"I play not my eleven best, but my best eleven"

It's a long story (so I won't bore you with it), but my wife and I will be finishing up a move to a more permanent residence today.  We've been renting a condo in downtown Chicago for the past 2 years, and while we are going to miss living downtown, we are excited to finally have a place of our own.  Needless to say, transitions are never easy.  We switched our cable and Internet to the new place, so for a few days in our condo we were without cable and Internet.  We decided to watch a DVD of Game 7 of the 2016 World Series between the Chicago Cubs and the Cleveland Indians.  You may remember that I am a diehard Cubs fan (see the excitement in my post, "The World Has Changed - Fly the W!" and the despair in my two more recent posts, "Lovable Losers Once More and "The Chicago Cubs Fire Sale").  While I was watching the game, I was quickly reminded of the importance of so-called role players.  

Not everyone can be the superstar of the team.  And to use a sports analogy (I promise I will get away from sports in a minute), not everyone can be a starter.  Every successful, championship team has a good mix of superstars and at least one role player.  According to at least one coach, "A role player is often the player who comes off the bench. He/she understands and accepts his/her role on the team. While on the bench, the good role player keeps his/her head in the game, and observes what's going on, where the weaknesses are in the defense, which opposing players are "killing us", what's happening on the boards, etc. He/she is "ready to go" when the coach calls." 

Most sports teams have role players - individuals who specialize in one or two areas of the game and who focus his/her attention on that specific aspect of the game in order to serve the needs of the team.  The role player accepts his/her job, even if it is a limited one, because the team's success depends upon it.  The role player is often behind the scenes, or as another coach put it, "The role player shuns the glory of attention, praise, and impressive statistics for the sake of the team. In doing this, the role player revels in another kind of glory."

Dexter Fowler played centerfield for the 2016 World Series Champion Chicago Cubs.  Even though he often started (he played in 125 games that year), but his key role on the team that year was to bat in the lead-off spot.  As sports commentator Joe Buck said during the Game 7 broadcast, "When Dexter Fowler gets on base, the Cubs win."  One sports pundit described Fowler's role as the "You go, we go" mantra.  There is absolutely no question that Fowler had a great year for the Cubs (his on-base percentage of .393 was a career-best), which he turned into a five-year $82.5 million deal with the St. Louis Cardinals the following year.  Unless you are a diehard Cubs fan, you probably wouldn't even mention his name if you were asked to name the best players on the Cubs roster that year (you'd probably name Kris Bryan, Anthony Rizzo, Kyle Schwarber, and Jon Lester).  

Every team - whether its a sports team or an organization - needs role players.  Harvard Business School professor Thomas J. DeLong  and health care consultant and entrepreneur Vineeta Vijayaraghavan call them "B players" (they use the label "A players" for the superstars).  They write, "A players, it is true, can make enormous contributions to corporate performance.  Yet in our collective 20 years of consulting, research, and teaching, we have found that companies' long-term performance - even survival - depends far more on the unsung commitment and contributions of their B players."

These B players (role players) may lack the luster and ambition of the superstars - DeLong and Vijayaraghavan find that the B players typically avoid the limelight.  But make no mistake, the team's success depends upon them.  They are the "glue" that holds the team together.  They are the "table setters" that keep things in motion.  They are the "go to" people in the company, the ones who seem to be connected to everyone and everything in the organization.  

Every team needs a Dexter Fowler.  Legendary Notre Dame football coach Knute Rockne once said, "The secret is to work less as individuals and more as a team.  As a coach, I play not my eleven best, but my best eleven."  Rockne had his share of superstars, but more importantly, he had his role players too.  

The view from above

I read another great piece in Ryan Holiday's daily devotional text, The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living the other day.  I thought it was worth sharing.  He started out with a passage taken from the book Meditations by the ancient Roman Stoic philosopher-king, Marcus Aurelius:

"How beautifully Plato put it.  Whenever you want to talk about people, it's best to take a bird's-eye view and see everything all at once - of gatherings, armies, farms, weddings, and divorces, births, and deaths, noisy courtrooms, or silent spaces, every foreign people, holidays, memorials, markers - all blended together and arranged in a pairing of opposites."

What is Marcus Aurelius trying to say here?  The data scientist and blogger Ranjani Mani suggests, "Step back, zoom out and look at life and what it offers from a larger vantage point. Despite how difficult that seems to sound in implementing, I believe this helps figure out the trivial from the important."

