2021 Leadership Reverie Reading List

For the last few years, I have posted a list of some of my favorite books on leadership of the past year.  This year, I am going to do something a little different and post the books that are on my reading lists for the coming year.  Here is my 2021 Leadership Reverie reading list (in no particular order):

1.  Profiles in Courage (John F. Kennedy) - I read this book several years ago and really enjoyed it.  Kennedy profiles several Congressional leaders in history that demonstrated what he called "courage", though he is really writing about leaders who demonstrated something that seems to be lacking in many political leaders today - integrity.

2.  Caste (Isabel Wilkerson) - Wilkerson's newest book has appeared on a number of "Best Books of 2020" lists.  Wilkerson won the Pullitzer Prize in journalism, and she is the best-selling author of another book on my list (see below), The Warmth of Other Suns.

3.  "The Warmth of Other Suns" (Isabel Wilkerson) - Wilkerson's first book tells the story of the Great Migration, the movement of African Americans out of the Southern United States to the Midwest, Northeast and West from approximately 1915 to 1970.  It's been on my night-stand for several months, but I've just not had the chance to read it yet (I joined too many book clubs this past year!).

4.  "A Promised Land" (Barack Obama) - My wife gave me this book to me for Christmas this year.  I didn't always agree with President Obama when he was in office, but I've always thought he is an extraordinarily gifted writer with a lot of great things to say about leadership.  He has shown all of us about what it means to be a leader during these last four years while out of office, perhaps just as much as he did while President.  I am really looking forward to reading this one.

5. "Becoming" (Michelle Obama) - This is another one that I've wanted to read for quite some time, I just haven't been able to get to it yet.  

6.  Upstream (Dan Heath) - I've really enjoyed reading all of the books by Dan and Chip Heath.  This is the first book written by Dan Heath without his brother and comes highly recommended.

7. "The Design of Everyday Things" (Donald Norman) - Someone recommended this book to me a long time ago (it was originally published in 1988), and I have been wanting to read it for quite some time.  Norman popularized the concept of user-centered design, and one of the main premises of his book is that people are often keen to blame themselves when objects appear to malfunction.  However, it is not the fault of the user but rather the lack of intuitive guidance that should be present in the design.

8. Hymns of the Republic (S.C. Gwynne) - I have always enjoyed reading history, perhaps even moreso military history.  Several years ago, I became hooked on books about the Civil War, one of the most difficult times in our nation's history.  There is a lot that we can learn about this period of history, particularly at a time now when our nation is more polarized and divided than at any time since the Civil War.  This is another book that has been on my reading list for a while.

9. Endurance (Frank Worsley) - I have learned so much about leadership by reading about Sir Ernest Shackleton and his failed expedition to Antarctica from 1914 to 1917.  This book tells that story from the perspective of the ship's captain, Frank Worsley, who in many ways is just as responsible as Shackleton for the fact that no one died on this expedition.

10. Great Expectations (Charles Dickens) - as my family knows, this is my all-time favorite book.  I have read it several times over my lifetime, and it's been a while since I last read it.  It's a work of fiction, but there is a lot that you can learn about leadership here as well.

There are a lot more books on my list this year.  I am still participating in the Cincinnati Mercantile Library President of the United States (POTUS) book club (due to COVID-19, we are meeting virtually, so I can still participate, at least for now).  We are reading a biography of each of the U.S. Presidents from beginning to end.  We just finished Ron Chernow's biography on Ulysses Grant.  I also have several more books on my shelf that I still need to get to.  

As President Harry Truman said, "Not all readers become leaders, but all leaders must be readers.”  Happy reading in 2021!

Top Ten Posts of 2020

Today is the LAST day of 2020!  What a historically incredible year it has been - and when I say "incredible" I mean it has been an incredibly difficult year and a year like no other.  I read an article in Time magazine yesterday that reflected upon this past year.  The writer, Time's film critic, Stephanie Zacharek, wrote "This is the story of a year you'll never want to revisit.  There have been worse years in U.S. history, and certainly worse years in world history, but most of us alive today have seen nothing like this one."

