Five frogs on a log

Do you remember the old nursery rhyme about five frogs who are sitting on a log?  There is an old riddle about five frogs too.  I've seen the riddle with various numbers of frogs (sometimes 3 frogs, sometimes 6 frogs) - it really doesn't matter too much.  The riddle goes like this:

Five frogs are sitting on a log.  Four decide to jump off.  How many are left?

What's the answer?  If you answered one, you are in great company.  But unfortunately, that's not the answer!  The answer is actually five.  There's a difference between "deciding" and "doing" - the frogs may have decided to jump off the log, but they haven't yet actually jumped off.

Okay, I know.  You are all probably rolling your eyes right now.  But the very subtle difference - some would use the phrase "we're splitting hairs here" - is actually quite important.  There is a very important difference between deciding and doing.  

The American politician Frank Clark once said, "What great accomplishments we'd have in the world if everybody had done what they intended to do."  There is a related concept, called the Law of Diminishing Intent that says, "The longer you wait to do something, the greater the odds that you will never actually do it."  

Procrastination is one of the most common derailers to success.  Getting started is one of the most difficult things for all of us to do, whether it's a personal goal or a professional one.  We have to overcome a lot of inertia to get started on a project or task, and the easier option is often to just delay or procrastinate.  

Carpe diem or Just Do It - whatever motivates you to get started, the important thing is to get started.  There's an important difference between deciding and doing.  Sometimes, we just need to get started doing.

"Clear the mechanism"

I recently finished a book called 4th and Redemption by Cincinnati St. Xavier High School football coach and 2013 Don Shula NFL High School Coach of the Year, Steve Specht.  St. Xavier has won four Ohio Division I state titles in football under Coach Specht (2005, 2007, 2016, and 2020), including the mythical National Prep Poll national championship in 2007.  The book is about the 2016 season, in which St. Xavier barely made the play-offs with a 5-5 record and won their final 4 games in "come from behind" fashion, including a 27-20 double overtime win against perennial football powerhouse and rival Cleveland St. Ignatius in the championship game.  Coach Specht writes, "This book is about hope in the midst of struggle – and we all struggle.  But there’s always hope. This team overcame so much adversity. They kept plugging and didn’t give up.”

It's a good read, even if you know or care very little about high school football in Ohio.  As I have reflected so many times in previous posts, the lessons we learned from participation or watching sports can often be applied to life in general.  Sports is a great metaphor for life.

Coach Specht talks about a concept that the team used to get through a number (an almost unbelievable number) of season-ending injuries to key players on the team - "Clear the Mechanism"  - in other words, "No more distractions.  Let's put the past behind us and focus on the task at hand."  The phrase comes from the 1999 movie, "For the Love of the Game" starring Kevin Costner and the late Kelly Preston, which is based on a novel of the same name by the author, Michael Shaara (who won the 1975 Pulitzer Prize for Fiction for his novel, "The Killer Angels" about the Battle of Gettysburg).  Kevin Costner plays Billy Chapel, an aging major league baseball pitcher who pitches a perfect game (no hits, no runs, no walks) against the New York Yankees in his final game.  Chapel whispers the phrase at the start of the game to eliminate all of the distractions - the sights and sounds and raucous fans - and focus on what he is there to do - win the game. 

For Billy Chapel and the 2016 St. Xavier Bomber football team, there were so many distractions that could have prevented them from reaching their goals.  "Clear the mechanism" focused 100% of their effort, energy, and attention on the goal, not on all of the other distractions.  Focus on the things that you can control - if you can't control something, it's not worth worrying about it.  

As the Stoic philosopher Epictetus writes in The Enchiridion, "There is only one way to happiness and that is to cease worrying about things which are beyond the power of our will."  In other words, worry only about what you can control - and what do you have control over?  Again, Epictetus writes, "Some things are in our control and others not. Things in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions."  

Clear the mechanism.

Reflections on leadership

About a week or so ago, I was invited to speak in front of a group of Master of Science in Nursing graduate students on my personal leadership journey.  I thought long and hard about what I would say to this group of new leaders.  I started out by telling them why I became a physician in the first place - as cliched as it sounds, I actually did want to help people.  Service has always been important to me, and I became a physician because I felt called to serve.

