Tom Peters Asks Where the Radicals Are in Healthcare


Here's a great essay from Tom Peters, a chapter from his book The Little Big Things: 163 Ways to Pursue EXCELLENCE.

The email that was forwarded to me with this content said, “Sharing is permitted,” so if you like this content, please buy his book.

In this essay, Peters mentions Geisinger Health System, checklists, and Dr. Peter Pronovost, who I've written about before.

The Little Big Things by Tom Peters. Copyright 2010 by Thomas J. Peters.
All Rights Reserved. Sharing is permitted–forward to a friend!

76. It Is Not Enough to Care!

I sure as hell wish this one weren't necessary. But I'm pissed off. Really pissed off. As pissed off as I've ever been.

We unnecessarily kill (very strong term; a little too strong – but I'm pissed off, remember) some 100,000 to 300,000+ patients in hospitals in the United States every year. We wound millions more – and that doesn't include the numberless victims in doctors' offices,” as a senior ER doc and exec told me.

And, yes, it is by and large preventable, as any number of hospitals and hospital systems prove, like Geisinger Health System, headquartered in Danville, Pennsylvania. And many, if not most, of the cures are simple, requiring management and systems fixes, not more technology.

For example, Doctor Peter Pronovost at Johns Hopkins Hospital instituted a common checklist, an idea shamelessly stolen from airline pilots' rituals, and he cut ICU line infections to zero at Hopkins. (FYI, experiment replicated in inner city Detroit.) Now “checklisting,” for any number of things, is becoming a staple in many hospitals. And, yes, many hospital employees are stretched to the breaking point—but the fact is, stressed out or not, religious hand washing creates, in 2010, near miracles in the world of patient safety.

To be sure, hospitals are “chipping away” at patient safety issues (and so-called “patient-centric care,” à la Griffin Hospital in Derby, Connecticut). There are literally thousands of experiments under way.

But …

“Chipping away” is simply … not … enough.

Instead I must disrespectfully ask:

Where are the … radicals?

Where is the … radicalism?

Glenn Steele has pulled off a miracle at Geisinger.

Where are the Glenn Steeles?

My wife recently waited five hours in an ER with a broken ankle – “she described the pain as “second only to labor.” But she isn't even pissed off – it's what has happened to all her friends, it's “what you expect.” As I write I've been to a “Top 10” hospital three times in the last ten days for tests. No, I was not left for hours upon more hours on a gurney in a hallway as Susan was. Nonetheless, there was a major error, two errors in one case, associated with each visit. One snafu could have had dangerous consequences for my beloved pacemaker. Yup, they batted a thousand. Three-for-three, an error 100% of the time.

At a dinner with eight guests, I deliberately turned the conversation toward this issue. Each … each and every one … of the guests or their immediate families had had a serious unforced error associated with their most recent hospital incarceration. In all but one case, the error had been life threatening. (And, depending on your interpretation, one may have resulted in an unnecessary death; at the least, it made a bad situation much worse.)

This is not right.

This is wrong.

Of course there are numerous “externalities,” as the economists call it. Still, if I'm CEO of a hospital, this is my house” and a 100 percent error rate is waaaaay beyond “inexcusable.”

Let me be clear and crude: This shit doesn't have to happen.

Where is the … Shame?

Where are the … radicals?

Where are the CEOs, systemic externalities or not, who … will not rest until this is fixed?

(As I write in October 2009, health care reform is wobbling through a dozen congressional committees. The outcome is unclear. That fact is irrelevant to this discussion. This is stuff that does not require Washington's legislative help. This stuff requires … raw, rad-i-cal determination … and an … abiding sense of responsibility.)

(Hospital professionals do care – almost to the woman and man. But, per General Chapman and Winston Churchill, it is not enough to care; you must succeed at what is necessary.)

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Very important message. Thanks for sharing this Mark. I know some radicals (some are members of the Healthcare Value Leaders Network, and some are involved with the Institute for Healthcare Improvement, 2 organizations that provide a space for radical thought and action). We need to find and organize more radicals – create a critical mass. Also, I will definitely buy Peters’ book.

  2. He is right. We accept a health care system that is broken and killing and causing great harm to hundreds of thousands of people a year. That should not be accepted. We should not allow those interested in preventing change for decades by blocking those who seek to change and improve the system.

    The political maneuvering of special interests against change has, for decades, prevented us from improving the system. The difficulty of fighting through the obstruction is far harder than just working on improving health would be absent the obstructionists.

    One radical, with great ideas (for health care and others) is Clayton Christensen. I have written about his disruptive ideas for health care previously:

    • Just to play devil’s advocate, there’s “obstruction” and then there’s “disagreement” on how to improve.

      Define “special interests,” please, because that could mean anything depending on who says it…

      Love the title of your last blog post, I will take a look…

  3. Peters rants. Quaid rants. Berwick rants. What difference does it make when those who can make a difference don’t care to LISTEN, let alone take action?

    • I agree ranting alone doesn’t accomplish much. Of anyone’s rantings, I’ve enjoyed Peters’ though.

      I don’t think Dennis Quaid or Don Berwick count as “ranters” to me. Quaid, considering what was done to his babies, is pretty measured and even keel in his discussions of improving patient safety and Berwick always has a lot of ideas of what healthcare should do…

      But you’re right, if nobody is listening, what’s the point?

      I think part of the Peters’ rant is to get others in the general public to start putting pressure on the hospitals…

  4. This ties in with your recent post “3 Reasons the General Public Doesn’t Think Healthcare Can Improve” and with the “shame and blame” culture in healthcare we’ve discussed here often enough.

    That prior post seemed to say that public perception provides a lot of cover for problems in healthcare. Lying on a gurney in the ER is normal! Where there is cover to be had in a culture of shame and blame, many people, unfortunately, will take cover rather than take responsibility.

  5. Where is the outrage! These issues were well highlighted in the 2001 report Chasing the Quality Chasm. It was also well known years before that.

    These issues have been normalized as it has in the Military Hospitals (Walter Reed Army Hospital) and numerous Public Hospitals.

    We are still finding hospitals that are continuing in the old ways and people are still dying and getting sick in hospitals. It’s in the newspapers almost daily.

    The improvement teams in hospitals have been nurtured. They are working on creating better process flows for patients, but very few on creating better workflows, checklist, standard work, or mistake proofing on errors and mistakes that have occurred in their hospitals.

    In all the times and hospitals that I have run events in, getting a doctor to spend time with the team were slim, but the output was huge! Yet, Drs. rarely come to the Kaizen meetings or show up for nightly out briefs or work with teams on something important (Patient Safety). Many dont want to get near the improvement teams. They have more important things to do.

    What is more important than to solve or prevent hospital safety issues so there is No Harm. Like I said, where is the outrage!

    • I ask that same question all the time. Even at the low estimates of 44,000 Americans killed by medical error each year, there should be outrage!

      I’m outraged and I’m not sure my outraged blog posts win me a seat at the table to try to help fix this.


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