Zacharek ended the article (it's definitely worth a read) with the following dose of optimism and hope, "Our optimism is our most ridiculous trait, and our greatest. It can’t always be morning in America. Sometimes we have to get through the darkest hour just before. The aurora bides its time."  Here's hoping that we are passing through the darkest hours and that it will soon be morning again.

As I have done in the past, here are the top blog posts from the past year.  I want to personally thank those of you who read my posts.  As I stated in my first blog post on January 2, 2016 ("First blog post!"), I don't claim to be an expert on leadership, so I write this blog for my own personal learning as much as anyone else's.  With today's post, Leadership Reverie will be up to 489 posts and well over 100,000 views.  It's been a great experience for me, and I have learned a lot about myself in my writing.  

Thomas J. Watson (Chairman and CEO of  IBM from 1914-1956) once said, "Nothing so conclusively proves a man's ability to lead others as what he does from day to day to lead himself."  As I wrote 488 posts ago, "Leadership has to start by looking inward at what you do with your own life."  Here's to another year of writing, learning, and sharing with all of you.  And here's hoping 2021 will be an easier year for all of us!

1.  "Tap Code" (February 9, 2020)

2.  "To protect the whole line" (June 16, 2020)

3.  "I'm good enough, I'm smart enough, and doggone it, people like me!" (April 22, 2020)

4.  "Amateurs talk strategy. Professionals talk logistics." (May 8, 2020) 

5.  "Vontae Mack no matter what"  (July 22, 2020)

6.  "Taming the Chaos" (February 23, 2020)

7.  "A brief hiatus" (July 11, 2020)

8.  "Death by meeting" (March 4, 2020)

9.  "A tale of two leaders" (February 26, 2020) 

10. "How 'bout those 'Heels?" (April 12, 2020) 

Holiday Greetings

Yesterday, December 21, 2020 was the longest, darkest night of the year.  In other words, starting today, the days will get longer and the dark nights will get shorter.  Even in prehistoric times, the Winter solstice was celebrated with festivals and rituals as the rebirth of the Sun.  It is no coincidence that both the Christian holiday of Christmas and the Jewish holiday of Hanukkah ("Season of Lights") are celebrated around the time of the winter solstice.  

This year, perhaps more than any other year in recent history, there is a special significance to the fact that the days are getting longer now.  We have symbolically passed, perhaps, from some of our nation's darkest times and are finally seeing the proverbial "light at the end of the tunnel."  The past year has been a struggle for many (perhaps most) of us.  We've experienced a global pandemic and an accompanying economic shutdown, civil unrest, and a contentious election (and we still do not fully know whether there will be a peaceful transition of power in our country).  Please make no mistake, we are still in the midst of a raging pandemic.  COVID-19 is completely out of control in several parts of our country.  And yet, there is hope.  And yet, there is hope.

Just this past week, the Food and Drug Administration authorized a second SARS-CoV-2 vaccine for emergency use.  Health care workers around the country are smiling for the first time, perhaps in a long time, after receiving their vaccination.  For the first time in a long time, we can start to see the end of the pandemic.  Better days are ahead, and there is renewed hope for the future.  The days are getting longer, and the Sun will shine again.

I was reminded of this renewed sense of hope by a post written by the author, Lindsay Chervinsky.  Her latest book, The Cabinet: George Washington and the Creation of an American Institution has been sitting on my nightstand waiting to be read.  I may finally have an opportunity over the next couple of weeks to sit down and read it!  Anyway, Chervinsky talked about another American President, Franklin D. Roosevelt, who used to deliver a series of evening radio addresses to the American public called his "Fireside Chats".  

On Christmas Eve, December 24, 1943, FDR sat down at his desk at his home in Hyde Park to deliver Fireside Chat 27.  He talked about his recent trip through the Mediterranean and Middle East and of his meetings with Winston Churchill, Josef Stalin, and General Chiang Kai-Shek.  He announced that General Dwight Eisenhower would be the new Supreme Allied Commander in Europe, and he hinted of the coming invasion at Normandy.  About half way through his address, he paused to reflect on what the nation - really, what the world - had been through during the past year.  He spoke of hope, a feeling of optimisim that maybe the world was turning a corner.