I also talked about how I joined the Navy during my second year of medical school - again, another opportunity to serve, though it was also a way to pay for my medical school education.  I shared with the group that after finishing my pediatrics residency, I completed my active duty service obligation by serving as a general pediatrician, first in Guam and then at the Naval Hospital, Camp Lejeune.  While I truly enjoyed my time in the Navy, I left for two main reasons.  First, I knew that I wanted to continue my education and training as a pediatric critical care physician.  Second, I felt that the only way to advance your career in the Navy as a pediatrician was to become a health care administrator.  I reasoned at the time that there was no way I would ever do that (I think I said something to the effect of "Over my dead body"), so I left active duty.  Ironically, here I am several years later - a health care administrator!

Someone once told me that whenver you speak to a group, you should try to stick to 3 key points.  Nothing more, nothing less.  I have always tried to follow that advice, and this particular time was no different.  Here is what I told the group.

1. "Focus on the job that you have, not the job you want to have."  

It's hard to plan out your career.  I am a great example of that - I never thought that I would be doing what I am doing now.  I've worked with and mentored leaders who have tried to plan out their career step by step - "I will take this job, because it will give me the experience that I need for the next one."  I've never subscribed to that theory.  If you focus on being the best that you can be - in your current position - the opportunities for career advancement will come soon enough.  Leo Tolstoy once said, "There is only one time that is important - NOW!"  If you are always focused on the future, it's hard to be successful in the present.  

2.  "Leaders eat last."

I've talked about this a few times in the past (see here and here for my most recent posts on this subject).  Leadership is all about taking care of your team.  The only way that you will be successful is if your team is successful.  There is an unwritten rule in the military that leaders let the troops eat first.  Simon Sinek (who incidentally wrote a book entitled "Leaders Eat Last", which I highly recommend) said, "The true price of leadership is the willingness to place the needs of others above your own. Great leaders truly care about those they are privileged to lead and understand that the true cost of the leadership privilege comes at the expense of self-interest."  Words to live by for sure.

3. "Leadership is lonely."  

I've said this before too (see my post on the Hollywood movie, "Twelve O'Clock High" which is a great illustration of this point).  I've heard this time and again from new leaders.  It's been written about and talked about many, many times.  Mandy Gilbert, writing for Inc. magazine said, "As the person in charge, it's inevitable that you'll be treated with a different regard than when you were a regular member of the team...You're no longer one of the gang.  You're one of them."  Leadership is lonely - but I would offer this additional perspective.  You are never truly alone as a leader.  You have a team around you that will energize and inspire you to lead them.  

I have been blessed with opportunities throughout my career.  It has been a journey for me - one that I would never trade.  And most importantly, the journey doesn't end.  I told the group that I am always trying to learn more, grow more, and be more.  The motivational speaker, Brian Tracy said, "Excellence is not a destination; it is a continuous journey that never ends."  So it is with leadership.

LA Speed Check

There's an old adage, "If you can measure it, you can improve it."  I absolutely agree - unfortunately, there is a corollary that says, "If you can measure it, you can rank it."  I've talked about two related concepts in the past known as Goodhart's Law and Campbell's Law (see "Your quality measure is no longer useful" and "Forced ranking - Goodhart's Law redux?", respectively).  

Goodhart's Law states that "When a measure becomes a target, it ceases to become a good measure.  When we establish a certain measure for performance, our natural response is to rank individuals on how they perform on that measure.  It follows that the individuals being ranked will work hard to improve their performance on that measure.  For example, when teachers are evaluated on the ability of their students to achieve certain benchmarks on standardized testing, studies show that they will "teach to the test" and emphasize the concepts that appear on the test to the exclusion of the ones that don't.      

Campbell's Law basically says, "When a measure becomes a target, people will be motivated to cheat in order to achieve that target."  Take, for example, the Wells Fargo accounting fraud scandal that came to light in 2016.  Wells Fargo established certain targets for their bankers - open a certain number of new credit card accounts every month, as one example.  Several employees of the bank actually opened up dummy accounts in order to meet these strict quotas.  Unfortunately, this was just one example of many cases of fraud, which ended up costing Wells Fargo fines and lawsuits totaling almost $3 billion.

Whenever we rank individuals (or organizations for that matter) based upon an attribute or performance, we run the real risk of creating another example of Goodhart's or Campbell's Law.  We take great pride at being the best - and it often gets us into trouble.

Brian Shul, a retired major in the United States Air Force, flew over 200 combat missions in the Vietnam War.  After nearly losing his life after being shot down towards the end of the war, he eventually returned to the United States and flew the SR-71 Blackbird, at the time one of the fastest military planes in existence.  The SR-71 was designed to fly at extremely high altitudes (85,000 feet) at high speeds (Mach 3.2, or three times the speed of sound).  If the "bad guys" shot a missile at the SR-71, it could just outrun the missile.