It's amazing what happens when we take another look at things from a new perspective.  I've certainly talked about how two different individuals looking at the same event from two different perspectives can come up with vastly different interpretations of that event (see "HRO: Reluctance to Simplify"), recalling to mind the famous effect in cognitive psychology known as the "Rashomon Effect" (the name of the effect is based on a 1950 Japanese movie Rashomon in which the plot device features different characters providing alternative and contradictory versions of the same incident), as well as the 2008 movie, Vantage Point, starring Dennis Quaid, Forest Whitaker, Sigourney Weaver, and William Hurt.  Just as important, when we view the same event or issue from a "bird's-eye" perspective, our interpretation of the event or issue changes as well.  We look at the event or issue in an entirely new and different way.

The astronaut U.S. Navy Captain Edgar Mitchell, who as the Lunar Module pilot on Apollo 14 was the sixth person to walk on the moon, once said after looking at the Earth from outer space (see my post "The Blue Marble Project"), "In outer space you develop an instant global consciousness, a people orientation, an intense dissatisfaction with the state of the world, and a compulsion to do something about it. From out there on the moon, international politics look so petty. You want to grab a politician by the scruff of the neck and drag him a quarter of a million miles out and say, "Look at that, you son of a bitch."  

Just look at the way that the Earth looks from outer space - indeed, it looks like a beautiful, big blue marble.  Seeing the Earth in this way gives a new perspective (it's called the "Overview Effect") - there are no longer any boundaries or borders between countries.  All you can see is one Earth - united in all its beauty.  There are no differences from this viewpoint, only similarities.

We can take a similar approach when we take a more global, bird's-eye view of issues we face as leaders.  Changing our viewpoint will force us to change our perspective, and changing our perspective often leads to discovery of new and different ways to tackle a problem.  Ryan Holiday ended his devotional with, "Many a problem can be solved with the perspective of Plato's view.  Use it."

"Eat that frog!"

What in the world did frogs ever do to us to deserve our contempt?  Consider just one of our leadership metaphors - have you ever heard the story about the boiling frog?  Basically, we are led to believe that if a frog is suddenly dropped into a pot of boiling water, it will immediately jump out and live to tell the tale.  If on the other hand the frog is placed into a pot of cool water which is brought slowly to boil, it will not perceive the danger and will slowly be boiled alive.  The take-home message is that individuals usually react slowly, if at all, to gradual or slowly accumulating changes or threats.  These same individuals, when faced with rapid or sudden changes or threats will react appropriately to remove themselves from the dangerous situation.

Have you ever heard the fairy tale about the frog prince?  In this one, a prince is punished for his arrogance by being turned into a frog, only to be rescued when a princess comes to kiss him.  Again, we assume that frogs live such a miserable existence that turning someone into a frog is the ideal form of punishment.

Finally, do you remember hearing the nursery rhyme about the five frogs on a log?  Compared to the two earlier examples, here the frogs in the story are playing a relatively passive role.  All of these stories came to my mind when I heard something that the 19th century American writer and humorist Mark Twain (one of my favorite authors) reportedly once said, "Eat a live frog first thing in the morning and nothing worse will happen to you the rest of the day."  Here we go again - frogs are such poor, miserable creatures apparently!

Laura Blinder posted an article entitled, "We tried it: Eat That Frog (productivity system)".  The self-help guru Brian Tracy even wrote a book based upon Twain's quote, "Eat That Frog: 21 Great Ways to Stop Procrastinating and Get More Done in Less Time".  Here, the proverbial "frog" is a difficult task that we probably should do (based upon its impact and level of importance), but one that we can't seem to get started doing.  Essentially, Blinder and Tracy are telling us that we should prioritize our lives based upon the goals we set for ourselves.  If a difficult task is one that will help us achieve our goals and priorities, then we should be doing it first before we try to tackle anything else.  

When you think about it more, Twain's metaphor makes a lot of sense.  We usually have a lot more energy and motivation at the beginning of the day, so tackling the toughest problems first (as long as they help us achieve our goals - if not, we should prioritizing other things) when we have the most motivation and energy is a smart move.  Tracy added his own version of Twain's quote, "You cannot eat every tadpole and frog in the pond, but you can eat the biggest and ugliest one, and that will be enough, at least for the time being."

"Something that could never, ever possibly destroy us..."

I came across an interesting fact the other day.  Apparently, the city of Ligonier, Indiana (a small town in the Northeastern corner of Indiana with a population of just over 4,400 people in the 2010 Census) is the marshmallow capital of the world!  I know what you are thinking - and the answer is no, I don't have all that much spare time!  I was trying to research the "Marshmallow Spaghetti Tower Challenge".  My wife is a middle school math teacher, and every year she asks her students to form into teams to see how high they can build a tower out of marshmallows, raw spaghetti, string, and tape.