“And even this year, we still have much to face in the way of further suffering, and sacrifice, and personal tragedy…But, on Christmas Eve this year, I can say to you that at last we may look forward into the future with real, substantial confidence that, however great the cost, "peace on Earth, goodwill toward men" can be and will be realized and ensured. This year, I can say that. Last year, I could not do more than express a hope. Today, I express a certainty, though the cost may be high and the time may be long.

Within the past year, within the past few weeks, history has been made, and it is far better history for the whole human race than any that we have known, or even dared to hope for, in these tragic times through which we pass.”

I am sort of feeling the same way this holiday season.  "...at last we may look forward into the future with real, substantial confidence" that better days are ahead.  We see the light, and we hope for the coming end to the pandemic.

I can't imagine a better message to send during this holiday season.  

May the blessings and peace of this season be with all of you.

Derek

"Leaders eat last"

Doesn't it seem like we've turned the corner?  The FDA has now approved the second SARS-CoV-2 vaccine for emergency use.  Many health care workers around the country have already received the first dose of one of these vaccines.  I have seen a number of pictures posted on social media of these same health care workers smiling for the first time in a long time after receiving their vaccine.  It does seem like better days are ahead, even if the COVID-19 pandemic is still raging out of control in the U.S.A. and several other countries around the world.

Many hospitals have prioritized those health care workers who are at the highest risk of COVID-19, either because of their specific job requirements or due to the presence of certain medical risk factors.  Other hospitals have not done as well.  For example, I've heard reports of at least one hospital that either forgot or chose to deprioritize the medical residents working there.  Other hospitals have used a lottery system to prioritize which individuals will receive the vaccination first.  These are not simple, easy decisions, and given all of the emotions around this issue, hospitals will not get it perfectly right.  

I can't wait to receive my vaccine.  As a pediatric critical care physician, I was placed in one of the highest priority groups at my own hospital.  I was working in the Pediatric Intensive Care Unit (PICU) just two weeks ago and took care of a number of children with COVID-19.  But here's the thing - I'm not going to be working in the PICU again until April.  I will be working on the hospital wards after the first of the year, but I should be able to protect myself with the infection prevention and control measures our hospital has in place.  There are a number of colleagues who deserve to be vaccinated before me, so I am going to wait my turn a little longer.

It's hard to wait.  But I've always believed in the concept described in Simon Sinek's book, "Leaders Eat Last".  As Sinek writes, "Great leaders sacrifice their own comfort–even their own survival–for the good of those in their care."  It's a concept well-known in the United States military.  The team matters more than the leader.

For now, I will continue to wear my mask everywhere (including when I run outside, by the way), wash my hands frequently, and socially distance to protect myself, my family, and the other individuals who I work with at the hospital.  When the time is right, I will be ready, willing, and eager to receive the vaccine.  For now though, I'm going to wait my turn.

"It's DoctorJill Biden!"

I thought a lot about writing this post today.  First, earlier in the year (see "A brief hiatus") I made a decision to try to avoid, if at all possible, making any significant political statements to avoid giving offense.  Second, I believe in the right to free speech, though at times I personally question how far I am willing to go to support that right.  Third, I fully recognize that at times it's difficult to take someone else's statement out of context.  After thinking about it further though, I asked myself how could I not comment on what has gone on in the past few days?  I have written posts on this issue in the past (see my three part blog post on "A life of privilege"here, here, and here, as well as "Word choice matters" and "What's in a name?")- and until something changes, I will continue to do so.