Shul tells a story that has come to be known as the "LA Speed Check".  Shul and his co-pilot "Wally" were on a routine training mission flying their SR-71 over the western United States.  Importantly, commercial air traffic controllers can see military aircraft on their radar scopes, though Shul's SR-71 was far higher than any other aircraft and was largely ignored.  Shul started to monitor the commercial radio traffic - in this case the communications between airplanes flying around Los Angeles (Los Angeles Center).  They first heard a lone Cessna pilot asking for a ground speed check.  The reply from Los Angeles Center was, "November Charlie 175, I'm showing you at ninety knots on the ground."

A few minutes later, the pilot of a slightly faster Twin Beech plane asked, in a slightly more arrogant "I'm faster than you are" voice for a speed check.  Again, Los Angeles Center replied, "I have you at one hundred and twenty-five knots of ground speed."

Not to be outdone, a nearby Navy pilot flying a F-18A Hornet called for a speed check in an incredibly cocky voice, "Center, Dusty 52 ground speed check."  Again, the reply, "Dusty 52, Center, we have you at 620 on the ground.”

Now, as he listens to all of this back-and-forth chatter, Shul wonders why the Navy pilot needs a speed check.  He is flying one of the most sophisticated airplanes in the world, and his air speed is displayed right in front of him on his "Heads Up Display."  Clearly this is a situation where the Navy pilot simply wants to rub it in that he is flying the coolest, the fastest, and the baddest plane in the sky!

By this point, Shul is ready to play around some.  They are flying about 13 miles above the Earth at speeds approaching 2,000 knots.  Regardless, in his calmest voice, Shul asks, "Los Angeles Center, Aspen 20, can you give us a ground speed check?”  Again, the reply, "Aspen 20, I show you at one thousand eight hundred and forty-two knots, across the ground."

At this point, Shul's co-pilot Wally joins in on the fun.  "Ah, Center, much thanks, we’re showing closer to nineteen hundred on the money."  The last reply from Los Angeles Center comes next, "Roger that Aspen, Your equipment is probably more accurate than ours. You boys have a good one."

The lesson here?  There's always someone who is going to be smarter, stronger, or faster than you.  There will always be organizations that are better positioned to succeed than your own.  It's all okay.  The important lesson is not to get too caught up in being at the top, thereby risking a "Campbell's Law" kind of situation.

Legendary UCLA college basketball coach, John Wooden, said, “Never try to be better than somebody else.  But most importantly, never cease trying to be the best you can be.”  We will always have performance goals and targets, and we will always have standards by which we are compared with others.  The important thing, in the end, is how we measure up to ourselves.

"All you need is faith, trust, and a little pixie dust..."

The Scottish writer, J.M. Barrie is best known as the creator of Peter Pan, the main character in his 1904 play and 1911 novel, Peter Pan, or the Boy Who Wouldn't Grow Up.  The stage play was a huge success, and the novel was an instant bestseller.  In fact, the novel has never been out of print.  Peter Pan was further immortalized in the 1953 Walt Disney film of the same name, which has always been one of my favorite Disney films.

What's not as well known is that in 1929, Barrie gifted the copyright for Peter Pan to the Great Ormond Street Hospital, one of the leading children's hospitals in the world.  In 1988, the House of Lords passed a special amendment to the United Kingdom's Copyright Designs and Patent Act, which gave the rights to Peter Pan to the hospital in perpetuity.  In honor of Barrie's gift, there is a statue of Peter Pan at the entrance to the hospital, although he looks a little different than the character in the Disney film.

One of my favorite scenes in the movie is when Peter Pan teaches the three Darling children how to fly - "All you need is faith, trust, and a little pixie dust" (the scene is accompanied by the song, "You can fly").  As my children will attest, the Peter Pan ride at the Disney theme parks is my absolute favorite.  

I've referred to magical "pixie dust" (technically, "fairy dust") a few times in the past (see "Vontae Mack no matter what").  ESPN anchor Chris Berman says at the end of the 2014 movie, "Draft Day", that "General manager Sonny Weaver, Jr. took one pick in the first round, the number seven pick. He sprinkled it with fairy dust, wished upon a star, and somehow, he turned it into not one, not two, but three potentially impactful players for his team next year. One pick!"  In other words, a little "pixie dust" creates magic - it's one of the key ingredients for innovation!

I am using "pixie dust" metaphorically, of course.  With a little innovation and creativity, one can create the proverbial something out of nothing - just like magic!  With a little persistence and focus, even the small things can be turned into something special.  Unfortunately, more often than not, we fail to appreciate just how special these "small things" can be in our lives.  We spend more time focusing on the big and important things, when at times, the seemingly insignificant or mundane things may be just as important.  

