National Doctor's Day - thank you to all physicians everywhere!

My first faculty appointment following fellowship was at the Children's Medical Center at the Medical College of Georgia in Augusta, Georgia (the hospital and university have since gone through a number of name changes and are now called Children's Hospital of Georgia and Medical College of Georgia at Augusta University, respectively).  The Medical College of Georgia actually has a very long and proud history as the nation's 13th oldest medical school and the third-oldest medical school in the Southeast.  There is apparently a tradition (I was only there for a year and must have missed this one!) called the "Raft Debate" that has faculty answering the question, "A surgeon, an internist, and a pediatrician are aboard a sinking ship.  Their only escape is a one-person raft.  Who should be the sole survivor?"  The idea is for the faculty to convince medical students on the pros and cons of the different medical subspecialties! 


One of the things that I remember most about my time at MCG was a plaque in the old library building dedicated to one of the school's early founders, Dr. Milton Antony.  Dr. Antony is buried at the historic "Old Medical College of Georgia" site (which is now on the National Register - see here), and I believe the plaque was originally at his burial site.  The plaque recognized Dr. Antony's contributions to medicine in the city of Augusta, the state of Georgia, and the Southeast region.  Notably, Dr. Antony founded the Southern Medical and Surgical Journal, which is still published today by the Southern Medical Association as the Southern Medical Journal. The plaque contains the following inscription:


In memory of Milton Anthony, M.D., Founder of this College.  A martyr to humanity and to the duties of his profession, during the fatal epidemic of 1839.  Cheered by Religious Faith through the Griefs and Trials of this life, he passed from the cure of the sick to the sleep of the just, amid the tears and blessings of the poor.  True to his own favorite maxim that a virtuous will is almost omnipotent, he overcame by study the defects of education and, patiently toiling to eminence, bequeathed to posterity a noble example of genius and industry, animated and directed by Patriotism and benevolence.

What impressed me then, and why I remember the plaque to this day, was the fact that Dr. Antony gave his life in service to his poor patients during a Yellow Fever epidemic in the year 1839.  How many other physicians have died, doing their duty in providing care to the sick?  The lesson stuck in my mind then, and I remember it even today.  I was reminded yet again of the lessons of service, sacrifice, and altruism during the 2014-2016 Ebola Outbreak in West Africa - so many of our fellow physicians went to West Africa to provide care.  So many of our fellow physicians signed up to care for potential Ebola patients here in the United States (a possibility that once seemed so remote, but soon became reality when two health care workers contracted the illness while providing care for one of the Ebola patients that had been transported to the U.S. for care).


So it is with the memory of Dr. Antony and my time at the Medical College of Georgia that I wish all of my fellow physician colleagues a heartfelt "Congratulations" and "Thank You" on this National Doctor's Day, March 30, 2018!

"Be like the Renaissance"

There was a movie in the 1990's starring Danny DeVito, Gregory Hines, James Remar, and Cliff Robertson that was directed by Penny Marshall called Renaissance Man.  Despite an all-star cast (look the actors up if you don't recognize their names) and a superb director, the film was a commercial flop (grossing US$ 24 million compared to a US$40 million budget).  The film critics hated it (Roger Ebert gave it one and a half stars and said "it feels like a cross between Dead Poets Society and Private Benjamin but does not have the warmth or spirit of those films").  Basically, DeVito played a divorced, down-on-his-luck advertising executive who loses his job, files for unemployment, and is given a temporary job to teach basic literacy classes to a group of misfit Army recruits at a nearby military base.  DeVito's character uses Shakespeare to teach his pupils how to read.  At the climax, one of the soldiers recites King Henry V's St. Crispin's Day Speech from Shakespeare's Henry V to rally the soldiers during a night-time training exercise.  Everyone passes with flying colors, DeVito's character gets a full-time job teaching Army recruits, and everyone lives happily ever after. 


Okay, why am I telling you about a movie that received a 17% Rotten Tomatoes rating?  It's all in the title - "Renaissance Man."  The urban dictionary defines "Renaissance man" as any individual (male or female, so we should say "Renaissance Person") with many talents or areas of knowledge.  There is another term that is more gender neutral - "polymath" - but essentially the term comes from the fact that so many celebrated figures from the Renaissance period were experts in a variety of seemingly unrelated subject areas.  The best example of a "polymath" is perhaps Leonardo da Vinci, who was famous for being an expert or mastering the disciplines of art, astronomy, engineering, mathematics, anatomy, and others. 