A few days ago, the Wall Street Journal published an editorial piece with the title "Is There a Doctor in the White House?", written by someone named Joseph Epstein that starts out with the following opening paragraph:

Madame First Lady—Mrs. Biden—Jill—kiddo: a bit of advice on what may seem like a small but I think is a not unimportant matter. Any chance you might drop the “Dr.” before your name? “Dr. Jill Biden ” sounds and feels fraudulent, not to say a touch comic. Your degree is, I believe, an Ed.D., a doctor of education, earned at the University of Delaware through a dissertation with the unpromising title “Student Retention at the Community College Level: Meeting Students’ Needs.” A wise man once said that no one should call himself “Dr.” unless he has delivered a child. Think about it, Dr. Jill, and forthwith drop the doc.

I won't repeat the rest.  As you can imagine (and rightly so), there was a huge backlash against Mr. Epstein (not "doctor" by the way) all over social media, as well as the regular media.  The article was appropriately called "highly offensive," and a number of individuals asked whether the article would have been written about a man who used the title "Doctor."  Several individuals said that the Wall Street Journal should have never published the piece, calling on the publishers to retract it (the publishers declined, by the way).  

It's disappointing that, as far as we have come, we still have a long way to go.  A recent survey by the American College of Healthcare Executives suggested that women healthcare executives with 5 to 20 years of healthcare experience were significantly less likely than their male counterparts to perceive their employes as gender-neutral, when it comes to hiring, promotion, evaluation, and compensation.  More worrisome is the fact that these perceptions have changed little in the past decade.  And of course, it's not just healthcare.  It's a sad fact that women have to work harder in today's business world to get the same opportunities, the same positions of leadership, and the same pay as men (and technically, the data suggests that they don't even get the same pay for the same position as men).  

Perhaps it would help to explain the origin of the word doctor.  According to the Merriam-Webster Online Dictionary, the word comes from the Latin docēre, which means to teach.  The original doctors were not physicians - they were teachers.  The title was conferred on theologians by the Roman Catholic Church when individuals were deemed to be qualified to explain church theological doctrine to laypersons.  It was only later, during the Renaissance, that the title started to be used more broadly to those individuals who were qualified in some academic discipline, including medicine.  About the same time, the term physician came into use to describe one who was skilled in the the art of healing.  In other words, physicians started to be called "Doctor" only after they became noted experts in the art of practicing medicine.  Based on the origin of the term then, not only is our soon to be First Lady deserving of the title doctor, one could argue that she is perhaps more qualified to be called doctor than I am (her doctorate degree is in Education).  

If you've done the work and earned the degree, you deserve the title.  The title signifies a certain level of expertise and signifies that an individual has enough knowledge that she or he can pass that knowledge down to others as a teacher.  "Doctor" is a title, not a profession.  It is an important distinction that gets lost all too frequently.

I am truly sorry that Dr. Jill Biden had to put up with this kind of malarky.  She certainly didn't deserve it.  How did she respond?  Here is what Dr. Biden said on Twitter:

"Together, we will build a world where the accomplishments of our daughters will be celebrated, rather than diminished."

I couldn't agree more.

Don't be a crab!

 There's a famous story - probably apocryphal - that goes something like this.  A young girl was walking along the beach and came upon a fisherman who was casting his line at the end of the pier.  As she came closer, she noticed that the fisherman had left his bait bucket uncovered.  When she looked inside, the bucket was full of live crabs.

The little girl asked, "Mister, why don't you cover your bucket so the crabs don't get away?" 

 
The fisherman responded that he didn't need to cover the bucket.  "The crabs won't get out.  You see, if there was only one crab in the bucket, it would use its claws to grab the edge of the bucket and crawl out.  But with all of these crabs in the same bucket, anytime one crab tries to grab the edge of the bucket and escape, the others pull it back down.  They will all share the same fate."

I don't know if that's what crabs really do - but it's a great story.  The crabs could work together, and they would probably all get away.  They could even work alone, and they would still escape if they would just leave each other alone.  How often do we see examples of this so-called "crab mentality" in the real world?

