Top Ten Leadership Reverie Posts of 2021

It's that time of year again, when everyone starts putting together their annual "Best of..." or "Top 10" lists.  Here are the "Top 10" (in terms of most viewed) Leadership Reverie blog posts for the year 2021:

1.  "What you permit, you promote..." (February 15, 2021)

2.  "Better a live donkey than a dead lion..." (March 16, 2021)

3.  "Sully's miracle" (May 2, 2021)

4.  "The grit in the oyster" (April 11, 2021)

5.  "Anyone can lead when the plan is working..." (October 17, 2021)

6.  "Hobbits and orcs, chickens and foxes, and the story of Velcro" (June 20, 2021)

7.  "Do hospital rankings matter?" (June 30, 2021)

8.  "Dart-throwing monkeys" (July 21, 2021)

9.  "Our America" (January 7, 2021)

10. "I think I literally have a better understanding of who killed Kennedy than what is offside" (March 7, 2021)

"Blue sky on Mars. That's interesting..."

Arnold Schwarzenegger, seven-time Mr. Olympia, former governor of California, and movie actor starred in the 1990 movie Total Recall based upon the science fiction writer Philip K. Dick's short story, "We Can Remember It for You Wholesale".  Apparently there was a remake in 2012 starring Colin Farrell, Kate Beckinsale, and Jessica Biel, but I don't think it was as successful as the original.  Besides, I never saw the remake.  The original was entertaining and had all of the usual Arnold one-liners.  The concept, however, was particularly interesting.

Basically, the movie takes place in 2084, and the planet Mars has been colonized by the people of Earth.  Schwarzenegger plays construction worker Douglas Quaid, who has recurring dreams about Mars and a mysterious and beautiful woman (who is not his wife).  He ends up visiting a company called Rekall that implants realistic, but false memories to spice up a boring life.  Quaid selects a memory that he is a secret agent working on Mars.  One of Rekall's techs comments, "Blue sky on Mars.  That's interesting."

Before the memory is implanted, he experiences a mental break and starts believing that he really was a secret agent.  Of course, Quaid ends up on Mars and for the rest of the movie, the audience has to separate truth from fiction, real memory from implanted false memory, and reality from fantasy.  The movie ends (of course, Arnold plays the hero and wins in the end) with a scene in which everyone on Mars looks up to see blue sky.  So if the memory was real, why did the tech at Rekall comment about the blue sky before he implanted the memory?  The blue sky on Mars suggests that it was all fantasy, but I guess we will never know for sure.

I've talked a little about the concept known as cognitive dissonance in an earlier post (see "Sour grapes and sunk costs..."), which I think is relevant here.  Cognitive dissonance states that when two actions or ideas are not psychologically consistent with one another, people do all in their power to change them until they become consistent.  At times, they may go as far as believing the unbelievable, say that they are a secret agent working on the planet Mars.   Remember, the original study by Leon Festinger involved members of a UFO religion in Chicago that believed in an imminent apocalypse - when the apocalypse didn't occur at the designated time (and the UFO's didn't arrive to pick up the church members and whisk them away to safety), the members didn't just abandon their strange beliefs, they actually doubled down and adhered to them even stronger.  

Here's the thing though - cognitive dissonance doesn't just apply to bizarre beliefs.  The social psychologists Carol Tavris and Elliot Aronson wrote an entire book providing everyday examples of cognitive dissonance, entitled Mistakes Were Made (but Not by Me).  As a still fictional, but more realistic example, Dan Gilbert in Stumbling on Happiness talks about the ending of the movie Casablanca (one of the greatest of all time, and my personal favorite).  Ilsa, Ingrid Bergman's character, wants to stay in Casablanca with Rick (played by Humphrey Bogart) instead of escaping from the Nazis with her husband (the plot details of how we ended up here don't matter, but trust me - watch the movie).  Rick (Bogart) tells her that she would always regret her decision not to leave with her husband, "maybe not today, maybe not tomorrow, but soon, and for the rest of your life."  Gilbert suggests that due to cognitive dissonance, regardless of the decision that Ilsa makes, it will always be the right one without any regrets.  She would have found reasons to justify either choice, along with reasons to justify not making the other one.  

