Black Box

If you are a leader who works anywhere in the realm of patient safety, there is a great chance that you are familiar with the commercial aviation industry.  The aviation industry, as a whole, has a safety record that those of us in health care wish that we had!  Commercial aviation is frequently cited as a so-called High Reliability Organization.  In other words, despite the inherent dangers of flying, there are surprisingly very few accidents.  

It's important to distinguish between "error-free" and "accident-free" here.  While the aviation industry has done a great job reducing errors, errors still occur on a daily basis.  As a matter of fact, most studies have documented that errors are made during every single flight.  High Reliability Organizations, like the commercial aviation industry, minimize the impact of the errors that are made, resulting in "accident-free" operations.

Another important distinction is that High Reliability Organizations invest time, money, and resources in order to learn as much as possible when the rare accident does occur.  It seems like every time that a plane has an accident (and again, this is very uncommon), the media starts asking a lot of questions about something called the flight recorder or "black box".  This is actually a misnomer - the flight recorder isn't black.  Instead, it is usually painted bright orange so that they can be easily found after an accident.  There are actually two components to the flight recorder.  The flight data recorder (FDR) records dozens of individual parameters (air speed, pitch, lattitude/longitude, wind speed, etc) several times per second, so that the recent history of the flight is preserved.  Conversely, the cockpit voice recorder (CVR) records all of the sounds (e.g. alarms) and conversations between the pilots and air traffic controllers.  Using the data from the "black box", investigators can determine what exactly happened to the plane and why it crashed.

I actually didn't know this, but after reading about the golfer Tiger Woods' recent automobile accident, I learned that cars now have cars now have data recorders.  They've actually been around for quite some time!  It's essentially the same concept as the "black box" used in aviation.  Investigators can use the data stored by the "black box" to learn how and why an automobile accident occurred.

I know what you're probably thinking.  Is there a health care version of the "black box"?  The answer may surprise you.  With the advent of the electronic health record, we have access to more data than we've ever had - but having access to data is not the same thing as having access to real-time event recorders like the "black box" used in aviation.  I would say that here, health care has a lot to learn from the aviation AND the automobile industry.  We are moving in that direction, but we're not there yet.

Just as important, in my opinion, is having access to a "black box" for leadership.  I'm not talking about having access to second-by-second recordings of everything that is going on around you, similar to the flight recorder or automobile data recorders.  Here, I am talking specifically about taking an in depth look at the decisions you've made, the conversations that you have had with your team, or the presentations that you make to your own supervisor.  Leadership is a constant, never-ending, continual learning process.  John F. Kennedy said that "Leadership and learning are indispensable to each other."  He was absolutely correct.  An important aspect of leadership is learning through reflection and analysis about your own performance.  

Here's an example of what I'm talking about.  Every time that I have the opportunity to go back and watch or listen to a presentation that I have made, I do so.  Just this past Friday morning, I watched myself giving a lecture to our Department of Surgery on - you guessed it - "High Reliability Organizations"!  I took the time to watch specifically to evaluate how I communicated, both verbally and non-verbally.  I wanted to see if there are any points that I made that were confusing.  Finally, I reviewed the slide deck that I used and watched carefully how the presentation flowed (in one case, I glossed over a slide so quickly that I have now taken it out for future presentations on this topic).  

Leaders need a "black box" too.  Take advantage of all the data that you have in front of you to learn how to become a better leader in the future.  Chances are that we will likely never wear a "leadership black box" that records our every decision, but there is a good chance that we will have access to data that can help us become better leaders.  As the American philosopher John Dewey said, "We do not learn from experience, we learn from reflecting on experience."  We learn from our "black box."

"A wise man once said nothing..."

There is an old proverb that goes, "A wise man once said nothing."  The political activist and writer Anne Lamott said, "Lighthouses don't go running all over an island looking for boats to save; they just stand there shining."  Contrary to popular notions of leadership, whether someone is an extrovert or introvert doesn't determine one's ability to lead.  For anyone who has doubts, I would point them to Susan Cain's 2013 book  Quiet: The Power of Introverts in a World That Can't Stop Talking.  I have mentioned this book a few times in the past (see Have you heard about the lemon juice test?).

I've talked about the fact that I was a shy kid in previous posts.  I used to hate being called out in class.  I hated it so much that when I was in first grade, I refused to read out loud in small reading groups.  One of my teachers thought that I couldn't read and placed me in the lowest reading group (see my post "Don't pigeon hole me!").  One day, a new teacher came in and figured out that I was just shy.  She encouraged me in the right way, and I moved to the top reading class very quickly (basically, she figured out that I could read very well, and I moved from group-to-group to the top reading group by the end of the day).  

