The secrets to effective leadership

I came across an online article the other day that referred to a classic book by someone named Napoleon Hill.  Apparently Mr. Hill was a famous American self-help author who wrote his book, Think and Grow Rich in the late 1930's.  Before Hill died in 1970, the book had sold over 20 million copies, and as of 2015, the book has sold over 100 million copies worldwide.  The online article referenced Hill's list of the 11 major attributes of leadership.  The list (see below) seemed pretty good, so I ordered Hill's book from the library. 

Hill's book (which I ended up NOT reading) is a self-help book that talks about the secret to being successful in life.  And here, success is defined by how much money you make in your lifetime.  I have to be honest, I don't really agree that success should be defined by how much money someone makes.  Supposedly, Hill studied the traits and habits of 500 self-made millionaires, including Andrew Carnegie, John Rockefeller, Thomas Edison, and Henry Ford, as well as Presidents Theodore Roosevelt, William Howard Taft, and Woodrow Wilson.  Here's what I found interesting though - apparently, whether or not Hill actually met these individuals, or studied them in any systematic way, has been called into question.  As a matter of fact, Hill was once called "the most famous conman you've probably never heard of."  He was apparently married three times, and was accused of fraud and kidnapping.  So, I guess you could say that his definition of success doesn't fit with mine or many others.

Regardless, I did find that his "secrets to leadership" made a lot of sense.  Here they are:

1. Willingness to assume full responsibility
2. Definiteness of decision
3. Definiteness of plans
4. Unwavering courage
5. A keen sense of justice
6. Cooperation
7. Self-control
8. The habit of doing more than paid for
9. A pleasing personality
10. Sympathy and understanding
11. Mastery of detail

Pretty good, right?  He followed this list with "10 major causes of leadership failure" which I think are relevant too.  Here is the list of Hill's leadership failures:

1. Inability to organize details
2. Unwillingness to render humble service
3. Expectation of pay for what they know, instead of what they do with that which they know
4. Fear of competition from others
5. Lack of imagination
6. Selfishness
7. Intemperance
8. Disloyalty
9. Overemphasis on the authority of leadership
10. Overemphasis on title

Again, there's a lot in both lists that are useful.  As for the rest of his book, as well as his recommendations on "how to get rich" - I will take a pass.

" A message to Garcia"

There is a famous story about an event that supposedly took place during the Spanish-American War.  As you undoubtedly remember from your U.S. History class during high school(I am, of course, joking) the Spanish-American War was a short 10 week-long war that was fought mainly in the Caribbean and Pacific between the United States and Spain in 1898.  Cuba, at the time, was fighting a war for independence from Spain.  President William McKinley sent the USS Maine to Havana to protect American citizens and interests in Cuba at the time.  There was an explosion on board the Maine on the evening of February 15, 1898, which resulted in the death of most of the crew (250 deaths out of a total of 355 sailors and officers).  Even though the cause of the explosion was not known, the incident was blamed on the Spanish ("Remember the Maine!") and President McKinley asked for a formal declaration of war.  The 1898 Treaty of Paris gave full temporary control of Cuba, as well as the Spanish territories of Puerto Rico, Guam, and the Philippine Islands to the United States.


Shortly after the USS Maine incident, the United States military sent spies to Cuba and Puerto Rico to gather military information.  1st Lt Andrew Rowan, a graduate of the United States Military Academy at West Point, was sent on a top-secret and voluntary mission to join up with General Calixto Garcia, commander of the rebel forces in eastern Cuba.  Rowan was supposed to remain in Cuba to ascertain "the strength, efficiency, movements, and general military situation."  The mission was considered highly dangerous ("suicide mission"), but was largely unsuccessful.  Rowan found Garcia after riding for several days through the Sierra Maestra Mountains.  Garcia promptly sent him back within a few hours of his arrival.


The details of Rowan's "top secret mission" were revealed (by Rowan himself) to an Associated Press correspondent named Elbert Hubbard.  Hubbard wrote a largely fictionalized account of Rowan's mission entitled "A Message to Garcia" that was highly popular and published broadly.  The essay's version of events suggested that President McKinley himself sent Rowan on the mission:


When war broke out between Spain and the United States, it was very necessary to communicate quickly with the leader of the Insurgents.  Garcia was somewhere in the mountain fastness of Cuba - no one knew where.  No mail or telegraph could reach him.  The President must secure his co-operation and quickly. 