Moving away from fiction, Tavris and Aronson mention the story of the 19th century Hungarian physician, Ignaz Semmelweiss.  It's a well-known and oft told story of how Semmelweiss suggested that physicians could drastically decrease the rate of puerperal fever (an infection after childbirth that was associated with almost 100% mortality in the pre-antibiotic era) if physicians would just wash their hands with soap and water.  He even conducted one of the first placebo-controlled clinical studies to justify his case.  For his efforts, he was ridiculed and lambasted by his colleagues, who not only refused to accept that hand-washing could reduce puerperal fever, but also convinced themselves that Semmelweiss was insane (truly).  Semmelweiss was eventually sent to an insane asylum, where he was beaten by guards and ironically died of a gangrenous wound infection.  

Even the statement "mistakes were made" is an example of cognitive dissonance.  In a sense, the speaker is saying, "Someone made a mistake, but it certainly wasn't my mistake."  The choice that Tavris and Aronson made for the title of their book was a brilliant one. 

The lesson here for leaders is that individuals and groups will hold on to their beliefs and perceptions, sometimes to the point of excluding all other possibilities.  If a mistake or negative outcome is involved, the tendency to hold on to these false beliefs and perceptions is even stronger.  I came across a quote from an anonymous author, "It's easy to judge the mistakes of others, but it's difficult to recognize your own mistakes."  We need to learn to be comfortable with making mistakes, because that is how we learn and succeed in the end.  And just as importantly, we, as leaders, need to create a psychologically safe environment so that others feel comfortable making and accepting their mistakes.  

Vitamin D

We all need vitamin D in order to maintain normal levels of calcium in our bodies.  Surprisingly, the single largest source of vitamin D is through synthesis of cholecalciferol (vitamin D3) in the lower layers of our skin epidermis through a chemical reaction that is dependent on exposure to the sun's ultraviolet radiation.  We can also get vitamin D through our diet (primarily via fortified milk, fortified breakfast cereals, or fish).   The biologically inactive cholecaciferol is converted to its active form in the kidney and liver.  

I was taught in medical school that one of the most common risk factors for vitamin D deficiency was inadequate exposure to the sun (people living far from the Earth's equator where there is less sunlight year-round are particularly at risk).  As winter fast approaches, the days have been getting shorter and shorter.  For the last several weeks, I have been walking to and from work in the dark (yes, I am fortunate enough to be able to walk to work right now).  I don't drink as much milk as I used to, so I am glad that starting tomorrow, the days will start getting longer again.  

Today, December 21st is the shortest day of the year - the winter solstice (which is technically defined as the day when the Earth's pole, in this case the North Pole, has reached its maximum tilt away from the sun)!  Starting tomorrow, the days will start to get longer again, and with more potential exposure to sunlight, my vitamin D levels should start to improve.  

December 21, 2021 is noteworthy, at least to me, for another reason as well.  If today is the shortest day of the year, it is also the longest night of the year.  Darkness will turn to light.  We wait with anticipation for the coming dawn, the light of a new day.  This year, of all years, we look to the sunrise with hope and anticipation.

I know it seems like things are getting bad again.  COVID-19 cases are starting to surge, and as infectious disease experts predicted, the Omicron variant of SARS-CoV-2 has become the dominant variant in the United States.  We've been dealing with this pandemic for almost 2 years, and I know people are tired of COVID-19.  However, I believe that we can still look to the future with hope and anticipation.  December 21st is truly symbolic.  There is, and there always will be, hope.

The author Orison Swett Marden said, "There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something better tomorrow."  The late Senator Edward Kennedy said, "The work goes on, the cause endures, the hope still lives, and the dreams shall never die."  Jesse Jackson said, "At the end of the day, we must go forward with hope and not backward by fear and division."  Finally, Desmond Tutu said, "Hope is being able to see that there is light despite all of the darkness."

Hope is our vitamin D.  We need the light of the coming dawn to give us hope.  We need hope to move us forward to the new day.

We can choose to look at all the things that are going wrong in our lives, and with the omicron variant, we seem to be going in the wrong direction.  Or, we can recognize that today is the darkest day of the year, which means that there is hope for tomorrow.  We can continue to do what we need to do to make sure that this pandemic will end, for all of us.  We can hope.  We can dream.  And we can go forward.