I will admit that this story provides a great example of how shyness adversely impacted my learning and development.  In other words, someone who is so shy that they don't want to be acknowledged publically or can't speak in front of a group is never going to do well in a leadership position.  That's not my point.  Susan Cain would argue that shyness and introversion aren't necessarily the same thing.  They can certainly co-exist, though whereas shyness is inherently uncomfortable (remember - I "hated" being reading out loud), introversion is not.  Introverts tend to prefer a more quiet, minimally stimulating environment.  They may even prefer to spend their free time reading a book instead of going out to dinner with a large group - this doesn't make them anti-social.  

My point is that most introverts - even the ones who were shy at one point - can function perfectly well in positions of leadership.  Cain lists a number of notable individuals who she describes as introverts - including Abraham Lincoln (arguably one of our country's greatest Presidents), Rosa Parks (whose actions started the Civil Rights movement), and Barack Obama, among many others.  Would you believe that David Letterman and Barbara Walters are introverts?  How about the entrepreneurs, Bill Gates, Steve Wozniak, Warren Buffett, and Larry Page?  All of these individuals have two things in common - they are all introverts and they have all been extremely successful in their professional lives.

If you happen to be an introvert - you are not alone!  More importantly, there is no reason why you, as an introvert, can't develop into a great leader!  Some times, silence speaks volumes.  As the ancient Greek philosopher Plato said, "Wise men speak because they have something to say; Fools because they have to say something."  So when the introverts speak, be sure to listen!

"Leader...ship"

As I've mentioned, one of the side effects of the COVID-19 pandemic - though it's probably more accurate to blame the lockdown - has been the significant increase in binge-watching at our house.  I learned that I really like the television series The Office, which aired on NBC from 2005 to 2013, played again on Netflix, and most recently made its way to the Peacock Network.  During episode 17 (episode 11 of season 2, "Booze Cruise"), regional manager Michael Scott (played by the actor, Steve Carell) said:

Leader… ship. The word “ship” is hidden inside the word “leadership,” as its derivation. So if this office is, in fact, a ship, as its leader, I am the captain. But we’re all in the same boat. Teamwork!

It's a funny quote, but I think there is a lot more to unpack here than what it seems at first glance.  Michael Scott isn't exactly a great leader (see a post from last year, "Is Michael Scott a bad boss?").  While taking your team on a "booze cruise" in lieu of a retreat might be popular, as this episode shows, it's not likely to be effective.  I would argue further that perhaps Michael Scott doesn't really understand what leadership is all about.  In the beginning of the quote, he suggests that leadership is all about being the so-called "captain of the ship" or the "boss."  While there is no question that leadership and management comes with some degree of authority and power, there is a lot more to being a leader than being the "captain" or the "boss."

There used to be a legal doctrine in health care law known as the "captain of the ship doctrine".  Basically, this doctrine was established with a case decided by the Pennsylvania Supreme Court in q 1949 case, (McConnel v Williams), which stated "...it can readily be understood that in the course of an operation in the operating room of a hospital, and until the surgeon leaves that room at the conclusion of the operation... he is in the same complete charge of those who are present and assisting him as in the captain of a ship over all on board."  Essentially, the Pennsylvania Supreme Court said that the primary surgeon is responsible for the actions of everyone else in the operating room, including other surgeons and the anesthesiologist.  This particular legal doctrine has largely fallen out of favor.  More importantly, the complex nature of medical care today, even in the operating room environment, requires a more collective, team-based approach in order to achieve the best outcomes.  While a surgeon is still an important piece of the puzzle (and maybe one of the most important pieces), there is no way that a patient can achieve a good outcome from surgery if the rest of the health care personnel aren't working together as a team.

I think we are long past the concepts such as "women and children first" and "the captain going down with the ship".  These are anachronistic concepts no longer seem relevant in the world in which we live today.  The same holds true for leadership.  And here is where Michael Scott nails it in the second half of his quote - "...we're all in the same boat.  Teamwork."  There is something magical about leading a team that is working together.  For a great read on this subject, I highly recommend General (retired) Stanley McChrystal's book, "Team of Teams".  If you want a book with a more nautical theme, check out "The Boys in the Boat" by Daniel James Brown.  

Most of the time, Michael Scott was a poor leader (and a poor manager).  But every once in a while, he came up with something great.  It is absolutely true that the word "ship" is hidden inside the word "leadership" - it's only meaningful if you apply the analogy that everyone on a team is on the same boat, and in order for the team to achieve its goal, they need to work together.