What to do! 

Someone said to the President, "There's a fellow by the name of Rowan will find Garcia for you, if anybody can."

The essay goes on to tell how Rowan was handed a letter to personally deliver to Garcia and did his duty with no further questions asked:


The point I wish to make is this: McKinley gave Rowan a letter to be delivered to Garcia; Rowan took the letter and did not ask, "Where is he at?" 

Hubbard's point was that Rowan could have asked for additional details, such as "Where is Garcia supposed to be?" or "How am I supposed to find him?"  Instead, Rowan just did it.  He delivered the letter, no questions asked and no detailed instructions requested.  Hubbard explained further in his essay:


You, reader, put this matter to a test: You are sitting now in your office - six clerks are within your call.  Summon any one and make this request: "Please look in the encyclopedia and make a brief memorandum for me concerning the life of Corregio."  Will the clerk quietly say, "Yes, sir," and go do the task? [just like Rowan did, I might add].


On your life, he will not.  He will look at you out of a fishy eye, and ask one or more of the following questions:

Who was he?
Which encyclopedia?
Where is the encyclopedia?
Was I hired for that?
Don't you mean Bsmarck?
What's the matter with Charlie doing it?
What do you want to know for?

Do you get the point?  Hubbard goes on further to conclude:


By the Eternal! There is a man whose form should be cast in deathless bronze and the statue placed in every college of the land.  It is not book-learning young men need, nor instruction about this and that, but a stiffening of the vertebrae which will cause them to be loyal to a trust, to act promptly, concentrate their energies: do the thing - "Carry the message to Garcia!"

It all sounds great to me.  But here's the unfortunate part of the story.  It didn't happen this way at all.  President McKinley never personally requested that someone, let alone Rowan, personally deliver a note to Garcia.  He probably never even knew about the mission.  As a matter of fact, Rowan likely would have been court-martialed for disobeying his orders (remember that he left soon after his arrival) AND leaked his story to the Associated Press.  However, the essay and, as a result, Rowan were extremely popular at the time, and the authorities in the War Department felt that Rowan was too popular to be criticized, let alone be court-martialed.


Hubbard claimed that his essay had been reprinted over forty million times by the early 1900's - he was probably exaggerating a bit.  Regardless, the phrase "to carry a message to Garcia" was in common use for many years to refer to someone taking initiative when performing a difficult assignment.  For example, the 1917 Boy Scouts of America Yearbook has a passage stating that, "If you give a Boy Scout a 'message to Garcia' you know that the message will be delivered, although the mountains, the wilderness, the desert, the torrents, the broad lagoons or the sea itself, separate him from 'Garcia'."  Reportedly, the phrase can be heard in a conversation between President Richard Nixon and Henry Kissinger in the famous "White House Tapes."  The U.S. Army apparently still uses Hubbard's essay in some of their training materials for infantry officers. 


It's a good metaphor and lesson, even if not completely true.  The next time someone asks you to "Deliver a message to Garcia" - just do it.

Culture...again!

We hear it over and over and over again (and that probably should tell you something) - safety culture is one of the most importance issues to address in order for health care organizations to provide safe care.  If you've worked in health care for any length of time, chances are that you have heard about two reports that were published by the Institute of Medicine in 1999 and 2001, respectively - To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century.  Both reports identified safety culture (defined by the Joint Commission as "the individual and group attitudes, beliefs, perceptions, and values that determine the organization's commitment to quality and patient safety") as an area for significant improvement in health care.  However, despite the incredible focus on culture to improve patient safety, a follow-up report in 2006 by the National Quality Forum identified 30 key practices for improving the quality of health care - safety culture was #1 on the list!  Notably, these recommendations have not changed over the years.  Creating and sustaining a safety culture should remain the top priority for improving the quality and safety of health care services delivered in the United States today.