The Bermuda Triangle of Leadership

When I was growing up, I was absolutely fascinated with the legends surrounding the Bermuda Triangle (known by some as the Devil's Triangle), a triangular-shaped area of the Atlantic Ocean bounded by the city of Miami, the island of Bermuda, and the island of Puerto Rico.  The triangular area covers nearly 500,000 square miles of ocean, and since the time of Christopher Columbus, sailors and pilots have reported strange phenomena and erratic compass readings while traveling in that area.  In addition, there have been a number of ships, planes, and in one case, a group of five TBF Avengers (Flight 19) that have mysteriously disappearing while traveling through the Triangle.  Through the years, various individuals have blamed these disappearances on everything from space aliens to the famed lost city of Atlantis.  There are just as many skeptics, however, as there are believers.  The U.S. Coast Guard has reportedly said, "In a review of many aircraft and vessel losses in the area over the years, there has been nothing discovered that would indicate that casualties were the result of anything other than physical causes. No extraordinary factors have ever been identified."

The legends and mysteries of the Bermuda Triangle no longer quite hold the same level of fascination with me today as they did when I was ten years old.  I suppose that's what happens when you get older.  These days, I am intrigued by a concept that is called the toxic triangle of leadership (a term proposed and popularized by Art Padilla, Robert Hogan, and Robert Kaiser).  In honor of my childhood fascination, I propose that we call this the Bermuda Triangle of Leadership.   The concept here is that it takes more than just a bad leader to create a hostile work environment.  Rather, it is a confluence of a destructive leader with susceptible followers and a conducive environment that makes organizations suffer.  

The first side of the triangle is destructive leadership.  Importantly, we rarely deal with absolutes when it comes to leadership - there are likely to be positive and negative results produced by bad leaders.  Using the characterization developed by Adam Grant in his book, Give and Take, destructive leaders are primarily "takers" - individuals who try to get as much as they can possibly get from a relationship.  Destructive leaders have a selfish orientation (as opposed to being selfless) and lead through dominance, coercion, and manipulation rather than through influence, persuasion, and commitment.  Destructive leaders generally thirst for power and are prone to narcissism.  To use Adam Grant's terminology, they take more than they give, and their motivation focuses on consolidating their power and increasing their status.

There are usually checks and balances to counter destructive leaders.  Susceptible followers form the second side of the triangle.  Two types of followers support destructive leaders - colluders and conformers.  Conformers passively allow destructive leaders to assume power, while colluders actively support them.  Colluders often mimic the destructive leaders' behavior, because they benefit from the power it gives them.  Conformers tend to stay "below the radar" in order to keep their jobs or to avoid conflict.  

Given the right set of environmental conditions - the third side of the triangle - destructive leaders working with susceptible followers leads to organizational failure.  Weak oversight and governance, unclear ethical standards, and an inadequate system of checks and balances comprise the conducive environment that create disaster.  Place a destructive leader with a group of conformers and colluders in the wrong organizational culture and you have your leadership version of the Bermuda Triangle.

The design of everyday things

I just finished reading The Design of Everyday Things by Don Norman (for those of you who are paying attention, the book was on the 2021 Leadership Reverie Reading List).  The book is a best-seller that was fist published in 1988 with the title The Psychology of Everyday Things.  I read the updated, revised, and expanded edition that was first published in 2013.  

Several years ago, I took a six-week course in the science of continuous improvement at Cincinnati Children's Hospital Medical Center called the Intermediate Improvement Science Series, or I2S2 for short.  One of the assignments was to choose from a list of recommended books and present an overview to the rest of the class (basically, write and present a book report).  I actually selected another book for my report - The Fifth Discipline by Peter Senge.  I have really wanted to read The Design of Everyday Things ever since.  After a number of years, I finally looked the book up on Amazon.  The reviews weren't all that great, so I decided to hold off on reading it.

Last month, I took a chance and decided to check the book out from our local library.  I can honestly say that I really enjoyed the book.  Perhaps I would feel differently if I was a subject matter expert (in human-centered design), but I thought the book was very informative and readable.