"What you permit, you promote..."

It's been said so many times in so many different ways that I can't really say who said it first.  While searching for the origin of this quote, I came across this version by former Fox News commentator Michelle Malkin once said (although many others have said it):

"What you permit, you promote.  What you allow, you encourage.  What you condone, you own.  What you tolerate, you deserve."  

Regardless of who said it first, or even who is saying it now, it is absolutely true!  Leaders create the culture, and the behaviors that they permit or allow are the ones that they encourage and promote.  I have witnessed firsthand (many times) how one disruptive employee can create stress, anxiety, and dissatisfaction amongst the other members of the team.

I recently came across an article that offers further proof that one disruptive employee can create a vicious cycle that encourages disruptive behavior all around.  Kristoffer Holm, Eva Torkelson, and Martin Backstrom reported their findings in a 2015 article entitled "Models of workplace incivility: The relationships to instigated incivility and negative outcomes".  There's a lot to unpack here, so let's start off defining some of the terms used in this study.

First of all, these investigators defined "workplace incivility" as "...low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect."  These behaviors generally include rude and/or discourteous behavior (including rude looks, ignoring someone, etc) and generally exclude overt behaviors such as yelling or aggresion.  

It's also important to define "instigated incivility" here.  So second, Holm, Torkelson, and Backstrom suggest that "instigated incivility" occurs when others witness or experience incivility themselves, they in turn are more likely to exhibit incivility to others.  In other words, incivility begets more incivility, creating a viscious cycle of behavior, culminating in the creation of what many call a toxic or hostile work environment.

Holm, Torkelson, and Backstrom studied the Swedish hospitality industry - specifically the restaurant and hotel industry to determine whether (1) witnessed or experienced incivility, from either supervisors or peers, instigated further incivility and (2) whether instigated incivility led to adverse outcomes, such as lower employee engagement and satisfaction or even turnover.  What they found may not be surprising to you (I kind of prepared you for this, right?), but the results are important nonetheless.  Workplace incivility - whether it was witnessed or experienced and regardless of where it came from (supervisor or fellow employees) - leads to instigated incivility, lower employee engagement, and employee turnover!

So, at least according to this study, poor behavior in the workplace inspires and instigates further poor behavior in the workplace!  As long as leaders tolerate this behavior, they are directly responsible for promoting the spread of this poor behavior.  In other words, you absolutely promote what you permit!

Imposters

There have been all kinds of new and important research studies coming out this past year during the COVID-19 pandemic.  We've certainly learned a lot about the SARS-CoV-2 virus, and thankfully we have more tools in our armamentarium to prevent (vaccines!) and treat COVID-19, the illness caused by that same virus.  There have been so many research studies that have come out on COVID-19 lately that it's virtually impossible to keep up.  Unfortunately, not all of this research is good.  As one of my colleagues recently pointed out (see "A second pandemic? Perspectives on Information Overload in the COVID-19 Era"), we live in a world of almost instantaneous access to information - and not all of this information is accurate. At times, social media and the lay press have reported new treatments before they have been subject to rigorous peer review.  Take for example the case of hydroxychloroquine which was touted as a miracle drug early on during the pandemic (including by POTUS), even though the evidence suggests that it does not prevent death from COVID-19 and may, in fact, be harmful.

I do not wish to contribute to this information overload or be accused of spreading false information, but I think the evidence in this case will support my claim.  The COVID-19 lockdown has a cause-and-effect relationship with the amount of television that I have "binge watched" in the past several months.  The evidence will show that I am not alone!  Earlier this year in a letter to the editor of the journal Psychiatry Research, a group of investigators found that during the lockdown, 73% of individuals surveyed (the survey was conducted in India, Bangladesh, Nepal, and Indonesia) reported a significant increase in binge-watching.  The average time spent watching television or related media increased by 3-5 hours per day.  Just over 9% of those surveys stated that they had binge-watched more than 5 episodes of a television series in one sitting, while around 20% stated that they had watched between 3-5 episodes in one sitting.  I have to admit, 3 episodes used to be extremely rare for me, but now it seems almost average!

