Leadership by Example:
Understanding the Principles and
Applying Them to Leadership Hazards
January 17, 2013
Webinar Transcript
Charles Denham: Welcome to our January TMIT National Research Test Bed high-performance
webinar. We are really delighted to have all of you joining us. The title is "Leadership by Example:
Understanding the Principles and Applying Them to Leadership Hazards." This is Charles Denham,
Chairman of TMIT, and I will be undertaking a few of our housekeeping details to get us started.
We just want to make sure – and I'm on slide three, for those of you [who] have downloaded the slides.
You may go to www.safetyleaders.org to download the slides.
I'm on slide number four and you'll see a picture of our former president, Bill Clinton, and the meeting that
we just helped participate in here in Laguna Beach, California. To the right of that is the menu bar that will
allow you to click on today's webinar, and by clicking on that you'll be able to then move to what I have as
slide five, and you can download the webinar video; and in the future, in [seven] business days, you'll be
able to download a word-searchable transcript and the slides as well, and be able to listen to the
program.
You see the cover of Dr. Sanjiv Chopra's recent, fabulous book, Leadership by Example, on that page.
On slide six, I want to remind you all that we are plugged into our social media program and our hashtag
is #safetyleaders. Follow us on Twitter and Facebook. And on slide six you can see where that is present.
Again, this webinar series, which is longer than three years running, every [third] Thursday of the month,
is focused on our calling, which is to save lives, save money, and create value in the communities we
serve. We think of it more of a calling than a vision or a mission statement.
The next slide is number eight, our Disclosure Statement, which I will not read for you. However, you can
read this disclosure statement – that no products, services, or technologies will be presented, and there
are no financial relationships that need to be reported pertinent to the topic. Further, our TMIT certification
disclosure statement is on slide nine.
And now, it is my great pleasure to address the wonderful panelists and reactors and our lead speaker,
Dr. Sanjiv Chopra. We have Dr. Chopra – and I'll introduce each one of them sequentially, but Dr.
Chopra; Sharon Rossmark, [who is] one of our leading trustees; David Parda, [who is] one of our clinical
trustees and the chairman of radiation oncology at the West Penn Allegheny Health System; and Patti
O'Regan who will represent the patients and their voice today. And Kyle, I'm not sure whether we have
Patti up yet. Let me know when we do and you can voice that.
I'll move forward. Generally we start our webinars with the voice of the patient and family, and Patti may
be tied up with clinical duties. We'll come back and have her close us.
So my job is really just to set up Dr. Sanjiv Chopra. He is really the star of our show. He has given the
speech that he will give, which tracks with his book, in over 50 settings. Before I introduce him, however, I
want to put into context where his message fits. So as most of our audience knows, I chaired the National
Quality Forum Safe Practices program with Gregg Meyer. We co-chaired that for a decade and put out a
number of these federal standards. The most recent is the 2010 update that may be used by CMS and
other federal agencies to tie payment to performance, and our first practice, which is Safe Practice 1. And
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by the way, I chaired the Safe Practices program for The Leapfrog Group and this area of culture, safety
leadership structures, and systems was the most heavily weighted area for the original Leapfrog Safe
Practice at 300 points out of 1,000.
Safe Practice 2 addresses culture measurement, feedback, and intervention; and again, many of the
principles that Dr. Chopra will address in his book and in his presentation are addressed there. And
teamwork training and skill-building – also the third Safe Practice – I would say that this is a wonderful
reference that could be used for your work with the Safe Practice. As we update the Safe Practices, I feel
certain that our committee – if we reform it for a 2014 set of practices, or we're working also with the
World Health Organization and were we to do this globally, that this book would definitely be a must-read
for that.
Setting this up, I wanted to remind us of the framework of Leadership, Practices, and Technologies – The
sweet spot of high performance at that intersection. Engaged leaders who are making sure that the best
and better practices: clinical, operational, and financial, are being adopted and then enabled by
technology. Too frequently, we're in love with technology and we realized that in my two organizations
that I chair, and also I [am] Editor in Chief of the Journal of Patient Safety. We've been in love with
technology and have forgotten that high performance begins with leadership, ends with leadership, is all
about leadership.
So what we'll do after Dr. Chopra delivers his message is, we'll look at 30 hazard areas that we reviewed
for you in the December webinar and you, as an audience, voted on the highest priority areas. We'll show
the results, and then we'll have an interactive discussion with Sharon Rossmark, non-clinical trustee;
Dr. Chopra, a leading hepatologist and a leader at Harvard Medical School, in addition to being our
author of what we're covering today; and then Dr. Parda and our patient advocate, [who is a] nurse
practitioner.
I'd like to remind you that we have rolled out the Surfing the Healthcare Tsunami movie that was
screened around the world on the Discovery channel. Dr. Chopra is in the movie at the close, as is
Sharon Rossmark, and we built the hospital leaders' toolbox that is available.
The final comment is that we are recommending – and have no financial relationship with Dr. Chopra or
his book – we recommend that this is a must-read for 2013, a fabulous book that you can use that would
be very inspirational to your team. So as I introduce Dr. Chopra now, I'll give him 30 minutes to brief us.
He is the Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical
School, and Senior Consultant in Hepatology. He has multiple publications and multiple books; however,
we're focusing on just this book. He's had a number of teaching awards and you'll find that his brother,
Deepak Chopra, is well known around the world, and we'd love to hear Deepak. However, when you hear
Sanjiv speak, he is absolutely magnificent, one-on-one or speaking to an audience, and I believe, really,
is one of our most inspirational speakers on the planet and has proved so by giving the same talk and
speech around the world in more than 50 settings.
He has a number of accolades, but I think most importantly, he really brings the head, the heart, the
hands, and the voice to high performance and does so in such a gracious and humble way that I know
that you will really enjoy him, and you can look up on our website more detail about his bio. However, it is
really inspiring to see such a great leader at one of our greatest medical schools really keep us focused
on the real issues of leadership in a wonderful book that gives us a great framework that can be applied
in patient safety, quality, engagement of physicians and their staff.
Sanjiv, would you take it away? There you go.
Sanjiv Chopra: Yeah. Can you hear me?
Charles Denham: Yes, sir.
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Sanjiv Chopra: Terrific. Thank you so much for that very kind introduction. I'm truly honored and humbled
to be speaking on the topic of leadership. It's a subject that's fascinated me as far back as I can
remember. If I ask you to conjure up images of great leaders, great leadership moments from the pages
of history or from contemporary times, who comes to mind? What stories resonate for you? Let us
together embark on this wonderful journey.
If I could have the first slide, Kyle.
Charles Denham: Kyle, can you advance? Go ahead. And I think, Sanjiv, you can advance them.
Sanjiv Chopra: Right. So this talk is entitled "Leadership by Example: The 10 Key Principles of all Great
Leaders.” And I'm trying to advance the next slide.
Charles Denham: The little caret at the top. Kyle, turn it over to me and then I can advance if Sanjiv's
having trouble.
Sanjiv Chopra: Yeah, it's easier. It would be great if I can advance.
Charles Denham: Kyle, turn control over to Dr. Chopra. Just to the right of the numbers of slides, Sanjiv.
You click on the forward caret.
Sanjiv Chopra: Right next to the number of slides?
Charles Denham: Where it says, "Slide number 24" just above the image.
Sanjiv Chopra: Okay. Okay, yeah. So if I click on that, it will go to the next slide?
Charles Denham: Yes, sir.
Sanjiv Chopra: Okay. Terrific. Yes, I see it. Okay. So one of the points I'd like to make is that all great
leaders, by their passion and sense of purpose and then their lifelong accomplishments, have lived a
great story, and those stories are told and retold by the people they inspire. They're told in the history
books. Their stories resonate with people in all the lands, and they do so for a long, long time. So you
don't have to be from America to say, "Abraham Lincoln, Martin Luther King, Jr., John F. Kennedy. What
amazing and inspirational leaders.” You don't have to be British to say, "Winston Churchill, what a fiery
orator and what a great leader.” You don't have to be from India to say, "Mahatma Gandhi, what an
inspiring leader.” You don't have to be from South Africa to be in awe of Nelson Mandela.
