Book John as a Speaker! (253) 307-6155

ABC Analyst, Professional Speaker, Author & Consultant


  1. Surviving the Affordable Care Act Earthquake: How To Incite the Changes You Need - in Time!
  5. The Bottom-Line Benefits of TEAM LEADERSHIP TRAINING - Proven Pathway to Minimizing Errors and Maximizing Quality

Surviving the Affordable Care Act Earthquake:
How To Incite the Changes You Need - in Time!

Whether we measure it in terms of reimbursement, patient safety, service quality, market share, or provider satisfaction, there's no question that the landscape of healthcare delivery is being as violently reshaped as if a great earthquake were roiling the terrain. And though we hate to admit it, when your once-familiar world has been upended, it is very hard to be calm and methodical enough to ferret out the right path to survival - especially if those steps are non-traditional. That is why tough and confusing times demand voices and influence from outside the institution - calm, incisive voices that can dramatically boost the urgency of the wake up calls needed to spark a Renaissance.

Providing that energizing wake up call is precisely what this Keynote (and any expanded seminar or half-day version of it) is designed to do: To spark, inspire, and incite the cultural and clinical, financial changes you need to surf this tsunami. It is, in other words, designed to be a powerful aide to your efforts to get your "army" marching in the right direction, and for the right reasons. The Return On Investment is immediate, especially considering how little time remains to make changes that depend on the buy in, and true ownership, of your rank and file.

The greatest threat to any healthcare institution right now is failing to infuse the appropriate sense of urgency in your people, physicians included.

[return to top]


Taking the title from the book by John J. Nance, this is the premier presentation that has been so in demand in the last 6 months in Healthcare. This presentation builds on the reality that American Healthcare is, in fact, a gigantic and complex Non-System, and that to achieve real patient safety and quality of care in such a chaotic environment requires building healthcare for the first time into a coherent, interactive system. Inclusive in this revolutionary approach is the fact that the American hospital cannot serve the patient’s best interests as long as it continues in the tradition of Ben Franklin (the creator of the first American hospital) as an institution built only for doctors, not patients. The hospital must become a true unified entity in which even the outside physicians consider themselves an integral and proud part of the team - rather than independent practitioners merely renting space for their patients in a farmer’s market. In addition, this lecture, in building on (not merely teaching) the book's thesis highlights the essential role of the physician as a leader (rather than a commander) in orchestrating the amazingly effective shift to Collegial Interactive Teamwork based on open communications, caring and trust. How the hospital board and C-suite become essential to this process of change - and how it can all be torpedoed by any leaders who refuse to understand the broader human effects of each cost-cutting decision - are major changes in the way we view the internal workings of healthcare governance. Why Hospitals Should Fly has become a runaway best seller in healthcare worldwide, and this presentation - recommended for 1.5 to 2.5 hours - not only explains why, but rallies the troops for immediate change. (While not required, it is highly recommended that copies of the book either be provided the participants, or made available in advance.)

[return to top]


WHY HOSPITALS SHOULD FLY (ACHE’s 2009 Book of the Year) sparked a nearly unanimous question across American Healthcare: “How? Agreed, we should be like the safe, happy, and cost-effective St. Michael’s hospital depicted in the book, but how on earth do you begin the process of change? How do you start the journey?”

That is precisely the question this entirely new presentation deals with - and answers - using specific methodologies, recommendations, and strategies to help you spark an energized internal determination to be the best.

Based on the voluminous research underlying CHARTING THE COURSE, (the sequel to Why Hospitals Should Fly), and targeted on 2014's tsunami of challenges and changes confronting the industry, this tackles the question of what to do now regarding increased dependency on HCAHPS and patient satisfaction metrics, CMS pressures and curtailed reimbursement, the expanding list of “never” events, and the massive challenge of creating a unified organization from a collection of siloed fiefdoms.

This dynamic lecture also takes you with great clarity into the heart of exactly what steps must be taken by senior and middle management to lead your people to break free of the “Way we’ve always done it” syndrome. It gives virtually everyone in the American Healthcare setting a crystal-clear understanding of what has to be done, and in what order, to create a unified institution whose members from bottom to top are truly dedicated to zero harm, the highest quality of care, communication, teamwork in its highest expression, and a common level of ownership.