Thanks to COVID-19, I learned that I really enjoyed the television series, The Office (I actually never watched it when it was on regular television).  We've watched The Crown (all of it), The Marvelous Mrs. Maisel (we lost interest after the second season), Grace and Frankie (I still haven't made it through the whole series yet), and Bridgerton (do NOT watch with your daughter - we fast-forwarded through a lot of it).  The two questions I get asked on Monday mornings have now become, "How was your weekend?" and "What shows did you watch?"  Lately, my wife and I have started watching the Bravo television series Imposters.  It's a pretty good show about a group of con artists (Maddie, Max, and Sally) who work for an evil villain known only as "The Doctor."  They make their targets fall in love with Maddie, and when the targets marry her, they steal all of their money.  We've enjoyed it, but apparently the series was canceled after the second season.  So, in the next few days, we will have to find another series to binge.

Anyway (I know - this was a very long-winded build-up), as I was thinking about binge-watching in general and this series in particular, I started to think about the impact of COVID-19 on something that has come to be called "Imposter Syndrome".  "Imposter Syndrome" was first described in a 1978 paper by the psychologists Pauline Rose Clance and Suzanne Imes, who wrote, "despite outstanding academic and professional accomplishments, women who experience the imposter phenomenon persist in believing that they are really not bright and have fooled anyone who thinks otherwise."  In essence, men and women who suffer from "Imposter Syndrome" feel that they are frauds - even when there is absolute proof that they are not.  

It's now recognized that "Imposter Syndrome" affects both men and women - indeed, some studies suggest that it affects more than 70% of the population.  There is even some suggestion that the COVID-19 pandemic is making "Imposter Syndrome" worse (see here and here).  The most important thing to recognize is that if you are feeling like a fraud - you are not alone!  Almost all of us, at one time or another, have felt like we are not qualified to be in our position or deserved our status in life.  

Which brings me to the article ("Stop Telling Women They Have Imposter Syndrome") that started this whole thing.  Just a few days ago, Ruchika Tulshyan and Jodi-Ann Burey wrote a Harvard Business Review post suggesting that for women in the workplace, "Imposter Syndrome" is more often due to systemic racism, microaggression, classism, xenophobia, discrimination, and other forms of bias.  They write, "..as we know it today, imposter syndrome puts the blame on individuals, without accounting for the historical and cultural contexts that are foundational to how it manifests in both women of color and white women. Imposter syndrome directs our view toward fixing women at work instead of fixing the places where women work."  According to Tulshyan and Burey, we should focus on addressing the culture of bias that exists in the workplace, rather than the feelings that have come to be called "imposter syndrome" per se.  We should treat the cause of the disease, not the symptoms of it.

We hear this same sentiment a lot when it comes to addressing physician burnout (see, for example, my post, "Don't ask me to take resilience training!").  Rather than focusing on the conditions - the system-level and organizational issues - that contribute to burnout, we tend to focus on the individual.  By focusing on the individual, we are subconsciously blaming the individual.  When emphasize things like resilience training and mindfulness (which I feel are important to address too) to the exclusion of the system-level factors, we are basically saying "Toughen up buttercup."  I think the same is true for "Imposter Syndrome."  By focusing on the individual, we ignore the system-level issues that are really at fault.

So what can a leader do to create a climate that hopefully prevents the feelings associated with "Imposter Syndrome"?  Melody Wilding for the Business Insider recommends five key points:

1. Foster psychological safety - I can't emphasize enough how important it is for leaders to create a climate of trust, transparency, and openness where workers feel that they can raise concerns, ask questions, and provide constructive feedback to leaders.  

2. Show what it means to work like a human -  Leaders can take steps to address overwork and perfectionism by modeling empathy and understanding.  It's okay to make mistakes.  It's okay to take a break away from work.  It's okay to leave work at the end of the day, rather than staying and working late all the time.

3. Recognize people's accomplisments - Here is a great point - praise the process not the result!  As the psychologist Carol Dweck (of "growth mindset" fame) recommends, leaders should praise the effort ("You worked really hard on this!") rather than solely focusing on the achievement itself.

4. Utilize feedback for development - I really like the concept of a 360 assessment, where not only the supervisor, but also the subordinate and peers can provide direct feedback.  However, building upon the first point, 360 assessments are useless and frequently counterproductive if there is not a climate of psychological safety.  

5. Create a culture of inclusion - building upon what Tulshyan and Burey emphasize, we absolutely have to address issues around diversity, inclusion, and equity in the workplace.  In my mind, these things go hand in hand with building a culture of psychological safety, which is foundational to everything else we've discussed here.

I want to end this post with a couple of quotes.  A famous scientist once said, "The exagerrated esteem in which my lifework is held makes me very ill at ease.  I feel compelled to think of myself as an involuntary swindler."  That scientist was Albert Einstein, arguably one of the most brilliant minds throughout all of history.  It's amazing to think that even Einstein was subject to these feelings of being an imposter.  However, he said something else that is just as important, if not more so.  Einstein once said, "Everybody is a genius.  But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid."