So here's my leadership mnemonic, and as you can see, it spells out leadership. I'm going to make a
case that great leaders listen; they listen with heart and soul. They have empathy and compassion. They
have an attitude that is upbeat and courageous. They dare to dream big. They're effective; they're
resilient. The have a sense of purpose. They have humility; they also often have great humor. They have
integrity. They have wild imaginations. They have great ideas and they pack other people's parachutes.
[I'm] trying to go to the next slide and I've gone, actually, backwards.
Charles Denham: I can advance them for you if you like.
Sanjiv Chopra: Okay. Yeah.
Charles Denham: It's the caret to the right. Would you like me to do it?
Sanjiv Chopra: Sure, why don't you do that?
Charles Denham: Great. What an honor that I get to be your AV assistant. I'm going to add it to my CV.
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Sanjiv Chopra: Okay. So the first attribute of leaders – that they are great listeners. That's the L in the
leadership mnemonic. And there's a wonderful anonymous thing, it says "Listen a hundred times. Ponder
a thousand times. Speak once.” Oliver Wendell Holmes once said, "It is in the province of knowledge to
speak. It is in the privilege of wisdom to listen.” And Abraham Lincoln once said, "It is better to be silent
and be thought a fool than to speak up and dispel all doubt.” The next slide.
The second attribute of great leaders is that they have empathy and compassion. And we were very
fortunate at Harvard Medical School, in our Harvard Medical School CME postgraduate course, a couple
of years ago, to have His Holiness, The Dalai Lama, as the keynote speaker. And he led a three-hour
discussion one morning on compassion, and the next day a three-hour session on wisdom, and he truly
embodies serenity, tranquility, compassion, and wisdom. And he once said, "Be kind whenever possible.
It is always possible." He also once said, "If you want others to be happy, practice compassion. If you
want to be happy, practice compassion.” Next slide.
In the Talmud it says, "Compassion is the highest form of wisdom." Next slide.
Here's a very inspiring colleague of ours at Harvard Medical School, Dr. Paul Farmer. He's a medical
anthropologist, a university professor, infectious disease specialist; and he, together with his colleague,
Jim Kim and many other colleagues have provided the most seminal care for the poorest of the poorest,
the most destitute in different parts of the world, in Haiti, [in] Rwanda, in Peru, in Russian prisons. Next
slide. And Dr. Farmer once said, "The idea that some lives matter less is the root of all that's wrong with
the world.” His favorite billboard is one that he saw in Haiti some years ago and it says, "The only true
mission is humanity.” Now on this slide, you see a patient on the left; this is a patient from Haiti. He's got
end-stage AIDS. He is literally on his death bed. And Dr. Farmer goes with Dr. Jim Kim to the pharmacy
at the Brigham and Women’s Hospital in Boston with an empty suitcase. And they sweet-talk their way
into the pharmacist giving them $93,000 worth of antiretrovirals. They fly to Haiti. They administer it to this
man on his death bed, and on the right part of the screen you can see that same individual; he is fully
recovered and has this beautiful baby. Next slide.
The story of Dr. Paul Farmer's work is told in a wonderful book by Tracy Kidder – Tracy Kidder is a
three-time Pulitzer Prize winner – and it's entitled Mountains Beyond Mountains: The Quest of Dr. Paul
Farmer, A Man Who Would Cure the World. Dr. Farmer received the MacArthur “genius award,” and he
has plowed all $450,000 into his foundation and continues to do this wonderful, inspiring work.
The next attribute of great leaders is that they have an attitude that is upbeat and courageous. This is a
true story of a building coming up in Texas. There's a laborer with a wheelbarrow full of bricks. There's a
newspaper reporter with a cameraman. They're going to write a story about this enormous building
coming up. He turns to the laborer and he says, "What kind of work do you do?” The laborer
[unintelligible] and he answers – next slide – he says, "Can't you see I'm carrying bricks on this hot,
muggy day?” A few minutes later, there's another laborer with a wheelbarrow and he's smiling and he's
whistling and he nods to the newspaper reporter, who turns to him and he says, "Tell me, what kind of
work do you do?” And he answered, "I'm helping build the most beautiful cathedral in the world."
There's a story about a janitor at NASA and he was asked, "What kind of work do you do?" And he said,
"I'm part of the team that puts astronauts into space.” So leaders possess an attitude that is always
upbeat and courageous. Next slide.
Sir Winston Churchill once said, he said, "Courage is rightly esteemed, the first of human qualities,
because it is the quality that guarantees all others." Next slide.
Charles Denham: Sanjiv, do you see "Great leaders lead with both heart and soul?” We have that slide
up.
Sanjiv Chopra: I don't see it yet. So great leaders – terrific, it just came on my screen. Great leaders lead
with both heart and soul. I'd like to submit to you that countries without great leaders, countries that do not
have leaders with great soul, will not only be economically and ecologically disadvantaged; they'll also be
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spiritually bankrupt, and they will emerge free from the morass and the shackles when only an
enlightened leader emerges. This is playing out now in parts of the Mideast, in North Korea, in the former
Burma, now known as Myanmar.
And that reminds me to talk to you about Aung [San] Suu Kyi, an amazingly inspirational leader. Her
father had won the election and he was assassinated. She won the election and for the last 18 years, she
has spent 16 years under house arrest. She's written a wonderful book – it's called Freedom from Fear –
and in it she writes, "It is not power that corrupts, but fear. Fear of losing power corrupts those who wield
it, and fear of the scourge of power corrupts those who are subject to it.” Next slide.
She got the Nobel Prize in 1991. The Burmese junta gave her permission to leave, but she knew very
well that if she left Burma, she'd never be allowed to return. So her late husband and sons received the
Nobel Peace Prize on her behalf. And in the citation, the Nobel Committee stated, "Aung [San] Suu Kyi
became the leader of a democratic opposition, which employs nonviolent means to resist a regime
characterized by brutality. Suu Kyi's struggle is one of the most extraordinary examples of civil courage in
Asia in recent decades." Next slide.
She was released on Sunday, November 14, 2010, and massive crowds gathered all over Burma; they
celebrated; they were overjoyed. But for Suu Kyi, one who has made extraordinary personal sacrifices for
her country, she felt that her work remained unfinished and – next slide – she declared, "If the people are
not free, I am not free.” Now luckily, things are starting to change in Myanmar. Aung [San] Suu Kyi has
been elected as a Member of Parliament. She went recently to Oslo to receive the Nobel Peace Prize in
person. Next slide.
The fourth attribute of great leaders is that they dare to dream big. I'm not going to relate the story of
Martin Luther King Jr. and his totally inspiring speech "I Have a Dream.” It's a speech that you can go to
YouTube; you can watch it. I tend to visit it and revisit it every three to four months in order to remain
inspired.
But I'm going to tell you the story of a young boy, who was growing up in Texas, and the school teacher
gives an assignment. She says, "Write an essay on what you want to do when you grow up.” And this
young man, whose father had moved from stable to stable, writes a seven-page essay on how he wants
to own a 200-acre horse farm. He draws sketches; he talks about pony rides; he talks about the nutrition
for these beautiful animals. And with great anticipation, he submits it to the teacher, and a few days later
the teacher says, "Let me show you your grade. This is a totally unrealistic dream. No one in a small town
has ever achieved anything like this, but you're a smart kid and if you want you can write another essay
and I'll be happy to grade it.” So the young man goes home; he thinks about it for a couple of days and
then he returns, and he hands back the essay to the teacher and he says, "You can keep the F. I will
keep my dream."
And the true story is that about 21 years later, he has a 172-acre horse farm. The teacher writes to him
and says, "I'd like to bring the kids for a picnic to your horse farm.” And this young man, who is now close
to 40 years of age, says, "Absolutely. I'd be delighted. Please come.” And when the teacher arrives at his
horse farm with the students, she turns to him and in front of the students says, "You know what? I want
to apologize. I was a dream stealer. I shall never do it again." Next slide.
The poet Robert Browning once said, "Ah, but a man's reach should exceed his grasp or what's a heaven
for?” Next slide.
Søren Kierkegaard, the great Danish philosopher and theologian, once said, "To dare is to lose one's
footing momentarily. Not to dare is to lose one's self.” So great leaders have these daring dreams; they
have a compelling vision; they don't think about the obstacles that may occur in the path to thwart their
goal, their vision to change the world for a better place. Next slide.