David Epstein and Malcolm Gladwell (yes - that Malcolm Gladwell) wrote an editorial in the journal, Ophthalmology (January 2018 issue) entitled, "The Temin Effect."  Howard Temin received the Nobel Prize for his discovery of reverse transcriptase, but he is perhaps just as famous for being a polymath (a so-called "Renaissance Person" in every sense of the word).  Epstein and Gladwell surmise that one of the reasons that Temin was able to "think outside the box" and come up with his discovery was the fact that he was so widely read and expert in other disciplines outside of science.  Recall that the widely accepted "central dogma" in molecular biology states that genetic information passes unilaterally from DNA to RNA to protein.  Temin's discovery of reverse transcriptase proved the converse - genetic information could go in the opposite direction from RNA to DNA.  As Epstein and Gladwell state in their editorial, "To imagine a possibility so heretical required imagination.  It required a paradoxical turn of mind.  It was, in a way, an observation born as much of a literary sensibility as a scientific one.  Temin's wide interests were not extraneous to his scientific pursuits.  A case can be made that they were in the service of his scientific pursuits."


Epstein and Gladwell's editorial was in response to a study by Jaclyn Gurwin and colleagues, in which medical students were randomized to an art training group versus a control group (no training in art).  The art training group attended professional art classes art classes at the Philadelphia Museum of Art (the study was conducted at the Perelman School of Medicine at the University of Pennsylvania).  The investigators in this study believed that by learning about art, these medical students would learn to better observe and describe physical examination findings - in this case, the ophthalmologic examination.  After six 1.5 hour training sessions at the Museum of Art, the first year medical students performed much better on a proctored ophthalmology physical examination test!  Herein lies proof (maybe) of Epstein and Gladwell's so-called "Temin Effect."


If I had to do it all over again, I would have spent more time during my school years taking a wider range of humanities classes.  Fortunately, I have reached a stage in my academic career where I can now spend more time reading and learning about things that I wished I would have learned a long time ago.  The lessons here for leaders is one that I have made before, but I think it is important and bears repeating.  Be well read.  Learn about things outside your area of expertise.  Be like the Renaissance.  You won't regret it.

"If you wait for people to come to you..."

The famous management guru, W. Edwards Deming, once said, "If you wait for people to come to you, you'll only get small problems.  You must go and find them.  The big problems are where people don't realize they have one in the first place."  Deming was essentially supporting a management technique now commonly known as "Management by Walking Around" (commonly abbreviated to MBWA).  MBWA was first popularized by Tom Peters and Robert Waterman in their 1982 best-selling book, "In Search of Excellence".  A number of leaders throughout history practiced this technique, even if before Peters and Waterman first described the method.  For example, President Abraham Lincoln commonly met his Union generals and troops in camp:

There is a famous photograph of General Dwight D. Eisenhower meeting the airborne troops on the eve of the Allied invasion of Normandy in June, 1944:













There is no question (at least in my opinion) that leaders should spend less time in the executive suite and more time on the front lines, regardless of where those front lines happen to be.  As it turns out, MBWA is not just for the battlefield.

But what does the research have to say on MBWA?  I came across an interesting study while cleaning off my desk this weekend (as it turns out, my wife was right when she told me that I don't even know what papers I actually have in all of my stacks of papers!) by two Harvard Business School researchers named Anita Tucker and Sara Singer.  Their working paper, called "The Effectiveness of Management-By-Walking-Around: A Randomized Field Study" presents the findings of their study conducted in the hospital setting.  The premise of their study was based on recommendations from the Institute for Healthcare Improvement (IHI) and the National Patient Safety Agency to institute executive walk rounds as a general method to improve safety culture, particularly when the walk rounds are focused on patient safety.  These two organizations based their recommendation on a study published in the Joint Commission Journal on Quality and Safety showing that initiation of executive walk rounds at one hospital (Partners Health Care) improved safety culture (measured via surveys of front line providers).  As it turns out, other studies have had mixed results, with one study showing that executive walk rounds actually worsened safety culture.

