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ABC Analyst, Professional Speaker, Author & Consultant


  1. Believing in ZERO HARM!
  2. The Mid-Course Correction: Where are we, how far have we come, and where are we going?
  3. Survival and Leadership in the Healthcare Revolution
  4. Surviving the Affordable Care Act Earthquake: How To Incite the Changes You Need - in Time!
  8. The Bottom-Line Benefits of TEAM LEADERSHIP TRAINING - Proven Pathway to Minimizing Errors and Maximizing Quality

Believing in ZERO HARM!
And Saving the Patient Safety Revolution from the Quicksand of the "good enough" zone.

If you're worried about your institution's Patient Safety Revolution hitting a wall on this 20th anniversary of the original IOM Report (To Err is Human, 1999), you're thinking ahead, and you're on target: Too many healthcare institutions are seeing their hard-fought progress toward zero unnecessary harm and high quality care seriously slowed and sometimes wholly derailed by several powerful forces, and once sidetracked, it's hard to get the train moving again.

Despite massive, sustained efforts, statistics still validate the staggering level of harm: 440,000 wholly avoidable patient deaths annually in American Hospitals (Dr. John James; Journal of Patient Safety, 2013), and over 4-million injured. It's enough to make hard working, sincere healthcare leaders at all levels lose both heart and hope, which can trigger a backslide toward Cottage Industry medicine and the way we've always done it.

The heart of the problem, believe it or not, is a toxic assumption: "Medicine is far too complex to ever allow complete elimination of avoidable patient harm." Not only is that assumption dead wrong, the very key to maintaining the Safety and Quality momentum you've fought so hard to achieve lies in your belief system. As other inherently dangerous industries have realized (on their way to High Reliability), if you don't truly believe that sustained zero harm is achievable, you'll never even get close.

With the rapidly growing importance of the Patient Experience as a priority centered around High Reliability status, safety and quality have now become a matter of financial survival. Yet there is a critical aspect of High Reliability that is too often missed: High Reliability is a philosophy, not a set of tactics and strategies, and that philosophy begins and ends with a sophisticated understanding of how human systems fail, and how to build systems that safety absorb the failures that can't be prevented.

Without the proper training and mentoring, pressured folks on the front lines (as well as their leaders) can conclude that their level of safety and quality is "good enough", which means acceptance of a certain minimal number of avoidable deaths, injuries, and near-misses from medical mistakes and human error. To patients and families with the misfortune to fall into that zone, however, "good enough" is chillingly unforgiveable.

This fresh, up to date and highly useful presentation is based on the past few years of John J. Nance's practical research and consulting, and it will give you a current, real-world picture of the massive profession-wide challenges as well as provide immediate takeaways. It will also reinvigorate your team's drive, dedication, and enthusiasm by affirming the inestimable value of their contributions and showing them what they can achieve.

The Mid-Course Correction:
Where are we, how far have we come, and where are we going?

Method: Re-dedicating the Organization to High Reliability (and the Underlying Target): How to Make Money AND do the Right Thing!

If you're familiar with military Stand-Downs, you know the concept of stopping periodically to assess what's working, what's not, and where you're headed, and you also know it's an invaluable tool. That is precisely the spirit and intent of this presentation: provide a takeaway-rich opportunity to re-dedicate the entire institution (from the front lines to the boardroom) to a clearly redefined set of goals - High Reliability, Just Culture, Outcome-generated income - and how fearless communication and the constant search for best practices are the keys to providing the best healthcare medical science can inform.

And, how to keep the doors open while doing all these things by maximizing income, lowering expenses, and utilizing cost-cutting expertise that's right under your nose in every department.

This program also articulates the latest and best methods of achieving the goals of safety, quality, and profitability. This is, in other words, tactical as well as strategic training for effective teamwork.

With equal importance and emphasis, this program method focuses on inspiring a dynamic re-dedication to achieve the tough goals by enlisting virtually everyone in the organization and instilling the confidence that each member is a vital change agent whose ideas, actions, support, and opinions do matter. The kickoff is a 90-minute energizing keynote presentation (which can be given more than once), followed by an interactive 90 minutes of intense, guided discussion involving the entire audience with roving microphones. The end-piece is an evening presentation to a leadership-rich audience which ideally includes physician leaders, C-suite, and board members. (This program can be adjusted to fit your specific needs).

Dealing head-on with the prejudices and pushbacks that have made cultural change so difficult (such as trying to spark full use of Team Stepps techniques or other teamwork-related training) requires a very frank discussion, and that's what this approach provides as a nucleus around which a more intense institution-wide focus can coalesce – a mid-course correction in NASA terms.