Lao Tsu once said, "A journey of a thousand miles begins with a single step.” Now, I've often been asked,
"Sanjiv, who comes to mind? Who resonates when the word ‘great leader’ is used?” And for me it is
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unmistakably Mahatma Gandhi in 1930 and the Salt March. I was born after Gandhi was assassinated
but, of course, I read about it in the history books and I was regaled with stories about Gandhi by my
parents, my uncles and aunts, and my grandparents. So India is under British rule. Salt is plentiful in
India, and yet the British have imposed this exorbitant tax for the poor people of India for salt and Gandhi
envisions the Salt March. He writes to the Viceroy and he says, "I consider the salt tax to be the most
iniquitous of all the laws, the most abhorrent, the most repugnant. And since India's Freedom Movement
will first begin for the poor, I'm going to conduct a Salt March. It's going to be 240 miles.” Gandhi is 62;
he's frail. The British miscalculated. They gave him permission. Gandhi then assembles 77 followers. He,
at 62, is the oldest; the youngest is 60. He has Hindus, Christians, Muslims, untouchables, and they start
the trek. They start to walk from one village to another and as they do, throngs of other people join them.
Twenty-eight days later he arrives in a coastal village, and by many accounts he puts his hand into the
sea water; he lifts it and there is salt. And he declares, "Henceforth, we shall not pay tax to the British on
salt.”
That image captivated the imagination of millions of Indians. But it also mesmerized parliamentarians in
Europe, leaders in America, common people in England, women factory workers, and it launched India's
Freedom Movement. Over the next six months there were 5,000 Salt Marches in India. Eighty to 100,000
people were arrested, beaten, jailed, some of them died, but it launched India's Freedom Movement.
The word Mahatma was coined by Rabindranath Tagore, a Nobel Laureate of Literature. And he said,
"Maha means great and Atma means soul. This is a great Mahatma.” But for the common people in India,
he was known affectionately at Bapu. Bapu means "Father.” Next slide.
Gandhi once said, "There are seven sins. Wealth without work. Pleasure without conscience. Knowledge
without character. Commerce without morality. Science without humanity. Worship without sacrifice and
politics without principle. And to me this sums up leadership. Great leaders have a work ethic; they have
a clear conscience; they have character; they have morality; they have humanity; they make enormous
sacrifices; and they adhere to their principles. Next slide.
Gandhi was a very simple man and he had very few worldly possessions. He was also masterful with his
eloquence. He started the Homespun Cotton Movement and he once said, "It is my certain conviction that
with every thread I draw, I am spinning the destiny of India.”
I heard a recent interview on National Public Radio by Sir Ben Kingsley, who acted as Gandhi; won the
Oscar. He immersed himself in Gandhi; he said, "I tried to do the spinning wheel. My record was seven
minutes before breaking a thread. Gandhi's was nine hours.” Next slide.
These are Gandhi's worldly possessions. Next slide.
Albert Einstein said of Gandhi, "Generations to come, it may be, will scarce believe that such a one as
this, ever in flesh and blood walked upon this earth.” If you look at many of the great leaders – Aung [San]
Suu Kyi, Martin Luther King, Nelson Mandela, even the young people in the Arab Spring – and ask them
or read about their work and say, "Who inspired you?” Many of them say, "Gandhi.” Next slide.
The next attribute of great leaders is that they're effective. Peter Drucker, the management guru, once
said, "Efficiency is doing things right; Effectiveness is doing the right things.” The same may be said about
the difference between managers and leaders. We need both. Managers do things right. Leaders do the
right thing. Next slide.
Now, when I think of effective oratory, I'm always reminded of Sir Winston Churchill. It is said that for a
one-minute speech, he prepared for 45 minutes. For a 45-minute speech, he prepared for 15 hours.
Major General Omar Bradley is reputed to have once said, "One speech of Sir Winston Churchill has
more might than an entire battalion." And John F. Kennedy – President Kennedy when he conferred
honorary U.S. citizenship on Winston Churchill in 1963 – declared Sir Winston Churchill took the English
language and mobilized it into battle.
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Here's an example of his oratory; he said, "We are resolved to destroy Hitler, every vestige of the Nazi
regime. From this nothing will turn us – nothing. We will never parley. We will never negotiate with Hitler
or any of his gang. We shall fight him by land. We shall fight him by sea. We shall fight him in the air, until
with God's help we had rid the earth of his shadow and liberate its people from his yoke."
But this begs the question – next slide – was Hitler a great leader? And to my consternation, at the end of
the last century there was an essay and a composition in Time magazine as to who was the greatest
leader of the last century. It was Einstein and Gandhi, but some people nominated Adolf Hitler. I think it
was also best answered in that same issue of Time magazine – next slide – where Elie Wiesel, a
Holocaust survivor, a professor at Boston University, and a Nobel Laureate wrote, "The fact is that Hitler
was beloved by his people – not the military, at least not [in the beginning], but by the average Germans
who pledged to him an affection; a tenderness and a fidelity that bordered on the irrational. … His
kingdom collapsed after 12 years in a war that remains the most atrocious, [the most] brutal and [the]
deadliest in history. But which, by the same token, allowed several large figures to emerge. [They include]
Eisenhower, De Gaulle, Montgomery, Zhukov, Patton … But when later we evoke the 20th century,
among the first names that will surge to mind will be that of a fanatic with a mustache, who thought to
reign by selling the soul of his people to the thousand demons of hate and of death."
Remember what Aung [San] Suu Kyi said. She said, "It is not power that corrupts, but fear of losing power
corrupts those who wield it, and fear of the scourge of power corrupts those who are subject to it.” All the
tyrants in ancient history [and] modern times rule on the basis of fear. Now Hitler clearly had all of
Gandhi's seven sins and many more; and I think, I'm confident, in your book and my book he was not a
great leader. He may have been a fiery orator and charismatic, but clearly not a great leader. Next slide.
Now here's a visionary leader. Muhammad Yunus, from the poor country of Bangladesh. Thirty years ago
he's traveling in a jeep. In a destitute village he meets a lady, Sufiya Begum. She made bamboo stools
and earned two cents a day. He says, "I was shocked. In my university courses, I theorized about sums in
the millions of dollars, but here before my eyes, the problems of life and death were posed in terms of
pennies.” Next slide.
He goes to the bankers in Bangladesh and he says, "Why don't you loan money to these poor people?”
He came, actually, across 42 women who in aggregate owed $27 to the money lenders. The money
lenders were charging them 200% interest every two weeks. They'd be mired in debt, never come out of
debt. He says the bankers almost fell over. So he started his own bank called the Grameen Bank. And in
the last 30 years they've given away close to $9 billion in loans. The average loan is $100. The majority of
people who get the loan are women. They have a 99-point-some percent return rate. These women are
empowered. They have a livelihood; they're official women who catch the fish. They have a cell phone.
On the cell phone is the picture of the central fishing market in Dacca. They click on it. They negotiate the
price of the catch. They have a livelihood. They're sending their kids to school. They have a home.
This is the concept of microloans. It is now being reproduced in more than 60 countries, including our
country. And then the citations of [the] Nobel Committee said, "Muhammad Yunus has shown himself to
be a leader who has managed to translate visions into practical action for the benefit of millions of people,
not only in Bangladesh, but also in many other countries.” Next slide.
King Solomon the wise said 3,000 years ago, "Where there is no vision, the people perish.” We need
visionary leaders like Muhammad Yunus throughout the world, but especially in these very poor, destitute
countries. Next slide.
So I want to make the point that great leaders reflect on key events in their life, or a single transformative
or “magical” moment. The moment can be jolting; often it's starkly negative; but it is momentous. And
from it emerges the burning desire to have a laser-like focus, a passion, to have a dream and make it a
reality. Next slide.
The Buddha once said, "Every life has a measure of sorrow. Sometimes it is this that awakens us.”
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On the next slide you'll see a friend of mine. I'm absolutely honored to call him a friend. That's the adult in
this photograph; his name is Jaime Jaramillo, but he's a national hero in his country, Colombia, and
hence the name, "Papa Jaime.” The story is that about 35 years ago, he was about 28 years of age, he's
standing at a street corner in Bogota and he's looking at these orphans who grew up in the sewer. He's
feeling sorry for their plight. There's a seven-year-old beautiful girl and she's looking at him and smiling.