We should stop judging fish, by its ability to climb a tree.  

Blinded to bias

I was feeling a little more tired than usual last night, so rather than running on the treadmill (the temperature is still in the single digits here), I decided to work-out on the stationary bicycle (not the Peloton!).  I occasionally like to read when I'm on the bike, particularly during an easier work-out, so I ended up reading an article in the Harvard Business Review about the Army's new selection process for batalian-level commanders ("Reinventing the Leader Selection Process").  It's a really nice article that I will definitely be posting about in greater detail soon.  However, I wanted to talk today about an older research study and concept mentioned in the article that the Army is using to try to reduce implicit bias.

As a reminder, implicit bias can be defined as "the pre-reflective attribution of particular qualities by an individual to a member of some social out group" (think: stereotype).  We tend to make generalizations and stereotypes based upon the unconscious opinions that we hold about someone.  So, for example, someone who is interviewing a prospective job applicant may be more or less likely to hire that individual based upon these stereotypes and opinions.  

Implicit bias is an important issue that unfortunately remains quite prevalent in the workplace.  For example, a recent study by Katherine A. DeCelles at the Harvard Business School found that minorities who "whiten" their resume in order to hide any references to their race are 50% more likely to get an invitation to interview.  In another classic study, Marianne Bertrand and Sendhil Mullainathan found that job resumes with a "white" name versus a "black" name are much more likely to get a call-back.  Job applicants with common "white" names needed to send about 10 resumes to get one call-back, while job applicants with common "black" names needed to send around 15 resumes to get one call-back.  Even more startling, a resume with a "white" name yielded as many more call-backs as an additional eight years of professional job experience.  

It's not just race and ethnicity that drives bias.  There is ample evidence of implicit gender bias in the workplace too, which brings me to the study that I mentioned at the very beginning of this post.  The story begins in 1952 and the Boston Symphony Orchestra has a diversity problem - too many men and not enough women are members of the Orchestra.  The leaders run a small experiment using blind ambitions (basically, musicians played their instruments behind a screen during the audition).  The thinking was that by hiding the musician's identity, he or (preferably) she would be judged based solely on their merit.  Unfortunately, the initial results still skewed towards hiring male musicians!  The problem was that the judges could still determine whether the musician was a man or woman based upon the sound of the women's heeled shoes.  The solution - remove the shoes!  Once the musicians played their instruments behind a screen AND without wearing any shoes, the number of women who were selected to advance in the audition process increased by 50%!

Blind auditions quickly spread to other symphony orchestras - it's become almost standard practice.  On the surface, this practice change seems to have been successful.  According to statistics from the League of American Orchestras, prior to blind auditions male musicians outnumbered female musicians by 2-to-1.  Now, at least as of 2013, the breakdown of male to female orchestra members is 54% to 46%.

Which brings me to the actual study (Orchestrating impartiality: The impact of "blind" auditions on female musicians), which was published in 2000 in the journal American Economic Review.  Two economists, Claudia Goldin from Harvard and Cecilia Rouse from Princeton collected four decades worth of data from eight leading American orchestras.  They found that similar to the experience reported way back in 1952 by the Boston Symphony Orchestra, blind auditions increased the probability that a woman musician was selected by 50%!

It's a really famous study (according to Google, the original paper has been cited over 1,500 times and is the subject of a number of TED talks, thousands of media mentions, and countless diversity, equity, and inclusion (DEI) workshops.  The study has been criticized as of late (see the Wall Street Journal report "Blind spots in the 'Blind Audition' Study").  Moreover, a follow-up study in 2017 conducted by a team of Australian behavioral economists suggested that perhaps blind auditions aren't as effective as previously believed.  In this study, more than 2,000 managers were asked to select recruits from randomly assigned resumes - some of these resumes were de-identified so that the gender of the applicant was masked.  The investigators found that de-identifying the resume actually reduced the likelihood that women were selected these positions.  While the reasons for these unexpected results can't be known for sure, perhaps some of the managers were aware of implicit gender bias and were therefore proactively hiring women.  Anthony Tommasini, writing for the New York Times posed this exact question and further suggested that the use of blind auditions kept orchestras from being racially and ethnically diverse.

On the surface, blind auditions make sense.  However, we will not know whether they truly level the playing field until they are subjected to randomized, controlled trials.  It's hard to argue with more than 50 years of experience though.  Perhaps the changes in the Army's officer selection process will help answer this question in the future.