Think about it.  We very rarely perceive how things can change, even during a single day.  Let's say that you want to get in shape or take off a few of the COVID-19 pounds that you gained over the pandemic.  You go to the gym today, or eat a salad for lunch instead of a turkey sandwich.  You don't necessarily notice the impact of that single work-out or that one-time decrease in calories on your overall level of fitness or weight.  Not after a single day anyway.  But over time, those small little changes can turn into something much bigger, and pretty soon you are running 3 miles again without getting out of breathe, or you are back to your pre-pandemic "fighting weight."  Every little thing counts, and the journey of 1,000 miles begins with just one small step.  That's the way that continuous improvement works.

I discussed the concept of the "butterfly effect" in my last post (see "For want of a nail..."), which describes how small events can grow and propagate to produce an extraordinarily big impact.  Under the right set of conditions, we can leverage the "butterfly effect" to our advantage.  I am not necessarily talking about setting in motion something like the "butterfly effect," but rather creating the necessary conditions through which a small event can grow and become a big event - in this case, a positive or beneficial "big event."  An approach based upon diversity, creativity, and innovation (back to "pixie dust") can produce what the safety science researcher, Sidney Dekker has called (see his book, "Drift into Failure"), a "drift into success."

Case in point - a few years ago, a 26 year-old Montreal man traded a red paper-clip for a house.  Technically, he traded the red paper-clip for a pen shaped like a fish, but through a series of 14 trades and swaps, he eventually ended up with a house!  It took him a little over a year to do it, but the story of how he accomplished the feat is both entertaining and instructive (you can watch his TED talk here).  Along the way, he met rocker Alice Cooper and actor Corbin Bernsen.  

Drift into success.  Turn a red paper-clip into a house.  Sprinkle on a little pixie dust.  That's all it takes.    

"For want of a nail..."

The meteorologist and mathematician Edward Lorenz once suggested that the flap of a butterfly’s wings might ultimately cause a tornado.  The story is now legend - essentially, on a cold winter's day half a century ago, Lorenz was punching numbers into a computerized weather simulation.  The simulation was based upon several different variables, including temperature and wind speed.  He had run the simulation earlier in the day and was repeating it to validate his initial results.  As many of us do in similar situations, he briefly left the computer program running while he went to go for a cup of coffee.  He was shocked to find, upon his return, that the results had dramatically changed.  He had changed one of the variables, basically rounding off a few decimal places (0.506127 was changed to 0.506) and was amazed to see how such a small change had produced a much larger change in his results.  

Lorenz published his findings in a little known paper entitled, "Deterministic Nonperiodic Flow" in the Journal of the Atmospheric Sciences in 1963.  Few scientists paid attention to this paper at first, and over the next decade the paper was cited just three times by researchers outside the field of meteorology.  However, over time, this little known paper described one of the foundational principles of the new field of chaos theory, with applications in fields as diverse as biology, geology, and physics.  The concept has even made its way into pop culture.  Robert Redford's character in the 1990 movie, Havana claimed, "A butterfly can flutter its wings over a flower in China and cause a hurricane in the Caribbean."  Jeff Goldblum's character in Jurassic Park said, "A butterfly can flap its wings in Peking, and in Central Park, you get rain instead of sunshine."

I'm not sure if I can believe that a butterfly flapping his wings in one part of the world can cause a hurricane on the other side of the world.  What is important to recognize, however, is the concept that, in Lorenz's own words, "nature is highly sensitive to small changes" (for additional comments, please see one of my earlier posts during the COVID-19 pandemic, "...all of this has happened before").  I was certainly reflecting on the "butterfly effect" when I wrote my last post on my own challenges with air travel this past weekend ("The razor's edge").  

There is an old poem that goes back as far as the 13th century that further illustrates how seemingly small, insignificant changes can produce large, and often dramatic, effects.  It's frequently mentioned in pop culture as well, so you may have heard of it:

For want of a nail the shoe was lost.

For want of a shoe the horse was lost.

For want of a horse the rider was lost.

For want of a rider the message was lost.

For want of a message the battle was lost.

For want of a battle the kingdom was lost.

And all for the want of a horseshoe nail.