And as they're having this interchange, a car comes around the corner; it stops; a window rolls down and
somebody tosses a toy. It's a yellow school bus, Fisher Price toy. The car recedes. The seven-year-old
beautiful girl comes running up to the middle of the street, picks up the toy and is looking at Jamie
Jaramillo and smiling. And as she's having this interchange, a truck comes around the corner and
smashes her into oblivion. And Jaime Jaramillo, 28 years of age, says to himself, "You know what? This
is my calling in life. I'm going to rescue these kids."
He has now adopted, housed, schooled and fed 35,000 of these orphans. Things were so bad in
Colombia that if one of these kids was begging outside a fancy restaurant, the restaurant owners would
call the police. It was really not the police; it was a death squad. They would take the kid back into the
gutter, shoot them or torch them.
He showed me the photograph of a young lady who was begging outside a restaurant. That's exactly
what happened to her. She sustained third-degree burns on half her body. He rescued her; she
underwent 17 reconstructive surgeries. She survived. She got a scholarship to come to America; got a
degree in computer sciences; went back to her native country; is married and has a two-year-old child.
And Papa Jaime says, "That is my grandchild. That is just like my biological grandchild. That child plays
with my biological grandchildren.”
He's now told the restaurant owners, “Please don't call the police. If you see one of my kids, call me and
one of my team will come and take the kid, put them back into the village, indoctrinate them into not
begging.” His kids have grown up to become teachers. They've grown up to become computer scientists.
They've grown up to become doctors. They've grown up to become surgeons. He also showed me a
handsome young man dressed in impeccable white, with a tennis racket in his hand, flanked by Pete
Sampras and Agassi, and that's the national junior champion of Colombia.
So truly an inspirational leader, he continues to do his inspirational work and is changing the lives of
millions of thousands of people, not only in his country but all over Latin America. Next slide.
Jim Collins once said, "The good-to-great leaders never wanted to become larger-than-life heroes. They
never aspired to be put on a pedestal or become these unreachable icons. They were seemingly ordinary
people, quietly producing extraordinary results.” Next slide.
Margaret Mead, the anthropologist, once said, "Never doubt that a small group of thoughtful, committed
citizens can change the world. Indeed, it is the only thing that ever has.” We've seen that play out right
now by young people all over the world.
The next attribute, the S of the leadership mnemonic, is that great leaders possess a sense of purpose.
Next slide.
Montaigne, the French philosopher, said, "The great and glorious masterpiece of man is to live with
purpose.” And young people can have amazing leadership qualities and a sense of purpose. Shown on
the next slide, you see this young lady, Jennifer Staple[-Clark]. She was a Yale pre-med student. She did
a rotation in ophthalmology and she was shocked to see many people with blindness that could have
been prevented. Who were these people? Poor people. People who couldn't afford to see an eye doctor.
So she goes back to Yale and with 29 other students, forms an organization called "Unite for Sight.” Now
in the last six years they have done 52,000 sight-restoring surgeries. They have seen 1.2 million patients.
They have trained 7,000 fellows. They have more than 5,000 volunteers. The volunteers include medical
students, nursing students, web designers, and even professors of ophthalmology.
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Truly inspirational leader, she got admission to Stanford Medical School and she said, "I want to defer
admission. I want to continue to work 60 to 80 hours for my organization.” And the Dean of Admissions at
Stanford said, "Jennifer, when you're ready, we'll be ready for you.” Next slide.
I also want to point out that there are amazing women leaders. We at Harvard University have Drew
Gilpin Faust, an amazing inspirational leader; Susan Hockfield at MIT; the Speaker of the House; the
Secretary of State in our country; many inspirational women leaders. There's a wonderful book by Helen
Fisher, an anthropologist and author, and she writes that, "Women have a finely tuned intuitive sense; a
keen imagination, patience, empathy, a desire to nurture children, kin and community, a talent for making
egalitarian connections with others."
If we want to see great leadership in our country, we want to see leadership on corporate boards, we
need to have more representation of women. There's only one country where at least 40% of major
corporation boards have to be represented by women, and that's the country of Norway. Other countries
are now talking about it. There's an international movement to have at least 15% of major corporations
represented by women. Next slide. Do you have it? It's not on my screen.
Charles Denham: Is that Joseph Campbell? It's up.
Sanjiv Chopra: Yeah. So Joseph Campbell once said, "Follow your bliss and doors will open where there
were no doors before." The Papa Jamies of the world, the Jennifer Staples of the world are following their
bliss. Next slide.
The H in the leadership mnemonic – I still see a barbell.
Charles Denham: Sir Edmund Hillary is up.
Sanjiv Chopra: Great leaders have humility. Sir Edmund Hillary, the first person to climb Mt. Everest with
Tenzing Norgay. He was asked, "What was the crowning achievement of your life? Being the first person
to climb Mt. Everest?” And he said, "No. It was the building of schools and clinics for the poor people of
Nepal." When he came down from the summit he turned to the Sherpas. He said, "What can I do for
you?” And that's what they said; they said, "Build schools and clinics.”
He started the Everest Foundation, the Himalayan Trust, and devoted many years of his life to that. He
was a very humble man; the son of a beekeeper. He once said, "I was just an average bloke; it was the
media that transformed me into this heroic figure. But as I learned through the years, as long as you don't
believe all that rubbish about yourself, you wouldn't come to much harm.” Next slide. He said, "I've
enjoyed great satisfaction from my climb of Everest, but indeed my most worth-while things has been the
building of schools and medical clinics. That has given me more satisfaction than a footprint on a
mountain.” Next slide. He also once said – I think it's a beautiful statement, "It is not the mountain that we
conquer, but ourselves.” Great leaders conquer their doubts, their fears. They have a compelling vision
about the future. They inspire their followers and they achieve greatness. Next slide.
Great leaders also possess a sense of humor. Benjamin Disraeli and William Gladstone were archrivals
and successive Prime Ministers in England. There was a quote attributable to Prime Minister Disraeli
about misfortune. So the next day a woman reporter is interviewing him and she says, "Prime Minister
Disraeli, what's the difference between misfortune and calamity?” And without skipping a beat he said,
"Well, if Gladstone were to fall into the Thames, that would be a misfortune; but if someone were to drag
him out, that would be a national calamity." Next slide.
Gandhi had a great sense of humor. Asked by a western reporter, after a beating and arrest of thousands
of Indians and deaths, "What do you think of Western civilization?” And Gandhi answered, "I think it would
be a good idea.” Next slide.
Great leaders have integrity, the I in the leadership mnemonic. Heraclitus, the great Greek poet and
philosopher once said, "The soul is dyed the color of its thoughts. Think only those things are in line with
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your principles and can bear the full light of day. The content of your character is your choice. Day by day,
what you choose, what you think and what you do is who you become. Your integrity is your destiny.” You
can do something with great integrity for decades and then you compromise your principles, your integrity
for one minute. It will tarnish your reputation and ruin your company, your hospital, your family.
The final letter in the leadership mnemonic is P, is for packing other peoples' parachutes. I'm going to
share with you a short story – next slide – and that is of Captain Charlie Plumb. So Captain Charlie Plumb
is sitting at a diner some 30 years ago having breakfast with his wife, and there's an individual sitting two
rows away who keeps looking at him. After a while he walks over. He says, "Are you Captain Charlie
Plumb?” So Captain Charlie Plumb says, "Yes, sir.” And the guy says, "You flew Air Force Phantom jets
off the Kitty Hawk during the Vietnam War.” Captain Plumb says, "That's true.” He says, "Your plane was
shot; you ejected; you were captured; you were a prisoner of war for six years and you were tortured.” So
Captain Plumb gets up and he says, "That's all true. Who are you?” And the guy answers, "I packed your
parachute.” So Captain Plumb says, "Oh, my God. I've been meaning to look for you and thank you.” He
says, "Tell me something. Do you keep track of everyone's parachute you've packed?” And the guy
answers, "No, sir. It's enough gratification for me to know that I have served.”