"Be excellent to each other!"

Just about 32 years ago (February 17, 1989 to be exact), the movie Bill & Ted's Excellent Adventure was released in theaters.  It's an entertaining movie starring the actors, Keanu Reeves and Alex Winters as two teenage "slackers" who travel back in time to meet historical figures for their high school history class.  Believe it or not, there are leadership lessons here!  

The story begins far into the future in the year 2688 in a utopian society based upon the music and philosophy of the Two Great Ones, Bill S. Preston, Esquire (played by Alex Winters) and Theodore "Ted" Logan (played by Keanu Reeves).  Apparently, the utopian future is in peril because of an alternative past - if the two teenage slackers, Bill and Ted fail their history assignment (the only thing that they had apparently learned all term was that "Caesar is a salad dressing dude"), Ted will be shipped off to military school, which will end their fledgling band "Wyld Stallyns" and forever change the course of history.  In order to save humanity, the leaders in the future send one of their citizens, Rufus (played by comedian George Carlin) back to the past in a time machine disguised as a telephone booth.  Rufus serves as a mentor to the two teenagers as they course through history in search of "personages of historical significance."  I won't ruin the story, but I will say that there is a happy ending.

One of the fundamental tenets of the philosophy according to "Bill and Ted" is "Be excellent to each other!"  How much better would we all be if everyone followed that recommendation?  How much better would the world be if we would all just "be excellent to each other"?  The author Robert Fulghum wrote a book in the late 1980's entitled All I Really Need to Know I Learned in Kindergarten - there is a lot of recommendations and life lessons in this book that could be summarized by saying, "Be excellent to each other" - share everything, play fair, don't take things that aren't yours, clean up after yourself, and say you're sorry when you hurt someone (among many others).

Continuing on this theme, with respect to leadership, Bill and Ted's philosophy best matches what Robert Greenleaf has called servant leadership.  As described by Greenleaf, a servant leader is a leader who seeks to be a servant first by caring for the needs of all others around them (see also, "Leaders Eat Last") and ensure the development and professional growth of future leaders.  A servant leader, is one who is "excellent" to those whom he or she supports on the team.  

If you want a real-world example of how to "be excellent to each other", look no further than this video from the 1998 Golden Globes Award.  The actor  Ving Rhames won the Golden Globe Award for Best Actor in a Miniseries or Television Film for his role as Don King in HBO's Don King: Only in America.  When his name was read as the winner, you can clearly tell that Rhames is thankful, proud, and honored to have won the award.  As he is shedding tears, he quotes Konstantin Stanislavski and says, "Love the art in yourself, not yourself in the art."  He then thanks all of the other nominees.  And then to everyone's surprise, he asks one of the nominees, actor Jack Lemmon (who had been nominated for his role in the movie "Twelve Angry Men") to come to the stage.  Once Lemmon joins him on stage, Rhames stuns everyone and says, "I feel that being an artist is about giving, and I'd like to give this to you."  He gives the Golden Globe award to Lemmon, who initially tries to refuse, but eventually accepts it.  Lemmon would go on to say that it was "one of the nicest, sweetest moments I've ever known in my life."

Can you imagine a Hollywood actor handing over his first major award - something he has probably worked hard for many years to earn - to someone he thought was more deserving?  That, my friends, is what being "excellent to each other" is all about.  Simply amazing.

Leadership is all about what you do for others.  Above all else, "be excellent to each other!"

The day after...

New team.  Same result.  NFL Quarterback Tom Brady, now playing for the Tampa Bay Buccaneers, played in the 10th Super Bowl game of his career and led his team to its second ever Super Bowl victory (the Buccaneers also won Super Bowl XXXVII in 2002) in Super Bowl LV last night.  Brady has now played in more Super Bowls than any other player (ten), won more Super Bowls (seven) as a player than any franchise (both the New England Patriots and Pittsburgh Steelers have each won six Super Bowls), and he has received the Super Bowl Most Valuable Player Award more than any other player in history (five - NFL Hall of Fame Quarterback, Joe Montana won the MVP award three times during his career).

What's remarkable is that Brady's former team, the New England Patriots, let him go at the end of the 2019 season.  After playing for 20 seasons in New England, Brady wanted a multi-year contract and the Patriots didn't want to give him one.  As far as quarterbacks go, Brady isn't just old (he is 43 years old), he's ancient.  It's incredibly rare that NFL quarterbacks can maintain the same level of consistency in their late 30's, let alone their early 40's.  His final season with the Patriots was less than Brady-like, so given his age and the decline in performance, you can't necessarily fault the Patriots for refusing to give him a multi-year contract.  So, Brady left the Patriots and signed with another team (the Buccaneers).