It's a great allegory, but here's an even better one from an actual event in history.  Anthony Eden was British Prime Minister Winston Churchill's Foreign Secretary in 1952 when he began to suffer severe bouts of abdominal pain and jaundice due to gallstones ("biliary colic").  The Queen's own personal physician, Sir Horace Evans recommended surgical removal of Eden's gallbladder, which was performed by a surgeon named John Basil Hume.  Hume was a very senior surgeon, but he was close to retirement and had not operated very much at that time (he had apparently removed Eden's appendix several years earlier, which is why Eden chose him to perform the procedure).  Unfortunately, Hume botched the procedure, which led to a number of complications and frequent bouts of illness for the rest of Eden's life.

Fast forward a few years to 1956, when Anthony Eden is now the British Prime Minister.  Egyptian President Abdel Nasser ordered his military forces to take over control of the Suez Canal (note that all of these events were detailed in a season 2 episode of the Netflix show "The Crown"), which quickly escalated into an international crisis (read more about the Suez Crisis here).  Three weeks later, Israel invades Egypt, and Eden quickly calls for British and French forces to occupy the Suez Canal Zone on the pretext of preventing further escalation between Israel and Egypt.  In reality, he wanted the Suez Canal back under international control in order to maintain delivery of oil to Western Europe.  Rather than restoring calm, Eden's actions throughout the crisis only worsened the situation.  Both the United States and the United Nations became involved, and all of the parties agreed to a ceasefire.  British and French forces withdrew, but Britain lost control of the Suez Canal (and many would say that was the day that the British Empire truly ended).

Historians believe (see here) that Eden, who was normally a very calm and cautious diplomat, had made a rash and ill-considered decision, largely as a result of his illness.  He suffered one of his bouts of abdominal pain and fever during the crisis, which adversely affected his decision-making and thought processes.  As a result, his actions of ordering a military intervention were entirely uncharacteristic.  He resigned in disgrace, and as I mentioned above, the British Empire was never the same again.  "For want of a nail...the kingdom was lost."

So, what are the leadership lessons here?  Most importantly, leaders should recognize that small, seemingly trivial or inconsequential events can have a dramatic impact.  That can be good or bad.  First, leaders have a tremendous opportunity to make a big impact (either positive or negative) with a relatively small change.  As a result, the intangibles or so-called "soft skills" of leadership, like building trusting relationships, establishing rapport and mutual understanding, and building morale are all incredibly important.   Second, the simple fact that small events can become big events makes it difficult to plan ahead for an unexpected or unintended outcome.  Most of work in complex environments, where event B may not always follow event A in any kind of organized, characteristic sequence.  We can mitigate these effects through high reliability principles (e.g., reluctance to simplify, commitment to resilience, deference to expertise, sensitivity to operations, and preoccupation with failure).

For those of us who work in these complex environments, we need to remember that "a butterfly can flutter its wings over a flower in China and cause a hurricane in the Caribbean" or a kingdom can falter "for want of a nail."

The razor's edge

The actor and comedian (and noted Chicago Cubs fan) Bill Murray starred in his first dramatic role in the 1984 film The Razor's Edge, based on the 1944 novel of the same name by W. Somerset Maugham.  There's a famous scene from that movie, where Murray's character has joined a Buddhist monastery and starts to feel like he has finally found inner peace.  One of the Buddhist monks tells him, "The path to salvation is narrow and as difficult to walk as a razor's edge" (which is paraphrased from a verse in the Katha Upanishad.  I can't say that the movie is one of my favorites (because it's not), but I love the quote.

I will shamelessly paraphrase this great quote and suggest that the line separating order from chaos is as thin as a razor's edge.  I've written a number of posts in the past on high reliability organizations, organizations that have succeeded in avoiding catastrophic accidents in environments where these accidents would be otherwise expected to occur with high frequency.  There is a related concept that I've spent less time talking about, known as Normal Accident Theory.  "Normal accidents" (the term was coined by Charles Perrow in the early 1980's) occur in industries characterized by complex and tightly coupled systems.  In other words, these accidents are expected to occur - hence, they are "normal."  High reliability organizations appear to avoid these so-called "normal accidents," which is why I find them so interesting to study.

The phrase "tight coupling" deserves some discussion here as well.  Tightly coupled systems are mutually independent such that even a small error in one part of the system can easily compound and propagate to the point where the whole system is adversely impacted.  Tightly coupled systems exist on the imaginary boundary - that razor's edge, if you will - between order and chaos.  