Captain Charlie Plumb was 24 years of age. He'd been married to his high-school sweetheart at the
Annapolis Naval Academy and off he goes to Vietnam. He has done 74 successful sorties. It's his last
one – 75th one – last one, four days before coming home and he's shot. He's a prisoner of war. He's
tortured. He's actually depressed. He's in a filthy, dingy, black infested cell, says to himself, "This is not
my war. This is my president's war. I was going home to my sweetheart."
And one day he thinks he hears a cricket chirping in the cell. He goes to investigate. It's not a cricket. It's
a piece of wire scratching the concrete floor through a hole in the wall. He pulls on it, there's a tug. It
disappears. It reappears two hours later with a note. It says, "I'm a fellow prisoner of war. Memorize this
code and swallow the toilet paper.” And over the next several months this individual has a conversation
with him, sometimes with these notes, but sometimes in the mess and sometimes when they go to the
latrine. And the guy says to him, he says, "Listen, I've been a prisoner of war here for two years. Do not
feel like a victim. That is a fatal disease; it's called victimitis and we will survive.”
It turns out there were 190 prisoners of war, elite fighter jet pilots in this camp. But there was one other
individual, the 191st person was a midshipman, 19 years of age, who fell off an aircraft carrier and was
captured. And two years later the Vietnamese say to this young man who's now 21 years of age, "You did
not drop bombs on us, we're going to release you.” And the young man naively says, "I'm part of the
team. If you're going to release me you have to release everyone.” Of course, they laugh and scoff at him.
And the person who connected with Captain Charlie Plumb says to him, "I'm the senior most person in
this camp. I'm in charge. Take my marching orders and go home.”
And here's the most amazing part of the story, in those two years, this 19-year-old midshipman had
memorized the names, Social Security numbers, addresses, telephone numbers, and the names of the
first of kin of the other 190 people. He comes back to America. On his own accord, his own money, he
crisscrosses the country, north to south, east to west, and he says to them, "Your husband is alive. Your
father is alive.” He was the ultimate parachute packer.
I asked Captain Charlie Plumb, I said, "What happened to him?” He said, "He became a teacher. He's 74
years of age. To this day he can recount those 190 names, Social Security numbers, telephone numbers,
addresses. But if you interrupt him, he has to start all over again.”
So to me, parachute packing is a metaphor for mentoring. As great leaders, you have to pack other
peoples' parachutes. Also remember to acknowledge those who packed your parachute. And my plea to
you is don't wait for the eulogy. In the sacred Hindu text, the Rig Veda, it says, "He who gives liberally,
goes straight to the gods. On the high ridge of heaven, he stands exalted.” Next slide.
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It's been said that it's very difficult to define leadership. Let me offer you my definition. "Leadership is the
ability to articulate a vision and walk the path, such that it inspires people to rise above the banality and
strife of their common-day existence and achieve the higher and common goal.” Next slide.
We've talked about the leadership mnemonic, the 10 tenets. Great leaders listen with heart and soul.
They have empathy and compassion. They have an attitude that is upbeat and courageous. They dare to
dream big. They're effective. They're resilient. They have a sense of purpose. They have humility and
humor. They have integrity. They have great ideas. They have wild imaginations. They pack other
peoples' parachutes and they adhere to their principles.
We've not talked about many other inspirational leaders: Nelson Mandela; John F. Kennedy; Abraham
Lincoln; Martin Luther King, Jr. Nelson Mandela, 27 years in prison, and when he's released he's asked a
question, "Do you harbor resentment or bitterness against your captors?” And he gave the most beautiful
answer. He said, "I have no resentment or bitterness.” He said, "Resentment is like drinking poison and
then hoping it will kill your enemies." Next slide.
We're going to conclude in the next minute. Remember, it is always possible to lead. You can lead at the
level of your civic organization, on a board, in the temple, in the church, as the CEO of a hospital, as
somebody in charge of quality improvement, in patient safety. There [are] so many different spheres in life
one can lead. Søren Kierkegaard said, "If I were to wish for anything, I should not wish for wealth and
power, but for the passionate sense of the potential, for the eye which, ever young and ardent, sees the
possible. Pleasure disappoints, possibility never. And what wine is so sparkling, what so fragrant, what so
intoxicating, as possibility!” Next slide.
Many, if not all, of you listening to this webinar today have already led and done so with great distinction. I
invite you: take a moment, reflect on it, then go tell your story. Next slide.
Each one of you has the spark of leadership. Keep it ignited. Thank you so very much.
Charles Denham: Thank you so very much for giving this inspirational message, Sanjiv. And what we're
going to do now is just go through a couple minutes of some slides, Sanjiv, and have you also to react
with our team regarding such topical areas, [of] which most of our leaders in the C-suite, our CEOs,
COOs, our Chief Operating Officers, Chief Quality Officers are unaware; and maybe you can react with us
and tell us how to apply some of these principles as we go forward.
What I want to do is, I'll go to Sharon Rossmark, one of our great leaders who is a nonclinical board
member, but Chair of the Patient Safety Committee. Before I do, Sharon, and react to Sanjiv and have
both of you and David Parda react to this, and we'll come back to Patti O'Regan, who's on one of our
lines. I do want to make sure that we address how we're going to apply some of these principles that one
of our great leaders and inspirational leaders, Sanjiv Chopra, can help us be really practical and think
about how we can get messages into the C-suite and the Board of Directors to help tackle these.
The slide you see before you is Net Promoter Score. This is a measure we use for every webinar, and we
measure your priorities of areas that you want to work on, and it is the strongest and most data-supported
loyalty score or customer service score in the world. Hundreds of companies have submitted their Net
Promoter Scores to measure the satisfaction with their products. And basically the math works this way:
when we survey you, or, let's say, jetBlue surveys you or Amazon surveys you or Facebook surveys you,
they say, "Would you recommend our product or service to a family, friend, or colleague?" and you score
a nine or a 10. That only gives you one point.
A 1-6 answer to that question with “highly recommend” – which would be a nine or 10 – a 1-6 is a minus
one, so that the Net Promoter Score pulls us out of the average and lets us really see, if we took all our
nines and tens and subtracted everyone who gave us a 1-6 from our nines and tens, and we give no
credit to the passives that give us sevens and eights, what is that number?
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We're really blessed, and we thought about not even putting up our score, although we use USAA
Banking which is the highest in the world and has been 87, flipped to 83, we have a three-year average of
87 and we're so grateful for you as an audience giving us such a high score, but we want you to see that
as popular a product service as Amazon at 76, or Apple at 71, or jetBlue, one of the top of the airlines at
64, or even Google, 56. This lets you see that a low number still is a highly recommended group.
Now, these are the 10 topical areas that we covered in December, and this is the first time, Sanjiv, that
we've shared this data with anyone. We went through 10 areas through our research with our test bed,
and our research test bed is the largest in the world. We polled our audiences and talked to our subject
matter experts and gave them 10 topics in leadership, 10 topics in technology and 10 topics in practices
and said, "Give us a Net Promoter Score for the areas you want us to cover in 2013.” And you'll see, in
the leadership, that integrated teams and integrated care focus got a 51. Identification and mitigation of
risks and hazards at the board, getting the board aware of the risks and hazards that we have in
hospitals, and safety and quality leaders got a 49; very high. Nursing and bedside healing focus, look how
high that was, 48.
Sanjiv Chopra: Terrific, yeah.
Charles Denham: Accountability for new risks was 48. And you see that these scores are all very high.
We didn't have them rank them. Everyone could give a 10 if they wanted. This is where they could rank
the priorities and even at 35, which is a very high Net Promoter Score, governance training was very high.
We see safety budget protection as a board chair action got a 38.
So these are the topics that ranked the highest. They're clustered between and 35 and 51% Net Promoter
Score. So again, you take all your nines and tens and you subtract all your 1-6s from your nines and tens
and give no credit for a seven and eight, this gives you the Net Promoters or those who would really
actively promote these topics.
Next, were Practice Targets. The surgical never events had just been released, Sanjiv, and we didn't
know that much about them. These are like the never events from the National Quality Forum. But
availability of medical records and health records got a 63. We know this is of crisis proportion but it's not
a sexy area; however, we know it's a major area, a life-saving area.