Pre-medical students are known to be fairly cutthroat.  That was certainly my experience.  Getting accepted to medical school was extremely competitive.  More than half of the individuals that apply for medical school every year don't get in.  In other words, several students are competing directly for a single spot in medical school.  It's definitely a "crab mentality" - student A has a better chance of getting accepted if student B gets lower grades.  Or at least that's the way most pre-medical students understand how the system works.  

It's probably time to re-evaluate the entire medical school application process.  Once a physician graduates from medical school and completes residency training, he or she will learn very quickly that excellent clinical care is performed by teams, not individuals.  In other words, there is no place for the crab mentality in the hospital or clinic setting!  If that's the case, wouldn't we be better off if medical schools prioritized pre-medical applicants who worked well in teams? 

We can achieve so much more together than we can achieve on our own.  It's probably time that medical schools changed their approach.  Work as a team - don't be a crab!

"The strength of the wolf is the pack..."

 The legendary basketball coach, Phil Jackson once said, "The strength of the team is each individual member.  The strength of each member is the team."  That sounds a lot like a line from Rudyard Kipling's poem, "The law for the wolves" from his book, The Second Jungle Book.  Kipling writes, "For the strength of the pack is the wolf, and the strength of the wolf is the pack."  Maybe Coach Jackson "The Zen Master" was thinking of that passage from Kipling (he is an avid reader who often gave books that he found inspirational to his players) when he talked about the strength of the team.  We can forgive him if he did, after all he won two NBA championships as a player, and coached the Chicago Bulls and Los Angeles Lakers to a combined 11 NBA championships as a head coach.

Both Jackson and Kipling are making an important statement about teamwork.  As the old metaphor goes, a chain is only as strong as its weakest link.  A team depends upon all of its members to achieve their collective goals.  Similarly, sometimes just being a member of a great team brings out the best in us - team success leads to individual success.

Perhaps not surprisingly, there's been a lot written in the management literature on teamwork.  I recently came across an article that really peaked my interest.  The article was written by a group of investigators from the Massachusetts Institute of Technology's Sloan School of Management.  It was the title that caught my attention - "Establishing high performance teams: Lessons from health care."  Please forgive me for being honest, but I wouldn't necessarily look to the health care industry for examples of great teamwork.  So, I couldn't help myself but to take a closer look.

The MIT investigators, Michael Anne Kyle, Emma-Louise Aveling, and Sara J. Singer, studied 12 primary care clinics trying to focus on improvement and become high-performing, multidisciplinary teams.  High-performing teams are foundational to organizations as they become high reliability organizations (HROs).  These investigators identified three different approaches to establishing team-based care as part of a journey towards high reliability: pursuing functional change, pursuing cultural change, and pursuing both functional change and cultural change together at the same time.  

Teams that focused on functional change only trained team members in quality improvement skills, such as PDSA cycles (plan-do-study-act), Lean/Six Sigma, and process improvement.  By teaching everyone on the team the new skills of improvement, everyone would have the right set of tools to not only help with an improvement project, but also to lead an improvement project.  Conversely, teams that pursued cultural change focused on improving communication, developing shared mental models, flattening the hierarchy, and being willing to accept failure and learn from it without fear of reprisal.  Finally, some of the clinics pursued a dual approach, focusing on both functional change as well as cultural change.

Which approach was the most successful?  It probably won't surprise you to learn that focusing on both functional change and cultural change together created the highest performing teams.  When you think about it, we really shouldn't be surprised by these results.  Functional change and cultural change, at least as described in the current study, are mutually reinforcing.  You really can't have one without the other.  

A few of the teams provided feedback.  One of the nurses in a high-performing clinic said, "We have become data fanatics."  Conversely, a social worker from one of the low-performing clinics said, "We have these projects and a lot of energy goes into them, and then they get dropped."

Cultural change created the favorable conditions in which everyone on the team felt comfortable speaking up to share their concerns, ask questions in order to learn, and challenge others on the team to do better.  Functional change gave the teams the skills to drive improvement, but the culture change created the atmosphere and team climate where it was possible to do so.  In other words, culture change and functional change together created an atmosphere where the strength of the wolf is the pack, and the strength of the pack is the wolf."