"Tight coupling" is an important concept to understand, so let me illustrate with an example.  The commercial aviation industry pushes right up against that razor thin border between order and chaos all the time.  Just think about it - airlines regularly overbook flights with the expectation that a certain number of passengers will cancel or miss their scheduled flight (a full plane is a lot more profitable than a half empty one).  This kind of set-up usually works to the airlines' advantage, but every once in a while something happens that creates chaos throughout the system.  Aircraft and flight crew rotation schedules are set up in such a way where everything seems to work until it doesn't.  Again, one event can create chaos across the system.

Just this past Sunday, there was a major thunderstorm in the southeastern part of the United States, which caused widespread flight delays across the United States.  Over a hundred flights were canceled at Fort Myer's Southwest Florida International Airport (RSW), causing passengers to face delays as long as 14 hours or more in some cases (those were the lucky ones - many of the passengers were stranded - including my wife and I, who were on our way back home).   Even though the weather in Fort Myers was close to perfect, flights coming out of RSW were delayed because they were waiting on planes coming in from airports north of the thunderstorm.  In some cases, inbound aircraft coming from Atlanta and other cities were forced to wait on the tarmac for as long as five hours before they were cleared for take-off.  A few incoming flights were re-routed to other airports instead.  Unfortunately, the thunderstorm eventually moved into Southwest Florida, which only caused further delays.

Passengers inside the RSW terminal were stranded and left to wait, often with little communication from the airlines.  Eventually, a number of flights were either canceled or delayed until Monday morning, as a number of the crews "timed out" (they reached the FAA's regulation for duty hours).  Chaos ensued, and not just in the "friendly skies."  As more and more passengers became stranded, the facilities at RSW were unable to handle the excess load.  Restaurants and convenience stores ran out of food and drinks.  Rental cars, Uber and Lyft drivers, and even hotel accomodations grew more and more scarce as the day turned into night.

My own firsthand "eyewitness" impression was that things quickly got out of control.  Patience grew thin and tempers began to rage.  It wasn't pretty.  It was chaos.  Luckily, my wife and I were able to get on a flight the next morning.  However, not everyone was as lucky - a number of passengers were told that they would have to wait one or two additional days before they would be able to catch a flight out of Fort Myers.

The commercial aviation system is tightly coupled - one event in one part of the system can compound and propagate to adversely impact the entire system.  The imaginary border between order and chaos is truly as thin as a razor's edge.  

High reliability organizations seem to have figured this out.  They are by no means immune to these potentially catatrophic events.  However, they have learned to develop the kind of resilience that prevents these potentially catastrophic events from becoming catastrophic.  They do that through:

1. Sensitivity to Operations

2. Deference to Expertise

3. Commitment to Resilience

4. Reluctance to Simplify

5. Preoccupation with Failure

There are likely other important lessons from this example that also illustrate how High Reliability Organizations minimize the impact of these potentially catastrophic events.  Communication and transparency are clearly important.  The airlines could have saved themselves a lot of trouble by just being more open and honest with the passengers.  At one point, after waiting several hours to leave, passengers were just about ready to board a plane when they were told that the crew had "timed out."  I do agree with the need to restrict duty hours, but I do find it hard to believe that the airlines didn't know that the flight crews were approaching that duty hour limit.  Why tempt the passengers with the possibility of an actual departure?

High Reliability Organizations, similar to commercial aviation, push the boundary between order and chaos.  Where High Reliability Organizations are different, however, is that they continuously thrive at the boundary zone between order and chaos, and for this reason, they are not subject to Perrow's "normal accidents."

The grit in the oyster

I recently came across an article that discussed something that I've never considered before.  Where do pearls come from?  I've always known that pearls are found in oysters, but why exactly do oysters make pearls?  The answer provides a really great analogy for life and leadership.  

Think about it - the word pearl is itself a metaphor for something rare and valuable.  For example, when we talk about important knowledge or advice, we often use the term "pearl of wisdom."  A pearl is considered one of the oldest and most precious of the precious gems, having been traded for over 6,000 years.  It is often called the "queen of the gemstones", and people in ancient times thought that pearls were the tears of angels.  If you are so inclined, pearl is one of the birthstones for the month of June and is typically given on the 3rd and 30th wedding anniversaries. 

Back to the original question - where do pearls come from?  Pearls, as I stated earlier, are organic (they are actually one of a small number of organic gemstones).  They grow inside molluscs (oysters, clams, and mussels), and they are essentially made of calcium carbonate.  But here is the really cool aspect of pearls - they actually start out as a piece of sand, grit, or other foreign object - in other words, an irritant!  In order to protect itself, the mollusc secretes a shiny, silky substance called nacre (also known as "mother of pearl" for obvious reasons now) to cover the irritant and wall it off from the rest of the organism.  Nacre is the same substance that lines the inner portion of the shell.  Over time, the mollusc will continue to secrete nacre around the piece of sand until it forms a pearl!

