation across former barriers.

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