When I first heard of the book in my improvement science class, my first reaction was, "What does a book on human-centered design have to do with continuous improvement?"  I was surprised - and I think you will be too - that the answer to my question was "plenty."  There are so many parallels between human-centered design and quality improvement, that I would argue that they are really almost one and the same.  

As an example, we often talk about a blame-free or just culture when it comes to patient safety in health care.  Individuals working in high reliability organizations work in a blame-free environment, where they are able to report errors or near misses without fear of reprimand or punishment.  Errors, almost always, result from defects in the system.  Norman writes about this concept in his book, "We need to remove the word failure from our vocabulary, replacing it instead with learning experience.  To fail is to learn: we learn more from our failures than from our successes."  He goes on to advise, "Do not blame people when they fail use your products properly.  Take people's difficulties as signifiers of where the product can be improved."  In other words, humans make mistakes.  When mistakes are made, re-design the system to prevent them from occurring again.

Norman describes in great detail the different ways that designers can force the desired behavior.  For example, he talks about using a forcing function (also called a poka-yoke in the Toyota Production System or Lean/Six Sigma) to "force" individuals to do the right thing.  As an example, drivers are unable to take a car out of park without first pressing down on the brake pedal.  Similarly, most ATM's "force" you to take the cash before you can remove your bank card.  

Norman goes on to talk about the different kinds of forcing functions - interlocks, lock-ins, and lock-outs.  For example, have you ever walked down the stairs of a public building and noticed a gate placed at the ground floor?  If you open the gate, you can walk down another flight of stairs to the basement.  The gate's sole purpose is to prevent people who are rushing down the stairs to escape a fire from continuing on (mistakenly) into the basement, where they could be trapped.  I have noticed those gates, but I never knew what they were for - mind officially blown!

Norman talks about something that he calls the "Iterative Cycle of Human-Centered Design," which he divides into four stages (admittedly, there are other versions of this same cycle in the design literature):

1. Observation

2. Idea generation (ideation)

3. Prototyping

4. Testing

Since this is a cyclical process (not a linear one), the "Testing" stage goes back to the "Observation" stage at the end.  If you are familiar with quality improvement, you will recognize this as a slightly different version of a Plan-Do-Study-Act or PDSA cycle.  Taking it one step further even, Norman recommends using small tests of change so that you an, as David Kelley (Stanford professor and co-founder of IDEO) calls, "Fail frequently, fail fast."  If the results of the test are negative, you can quickly move on to the next test without wasting further time and resources.

As if all this weren't enough, Norman dedicates an entire chapter ("Human Error?  No, Bad Design") to discuss the different kinds of human error and design principles that can be used to mitigate them.  I have to say that this chapter  was one of the best discussions of human error that I have ever read.    which he classifies as either slips ("a slip occurs when a person intends to do one action and ends up doing something else") or mistakes ("a mistake occurs when the wrong goal is established or the wrong plan is formed").  Notably, slips are more likely to be made by experts, while mistakes are more common with novices.  Norman talks further about rule-based, skills-based, and knowledge-based mistakes.  He also talks about error reporting and detection, the use of checklists, and the root-cause analysis technique.  

Overall, I think this would have been a great book to read during my improvement science class.  I am glad that I finally read it, and I would highly recommend it for anyone interested in improvement science, patient safety, or human-centered design.

Metric Madness

If you want evidence that people don't like change, look no further than the Metric system.  I first learned about meters, grams, and liters when I was in elementary school.  My teachers told me that soon, everyone around the world would be using the Metric system, which is a system of units of measurement that are based on the number ten.  It is relatively simple in concept and easy to understand.  Surprisingly (at least to me), the Metric system has been around since the 1790's, when it was first developed by the French.  

As of today, there are just three countries around the world that have still not officially adopted the Metric system - Myanmar, Liberia, and the United States.  Please note that the United States still officially uses a system of measurement adapted from the British Imperial system of measurement, which even the British moved beyond in 1965.  American scientists, hospitals, and Olympic athletes do, in fact, use the Metric system, though most Americans do not.  The late U.S. Senator Jesse Helms once said, "If God had wanted us to use the Metric system, Jesus would have had 10 apostles" (just for the record, Christian teachings state that Jesus had 12 disciples). 