Two of my favorite studies in this area compared safety climate/safety culture in hospitals to that in naval aviation.  As you may recall, naval aviation (specifically, aircraft carrier flight operations) was one of the original prototypes for the study of High Reliability Organizations (HRO's).  Given that many hospitals now aspire to become HRO's, it seems intuitive to compare and contrast the prevailing attitudes and level of commitment to safety in hospitals versus naval aviation.  The first study compared different hospital personnel with U.S. Navy pilots.  For the purposes of this study, "problematic responses" to a safety climate/safety culture survey were defined as those that suggested an absence of a commitment to safety.  The number of problematic responses was 12 times higher in health care workers in comparable high-hazard environments (the Emergency Department and Operating Rooms) compared to Navy pilots. 

The second study was performed over 5 years later and found that safety climate was three times higher, on average, among U.S. Navy aviators compared to hospital workers (this was a really large study that involved nearly 15,000 naval aviators and 15,000 hospital workers).  More interesting was the fact that responses of U.S. Navy commanders (the individuals "in charge") were congruent with the rest of the aviators that were surveyed.  In other words, both the leaders/managers and frontline workers felt that there was a true commitment to safety in their organization.  In contrast, hospital managers often felt that there was a commitment to safety when frontline workers did not! What does it say when hospital leaders feel that their organization is committed to safety and the frontline workers feel quite differently?

So, with this in mind, what can we, as hospital leaders, do to create and sustain a climate of safety?  It absolutely starts with something that Harvard Business School researcher,  Amy Edmondson has called "psychological safety".  Leaders create the kind of environment where workers are free to speak up about their concerns without fear of retribution or ridicule.  "Psychological safety" means that individuals can openly admit their mistakes and learn from them. 

Want an example of psychological safety?  Look no further than a study recently published by investigators from the Northern Arizona University.  These investigators looked at the climate of safety at several NCAA Division I football programs during the 2017 college football season.  Football players were significantly more likely to self-report the signs and symptoms of a potential concussion if   they felt that safety was important to their coaching staff.

Imagine what that would look like in the hospital environment and ask yourself this one question.  How frequently do providers at your institution self-report needlestick injuries? How frequently do they report potential safety concerns about a patient?  If you don't hear these kinds of reports at your organization, chances are that you have some work to do around safety culture.

Two sides of the leadership coin

Travis Bradberry wrote an article for Forbes magazine in 2015 entitled, "Are you a leader or a follower?"  It's generally a very good article, but the title suggests that there is an important distinction between leaders and followers.  For example, Bradberry makes some really good points.  First, Bradberry suggests (and I would agree) that leadership has nothing to do with your title.  Similarly, leadership has nothing to do with authority or seniority. 


Bradberry states clearly, "You're not a leader just because you have people reporting to you.  And you don't suddenly become a leader once you reach a certain pay grade." 


Similarly, as John Quincy Adams said, "If your actions inspire others to dream more, learn more, do more and become more, you are a leader."


Second, Bradberry argues that "Anyone can become a follower, even while holding a leadership position."  Unfortunately, his definition of "follower" is someone who is "a slave to the status quo" or someone who "lacks vision" or who doesn't motivate those around them to be their absolute best. 


He goes on, "Leadership and followership are mindsets.  They're completely different ways of looking at the world.  One is reactive, and the other is proactive.  One is pessimistic; the other is optimistic.  Where one sees a to-do list, the other sees possibilities."


Ouch.  Bradberry clearly thinks that being a follower is a bad thing.  Or at least he thinks that being a follower is not a desirable thing.  Unfortunately, I think Bradberry misses an important point.  There is nothing wrong with being a follower.  In fact, one could certainly argue that without followers, there would be no leaders.  As the leadership expert, Barbara Kellerman stated, "Followers are more important to leaders than leaders are to followers."  Almost by definition, you cannot be a leader unless you have followers.


Individuals often self-identify as leaders versus followers.  More importantly, there are a number of studies that suggest that individuals who self-identify as leaders are more likely to exhibit prototypical leadership behaviors (self-confidence, self-esteem, group dominance, etc.).  The converse (do individuals who identify as followers exhibit good leadership) is not necessarily true, or at least this particular question has not been studied.  The more relevant question therefore becomes, can good followers be good leaders?  There are at least a few studies that suggest that being a good follower will increase an individual's capacity to influence a group.  In other words, good followers can be good leaders too.  There is at least one recent study from the University of Queensland in Australia that suggest this to be the case.