So what did Anita Tucker and Sara Singer find?  They randomly selected 92 U.S. acute care hospitals to participate in a safety culture survey, and then they randomly selected 24 hospitals from this group for their intervention (the remaining 68 hospitals not selected therefore served as controls).  The MBWA program was implemented in at least one unit of each of the selected hospitals (though some hospitals dropped out through attrition).  Note that the MBWA program focused on patient safety and was fairly robust and labor-intensive.  "Perceptions of improvement in performance" ("PIP")was their primary outcome measure (essentially a before-and-after comparison of safety culture, with some other elements).  Overall, and somewhat surprisingly, the MBWA program was associated with a statistically significant decrease in PIP!  Digging deeper into the results, Tucker and Singer were able to determine that the executives' presence on the inpatient units was not helpful unless it enabled active problem-solving.  Moreover, focusing on easy-to-solve problems, or the so-called "low-hanging fruit" rather than more difficult to solve problems usually produced the greatest increases in PIP. 

How do you explain these results?  I have three thoughts.  First, merely "going through the motions" and simply showing up on an inpatient unit is not likely to be successful.  Yes, it is important for leaders to be visible, but they have to show that they really care about what's happening on the front lines.  Too many leaders "just show up" and expect to be applauded by the front line team members for their "efforts."  Second, at least in this study, leaders are more likely to be favorably received if they identify problems and then solve them.  I do think that leaders can and should identify system-level issues and problems, even if they are likely to be difficult to solve.  Perhaps if leaders can demonstrate that they are actively working to solve even these most-difficult problems, they would be viewed more favorably than what Tucker and Singer were able to show.  Third, and perhaps most importantly, Tucker and Singer's study focused on patient safety.  There are many, many more things that can be addressed with MBWA (for example, employee satisfaction/engagement with leaders expressing their gratitude and thanking front line staff for their hard work) beyond just patient safety.  It would be interesting to see if MBWA had positive benefits beyond just safety culture.

Whatever you call it - executive walk rounds, leadership rounds, or "management by walking around," leaders should be visible at all levels throughout the organization.  Regardless of the results provided by Tucker and Singer, MBWA is probably a low-cost intervention that would be justified by even marginally positive results.  The fact that the MBWA program in Tucker and Singer's study worsened safety culture is concerning, but for now, to paraphrase Deming, "Don't make the people come to you - go to them!"

"Do I have to be better?"

As I have stated on a number of occasions in this blog, I have been enjoying reading about the Stoic philosophers lately.  I subscribe to a daily e-mail from Ryan Holiday ("The Daily Stoic") which I have really enjoyed.  Today's post included a quote from a book by Steven Pressfield's novel, The Tides of War (which I have not read, but I think it is about the Peloponnesian Wars). One of the characters in the book apparently claimed:


How does one lead free men?  By being better than they...By being better and thus commanding their emulation.


When I first read this quote, I had to ask myself - "Do I have to be better?  Do leaders have to be better than those who they lead?  And if so, better at what?"


I actually don't know the answer to my own question.  I think (though, I am not 100% sure) that when it comes to the military, the expectation is that the leaders in command are, in fact, better at being soldiers, sailors, airmen, or Marines than those who they lead.  Ponder this for a moment - there are myriad examples from Hollywood movies, books, and articles that strongly suggest that those in command have to lead by example.  Whether it is the wearing of the uniform, training at the rifle range, or participating in physical training (i.e., exercise), the leader is expected to look more polished, work longer and harder, and finish near the top compared to everyone else.  I can remember my own drill instructors telling us this when I was going through my own military training.


Okay, I get it.  Leaders in our military may actually need to be better than anyone else.  But what about in disciplines or fields outside the military?  What about, say, health care?  Do leaders in health care need to be better than everyone else?  I don't think so.  We, as leaders, absolutely have to set an example.  Leaders set the vision and drive the culture that achieves that vision.  Part of leading by example is working hard and showing the kind of dedication to your job that will help foster the right kind of culture.  But do leaders necessarily need to be better at everything?  In my opinion, absolutely not.  The teams we lead are better because they have members with different, diverse backgrounds and different areas of expertise.  We achieve more because we are diverse.  In other words, there is no way that a leader has to know absolutely everything that each and every member on the team knows.  By extension, there is no way that a leader has to be better at every part of the job that each and every member on the team has to do in order for the team, as a whole, to be successful.


I guess what I am trying to say is that we don't have to be "better" at all of the tasks and sets of skills that are required for the team to be successful.  However, when it comes to things like working hard, being optimistic, and putting your best foot forward, we as leaders absolutely need to be better than everyone else on the team - in other words, leaders have to be better at all the things that comprise leadership!