Why are Americans so resistant to this change, especially when nearly every other country around the world have officially adopted the Metric system?  The U.S. Constitution gives Congress the power to "fix the standard of weights and measures" in Section 8 of Article I.  The Metric Act of 1866 legally recognized the Metric system, opening the door for the United States to adopt it as its official system of measurement.  However, adoption of the Metric system was never mandated, and most industries at the time continued to use the old system of measurement.  Congress tried again in 1975 with the passage of the Metric Conversion Act which declared that the Metric system was the "preferred system of weights and measures for United States trade and commerce."  However, adoption again was not mandated.  I suspect that until adoption is no longer mandatory, most Americans will continue to use the system of measurement that they are most comfortable with - the one adapted from the British Imperial system.

One of the major reasons Americans haven't embraced the Metric system is that people are just resistant to change.  We've talked about change resistance before.  Change can be uncomfortable.  I can remember a time when I was growing up that units of measurement (distance markers on the highway, volume measures at the gas pump, etc) were listed in both the British Imperial system and Metric system with the goal of increasing the level of comfort with the Metric system (shortly after the 1975 Metric Conversion Act).  As with any change initiative, old habits are hard to erase.  Whenever people get out of their comfort zone, even just a little bit, they will revert back to the "tried and true" way of doing things.

I suspect that part of the reason is financial.  There is no question that there will be a cost associated with making the change to the Metric system.  NASA estimated that it would cost the U.S. government over $370 million to change fully to the Metric system.  The total cost of a conversion is hard to determine, but there is no question that it would be expensive.  

There are certainly cultural, financial, and likely political (unfortunately, politics is always a factor in these kinds of issues) reasons why the U.S. is one of only three countries that haven't changed to the Metric system.  I don't necessarily always subscribe to the rationale that "just because everyone else is doing something", you should follow suit.  But in this case, there are a couple of real-world accidents where conversion between the Metric system and the British Imperial system played a causal role.

Air Canada Flight 143, now known as the "Gimli Glider", a scheduled commercial flight from Montreal to Edmondton was forced to make an emergency landing on July 23, 1983 after running out of fuel at the half-way mark at an altitude of 12,500 meters (that's about 41,000 feet for us stubborn, bull-headed Americans).  The plane ended up gliding down to an abandoned Royal Candadian Air Force base in Gimli, Manitoba (hence the "Gimli Glider").  While there were multiple holes in the proverbial "Swiss Cheese", one of the reasons that the plane ran out of fuel is because the ground crew mistakenly switched between pounds and kilograms of fuel.  The Boeing 767 departed with only 45% of its normal fuel load.

More recently, NASA lost the $125 million Mars Orbiter in 1999 when the engineering team failed to convert from English to Metric units when exchanging vital data before launching the spacecraft.  Apparently, during the landing itself, Lockheed Martin was sending thrust calculations based in the British Imperial system of units (pounds), while NASA was expecting Metric units (Newtons).  The spacecraft crashed onto the Martian surface and was lost.  There are numerous other examples.

Okay, I know what you are thinking.  What does THIS have to do with leadership?  In my mind, failure to change to the Metric system has everything to do with leadership.  The success or failure of any major change initiative depends upon how that change is managed by the organization's leaders.  The change guru John Kotter said, "We know that leadership is very much related to change.  As the pace of change accelerates, there is naturally a greater need for effective leadership."  Leadership is all about change.  

Making the transition to full adoption of the Metric system in the United States will require a leader who is fully committed to making the change and willing to push it.  We've had plenty of time to embrace the Metric system.  And as the examples above suggest, there is no better time to do so.

Digging for gold

The 19th century steel industry magnate and philanthropist, Andrew Carnegie said, "You develop people the same way you mine gold.  When you mine gold, you have to move tons of dirt to find one ounce of gold.  But you don't go in there looking for the dirt.  You go in there looking for the gold."  I think that is particularly true for recruiting and/or developing leadership talent.  