Kim Peters and Alex Haslam conducted a study involving slightly over 200 Australian Royal Marine recruits going through their 32-week training program.  They tracked whether individual recruits self-identified as leaders versus followers on five separate occasions during their training.  In addition, the recruits' leadership and followership was independently assessed and rated by both their commanding officers, as well as their peers.  The results were somewhat surprising.  Recruits who saw themselves as natural leaders were typically seen by their peers as leaders.  Instead, it was the recruits who self-identified as followers that were rated by their peers as good leaders and ultimately emerged as leaders during the program. 


Of interest, the recruits who self-identified as leaders were also rated by their commanding officers as having more leadership potential than recruits who self-identified as followers.  Peters and Haslam concluded that what constitutes good leadership is highly dependent on where the evaluators are standing at the time.  Those who are part of the group and able to personally experience the capacity of their fellow peers to influence the rest of the group are more likely to recognize even followers as being good leaders.   


The way I see it, in order to be a good leader, you must learn to be a good follower.  Individuals are more effective leaders when they are seen as part of the group - one of us - as opposed to one of them.  Individuals are seen as leaders when they are doing it for us as opposed to doing it for themselves.


I will close this post with one last quote.  Mike Bonem and Roger Patterson, in their book, "Leading from the Second Chair" once said, "If you believe lack of authority prevents you from leading effectively, it is time to rethink your understanding of leadership."  Start by being a good follower.  True influence - the sine qua non of leadership - will come after that.

"A society grows great when old men plant trees whose shade they know they shall never sit in..."

I came across an old Greek proverb the other day that I really, really liked.  It goes like this, "A society grows great when old men plant trees whose shade they know they shall never sit in."  Pretty amazing, right?  Why would an old man or an old woman want to plant a tree, if for no other reason than to leave the world a better place.  One of the great things about people these days is the fact that we all want to help others (at least most of us).  Certainly, we would all like to leave our children and grandchildren a better world to live in, long after we die.  But our altruism can and frequently does go deeper than our own self-interest (which, I would argue includes our children and other family members).


We do have limits, of course.  For example, there was one recent study that showed that individuals are willing to forgo a monetary reward in order to spare someone else from undergoing a painful electric shock.  Participants were even willing to undergo a painful electric shock themselves in order to spare someone else from having to do so.  Perhaps not surprisingly, participants were less willing to undergo a painful electric shock in order to secure a monetary reward for someone else.


We also want to feel confident that when we do give our time and money for someone or something else, that is actually going to do good.  I've previously posted about something called "Effective Altruism" (see "The Innkeeper's Tale"), which is a movement that seeks to answer one simple question: how can we use our resources to help others the most?  In other words, we want to do the "most good for the most people."


"Effective altruism" is important to organizations and governments as well.  There are several studies, articles, and books that have called into question the billions of dollars in government aid money that have gone to developing nations with the goal of reducing poverty and increasing economic growth.  While their motives were altruistic (in most cases), the impact of this money has been limited.  More concerning, in most of these countries, poverty has actually increased despite the billions of dollars that have been invested (see, for example, "Dead Aid" by Dambisa Moyo, "The Elusive Quest for Growth" by William Easterly, "The White Man's Burden" by William Easterly, and "The Bottom Billion" by Paul Collier).