The surprise ending to this story is that while Brady won his 7th Super Bowl with his second team, his former team failed to make the play-offs and experienced their first losing season since before Brady played there.  I've gone on record several times (see "The Patriot Way", "The Patriot Way Redux", and "That makes it twice...") about the fact that regardless of whether you like NewEngland Patriots Head Coach Bill Belichick, Tom Brady and the Patriots organization, you have to admire the kind of culture that they have built over the years.  And now, it seems that maybe Tom Brady had more to do with that culture than I or anyone else has given him credit for.  

Social media last night hasn't been particularly kind to Brady.  He has previously supported the 45th President of the Untied States and has claimed that "they are good friends."  There were several pictures of the two Super Bowl quarterbacks entering the stadium before the game yesterday afternoon - Chiefs quarterback Patrick Mahomes was wearing a face mask, while Brady was not.  There have been accusations about cheating in the past (see "Deflategate").  Regardless of his political views or who he chosen to hang out with, there has to be more to Tom Brady's winning ways than pure athletic talent.  One can admire his leadership on the field and in the locker room without necessarily agreeing with what he does off the field.  

Character matters - you can't be a leader without it.  But again, there is absolutely no way (zero chance!) that Tom Brady wins 7 Super Bowls without being a good leader in his chosen profession.  Look - I don't know Tom Brady.  I have no idea what he believes about COVID-19 and wearing masks.  I don't know whether he agrees with or supports everything that the last President has said or done - I certainly hope that he does not (and there's some evidence to support that he doesn't).  I wish he would use his superstar status to advocate for matters that are important to me and should be important to all of us.  But let's not use his political beliefs as an argument against whether he is the greatest football player or the greatest athlete of all time.

Regardless of whether you personally like him or not, you have to admit that Brady's body of work as a football player support the argument that he is the greatest player of all time (G.O.A.T.) in football.  Many would argue that he is "the best ever in all sports".  Brady's resume is certainly impressive and deserving of these kinds of discussions.  

Again, social media has literally blown up overnight with arguments for and against his status in the pantheon of all-time sports legends.  Other professional athletes mentioned as deserving the GOAT label include tennis star Serena Williams who has won 39 total tennis Grand Slam (Australian Open, U.S. Open, French Open, or Wimbledon) in singles (23), doubles (14), and mixed doubles (2) and current NBA star, LeBron James.  I would also include NBA Hall of Famer Bill Russell, who led his team, the Boston Celtics, to eleven NBA Championships, in any GOAT discussion.  

Each and every one of these athletes (I would argue that James should finish his career before being considered worthy of GOAT status) is deserving for their contributions to both their individual sport and to sports in general.  However, their feats of greatness couldn't be more different.  Maybe we should just celebrate their accomplishments in total and not argue about who is deserving of the greatest athelete of all time.  Maybe we should simply recognize that we don't have to agree with someone in order to admire what he or she has accomplished in his or her chosen profession.

"You talk too much!"

I just can't believe what some people say out loud!  I wasn't necessarily planning on posting on this topic so soon again, but clearly I am justified in doing so.  Recent news has confirmed some of the points that I made in a few of my recent posts (see "COVID-19 and women" and "Do we need a National Women Physicians Day - 2021 version").  Apparently, the top official on the Tokyo Olympic Planning Committee complained that the women on the committee talked too much during meetings.  

Yoshiro Mori, a former Prime Minister of Japan and the current president of the Tokyo Olympic organizing committee, reportedly said, "board meetings with lots of women take longer" because "women are competitive -- if one member raises their hand to speak, others might think they need to talk too."  He later added, "If you want to increase female membership, you would be in trouble unless you put time limits in place."

Wow.  Mori of course apologized the next day, claiming that he would like to withdraw the comments he made to those who were offended.  As the CNN writers reporting on this story said, "...women regularly face gender discrimination in the workplace and when seeking positions of power."  I would argue that the statistics show that it's not just women in Japan!

Here's the goofy part to this whole story.  Mori's perceptions are actually wrong.  The available evidence suggests that the opposite is true - men actually talk more than women in meetings.  For example, in a systematic review of 56 studies by the investigators Deborah James and Janice Drakich, only two of the studies revealed women talked more than men. To the contrary, they found that 34 of the studies showed that men talked more than women!  