There is an old saying, "People don't leave bad jobs, they leave bad bosses."  As it turns out, this is more than just a cliché - there is evidence to back up the statement.  A Gallup poll of more than 1 million U.S. workers found that 75% of the workers who voluntarily left their jobs did so because of a bad boss or direct supervisor.  As the Gallup CEO at the time, Jim Clifton, summarized the 2013 "State of the American Workplace" survey, "The single biggest decision you make in your job - bigger than all the rest - is who you name manager.  When you name the wrong manager, nothing fixes that bad decision.  Not compensation, not benefits - nothing."

I should point out that most, if not all, of the studies citing "bad bosses" as one of the most important reasons that workers leave their jobs were performed prior to the COVID-19 pandemic.  If selecting managers and supervisors was important before the pandemic, it is even more so now!  Investing in leadership training and development is not only a good idea, it is an organizational imperative!  Just as important is the leadership selection and recruitment process.

I think the military definitely understands the organizational imperative to identify, select, develop, and train leaders.  In this case, it's not just the survival of the organization that is at stake.  As the former Army Chief of Staff, General James McConville explains, "From where I sit, command is a privilege.  It's a great privilege to lead America's best, and we have a sacred obligation to get absolutely the best, most committed leaders that we have in charge of these great Americans, who have raised their right hand to serve."

The U.S. Army has invested significant resources to getting leadership identification, recruitment, development, and training right.  The military has been and always will be an important source of government and industry leaders.  It's important to recognize, however, that even the military doesn't always get it right, when it comes to leadership development.  According to a survey performed in 2009 of over 22,000 soldiers in the Army, 20% said that they were serving under a toxic leader.  Recognizing that they could do better, the Army has developed a new selection process that I think captures perfectly the importance of leadership recruitment and development, called the Battalion Commander Assessment Program, or BCAP.  One of the architects of this innovative program, Colonel Everett Spain, summarized the components of BCAP in an article from the Harvard Business Review published a year ago.

Battalion commanders generally have spent 17-20 years of military service and represent the first executive-level position in the Army.  They are lieutenant colonels who are in charge for approximately 500 soldiers, and the Army selects about 450 of these commanders every year.  The Army completely overhauled the Battalion Commander selection process, and the level of attention and investment into this process is quite instructive.

The interview and selection process takes four full days.  All candidates undergo a battery of tests, including physical fitness test, writing and oral communication skills assessments, psychometric tests, cognitive and strategic talent tests, and formal interviews.  Somewhat unique to this process was the fact that both the interviewees (the officer candidates) and interviewers were trained prior to participating in the four-day event.  Interviewers received extensive training on ways to reduce bias, as well as training on scoring systems and behavior-based interviewing techniques.  Candidates were provided with an orientation to the process in general, as well as an introduction to the STAR method (which teaches people to answer questions by describing the situation, the task, the action taken, and the result).  As an additional way to eliminate bias, the program used double-blind auditions (a black curtain separated the candidates from the interview panel at all times), a technique adopted by the Boston Symphony Orchestra in the 1950's.  

The impact of the BCAP program is unknown at this time.  Only time will tell how effective the new assessment will be in identifying and developing the most talented leaders for the Army.  What is clear is that the Army has made a significant investment in their new program.  To paraphrase the quote by Andrew Carnegie at the beginning of this post, they are moving tons of dirt to find a little gold.  I think it will prove to be worth it.

Expedition behavior

It's been an interesting week in college football.  Aside from the ongoing drama (Who's in and who's out?) of the NCAA FBS (Football Bowel Division) College Football Playoff rankings that will be released today, we've witnessed the usual end of the year coaching carousel (see an older post, "You're fired!").  Two head coaches (Oklahoma's Lincoln Riley and Notre Dame's Brian Kelly) from two of the most storied programs in all of football left to go coach at two other so-called "blue blood" programs.  The manner with which one of these coaches (the former Notre Dame head coach) was far from ideal (although true to form based on his past departures).  Kelly reportedly let his coaching staff and players know that he was leaving via text message while he was away on a recruiting trip.  Rubbing the proverbial salt in the wound, he even tried to entice key members of Notre Dame's coaching staff to join him.  As the pundits continue to say, college football is a business, and sometimes business stinks.