Prevention of healthcare-acquired infections. So many organizations say, "Oh, we're there. We've already
got a program.” And many CEOs and boards say, "Oh, we've got a program, Sanjiv, it's great.” Look at
62; what an amazingly high number.
Sepsis, that's also infection, 62%. Pain management, which flies way under the radar, that is an iceberg
that's under the waterline; we'll have 20,000 preventable deaths from short-acting narcotics. And we know
that you work with liver transplant patients, Sanjiv, and know that pain management is a really key issue.
Look at how high end-of-life was. And then safe blood management: we had no idea the huge opportunity
that we have to reduce overuse, underuse, and misuse of blood, and that most hospitals could save at
least a million dollars this year by proper management of blood and actually, adequately identifying those
[who] are anemic and reduce what is a liquid transplant, and really has a huge impact on length of stay
and cancer.
Then failure-to-rescue continues to be a huge problem at 42. Then you see spine care and cardiac care
were much lower. This one was very shocking and I'm going to go to our panel. We have 30 minutes for
Q&A in our panel, but look how high the number was for EHR and health IT systems; 75 is just
staggering.
Now we know, because we have non-disclosure agreements with malpractice organizations and that
we're working with the IOM report on health information technology and our CPOE Flight Simulator, that
this is a calamity of catastrophic proportions. The adoptions of EHRs and CPOEs [have] introduced a
whole new set of risk variables, but we were shocked to find that our safety and quality officers also
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ranked it that high. Interoperability failures kind of go with that, but we teased that out as a separate one.
And then treating children with adult technologies like CT-scan protocols for adults, dramatically
over-radiating children – a big one.
Now, this 10, Sanjiv, and Dr. Parda and Sharon, came from ECRI and these were their 10 and we wanted
to test our group. But even the 38% is pretty high for caregiver distractions. The infusion pumps we would
expect to be high. Alarm hazards; we got a zero for embolism hazards.
Now this is the first time, Sanjiv, that anyone has seen these, so I'll be clicking through them. But what I
wanted to do, if Sharon has had an opportunity to look at these – and I'll go back to leadership targets –
and, Sharon, I'd like for you to react to Sanjiv's presentation. Yes, it was inspirational. Yes, it was highlevel. But what he has shared with us is the difference between leaders and managers. The meeting that
we just had where we had President Clinton with us, we were shocked to have a CEO, [whom] I will not
name, but a CEO give us the typical, "I'm an administrator and I expect the clinicians to come and tell me
what safety issues are about." At the front line, Sharon, that's impossible. Isn't it important that the board
weigh in and at least ask the right questions about these topics? But I'd like you to react to what Sanjiv
has shared about leadership and then couple it to these practical areas. Sharon?
Sharon Rossmark: Yes. Thank you, Chuck, and thank you, Dr. Chopra, for the outstanding presentation.
That was very heartfelt. In fact, I'd like to take one of your examples and just use it as a metaphor. So,
Chuck, just to position the conversation, now that the changes brought on by the Affordable Care Act are
beginning to affect, boards are challenged with guiding our hospitals through major transformations. And
the metaphor that I thought about as Dr. Chopra was covering his presentation is that, in my opinion,
boards and hospitals are packing the parachutes for the communities that we serve and we have got to
step up through this transformational period and continue to put a focus on patient safety.
And so in my opinion, the traditional approach of leading an organization through change is being
redefined. One, because of the enormity of the change; and two, because of the need to partner with our
communities more than ever to ensure that patient safety and quality care is being delivered. And so as I
listened to his presentation, each step as he walked through the metaphors for leadership, I kept thinking
about how that would apply to the healthcare field, in particular, board decision-making and guiding
healthcare change in this country.
And so I'm a huge supporter of understanding what it takes to go from good-to-great; and needless to
say, it felt good when I saw his one slide talking about good-to-great, because for healthcare that's going
to require focus on delivering a different healthcare model than what we've known in the past, and we're
at that intersection where we can now put quality care and patient safety in the spotlight. And so I think
his message today was right on point for what we need to understand in moving forward, particularly in
leadership roles.
Charles Denham: Sharon, I've highlighted with the highlighter pen the areas that our audience, who [are]
about two-thirds safety and quality leaders, about 10-15% C-suite, and then other – the areas that they've
identified that are key. Is it fair to say that our boards – and I know that you and I have talked about this at
length – really need training on these topics? You can't pull the questions out of thin air, can you?
Sharon Rossmark: Oh, no. You cannot pull the questions out of thin air. And you know what, just looking
at that very first one about integrated teams and integrated care, you know while there may be an I in
integration, the one thing that we say in sports is that there is no I in team. So collectively, caregivers,
leaders and staff must work together to move an organization to greatness. And so actually, the ones that
you've circled, I think, are right on point on what we need to understand and make sure that we're willing
to say, "I don't understand. I don't know." And ask the right questions in order to ensure better quality care
and patient safety in this country.
Sanjiv Chopra: Sharon, I loved what you said. There is no I in team.
Sharon Rossmark: Yes.
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Sanjiv Chopra: What a wonderful way to articulate it.
Sharon Rossmark: Yes. Thank you.
Charles Denham: So, Sanjiv, and first Dave Parda. David Parda is the Chairman of Radiation Oncology
in the Oncology Services at West Penn Allegheny Health System, undergoing amazing change, and is a
clinical board member who has helped guide them and has continued to help guide them through some
very stormy financial waters. Dave, do you want to react to what you're seeing here as a clinical board
member? And then we'll come back to Sanjiv about your thoughts as you've had time to kind of
synthesize this. Dave?
David Parda: Thank you, Chuck. I think that we've been thinking a lot about the culture transformation for
doctors and for medicine, and that transformation going from a competitive, autonomous, individualistic
type of approach to a more a collaborative, collegial, and team-based approach. That's key at clinical,
operational, and financial areas and it's certainly key at the board level. My view from the past three years
of being on the board of my health system has been that it is very easy to lose sight of your primary
purpose, in that that purpose is to serve patients and enable healthcare professionals to serve patients at
the highest level, especially in the financial distress that our health system has experienced. It really does
degenerate to just financial assessments – the spreadsheets. It's been very easy for patients and
healthcare professionals to get lost in the mix.
Fortunately, there were four physicians out of 18 board members [who] have been really fighting hard for
the 12,000 employees and for patients, and I do think that we've been able to have some small impact to
improve the focus of service to patients and healthcare professionals.
Charles Denham: So, Dave, as you see these up on the screen, are there any that jump out at you? I
think you and I have been really amazed at the lack of knowledge of our board members across the
country on risk and mitigation, and have continued to be pretty focused on finance, especially as we're
going through these troubling waters of reduced payment.
David Parda: Yeah, I think that's so true, Chuck. One of the most common phrases that I had at the
board meetings was that we never have any clinical and operational context in any of our discussions. So
I think that top item of integrated teams and integrated care focus is the key. Integration is the key and
becoming much closer to the patient and the bedside is absolutely the key. I think a lot of other things will
fall in place as that happens.
So a lot of your focus of getting to the board level is so critical, because I can tell you that in this $1.6
billion health system with 12,000 employees, decisions that affected all 12,000 employees and the
hundreds of thousands of patients [whom] we take care of were really happening in such a small,
unilateral vacuum with, essentially, oftentimes one to three corporate management leaders and maybe
five board members. That was the situation in our health system and five board members with no clinical
and operational context, knowledge, and frankly not enough interest.
Charles Denham: Great. Thank you, Dave. I think that it's just so critical that we could get the message
into the C-Suite and to the board. Sanjiv, I've highlighted, also – the care of the caregiver has really
packed the parachute of your staff and you see a 40. Although it's a 40 Net Promoter Score, that means
we've subtracted all the 1-6s from all the nines and tens and still have 40% that would be promoting. In a
room of a hundred people would walk across the room to push for care of the caregiver and leadership
development investment. Any reaction to these before we go to the next one with our panel?
Sanjiv Chopra: Yeah, I actually have a reaction to what was just said, which is that, Chuck, the wonderful
and comprehensive work you and others are doing gives one so much optimism and hope about the
future. Oprah Winfrey once said, "The future is so bright it hurts my eyes.” And I was reminded of that
seeing all these charts and figures.