It is with all of these thoughts in mind that I want to talk about another book on my "Recommended Books to Read List" for 2019.  Two economists from the Massachusetts Institute of Technology, Abhijit V. Banerjee and Esther Duflo were awarded the 2019 Nobel Prize in Economics just this past week.  Banerjee and Duflo (and their co-winner, Michael Kremer from Harvard University) pioneered a unique approach to addressing global poverty using an evidence-based approach.  They broke the issue of global poverty into smaller, more easily manageable questions and used field experiments to test different solutions to the problems that these questions identified.  For example, when trying to tackle childhood education, one of the most effective interventions that these investigators found was to treat school-aged children for worms!  For only US$ 0.60 per child per year, school-based deworming reduced serious worm infections by 61 percent, which subsequently reduced school absenteeism by 25 percent!  But here's the interesting part.  They also found that time and money invested during the school-age years resulted in significant improvements in the labor supply more than 10 years after their original study!  Men who participated in the original study were able to spend more time at work (i.e. less work absenteeism) and were more likely to hold higher paying manufacturing jobs, while women who participated in the study were more likely to have attended secondary school.  Banerjee and Duflo talk about this study and more in their excellent book, "Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty", which was the Financial Times/Goldman Sachs Business Book of the Year when it was released in 2011.  Their book details many of the problems and issues with the old (though still used unfortunately) approach to developmental economics, as well as their recommendations and solutions to the problem of global poverty. 

"Be good to yourself"

The 1980's American rock band, Journey released their hit song, "Be Good to Yourself" in 1986, which ended up being their last Top 10 hit on the U.S. Billboard Hot 100.  The song was a bit of self-affirmation for the group's lead singer, Steve Perry - the chorus said it all:

"Be good to yourself, when nobody else will."

There was another self-affirmation that became famous this past week.  Three year-old Ayaan's mother taught him to recite the following self-affirmation every morning when he was just two years old:

"I am smart.  I am blessed.  I can do anything."

This past week, his mother observed him saying those same words to himself while he was walking to school.  She recorded Ayaan on her cell phone, and the video went viral.

It turns out that 80's rock musicians and three year-old toddlers can teach us something that we should apply in our own lives.  Self-affirmation is formally defined (thank you Merriam-Webster) as the act of affirming (stating positively, validating, and confirming) one's own worthiness and value as an individual for beneficial effect.  There are countless studies in the field of psychology (see "self-affirmation theory") that strongly support what both Steve Perry, three year-old Ayaan, and countless others have - yes, even Saturday Night Live's Stuart Smalley - have learned firsthand.  Using self-affirmations on a daily basis increase our sense of self-confidence, self-worth, and self-esteem.  Self-affirmations reduce the adverse effects of stress and improve our health.  Daily self-affirmations can help us be more successful in school and at work.

According to research performed by Dr. David Creswell at Carnegie Mellon University, daily self-affirmations can improve problem-solving under stressful conditions.  According to Creswell, "An emerging set of published studies suggest that a brief self-affirmation activity at the beginning of a school term can boost academic grade-point averages in underperforming kids at the end of the semester."

There was another interesting study involving a technique called "self-monitoring" (a form of self-affirmation) in a group of "unskilled league bowlers" (on a side note, if you've never been bowling, it's a game that certainly requires a level of skill to be able to compete on a regular basis).  Basically, a group of 133 women who bowled in a weekly league competition were assigned to one of four groups - Positive Self-monitoring, Negative Self-monitoring, Instruction, and Control.  All of the subjects, except those in the Control group, received a free 20-30 minute bowling lesson from a professional bowler at the start of the study.  The bowlers in the Positive Self-monitoring group rated themselves after each frame (a complete game in bowling consists of 10 "frames" where the bowler has two chances to knock down all of the bowling pins) on what they were taught using the following scale: 1 = good, 2 = very good, and 3 = excellent.  Importantly, these bowlers were instructed to rate themselves only when they felt that they had performed the skills well.  Conversely, the bowlers in the Negative Self-monitoring group were asked to focus on the errors that they made and rated themselves with a different scale: 1 = terrible, 2 = very poor, and 3 = poor.  Those bowlers in the Instruction group received the bowling lesson but did not rate themselves, while those in the Control group didn't get the lesson and were told just to submit their scores after each game. 

So, what happened at the end of the study?  The bowlers in the Positive Self-monitoring group significantly improved their scores from baseline AND outperformed all of the others groups.  On average, those bowlers (recall that they were unskilled bowlers) in the Positive Self-monitoring group increased their bowling average by 11 pins per game over and beyond the slight improvements noted in the Negative Self-monitoring and Instruction only groups (the bowlers in the Control group did not improve at all).  On a side note, some of the bowlers in this study were "skilled" - these groups did not significantly improve, regardless of their group assignment.  In other words, as the investigators in this study concluded, "these findings indicate that positive self-monitoring affects behavior most favorably under those circumstances in which people are learning something new, difficult, or perceived as difficult" (and perhaps not when they are trying to refine an already well-developed skill).