Personal Everest

I am what you call a "mood reader."  In other words, I typically will read books and articles from a similar genre or topic for a while before switching to something else.  For a while, I was reading anything and everything on the American Civil War (I still have a few books left to read, so I will likely switch back at some point).  Before that, I was engrossed in books on the British Navy in the Age of Sail (the Aubrey/Maturin series by Patrick O'Brian, the Horatio Hornblower series by C.S. Forester, and the Richard Bolitho series by Alexander Kent).  Currently, the topic of interest seems to be disasters and high adventure.  I just finished the book, Alive, which tells about the story of the sixteen survivors of Uruguayan Air Force Flight 571, which crashed in the Andes Mountains in 1974 (the book was made into a 1993 movie starring Ethan Hawke).  I have also been reading a lot of books about Ernest Shackleton and his 1914-1917 expedition to Antarctica.  Finally, I seem to be reading a lot about Mt. Everest (the book, Into Thin Air is just one example).  I have found that this whole genre of stories is a really good place to learn about leadership.  And, climbing Mt. Everest in particular has become a common metaphor for tackling significant challenges and attaining hard to reach, so-called "stretch goals" in your personal and professional life (there are, in fact, a number of articles, blog posts, and self-help books that utilize this particular theme - see just one example here).

So, it was really coincidental that I came across two very interesting articles this weekend.  There was a short article in the Cincinnati Business Courier about a local entrepreneur who was getting ready for an attempt on Mt. Everest.  More interesting was an article that appeared in the New York Times about the mountaineer, Alison Hargreaves.  The New York Times is apparently running a brand new feature called "Overlooked" which tells stories of some very remarkable women.  The articles appear in the Obituaries section of the newspaper, and each one starts with the following opening line:

Since 1851, obituaries in the New York Times have been dominated by white men.  With Overlooked, we're adding the stories of remarkable women.

I encourage you to take a look (here is the link), as there are some really interesting stories about some remarkable women throughout history, including Henrietta Lacks, Emily Warren Roebling, and Ada Lovelace, to name just a few).  The most recent story, as I said earlier, is about the mountaineer Alison Hargreaves, who was the first woman in history to climb Mt. Everest alone (no one was helping her set up fixed ropes or scouting the trail) and without the use of bottled oxygen.  She accomplished this feat on May 13, 1995 and sent the following radio message to her son and daughter, "To Tom an Katie, my dear children, I am on the highest point of the world, and I love you dearly."  In fact, she was only the second person ever to accomplish this feat, the first being an Italian mountaineer named Reinhold Messner in 1980. 

When asked if a female climber needed to be tougher than a man, Hargreaves answered very poignantly, "I think that women in general have to work harder in a man's world to achieve recognition."  In fact, after Hargreaves and her colleagues died trying to climb K2 (the second highest mountain in the world) on August 13, 1995, there was a notable backlash and media frenzy in which she was called selfish for choosing to leave her poor children behind to try to climb a mountain.  Please note that no one - absolutely no one - publicly or privately questioned all of the fathers who died with her.

As I sit here and think, I can only wonder about how many other women have found themselves in a similar situation - even if it wasn't necessarily a life-or-death situation like climbing Mt. Everest or K2.  Do women really need to do even more than men to gain the same level (actually, it's never really the same level, is it?) of recognition and accolades?  Unfortunately, I think so.  Hopefully this is starting to change.

We all have our personal Mt. Everest's.  I think what is most important, however, is that we don't force women to climb Mt. Everest in order to gain the same level of recognition that a man who climbs Mt. Kilamanjaro or Denali receives.

Hell keeps freezing over...

I checked off another item on my bucket list this past Monday night and saw the band, "The Eagles" play live in concert in Indianapolis.  A couple of my kids bought me two tickets to the concert for Christmas this year.  I have been a lifelong fan of the Eagles, and to finally see them together in concert was an absolute thrill.  The band was without founding member, Glenn Frey, who died in January of 2016.  Instead, country music legend, singer/songwriter, and guitar virtuoso, Vince Gill and Frey's son, Deacon joined the band for their tour.  I have always been a huge fan of the Eagles' drummer and lead singer, Don Henley and have seen him play live as a solo artist a couple of times.  However, I have to say that Vince Gill and Joe Walsh stole the show.  Thanks to my beautiful wife for joining me, especially since she really isn't an Eagles fan!