In fact, sparking that deep feeling of ownership (not just engagement) in everyone is a key focus.

This lecture is both a call to arms and a means of building a groundswell of enthusiasm and belief that we CAN dramatically change the culture, get to zero harm, and find new and highly-effective means of reducing costs and working together.

[return to top]


The average board of directors of the average American hospital is facing a forced revolution, including the threat of the Sarbaines-Oxley law that - if expanded by Congress to include hospital boards - could impose individual personal liability on each director. It is not enough for a board to be concerned about patient safety, boards are primarily responsible for each and every medical decision made in their institutions, and contrary to traditional practice, and handing clinical responsibility to the physicians does not discharge the board's obligations, and can expose the institution to ruinous lawsuits. It is difficult for boards to focus on clinical matters affecting patient safety and quality outcomes when the traditional role has been keeping the ship afloat financially. But that's where the seismic changes are occurring in governance. Boards must accept the responsibility for clinical decisions and guidance as much as for financial stability, and this is a painful reality.

In addition, Board training and progressive education is increasingly necessary as the complexity of providing healthcare becomes more apparent and more tied to board performance. In fact, the time demands and level of expertise now required of boards nationwide may require changing the concept of hospital board membership as an unpaid public service to one of at least partial compensation. In other words, we may need to pay board members to exercise the massive time commitment required of them.

No CEO or other member of the C-suite in a hospital can provide the appropriate control and oversight of physicians without massive board resolve and participation, especially in the area of instituting and using best practices uniformly. In fact, the very existence of a hospital, large or small, will depend in the near future on how fast its board can mandate and guide the clinical staff to adopt and thoroughly inculcate the best procedures and practices medicine can provide.

This very dynamic lecture will change the way your board looks at its duties, and will delve deeply into the cause-effect relationship of the board’s actions or inactions and the right of their hospitals patients to be free from unreasonable risk of inadvertent harm. With patient safety disasters (i.e. medical mistakes) now the 4th leading cause of death in the United States, these issues must be faced and acted on, not just debated. This is a pivotal wakeup call presentation best utilized in off-site board retreat settings. While John Nance will still accept some board presentations individually, for full board retreats, the team approach of having both John Nance and Kathleen Bartholomew (the author of 4 major nursing books, including Ending Nurse-to-Nurse Hostility; Why Nurses Eat Their Young and Each Other) co-present is synergistically effective. Their efforts as a team speaking to board has been repeatedly praised for rapidly educating and redirecting the efforts of hospital boards through a hard-hitting exposure to the realities of what it takes to protect their patients.

[return to top]

The Bottom-Line Benefits of TEAM LEADERSHIP TRAINING - Proven Pathway to Minimizing Errors and Maximizing Quality

As of the first months of 2014, a multiplicity of new studies have begun validating up to fifty percent reductions in Wrong Surgeries (wrong site, wrong medication, wrong patient, retained object) throughout hospitals and healthcare settings. The engine of change in virtually all these results is a steadily and universally applied program of Team Leadership Training for the entire medical team involved in any form of surgical intervention at the patient's beside, in the OR, the cath lab, ER, or the physician's office. Going far beyond the basic exposure to Team Stepps and aviation's Crew Resource Management, Team Leadership Training creates proven and professional Collegial Interactive Teams, but must be built on complete cultural change.

This lecture lays the groundwork for why this is such a powerful and certain way to improve the performance of not just surgical interventions, but virtually all medical interactions. The hallmark of a mature Collegial Interactive Team is a leader who knows how to bring out the best performance and best participatory ownership in each member of the team. A trained CIT leader - often a physician - knows how to eliminate all communication barriers by making it completely safe for any member to speak up, and by creating and maintaining an atmosphere of mutual respect, constant learning, and non-hierarchical interchange. While these principles, techniques, and methods have never been taught in medical schools, nursing schools, or traditionally used in medicine, the dramatic and positive effects of appropriately inculcating such team leadership go directly to the bottom line, inclusive of significant improvement in morale.

[return to top]

John J. Nance has been recognized as one of the most important thought leaders in contemporary American Healthcare. Awarded the Distinguished Graduate for Public Service