Let's summarize what we've discussed so far.  Self-affirmation improves our self-esteem, our mood, our health, our ability to learn a new skill, and our chances of success.  How best can we use self-affirmation, then, in our daily lives?  As it turns out, there's some great research here too.  The language that we use to refer to ourselves appears to be really crucial.  For example, using non-first-pronouns (here's a link for a quick refresher, but basically first pronouns include "I", "me", and "we") and our own name in our self-affirmation is better.  For example, if I want to do well in my next 5K run, I should talk to myself beforehand and say something like this:

"Okay, Derek.  You've trained hard for this.  Now it's time to show what Derek can do."

In other words, we should be taking a "fly on the wall" perspective and observe our own selves from a distance (this is known as self-distance, which refers to "instances in which people focus specifically on the self from a distanced perspective").  The evidence is fairly compelling.  Talking to ourselves in the second- and third-person actually improves our chances for success!  Based on what this last set of studies have shown then, Ayaan's mother should have taught him to re-phrase his daily self-affirmation in the following manner: "Ayaan is smart.  Ayaan is blessed.  Ayaan can do anything!"

If you are not using self-affirmations, you should try them out.  Remember, "Be good to yourself."  More importantly, remember to tell yourself that you are good.  Thanks, as always, for listening!




 

"I learned everything that I needed to know in kindergarten..."

There is a poem by Robert Fulghum called "All I Really Need to Know I Learned in Kindergarten" that we would do well to remember in days like these.  We all learned things like:


Share everything.
Play fair.
Don't hit people.
Put things back where you found them.
Clean up your own mess.
Don't take things that aren't yours.
Say you're sorry when you hurt somebody.


As Fulghum stated so simply, yet so elegantly, "Everything you need to know is in there somewhere."


Think what a better world it would be if
all - the whole world - had cookies and milk about
three o'clock every afternoon and then lay down with
our blankies for a nap.  Or if all governments
had a basic policy to always put things back where
they found them and to clean up their own mess.


It's pretty amazing when you think about it.  Some of the basic principles of getting along with one another could be taught to all of us adults by a 5 year-old kindergartener.  And I am not just talking about our government leaders (though, I would argue that our government leaders would do very well to learn those lessons too).  We could take some of these lessons to heart in our own organizations.


I am reading a book by the author Leah Weiss right now called, "How We Work: Live Your Purpose, Reclaim Your Sanity, and Embrace the Daily Grind".  Dr. Weiss mentions a fairly recent study conducted by Jane Dutton, Gelaye Debebe, and Amy Wrzesniewski entitled ""Being Valued and Devalued At Work: A Social Valuing Perspective" that we would all do well to read and carefully consider.  As a matter of fact, it probably should be required reading for all of us in the health care industry.  It's really that powerful.


These investigators wanted to answer a simple question - "How do people doing hospital cleaning work feel about doing this kind of work, and how do other people at work affect the experience of this job?"  They conducted a series of focus groups and personal interviews with close to 30 members of one hospital's environmental services department.  What they found may surprise you, and it certainly should catch your attention.


First, and perhaps most importantly, every single hospital cleaner that they interviewed felt like their job was important to the overall mission of the hospital (I can't help but think of the story I referred to in "Back to that vision thing...NASA, Cathedrals, and an Automobile Executive" involving President John F. Kennedy and a janitor at NASA).  There is no question that environmental services are critical to daily operations in a hospital.  As the investigators in this study emphasize, "A hospital's effectiveness depends on the work of the cleaning staff.  The delivery of quality care to patients in a hospital rests on the effective care for the physical infrastructure of the hospital.  Those who clean hospitals ensure a safe and sanitary environment for the execution of routine and complicated medical procedures."