A widely cited study on this topic by Barbara and Gene Eakins observed 7 university faculty meetings and found that men spoke far more often and far longer than the women.  The longest comment by one of the female faculty in all seven meetings was shorter, in fact, than the shortest comment by a male faculty member.

The facts support that men talk more than women in professional settings.  Even more surprising (though maybe not so surprising to women), a study by Susan Herring found that online messages written by men were twice as long as those written by women.  

Men talk more.  Men write more.  Women talk less.  Women write less.  At the risk of writing too long, I will end with that.

"Do we need a National Women Physicians Day"? - 2021 version

Today, Dr. Elizabeth Blackwell, the first woman to graduate from medical school and become a physician in the United States, would be 200 years old!  So, as we celebrate Dr. Blackwell's 200th birthday today (and, not by coincidence, National Women Physicians Day), I have to ask one more time, "Do we need a National Women Physicians Day?  The short answer - 100% yes!

I first posed this question a couple of years ago (Do we need a National Women Physicians Day? posted on February 3, 2018).  At that time, I briefly reviewed Dr. Blackwell's professional life and some of the challenges she had faced as the first woman in medicine.  Notably, she had applied to a number of medical schools throughout the northeastern United States without any success.  The faculty at New York's Geneva Medical College actually referred the question of admitting a female to the all-male student body, who in a rather surprising turn of events, voted "yes" largely as a joke.  She was admitted to medical school, and the rest, as the saying goes, is history.  I went on to discuss a few of the studies showing that female physicians earn less than their male counterparts and frequently suffer from gender bias, discrimination, and sexual harassment in the workplace.  I also highlighted a study suggesting that women may actually have better outcomes compared to men!

The following year on February 3, 2019, I posed the same question (Do we need a National Women Physicians Day - one year later).  That year, I again wrote about Dr. Blackwell and provided a quote - "If society will not admit of a woman's free development, then society must be remodeled."  I talked about two examples of gender bias and overt discrimination.  The first example was an editorial written by a Dallas physician who suggested that the reason women physicians were paid less than their male counterparts was because they didn't work as hard.  The second was a simulation study published in the journal, Critical Care Medicine, in which the investigators suggested that resuscitation teams led by female physicians was not ideal - ""The management of a cardiac arrest situation by a team of first responders is a highly time-critical emergency event that requires short and precisely verbalized commands by a determined leader, rather than a focus on social relationships or affective issues. A cardiac arrest situation should therefore favor males as primary leaders. Our results are in line with this conclusion."  Notably, this was a simulation study - a follow-up study with actual patients suggested the opposite.  Patients suffering cardiac arrest did better when the resuscitation teams were led by female physicians.

Last year (Today is National Women Physicians Day), I again talked about Dr. Blackwell.  And once again, I talked about the gender pay gap and the evidence that women physicians continued to suffer gender bias, discrimination, and sexual harassment in the health care setting.  So, if I were to summarize where things currently stand, I would have to say that things are not much better.

More concerning, as I discussed in a post last week (COVID-19 and women), things might even be worse.  The COVID-19 pandemic has not only made things worse, we may even have slid backwards.  Women are leaving the workforce in far greater numbers than men - this is true in just about every sector of the economy, including health care.  It's a struggle for a lot of us in academic medicine these days, but this may be even more the case for women.  This is concerning - we had problems with gender disparities in academic leadership positions, editorial boards, and conference speakers even before the pandemic (check out a brief report published last year by my former colleagues in Cincinnati).  Just last month, a group of investigators published a study in the journal Pediatric Critical Care Medicine that found that the percentage of researchers publishing clinical trial results in the field of pediatric critical care who are women still lagged behind the percentage of overall women in the pediatric critical care medicine workforce.

While we have a lot of work still ahead, I remain optimistic for the future.  Just a few weeks ago, we witnessed the swearing in of the first female Vice President of the United States.  There is a greater awareness for issues around gender diversity, equity, and inclusion in medicine today - perhaps COVID-19 will further illuminate these issues for us.  With awareness comes change - I've known a number of colleagues who have declined invitations to speak at national meetings where there weren't enough women speakers invited as well (don't participate on "manels").  Just this past year, the Journal of Vascular Surgery retracted a really offensive study judging public social media posts of women surgeons wearing bikinis on off-hours as “potentially unprofessional”in response to a number of complaints on social media. 

There is hope.  And it can start today, on this the 200th birthday of the first female physician in the United States.  Dr. Blackwell said it best, "If society will not admit of a woman's free development, then society must be remodeled."  Let's remodel society.