Think about it - pearls essentially exist as a defense mechanism against an irritant!  One of the most precious of gems starts out as the "grit in the oyster."  The metaphor here is a beatiful one.  Call it whatever you want, perseverance or resilience, we too can make a pearl out of a piece of sand.  

The philosopher Friedrich Nietzsche famously said, "That which does not kill us makes us stronger."  

Winston Churchill said, "If you are going through Hell, keep going."  

And Helen Keller said, "We can do anything we want to do if we stick to it long enough."  

Nelson Mandela said, "It always seems possible until it's done."  

The Navy SEALS live by the motto, "The only easy day was yesterday."  

All of these quotes essentially say the same thing - no matter what the trial in life we face, if we keep trying and don't quit, we can make something beautiful (a pearl), out of something ugly (a piece of grit).

Don't be an agent of chaos!

Everyone in our family has heard me say it - "the deepest, darkest corner of Hell is reserved for people who drive slow in the fast lane."  It always seems that whenever I am in a hurry, it's inevitable that I will get trapped behind another driver who is going 5 or 10 mph below the speed limit in the passing lane. Driving slow in the fast lane is considered a cardinal sin (or at least it should be).  These drivers just don't break up the normal flow of traffic, they violate a fundamental law of nature by disrupting the natural order of the universe.

We do not like chaos.  Congested traffic causes chaos (for everyone, not just me!).  If you need proof, just consider the recent events in which the container ship, the Ever Given blocked the flow of traffic through the Suez Canal and in so doing, disrupted the global economy!  

Compare and contrast the situation in the Suez Canal or the traffic jam that often results when someone is driving slowly in the passing lane with the incredible beauty, order, and symmetry of a flock of starlings in flight (see a beautiful video here).  It's called murmuration, and it's absolutely fascinating to observe.  It's incredible that starlings are able to generate order out of chaos in this manner.  What's even more amazing is the fact that scientists can artificially produce a similar phenomenon in a computer simulation with just three simple rules (see the video of Craig Reynold's "boids" algorithm here and here):

1. Separation - steer to avoid crowding local boids and other objects

2. Alignment - steer towards the average heading of local boids

3. Cohesion - steer to move towards the average position of local boids

It's pretty amazing to watch.  Scientists have studied the flocking behavior of a number of animal species, including starlings.  We can observe similar phenomena with schools of fish.  It's been worked out mathematically (see "Effective leadership and decision-making in animal groups on the move"), and similar processes have even been observed in humans in the laboratory setting (see "Consensus decision making in human crowds").  We are, in fact, part of the animal kingdom.  So, whether our ability to move through crowds or in crowds is our innate "animal senses" or some other as yet unrecognized pattern of human behavior, the fact remains that we can create order out of chaos, in ways very similar to the murmuration behavior of starlings.

Now there is one last thing that annoys me (and it probably annoys you too).  Have you ever walked down the side of the street only to narrowly escape walking into another person who is texting on his or her cell phone?  Which brings me to my last scientific study.  Hisashi Murakami, a professor at the Kyoto Institute of Technology recently published the results of a series of outdoor experiments performed on the campus of Tokyo University, in which he and his colleagues filmed two groups of students walking down a narrow path about 30 feet long (see "Mutual anticipation can contribute to self-organization in human crowds").  The two groups walked towards each other at a normal walking pace.  Murakami and his colleagues noted that the groups of students effortlessly and spontaneously formed separate channels through the traffic.  In the follow-up experiments, three of the students were instructed to perform a simple task on their cell phone.  The result?  Complete chaos!  Just this small number of distracted walkers completely slowed down the flow of traffic and disrupted the organized patterns with which the students effortlessly moved through traffic.  Veronique Greenwood, writing for The New York Times, called these students "agents of chaos".

The simple lesson here is "Don't be an agent of chaos."  Never drive slower than the normal flow of traffic in the passing lane and don't ever walk down the street with your face buried in your cell phone!  But what's the real lesson here?  There is a natural, spontaneous order to the universe demonstrated by flocks of starlings, schools of fish, and humans walking in crowds.  The same can be said for organizations.  We frequently find that organizations can create order out of chaos, and similar to the aforementioned boids, leaders can help facilitate this natural, spontaneous order with just a few simple rules.  