Consider for a moment the impact on environmental services on infection prevention and control.  Just think of how crucial environmental services is when either operating rooms or inpatient rooms need to turn over quickly between patients.  Finally, think of how important environmental services workers are to the overall patient experience.  Again, these investigators point out, "In a time of extreme distress for patients and their visitors, the cleaner is often seen as someone who is willing to listen, spend time, and be sympathetic."


So, you would think that members of the environmental services department are considered part of the health care team, right?  Think again.  Dutton, Debeb, and Wrzesniewski heard close to 200 different stories during their interviews with hospital cleaners that described the various interactions with physicians, nurses, patients, and visitors.  Unfortunately, some of the most commonly experienced interactions were negative in nature, causing the workers to feel devalued, unimportant, and not part of the team.


Negative interactions were broadly classified into several different categories.  For example, lack of acknowledgement was the most common negative interaction experienced.  Cleaners shared stories of groups of physicians (in most, but not all cases) walking by them without acknowledging them in any manner:


"The doctors have a tendency to look at us like we're not even there, like, you know, we'll be working in the hallway, and you know, no recognition what you are doing whatsoever."


"In the S unit, I've been working there almost a year now and they used to not speak to me.  They would see every weekend and not say hello, just hello.  Or they order out for lunch a lot and they never ask me to order out to lunch."


"And the doctors stand in the way.  And what I mean by 'doctors that stand in the way.'  I mean literally, stand in the way.  Like you're going down the hallway to sweep it.  Doctors will stand in the way.  You have to ask them to move, every day, the same doctors every day."


Hospital cleaners struggled with one particular issue fairly frequently.  "Cleaners fight against an occupational stereotype that suggests that they steal, lie, and generally cannot be trusted."  Hospital cleaners struggled a lot, for example, when cleaning patient rooms.  In order to clean a patient's room, they would invariably have to move personal articles out of the way.  They felt quite reluctant to move personal articles out of the way for fear of being accused of trying to steal them. 


Finally, physicians and nurses often made the cleaners' jobs more difficult by not picking up their own messes. 


"I don't think the doctors and nurses value our jobs more or like they should.  They take advantage of, you know, our jobs as being housekeepers and picking up after them...they are too lazy to pick up after themselves or they leave trash all over the place."


There's a lot to unpack in this study.  Fortunately, not all of the interactions were negative in nature.  There were, in fact, some very positive interactions as well.  So, other than remembering the Golden Rule and all the lessons that we learned in kindergarten, how can we make non-clinicians feel like that they are an important part of our health care team?


1. Recognize the cleaner's presence.  Say "hello" or "good morning" for sure, but try to get to know the environmental services staff.  Always be friendly, courteous, and respectful.  But try to make a deeper connection than just "hello."  Get to know them!


2. Make the cleaners' jobs easier by cleaning up after yourself!


3. If you are ordering lunch as a team, invite the environmental services staff to participate!


4. Get out of the cleaners' way when they are sweeping or mopping the floor!


It's all very simple.  As Robert Fulghum says, "Everything you need to know is in there somewhere.  The Golden Rule and love and basic sanitation...And it is still true, no matter how old you are - when you go out into the world, it is best to hold hands and stick together."

"Our humanity is worth a little discomfort, it's actually worth a lot of discomfort."

Ijeoma Oluo, the author of the new book, "So you want to talk about race" recently said, "Our humanity is worth a little discomfort, it's actually worth a lot of discomfort."  She was talking specifically about the issue of racial justice and the current state of our society.  Oluo means that you are either fighting racism or you are complicit.  It's not easy to talk about issues such as racial equality, but if we are to move forward as a society, we absolutely have to do so.  And it will be uncomfortable.


My wife and I recently had the opportunity to hear Bryan Stevenson speak at an event sponsored by the Public Library of Cincinnati and Hamilton County.  Stevenson is the founder and Executive Director of the Equal Justice Initiative, a human rights organization based in Montgomery, Alabama, and the author of the critically acclaimed book "Just Mercy" (the book was recently made into a movie, starring Michael B. Jordan, Jamie Foxx, and Brie Larson, which opens on Christmas Day, December 25, 2019).  I have to be honest, the book has been sitting on my night stand for the past couple of weeks.  My wife recently read it in her book club, and the book is actually our youngest daughter's (it was her freshman college class book).  After hearing Mr. Stevenson speak, the book has moved to the top of my list of "books to read" and is now being carried back and forth to work (recall, "Today's word is...Tsundoku").  I started reading it yesterday.