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I think one of the key things [that] has been said is that there has to be a lot of transparency. We have to
have team effort. We have to tell stories. I find that people on boards can often get numbed with statistics.
Not that he is in any way somebody I salute, but Stalin once said, "One death is a tragedy; one million is a
statistic.” I think one of the key things for us to do is tell the stories.
Charles Denham: Absolutely.
Sanjiv Chopra: If we talk about patient safety and we say there were so many cases of
ventilator-associated pneumonia; so many cases of sepsis that occurred because of so many medical
errors; 90,000 people die every year from preventable medical errors. That's a jumbo jet crashing every
day.
People get numb. But if we tell the story of one seven-year-old girl, or one 42-year-old person, or one
68-year-old grandfather, and say this person died because of errors we made, that will be very powerful. I
think leadership is storytelling. I think there's a huge opportunity for us here, to take all these crises and
issues we're dealing with and tell stories, and then get to the next level.
Winston Churchill once said, "A pessimist sees difficulty in every opportunity; an optimist sees opportunity
in every difficulty.” I mean, you think about patient safety and you think about burnout and you think about
leadership development at the level of the board, the care of the caregiver, all of that, I think we have to
start telling more stories.
Charles Denham: Absolutely. Thank you so much, Sanjiv. We'll go to the clinical practice targets and I
think we have our nurse practitioner, who's also had a tragedy in her family of patient safety, Patti
O'Regan. And we'll go to her in just a moment. I want to make sure, Kyle, that we have her on the line.
But the practice targets. So those were the leadership issues. We got a 73% on the surgical never events
that have just been published and this is the new thing because we have not been as familiar with them.
And then we look at a cluster in the 60s of availability of medical records, still the plaguing infections and
pain management, as well as end of life. These all are clustered around close to 60 as a Net Promoter
Score. Again, that's subtracting everybody [who] did a 1-6, no credit for seven and an eight. These are
extremely high. Sanjiv, this is your first time for seeing these, so I'll go to Dave Parda. But Dave, as you
look at these, does this resonate with what you see at the front line?
David Parda: Absolutely, Chuck. With the increasing complexity of all the things that we do, I think that
patients are [rightly] confused as to how some of these simple types of things fall through the cracks. We
know that given the complex processes and the number of people involved in these activities in delivering
care, that it can get complex pretty quickly. It's a reasonable expectation that we need to be able to take
care of these top priorities.
Charles Denham: So, Sanjiv, any reaction here? You practice a highly technical and highly complex area
of medicine. You've got referrals that come into Harvard all the time and Beth Israel and your work in
hepatology, but you also have a great view through being Dean of Continuing Education. Are you
surprised and would you agree with these areas as being high priorities? We want to know because we
want to serve our national test bed of 3,000 hospitals.
Sanjiv Chopra: No, not at all. I think these Top 10 Potential Practice Targets are amazingly resonated for
me. I think this is what we have seen play out in community hospitals but also in big academic centers
and it's no surprise to me that this is the response: end-of-life care, patient management, timely diagnosis
and treatment of sepsis, all such important things. You and I have talked about Albert Schweitzer and he
used to think that reverence or truth trumps everything. Then one day he's a prisoner of war and he's in a
train and he sees these hippopotami and baby hippopotami frolicking and it suddenly hits him: it's
reverence for life.
I think all of us in the healthcare field should feel so privileged that we are taking care of patients. We're
there for their well-being and we have to have reverence for life.
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Charles Denham: So in the lower right-hand corner of your screen, we are going to poll you as an
audience again, as we typically do, to get guidance to serve you, and the first question is, "Would you like
more drill-down detail on applying Dr. Chopra's framework?” And again, Net Promoter Score. "I would like
more inspirational leaders to present their frameworks for performance."
Generally, Sanjiv, we are more technical. It was so shocking to me to be at a national meeting and hear a
hospital leader describe themselves as a passive administrator, expecting the clinicians who are
practicing every day to bring them the safety hazard and not have the strength and the desire to lead
instead of just manage the plan, and passively allow things to just unfold which I think is a real – one of
the cultural cancers we have is passivity in a C-Suite, and that's where, Sharon, we're so grateful to have
a leader like you.
The third question is, "I want TMIT to address high scoring areas of the hazards presented.” Let us know
these are what you want. Then the next one is, "I want a deep dive on medication, adverse event
prevention.” "I want a deep dive," the next question on "failure-to-rescue.” These are two topics of this
recent global meeting we had last week.
And the third one is, "A deep dive on blood safety, savings, and adverse events.” Because we know we're
going to cover the high areas here, but we're polling our audience there. Do we have Patti O'Regan on
the line to be able to comment on what she heard from Dr. Chopra before we go to the technologies?
Patti, are you on?
Kyle, we'll wait to hope that we can get Patti on to be the voice of the patient, which we always try to do,
Sanjiv, in every one of our meetings. And here is a caregiver who is also a patient family member. In
technology, now that we've addressed leadership.
Patti O'Regan: Can you hear me?
Charles Denham: Yes, we can you, Patti. Do you want to comment now before we go to the Top 10
Technology Hazards?
Patti O'Regan: I'd love to.
Charles Denham: Go ahead.
Patti O'Regan: Thank you, Chuck, very much. Thank you for inviting me today as it's a true pleasure
listening to Dr. Chopra, you and the rest of the panel members. As you said, I happen to have had a
family member die from medical errors, so I had that visceral experience, and I'm also a clinician who
provides care day-to-day with patients in facilities.
I wanted to just – because I know you're running short on time, probably – give you two quick anecdotes
that recently happened that remind me of the qualities that Dr. Chopra was describing to us. Those
qualities that you've just gone over, Dr. Chopra, are very near and dear to my heart. Just a couple of days
ago, I was walking out of a facility around 8:00 at night. There are two men, one turns out a 96-year-old
man, and someone who looked to be either his grandson or his son, and they were sitting in this dimly lit
hallway leading to the doorway and there was nobody there with them, but they were obviously in
distress. So I stopped and said, "Can I help you?” And the one that was in most distress said, "Yes, can
you find Sandy for me?” And I said, "Well, I'm new here, I don't know a Sandy.” And he started to vent.
And I realized that this man was in great distress, just by observing him and hearing what he said and
watching this 96-year-old frail man next to him in this dimly lit hallway. So I said, "What can I do to help
you?” They said, "You can find Sandy.” And then they started telling me about this 96-year-old man who
had his wife who's being discharged and the series of errors that apparently had happened, and this is a
very good facility. The administrator just wasn’t responsive to the patient.
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But this is an incident that just recently happened and the younger man said, "I'm a very good friend and
he has his wife in here and the doctor won't call us back, and she's supposed to be discharged. We went
to the pharmacy, they didn't have the medications yet after they told us to go there. I called here and they
transfer me to [unintelligible]. So this man was going through this problem with a system that was not
working. And I felt so bad for him. And I said, "Let me take you wherever Sandy [unintelligible] take you
there now. I don't know her, but we will find her.”
So he felt a little relieved and the three of us walked up to the nursing station. I asked, "Can you tell me
where Sandy works?” And they said, "Well, we're not sure, she might work down there at this nursing
station.” And so we started to go down there. And the whole time this younger man has a dialogue in my
ear, he keeps telling me, "Well, you know, they say they're going to do it. They don't.” I mean, he was just
so frustrated. He didn't know [whom] to talk to. He didn't know anybody [who] could fix this for him.
So we spent about 15 minutes looking for Sandy, and going into rooms, one by one even, because
nobody seemed to know where Sandy was or who she was. So we found Sandy and one person said, "I
think she's in the break room.” I said, "Well, could you go get her? These two people really need to talk
with her. She's the last one they talked to here, and she gave her name, said, ‘Look for me when you get
here.’”
They went in, Sandy came out, and then I left the scene and went home. But the message for me there
was that there was a whole series of errors going on. There was a lady [who] was being discharged and
the facility that I work at – I mean, there's a great likelihood that she had numerous illnesses that she was
going home with. It's just like 10, 15 years later after the serious event happened in my life, and I keep
seeing the same thing over and over. But in the meantime I've seen good things happen.