I was trying to think of something to write about today - I certainly could have tried to write something about International Pi Day (3/14), which is today.  Or I could have tried to incorporate something about the "Ides of March" which happens tomorrow (3/15).  I kept coming back to the Eagles.  Believe it or not, the band started out as a back-up band to singer Linda Ronstadt in 1971 (the original line-up included Henley, Frey, Bernie Leadon, and Randy Meisner).  Throughout the 1970's, the band would change line-ups again and again, with only Henley and Frey remaining the constant (Bernie Leadon was replaced by guitarist Don Felder, Joe Walsh would later join the band, and bassist Randy Meisner was eventually replaced by Timothy B. Schmit).  The band would eventually have several number one hits, Grammy music awards, and number one albums before breaking up in 1980.  The break-up wasn't a friendly one - in fact, Frey reportedly told Don Felder during their last concert together, "I'm gonna kick your ass when we get off this stage!"  There are certainly a number of lessons here about working in a group setting (I am sure that ego's played a major role, as each member was a superstar in his own right).  The break-up lasted over 14 years, but they would reunite for another tour and live album called "Hell Freezes Over" (Don Henley told a reporter in 1982 that the band would get back together, "when hell freezes over...").  The band has stayed together, off and on, since that time (minus Don Felder, who would later sue the other members of the band).  They even released another studio album in 2007.

What struck me as something interesting to write about was the fact that three of the members of the band (Schmit, Henley, and Walsh) are all 70 years of age or older.  Why would someone still be touring around the country playing rock-n-roll music at 70 years of age?  I have no direct knowledge of their financial situation, but I am guessing that they are all doing just fine in that arena.  So they aren't doing it for the money.  I kept asking myself this question, over and over, and kept coming back to the most logical answer - they do it because they love it.  Plain and simple, yet incredibly powerful.  They just love playing their music.  You could tell they were getting tired towards the end of the show on Monday night, but they came out to play two encores after a 28-song set (basically playing every single one of their hits).  It had a "this is the last time we are probably going to be able to do this" feel to it, especially since some of the songs that they played hadn't been played live in many, many years. 

We could all be so lucky to be just as passionate about our profession as the Eagles are about theirs.  Things are not always easy - we all have "one of those days" when we question why.  But having a passion keeps us engaged and keeps us looking forward.  I hope each and every one of you has that passion and keeps it going.  Keep playing the music, and hopefully hell will keep freezing over...

"Ipsa scientia potestas est"

I never learned how to speak (or write) Latin.  I wanted to take Latin in high school, but both my school advisor and parents told me that "Latin is a dead language" and that I should take something more useful instead.  I took German - three years in high school and two years in college.  Actual number of times I have ever used German?  Zero.  Actual number of words that I could write, speak, or understand in German?  Pretty close to zero.  So, I suppose I would have fared just as well taking Latin instead.  The phrase "ipsa scientia potestas est" could be in German, and I would still have to trust someone else's translation, but it is actually in Latin.  It's from Francis Bacon's Meditationes Sacrae published in 1597 and is translated to, "Knowledge is power."

Knowledge IS power.  I have finally reached a time in my life where I have been once again afforded the opportunity to learn about all of the things I think (now) that I may have wished I would have learned when I was much younger.  I have opened my eyes to whole new worlds in some cases (art, architecture, and world history, as a few examples), and I have even started to re-learn some of the things that I once knew and had forgotten (algebra, trigonometry, and calculus, as a few other examples).  I have expanded my horizons beyond medicine and science to other fields by reading a much broader range of topics in books that I never would have given a second thought at reading in the past.  I am building up my commonplace book, which now is approaching over 400 entries.  I am learning about new places, different cultures, and different time periods, and I am absolutely loving it!

Why the sudden interest in all of these different topics?  Am I just wasting my time?  What is the point in reading about architecture or learning algebra again, when I spend my professional life in a hospital taking care of children?  I get it, believe me.  Reading about topics like world history or architecture, or spending the time re-learning how to factor a polynomial are not everyone's so-called cup of tea.  But maybe I have learned, through the wisdom of the years, that building a broad knowledge base in a variety of different areas is one of the keys to successful leadership. 

I am sort of talking to a younger version of myself here.  I remember once, probably when I was 18 or 19 years of age, walking with my father around the neighborhood.  I had just finished either my first or second year of college (I can't remember exactly), and he was trying to explain to me why I had to take humanities (or for that matter, German) in college, especially when I was going to enter a science field.  He told me then, and I was either too naïve, too young, or just too plain stubborn to understand, that building a base of knowledge in a broad range of topics was the key to being part of a group, a team, or a community.  "Talking intelligently on a wide range of topics, even when you aren't expert in them, is really important.  You will understand and appreciate that some day," he said (or something kind of like it).  He didn't convince me then, but I wish I would have really listened and understood him.