Since graduating from the Harvard School of Law, Mr. Stevenson has spent his career (really, his life) helping the poor, the incarcerated, and the condemned.  His legal team has won reversals of cases or releases of prison for over 135 wrongly condemned prisoners on death row, as well as countless others who were wrongly convicted or unfairly sentenced.  During his speech, he told the story of a young child (12 years of age) who was tried as an adult and sent to jail for murder (he also tells the same story in his book, as well as the HBO documentary based on his life, "True Justice: Bryan Stevenson's Fight for Equality").  The psychological and physical trauma inflicted on this child during his first night in jail was more than just "cruel and unusual punishment."  It was immoral and wrong, even if he did commit an unspeakable crime.


I would encourage you to watch Mr. Stevenson's documentary, or at least his TED Talk "We need to talk about an injustice".  He is an amazingly gifted speaker.  He is awe-inspiring.  And he speaks truth.  Rather than talking about these issues in depth ("I could talk all night on the problems we are facing as a society"), Mr. Stevenson chose to talk about solutions.  His solution, in essence, boiled down to four key points:


1. Proximity: We need to get closer to the people in our community who have been marginalized and excluded.  Proximity will allow us to share in their experiences and learn from them.  Knowledge is powerful.  It's like the old adage says, "Before you judge someone, walk a mile in his or her shoes."  We can learn so much from just experiencing the typical day in someone else's life.  By doing so, we often gain a greater appreciation and a deeper understanding about why they do the things they do, why they make the decisions they make, and how they live the lives that they live.  Proximity matters.  Personal closeness matters.


2. Change the narrative: We hear so much today about the false narrative, regardless of whether the issues deal with race, poverty, immigration, etc.  We can only change the narrative if we acknowledge our past injustices and learn from them.  Mr. Stevenson shared one anecdote that I found particularly powerful, dealing with the issue of statues of Confederate leaders from the Civil War.  He stated that the two largest high schools in Montgomery, Alabama were named after Jefferson Davis and Robert E. Lee.  Every year, on January 19th, while the rest of our country celebrates Martin Luther King, Jr Day, Robert E. Lee Day is celebrated throughout the South (in Florida it is actually a legal holiday).  There are statues of Confederate war "heroes" or streets named after Confederate Generals and politicians all around the South even still today.  In contrast, other countries have acknowledged their past.  Stevenson states, "You can't walk 100 yards in Germany without seeing a reminder of the Holocaust.  But you will never, ever find a statue of Adolph Hitler there."  In order to move forward as a nation, we have got to change the narrative.


3. Stay hopeful: Mr. Stevenson tells how he has found hope even in some of the darkest days of his career.  He tells about one particular instance, when he went to go see a client in jail and was subjected to overt racism (he was forced to prove that he really was a lawyer to one particular security officer and had to undergo a strip search to even enter the jail - in this case, the security officer had bragged about the fact that he was a White Supremacist).  His client was mentally disabled and had been through a long series of foster homes.  During the trial, Mr. Stevenson noticed the same racist security officer in the courtroom.  However, the next time he went to see his client in jail, the same security officer let him in - he even pulled Mr. Stevenson aside to apologize for his previous behavior.  "Sir, I too came from a long series of bad foster homes.  I was lucky enough to have escaped.  You are doing good work.  Please keep it up."  In other words, people can change.  We need to remain hopeful that people can and will change.  Society too will change. 


4. Do things that are uncomfortable and inconvenient: "Justice requires that good people position themselves in difficult places and bear witness."  We have to get uncomfortable and confront all of these issues head on, just as Ijeoma Oluo suggests.  We need to take a stand and speak out against discrimination in all its many forms.  Justice requires it.  At times, standing on our moral principles may force us to confront friends and even family members - but we have to do so.  Racial justice requires it.


The event this past week was awe-inspiring.  It was powerful.  I encourage you all to check out Bryan Stevenson's website, his TED talk, his documentary, and, like I am now doing, his book.