Charles Denham: Well, Patti, I think your story is a wonderful illustration of the integration issue that
we're being challenged with. I'll go now to the technologies and maybe have you close us with just a
30-second inspirational view of things. But you really addressed what ended up to be the top issue on our
list, which was this integration issue. And now it beautifully segues us to this patient HIT solution focus
that we keep thinking we're going to solve our integration challenges and problems with technology.
And Sanjiv, I think you and I have had this conversation. Without leadership to reengineer the care
processes that IT should enable, that's never going to happen. In fact, you can see on our slide right now
of the 75% Net Promoter Score that we have of this issue of IT and EHR issues and interoperability,
these end up to be very, very high and we have data that we can't we share, but we work very closely
with malpractice firms and we're finding that the fastest growing and big, big area is not in neurosurgery
or OB, but in primary care and internal medicine. And it's the integration of care and making sure a patient
does get that handoff that Patti mentioned, and the continuity issue turns out to be staggeringly important,
and then we've got the new socio-technical model issues of man/machine interfaces of us trying to be
able to solve that with pull-downs on screens. And we have trainees [who] are not going in and talking to
the patient, but then ordering tests and then copy and pasting plans without talking to patients.
Sanjiv Chopra: True. Yeah.
Charles Denham: And having a staggering number of malpractice events that occur. So, Sanjiv, I'll go to
you first and then to Dave Parda regarding these technology hazards. But 75% nines or tens, subtracting
everything else from it is a staggering number. I mean, I was blown away when I saw 75%, because we
know it, as safety experts know, that this is a big issue. I had no idea that our test bed was seeing the
same thing. Sanjiv?
Sanjiv Chopra: Yeah, I'm actually flabbergasted to see that high of a figure of 75%. But you know
technology is not the solution to everything. I think technology is a tool that if used properly will enable us.
You've often said it best, I think, Chuck, about the heart, the mind, the hand – it all has to come together.
That's the only way we're going to really make a difference and a major dent in dealing with all the issues.
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Charles Denham: So, Sharon, if we hadn't shown this to you, these technology issues – if you hadn't
seen this slide, would you know that these are major hazards for which you're responsible at the board
level?
Sharon Rossmark: If I had not seen this outside of my organization, I would not have known, no. To
answer your question. And to the point that has already been made, these are critical patient safety. It
goes back to one of the other Es in Leadership around “efficiency is doing it right, but effectiveness is
doing the right thing.” We have got to do the right thing to bring these numbers down. This is just
unacceptable.
Charles Denham: And you see that surgical fires, of which there may be [fewer] than 200, more than a
hundred, [fewer] than 200, is a 20. But look at these areas of the caregiver distraction and these are
caregivers, many of them in our test bed. And then we've been working on infusion pump errors, we were
shocked to see that that was that high.
Sanjiv Chopra: 47%.
Charles Denham: Because we have been working on this for almost a decade.
Sanjiv Chopra: Isn't that amazing?
Charles Denham: I mean, we had David Classen and David Bates, and we've got some of the leaders
in the world, that we're not surprised to see this issue of children using adult technologies because we're
working with WHO and leaders all over the world and we're focusing on imaging and testing, as you
know, Sanjiv.
Sanjiv Chopra: Right.
Charles Denham: And we know we'll do 240 million CTs globally, 80 million in the U.S., 90% are adults
but the 10% [who] are kids, 90% are done in non-child-focused environments and a majority are not using
right-sized protocols. In 15 years, it's estimated that overuse CT scan this year will generate 29,000
cancers in 15 years from today.
So, Dave Parda, as a radiation oncologist, you and I were both trained in our fundamental work in
radiation safety and we know this is an issue, but even I was shocked that we had adult protocols being
used for kids when you and I worked so carefully as radiation oncologists treating children with tumors.
Why don't you react to this big number of the risks with the EHR? Because I know you're very technically
astute in your world.
David Parda: Yeah, radiation oncology is one of the few fields in medicine that is completely
computerized. We can't treat the patient without a computer, and more and more we're connecting the
overall clinical electronic medical record to those technical IT systems. That potential for mismatch is very
huge and there have been several deaths associated with radiation misadministration. In the radiation
oncology world, where you're delivering megavoltage radiation, an error that's relatively small
mathematically can result in death. In the radiology world where it's kilovoltage radiation, the big concern
is increased cancer risk and some of the skin effects that you were talking about.
This is something that on a daily basis we really have to work on with a lot of vigilance. And talking about
leadership, Chuck, it really does take leadership from these fields to make sure that these technology
standards are improved and the interface as an interoperability improves.
Charles Denham: So, Dave, I'm going to go to you and then Sanjiv and then to Patti to close us with a
very short inspirational, so we can stay on time. But Dave, these issues that I just put back up. I put
Sanjiv's framework back up. Wonderful presentation, lofty, inspirational. But isn't this the meat of what
we've got to bring back in the C-suite?
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You and I are very technically focused that our training as rad oncs, and I'm trained in business medicine
and engineering and very highly technical, and in care-process reengineering, but what I see missing in
the board room is exactly what we have on the screen here that Sanjiv so eloquently shared with us. Isn't
that true? Isn't this what's missing? We don't have leaders. We've got administrators passively moving
things along with the financial focuses. Is it not these issues that Sanjiv has shared with us that we've got
to get back in the boardroom?
David Parda: I agree, Chuck, and Sanjiv's presentation is so inspiring. Something that inspires us every
day is some of the words from Viktor Frankl, the noted psychiatrist, neurologist, and philosopher who
wrote about man's search for meaning after he and his whole family were in concentration camps in
World War II. One of the things that he said is, "I wanted to be a good doctor. I hope I was a good doctor,
but in the face of all of it, I wanted to remain human.” That is absolutely something that we as doctors,
and certainly our administrative colleagues, need to think about and practice every day.
Charles Denham: Well, you're so right. But it's a risk, Sanjiv, to ask you, with a pretty technical safety
quality audience, bring you here. It was a risk that was well taken, I believe, to have you inspire us in
coupling these inspirational concepts to the work we've got to do at hand, is critical because the passion
will be make or break. Sanjiv, final thoughts and then we'll go to Patti so that we can finish on time.
Sanjiv Chopra: Oh, well, it's been a wonderful exercise for me. It's really been an honor for me. I think all
of us who are clinicians, who work with patients … it is an incredible, incredible privilege. It's also the only
profession, I think, if you put your head on the pillow every night and ask yourself the question, "What was
the one new thing I learned today?” You'd be able to answer that.
I'm trying to start a little study here at University of Massachusetts and with colleagues at Harvard Medical
School at one of the hospitals to say that at the end of every single patient encounter, we should ask the
question, say to the patient, "I'm privileged to be your physician. I'm privileged to be your nurse. I'm
privileged to be your clinician. Tell me what I can do to be a better advocate for your well-being.” That's
what we need to do and I'd love to do this as an experiment, as a pilot of maybe even a randomized
study, have the cardiologists to do it – the others don't do it – and see what happens at the end of the
year. We're so privileged to be in this field.
Charles Denham: Thank you, Sanjiv. We would love to have you to come back and tell the stories that
come from that as well as the studies. I'd like to keep all our speakers on as we finish; and Patti, would
you send us off with just a short inspiration?
Patti O'Regan: I'd love to. There was a person in my office the other day and I'd like to share a quote
from her. That person was sitting there as a family member who was worried about one of her loved ones
in the facility, and this is her quote. She said, "I'm a medical provider and I see death every single day.
But it's different now when it's you or when it's me.” It was very profound for me to hear that from her and
as she talked on, it was very obvious that she is now turning to view her patients a little bit differently
through the learning that's going on in her own life. I'm very grateful to be here with you folks today.
Charles Denham: Thank you, Patti, and so we'll keep our speakers on so we can just do a cycle of
improvement. This ends our webinar. We want to thank Dr. Sanjiv Chopra from Harvard Medical School
and renowned speaker from around the world. Sharon Rossmark, I think, a role model; if you want a role
model for a great trustee, it's Sharon. Dave Parda, the role model for a clinical board member and
clinician that we could look up to, and then Patti O'Regan, a nurse practitioner and who's lost someone in
her family.
God bless you all and we'll see you next month and look forward to another great webinar. Thank you all
for your attendance.
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