He was right then, and I hope you can appreciate that I am right now.  Now, more than ever, we all need to be conversant in so many different areas that we can better communicate with each other, find common ground, and learn from each other.  We need to be like Abbe Faria, the character from the book, The Count of Monte Cristo, who teaches Edmond Dantes mathematics, languages, science, and philosophy and said, "...to learn is not to know; there are the learners and the learned.  Memory makes the one, philosophy the other." 

Leadership requires a broad range of skills and knowledge.  The more a leader knows, the better equipped he or she will be to create a vision, build consensus among the diverse members of a group, and unite them for the single purpose of reaching their goals.  Knowledge is a powerful asset that empowers leaders to achieve great results.  Indeed, knowledge is power.

So hopefully Francis Bacon's Latin phrase does actually translate to "Knowledge is power."  Regardless, perhaps it is time for me to finally learn Latin.

Acrophobia

I have a confession to make - it's one of those deep, dark secrets known only to the members of the Wheeler family.  I suffer from a condition known as "acrophobia."  If you don't know what that means (don't be too down on yourself, I had to look it up this morning), it basically means that I have a terribly irrational fear of heights.  I can't remember when my fears first started, and I really can't remember a time when I wasn't afraid of heights.


There was that time when I was probably 5 or 6 years old and one of the older kids in our neighborhood was charging the rest of us kids a quarter to climb up the rope ladder into his tree house.  I remember running to my Dad, who I think was painting our house or something like that, and asking to borrow a quarter.  Of course he gave it to me, probably without asking why I wanted a quarter.  I ran back and apparently did okay climbing the ladder up into the tree house.  The problems didn't start until the older kid thought that I had reached the end of the prescribed time limit for the quarter and it was time to come down.  "Absolutely no way!"  I refused.  I remember the gathering crowd of neighborhood kids pleading with me, trying to convince me to come down.  One of the neighborhood kids went and got her really tall, older big brother (I don't remember how tall he really was, but to a 5 or 6 year-old he seemed like he was at least 7 feet tall).  Still no luck - I just wasn't going to come down.  I was too afraid.  I finally begged one of the other kids to go get my Dad, and he helped me down.


The problems continued later in my life.  There was the time I was helping shingle a patio roof in Appalachia on a youth group mission trip.  Okay, I know what you are thinking.  Why in the world was I up on a roof if I was afraid of heights?  One word - pride.  I was too proud to let anyone else know of my fear.  I ended up falling off the roof during the climb back down the ladder - it wasn't that tall, and the ground was really soft, so I suffered nothing worse than a wounded pride and some ridicule by my fellow missionaries.  I remember another time when my friends and I (well, mostly my friends) decided it would be great fun to jump off the 10 meter high dive platform.  I remember stepping to the edge and looking down - wow that's a long way down.  But again my inner pride decided it would be better to jump than to turn around and walk back down the steps to the pool deck.


I remember repelling down the side of a repel tower when I was in the Navy.  It was one of those things that I had to do - I hated it, but I did it.  When our training instructor asked if we wanted to do what is called a "free repel" (basically, just the rope and no wall - think of using a rope to get out of a helicopter), most everyone else in our group said "yes" but I said "no thanks."  My wife is far more adventurous than me, but she knows about and tolerates my acrophobia.  I remember going ziplining on one of our wedding anniversaries a few years ago.  She loved it.  I tolerated it.


I guess what I am trying to say is this - over the years, I have learned to overcome my fear of heights.  I have put myself into these situations, either because it was the right thing to do or because I really didn't have a choice.  And in spite of my fears (I have to admit, in most of these cases, I was absolutely terrified!), I did just fine.  I survived.  There was always soft ground to land on (in the case of my roof experience in Appalachia), water to break my fall (in the case of the dive tower experience), a rope to hang on to (in the case of the repelling experience in the Navy), or a hand to hold on to (in the case of the ziplining experience with my wife). 