First, top-down mandates rarely, if ever, create this natural order.  On the contrary, top-down mandates frequently create chaos.  Second, leaders frequently try to create order within the organization by changing or adding more rules.  Again, the studies above suggest that order can be created with just a few simple rules.  Too many rules leads to chaos.  Third, and perhaps most important, cohesion and alignment are critically important.  Leaders can help foster alignment by creating a shared vision, and they help facilitate cohesion by making sure that everyone on the team understands and buys into that vision.  

The year of Karen

A few months ago on December 27, 2020, Julia Carrie Wong wrote an article for the British daily newspaper The Guardian declaring that 2020 is the "The Year of Karen".  You may have watched M&M's Super Bowl LV ad (the $5 million campaign is called M&M's Bring Peace to the World) in which a man hands a woman a bag of M&M's while apologizing for "mansplaining" (and then, of course, proceeding to explain "mansplaining to the woman), as well as other examples of how arguments and disharmony are resolved with M&M's.  One woman even hands a bag to another woman, saying, "I'm sorry I called you Karen."  Of course, then Karen replies, "That's my name," leading the other woman to hand over another bag of M&M's while saying, "I'm sorry your name is Karen."

What's all the fuss about Karen?  If you don't know (and forgive me if I am "mansplaining" here), the name "Karen" has become a pejorative term to describe any woman who seems to be self-entitled or demanding beyond the scope of what would be considered normal.  The term is often used to describe a white woman who uses her "white privilege" to demand her way.  The term has been linked with anti-vaccination beliefs, prejudice, microaggression, and overt racism, and apparently there is even a characteristic hair-cut associated with this stereotype called the "Can I speak to your manager?" haircut (see the description for that here).  In the aforementioned article by Julia Carrie Wong in The Guardian, the "Karen" meme has helped change the way that America talks about racisim.  She writes, "The image of a white woman calling police on Black people put the lie to the myth of racial innocence."

As it turns out, there are other pejorative uses of both male and female proper nouns.  For example, Drs. Molly Carnes and JudyAnn Bigby wrote an article in the Journal of Women's Health in 2007 defined what they called "Jennifer fever" as it pertains to academic medicine.  They actually built upon a concept first defined by Barbara Gordon in a 1988 book, Jennifer Fever: Older Men / Younger Women.  At the time of Gordon's book, "Jennifer" was the most popular girl's name at the time.  Gordon used the name to describe younger women who attract the attention of older men, frequently at the expense of neglecting older women their own age (who Gordon called, "Janets").  Carnes and Bigby similarly describe the problem where mid-career male faculty in academic medicine (who they call, "Daves") mentor, coach, and help develop younger female faculty.  Unfortunately, this level of mentorship and career assistance is short-lived.  Once the female faculty members get to the point where they compete with the "Daves" (in other words, once they reach the "Janet" stage), they are frequently abandoned and left on their own.

The "Jennifer" and "Janet" problem is real.  According to a follow-up article by Drs. Anna Kaatz and Carnes, while women and men enter academic medicine at roughly the same percentage (and in my own specialty, pediatrics, more women are entering the field than men), women account for only 32% of associate professors, 20% of full professors, 14% of department chairs, and 11% of deans at U.S. medical schools.  As another article points out, academic medicine is "making mid-career women physicians invisible."

There's even more pejorative names (see, for example, the Matilda effect  which follows loosely something known as the Matthew effect), but in the interest of your time, I will just refer you to the links.  Unfortunately, the "Matilda effect" (in which male colleagues take credit for discoveries made by females) is also alive and well in academic medicine.  So, as we have moved on from Women's History Month in March, what can we do to prevent "Jennifer" from becoming "Janet" or make sure that "Matilda" gets the proper credit that she deserves?  

As one article emphasizes, mentorship is not enough.  Mentorship is incredibly important, but sponsorship is just as important, maybe even more so.  "Sponsorship" is defined as "active support by someone appropriately placed in the organization who has significant influence on decisionmaking processes or structures and who is advocating for, protecting, and fighting for the career advancement of an individual."  I like to think of "sponsorship" as "mentorship on steroids"!  Sponsors are often placed higher in the organizational hierarchy.  As such, these individuals have already "arrived" or "made it to the top" and will feel less threatened by the academic success and promotion of mid-career female faculty.

There are myriad articles on mentorship in academic medicine.  However, there are surprisingly few articles on sponsorship.  Maybe now is the time to change that.  I wish it could be as easy as handing out bags of M&M chocolate candy, but it's not.  It's going to take dedicated effort, commitment, and dedication to address the gender disparities in academic medicine.  Some day, maybe we will look back on the "Year of Karen" and be able to recognize that this was the time when things finally started to change.