The Bridge Over the River Kwai Syndrome

I recently watched the classic war movie, "The Bridge Over the River Kwai", starring Sir Alec Guinness and William Holden.  It was the highest grossing film during the year it was released (1957) and won 7 Academy Awards, including Best Picture, Best Director (David Lean), Best Adapted Screenplay, and Best Actor (Sir Alec Guinness).  The movie tells the story of a group of British Prisoners of War (POWs) who build a railroad bridge over the River Kwai in Burma, during World War II.  It is based on the novel of the same name by the French writer, Pierre Boulle, and is loosely based on the real-life construction of the Burma Railway (nicknamed the "Death Railway"because of the large number of POWs and conscripts who died during its construction).  It's a fabulous movie, and I'm not really sure why it took so long for me to sit down and watch it in full (I've seen bits and pieces of the movie over the years).

As it turns out, the movie ends up being all about leadership ("What can we learn about leadership from a movie?").  Guiness stars as Lieutenant Colonel Nicholson, the senior British officer at the POW camp, who provides a very interesting case study in leadership.  At the beginning of the movie, the commandant of the camp, Colonel Saito (played by the actor Sessie Hayakawa, who received an Academy Award nomination for Best Supporting Actor for the role) tells Nicholson that all of the POWs, including the officers, must work on the construction of the bridge.  Nicholson refuses, telling Saito that according to the Geneva Convention relative to the Treatment of Prisoners of War, 1929, officers are exempted from manual labor.  Saito, of course, insists that the officers still work.  When the officers still refuse, Saito forces all of them to stand at attention during the intense heat, while the rest of the POWs march off to work on the bridge.

Nicholson and the rest of the officers are placed in solitary confinement (Nicholson's punishment is particular harsh, as he is placed in an iron box) for several days without food or water.  Saito eventually gives up, and Nicholson and the other officers proudly return back to the men.  While all of this is happening, three officers escape, including an American naval officer, Lieutenant Commander Shears, played by William Holden.  Two of the officers are shot, and only Shears successfully escapes.

Meanwhile, as Nicholson slowly regains his strength, he is shocked and disappointed to learn that the British enlisted POWs were sabotaging the construction of the bridge.  Over the protest of a few of his officers, he orders the POWs to be professionals and take pride in their work, for that is what British soldiers and gentlemen should do.  Nicholson drives his men to build and finish the bridge in time, and they even hold a celebration once the job is done.  For Nicholson, it is not only a matter of professionalism, but also a characteristic of the hard work, dedication, ingenuity, and integrity of the British soldier.  When someone challenges him whay he is helping the enemy, he emphatically states that what he is doing is in fact boosting the morale, discipline, and order of his men and upholding the reputation of the British Army.

Again, while all of this is happening, William Holden volunteers for a commando mission to destroy the bridge.  He leads a team back to the POW camp, and later that night, under the cover of darkness, the team places several charges on the bridge.  Unfortunately, overnight the river waters receded to uncover the detonation wires, which are spotted by both Saito and Nicholson.  Nicholson actually tries to prevent the bridge from being destroyed!  Shears and the members of his team are shot, and Nicholson finally realizes what he is doing.  He is shot as he exclaims, "What have I done?"  As he falls, he detonates the bridge just as a train is starting to cross it.  The bridge falls, and the train is destroyed.  

Leadership experts are quick to point out the dichotomy in Nicholson's leadership.  He starts off leading by example, risking his own life to stand up for his principles and for his fellow officers.  His leadership is further on display as he leads the POWs to build the bridge in record time.  However, he seems to lose sight of the fact of the long-term goal of winning the war!  It's a great lesson about goal obsession that has been called the "Bridge Over the River Kwai syndrome".  

As Samuel Bacharach writes in Inc. magazine, "Leadership can be an intoxicating, distracting force that blurs common sense and straight thinking.  The Bridge Over the River Kwai reminds all leaders that they must never forget their bigger mission."  Indeed.