If I've been privileged to work with you in the past, and depending on the year, you'll probably recall that my efforts have previously focused on the challenges of patient safety and dealing with human and clinical error. This presentation series is quite different in that it provides a guided chance to stand aside and assess where you are and what is working, as well as what isn't. Consider this a highly useful opportunity to discuss the big picture with clarity and renewed purpose.

The tone of the main keynote is intense, fast-paced, and laced with appropriate humor to defuse the tough spots. The evening presentation, while more to the point, is crafted to be entertaining as well as deeply substantive, and the entire day is constructed to re-infuse a widespread feeling of optimism and purpose.

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Survival and Leadership in the Healthcare Revolution

For: All Leaders involved in healthcare, and specifically Hospital/Clinic/Healthcare System C-Suite Chiefs, Directors, Staff Vice Presidents, Managers, Department Heads (Clinical and Non-Clinical), Medical Executive Members, and Members of the Board of Directors/Trustees.

This wide-ranging half-day (4 hours) of dynamic training and coaching for healthcare leaders of all levels consists of a carefully selected and hard-hitting mix of didactic presentation and Socratic discussion, and enterprise coaching for immediate improvement of safety, quality, communication, and teamwork creation.

Encapsulated in the curriculum are the same presentation elements and voluminous takeaway techniques that have been so highly effective in John Nance’s bi-annual segments in the Intermountain ATP Course in Salt Lake City, as well as his twice yearly segments in the Leadership Series conducted by Texas Children’s Hospital in Houston.

John Nance’s background in law, system safety and human factors, national broadcasting and journalism - in addition to his quarter century in medicine - inform a wide range of useful insights regarding both the serious risks and potential remedies for being unprepared to respond appropriately to sentinel events.

Schedule will be tailored to your specific time requirements:

6:30-7:00 - Registration and continental breakfast

7:30-9:00 - Opening lecture covering the immense current challenges to healthcare institutions, including specifics of the changes necessary for both basic survival and for achieving the levels of Patient-Centric care required. The focus is on laying a predicate of reality by comparing the true measures and metrics increasingly available to patients and the public with what are too often dangerously ineffective attitudes and assumptions about patient safety, physician leadership, and the seismic shift away from fee-for-service. Creating a system of reimbursement and legal accountability based on performance and outcome before it’s forced on you is a key to survival. This section will also articulate what is necessary to become a Highly Reliable human system, and it will highlight the pivot points where healthcare institutions have to significantly change their inner structure to achieve such performance results.

9:30-9:45 - Break

9:45-11:00 - This is a solution-oriented presentation on a major shift in the systems required for safety and quality. It fosters a thorough understanding of the ways in which human institutions and humans fail, and the practical methods of absorbing those mistakes and errors that cannot be prevented. This section is a key component for structurally addressing the obligation of providing your patients with the best healthcare available through medical science, not just the best that individual practitioners can provide. Sustainable quality begins with the belief and a structure to provide a serious pursuit of zero unnecessary harm, and that, in turn, requires a significantly new philosophy and strategy. A brief outline of the “NTSB Method” as an integral component of Just Culture will round out the hour.

11:00-12:00 - Intense Socratic discussion of the material presented so far with emphasis on guiding the group to begin thinking about how to reach threshold consensus on what steps are most important, and in what order change should be tackled.


At the end of this day, participants should be able to:

1. Explain the basic reasons that massive and substantive change in the way healthcare is structured and practiced cannot be avoided by any healthcare institution.

2. Describe the magnitude of the Patient Safety challenge and how Boards and C-Suites should be prioritizing safety.

3. Describe the basic elements of a High Reliability Healthcare Organization, and why the traditional structure of healthcare is generically incapable of achieving such status.

4. Articulate the key reason(s) why fee-for-service-based reimbursement cannot continue, and why there is a significant increase in the legal and ethical risks fueled by the often pernicious influence of doing more things for more money.

5. Detail the basic elements of the popularly labelled “Patient Experience”.

6. Explain the basic ways in which humans fail, and the most effective way of minimizing such failures, and of blocking the ones that can’t be prevented from causing patient harm.

7. Describe the importance of true transparency in all quarters of a healthcare institution in relation to providing the best healthcare available.

8. Describe the effects of disruptive behavior by anyone, physicians included, on patient safety. Describe the increasing legal threat to failing to take firm action to prevent disruptive behaviors and eliminate those who continue to indulge in the same.

9. Describe the direct connection between poor relationships and poor communication and increased patient safety risk as well as decreasing quality.

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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.

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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.)

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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.

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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.

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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.

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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