I don't want to talk about Brian Kelly.  What I do want to talk about is what happened after he announced that he was leaving Notre Dame to be the new head football coach at LSU.  The players rallied around their coaches, and the assistant coaches rallied around the players.  None of the coaches followed Kelly to LSU (at least so far), telling the players that they were committed to staying and finishing the season at Notre Dame.  Take a look at the video of Offensive Coordinator Tommy Rees telling the team that he was staying.  More importantly, check out the video of how the Notre Dame players welcome the former Defensive Coordinator and now Head Coach, Marcus Freeman for the first time as the head coach.  Lastly, check out what Coach Freeman tells his players about what is important and how they need to finish the season together.  

I suspect that the football players at Notre Dame went through an emotional rollercoaster this past week.  The behavior of everyone in the program (aside from the former head coach, of course), from players to coaches to administrative staff beautifully illustrated something known as "expedition behavior" - placing the needs of the collective whole first and foremost above the needs of the many individuals.  The term was first used and described by the legendary mountaineer Paul Petzoldt for his National Outdoor Leadership School, which he founded in 1965.

"Expedition Behavior" is all about the team.  "Expedition Behavior" is how teams consistently perform at a high level, even when faced with unpredictable and unexpected risks.  When I think about high-perfomance teams, I of course think about High Reliability Organizations.  These organizations recognize that their success depends upon how the team works together to achieve a collective mission and vision.  To use another popular analogy, everyone in the boat is rowing in the same direction towards a common goal.

Who knows whether or not Coach Freeman will be a successful head coach.  It's certainly too early to tell for sure, but I have a sneaking suspicion that the University of Notre Dame's football team will be just fine.  They are in great hands, and the expedition will succeed.

"In God we trust. All others bring data."

W. Edwards Deming, an industrial engineer and arguably one of the founders of the Total Quality Management movement, reportedly once said, "In God we trust.  All others bring data."  In other words, if you are both omnipotent and omniscient, you probably can make a convincing argument on your own.  If not, you better have the data to back it up.

There is absolutely no question that data can be powerful.  The right data can motivate change, and change is the essence of continuous improvement.  You may already be convinced, but just to prove it to you, I want to briefly talk about two important and recently published studies.  

As Deming himself stated, "Uncontrolled variation is the enemy of quality."  Clinical protocols and care guidelines exist to minimize variation in care as much as possible.  Once variation is controlled, providers can monitor outcomes and adjust the protocol accordingly.  However, developing these clinical protocols and care guidelines is not easy - it takes time and money (and most importantly, it takes buy-in from the key stakeholders).  Here is where these two aforementioned studies come into play.  Both studies involve critically ill children who have undergone surgery for congenital heart disease.

Using a technique that they called "target-based care", investigators at Primary Children's Hospital in Salt Lake City, Utah and Lucille Packard Children's Hospital at Stanford in Palo Alto, California significantly reduced the variation in care that children received following cardiac surgery.  The way that they accomplished this is particularly interesting (and relevant to the "power of data").  They did not use clinical care guidelines or protocols.  Instead, they merely posted specific targets for the expected or typical time it would take to remove a patient from the ventilator, discharge from the intensive care unit, and discharge from the hospital.  These targets were based on either published data from national outcome registries or internal data, respectively.  That's all there was to it.

These targets were placed on regular signs and posted at the bedside for all to see.  The targets were visible to both the members of the care team, as well as the patient's family.  As the investigators emphasized, this level of transparency led to both clinical improvement opportunities in real time, as well as influencing expectations and creation of shared mental models to improve the family's understanding of the care being provided.  The care team was not asked to alter their practice, but even without a protocol or guideline, the variation in care (as measured by the standard deviation around quality metrics, including the targets themselves) significantly decreased.  At least at Lucille Packard, the overall length of stay in the ICU and hospital also decreased!  Finally, the patient/family experience improved as well.

The simple act of posting the typical and/or expected benchmarks in the care of the individual patient reduced the variation in care, improved the patient/family experience, and in at least one of the studies, decreased the overall length of stay in the hospital.  Here are two perfect examples of the power of data.  Nothing fancy or costly was required, except having access to data (which is important, but not too difficult) and a piece of paper to write and post the data on for all to see.