Fear - and in particular, what you have to do to overcome fear - is something that I have been thinking a lot about lately.  Some times, being a leader means that you have to overcome your fears.  Standing up for what you believe in, even when it is incredibly unpopular or risky, is one of the most difficult challenges that a leader will face, but face it he or she must.   I am particularly thinking about all the companies that have recently come out against the National Rifle Association.  Whatever your political stance on the gun issue, I think you can appreciate that the NRA is one of the most powerful lobbying groups in the United States today, and many a political leader and organization have found that out the hard way.  I am particularly thinking about Delta Airlines, one of those organizations who came out and stated publicly that they would no longer be affiliated with the NRA following the mass shooting in Florida (and in particular, the NRA's response and public comments to that shooting).  What did Delta Airlines get in return?  The pro-gun and pro-NRA Georgia state legislature basically took away one of Delta's tax breaks.  Delta remained firm in its conviction to do what they thought was right, even at the risk of going up against an incredibly powerful and politically very well connected organization.  They suffered retaliation as a direct result, but they remained firm.  Delta overcame the fear.   


Leadership is kind of like that.  As leaders, we can still be terrified, but we have to do what is right.  And most importantly, there is always soft ground or water to help break our fall, or a rope or hand to hold on to.

"Patients come second..."

Paul Spiegelman and Britt Berrett wrote an interesting book called,"Patients Come Second: Leading Change by Changing the Way You Lead".  The premise of the book is fairly simple to understand - in this era of health care consumerism, when patient/family experience scores are being published on the Internet and will eventually be tied to payment, those of us in health care need to recognize a simple truth that is fundamental to service organizations.  You can't take of your customers if you don't take care of your employees. 

Let me be clear at the outset.  As a physician - indeed, as a physician who continues to practice - I completely recognize the personal bond between a patient and his or her physician as unique and distinct from that between a customer and a business owner.  However, like it or not, we also need to start to understanding the perspective of our patients and families as customers who have choices about where to go to seek care, because they do have a choice.  First and foremost, we should be treating our patients and families exactly how we would want to be treated.  But, the patient and family experience goes beyond that.  We need to recognize that patients and families deserve to be treated with respect, kindness, and compassion by every individual that they interact with during their health care experience - the physician, the nurse, the phlebotomist, the X-ray technician, the therapist, the front desk receptionist, the appointment clerk, etc., etc., etc.  Our hospitals and clinics should be clean, but they also should be warm and welcoming.  Rather than the bland, overly sterile environments of the past, hospitals and clinics should be happy, bright, and comforting (for a more in-depth explanation and potential suggestions on how to do this, check out "If Disney Ran Your Hospital" by Fred Lee). 

Back to Spiegelman and Berrett - happy, optimistic, energetic, and enthusiastic employees will lead to happy, optimistic, energetic, and enthusiastic customers!  So, if we really want to drive improvement in the patient and family experience, we have to start with the people who provide the care in our hospitals and clinics!  Improving the health care employee experience will significantly improve the patient and family experience (which will, if you believe all of the data out there - and I do - increase hospital revenue and decrease hospital costs!). 

Which brings me to another point.  Hospitals and health care systems must recognize that one of the best ways to become the "Best place to go for care" is to become the "Best place to work."  I recently read in a magazine that a major health care organization was considering cutting back on some of its employee benefits.  A representative from the hospital was trying to explain that the hospital was already "Best in Class" with respect to its benefits package, and by scaling back on some of the benefits, they could cut costs significantly and still remain near the top in their benefits package.  Those are definitely hard decisions to make.  However, I would argue the opposite point.  Cutting employee benefits is one of the quickest ways to lower employee satisfaction.

I am reminded of one of the stories that I read about in the two books by Howard Schultz, former CEO at Starbucks.  Schultz very early on decided to provide health care benefits to every employee at Starbucks - even the hourly employees!  Even when Starbucks was going through some of its most difficult times and even when the Board of Directors tried to convince him otherwise, Schultz remained firm that he would not cut this benefit.  He wrote, "Our first priority was to take care of our people, because they were the ones responsible for communicating our passion to our customers.  If we did that well, we'd accomplish our second priority, taking care of our customers."  He went on further, "I used to think that marketing was the most important department at Starbucks.  Today, I'd say, unequivocally, it's human resources.  Our success depends entirely on the people we hire, retain, and promote.  However outstanding our performance in marketing, design, real estate, manufacturing, store operations, new products, or R&D, it is ultimately interpreted and given life and meaning by the people of the company.  How well each function is carried out depends entirely on how they feel about one another and how much they care about Starbucks.”   In other words, at Starbucks, "Customers come second."