Marshmallows absolutely fascinate me.  They actually come from plants (Althaea officinalis, a plant that is found in the marshy areas of Europe and western Asia) and were first made by the ancient Egyptians around 2000 BC.  The Egyptians revered the tasty treats and generally reserved them only for the pharaohs and the gods.  Marshmallows were once used by physicians to treat sore throat, cough, and wounds.  The 16th century English philosopher Francis Bacon once said, "Life is a marshmallow, easy to chew but hard to swallow."  The Stay Puft Marshmallow Man was the villain at the end of the 1984 film Ghostbusters (Dan Akroyd's character Ray chose the marshmallow man, because he thought it was "something that could never, ever possibly destroy us").  All of us know marshmallows as one of the three ingredients for the summer treat S'mores (the other two being graham crackers and chocolate).  

Marshmallows have been the subject of at least one other famous study in psychology (conducted by Walter Mischel and Ebbe Ebbesen), known as the "Stanford Marshmallow Experiment", which I have posted about more than once in the past.  Today, I want to revisit my wife's classroom and talk about the "Marshmallow Spaghetti Tower Test".  Basically, as I mentioned above, the challenge is to see how high a team of students can build a tower from several pieces of raw spaghetti, string, tape, and marshmallows (they only have twenty minutes to build their tower).  Scott Anthony wrote about this unique challenge in a Harvard Business Review article from a few years ago ("Innovation Leadership Lessons from the Marshmallow Challenge"), and Tom Wujec talked about his experience using the challenge with business executives in a short TED talk ("Build a tower, build a team").

As I mentioned, my wife uses this challenge in her classroom every year.  I am fascinated by what she has found year after year - the students in the lower grades frequently outperform the students in the upper grades!  In addition, she has also found that the advanced classes don't do as well as the regular classes.  She tells me, "The older and advanced classes waste a lot of time trying to plan out the steps that they will take before getting started, while the younger and regular classes jump right in and learn by trial-and-error."  

It also seems that the older and more advanced classes go through Bruce Tuckman's classic stages of group formation ("forming, storming, norming, and performing").  Tom Wujec talks about his experience with this challenge in his TED talk.  He consistently finds that kindergarteners outperform business school students and lawyers!  Check out the figure below:

Similar to what my wife's experience, Wujec finds that the business school students spend a lot of timing trying to identify the group leader (with students frequently jockeying for position), going through the stages of group formation, and planning out in detail what they are going to do in order to construct their tower.  Conversely, the kindergarteners just proceed and learn by trial-and-error.

Does my wife's and Wujec's experience suggest that kindergarteners are more creative than business school students?  As Scott Anthony writes, "It's hard to escape the conclusion that we all begin with creativity and curiosity, which too many of us systematically unlearn as we go through the education system and scale up the corporate ladder."  The best way to drive innovation and creativity may be to adopt a "beginner's mind-set" and continue to foster curiosity by continuously challenging yourself with new things and new experiences.

It's also interesting that Wujec's teams comprised of CEO's and Executive Administrators outperform the kindergarteners, perhaps indicating that "innovation happens most often when different mind-sets and skills collide."  Here the lesson is to diversify your personal and professional networks.  Studies consistently find that diverse teams, particularly ones where everyone on the team feels empowered to contribute, identify creative and innovative solutions and ideas.  It may also help to ask a few kindergarteners how they would tackle a problem!

Scott Anthony concludes his article with the following point.  "It's reasonable to assume that leaders will confront more, not less, ambiguity in the future.  The best way to prepare is to seek every opportunity to plunge into chaos and radically diversify your innovation network."

Find your "yes" burning inside

Last time I talked about the fact that "working hard" is not the same as "working productively."  I mentioned Ryan Holiday's daily devotional text, The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living, which I have been faithfully reading since the beginning of the calendar year.  As it turns out, Ryan Holiday also has a blog and a daily email on the philosophy of Stoicism.  I wanted to continue on the theme of working productively with a passage from one of Ryan Holiday's recent posts.  The Roman Stoic philosopher Seneca said, "We will benefit from that helpful precept of Democritus, showing us that tranquility lies in not undertaking tasks, either in public or private, that are either numerous or greater than our resources."

Democritus is frequently referred to as the "laughing philosopher" due to his emphasis on being cheerful (another big proponent of looking on the bright side!).  Incidentally, we have Democritus to thank for the term, "atom" which comes from the Greek word "atomos" meaning "indivisible" (Democritus and the Atomists believed that atoms were the smallest indivisible bodies from which everything else was composed).  But I digress - let's get back to Seneca.

My point (and Seneca's too, I believe) is that "good working hard" doesn't always get us to where we want to go or need to go.  We have to take into account what we can reasonably accomplish with the time, energy, and resources that we have available.  As leaders, we need to learn to prioritize.  As Ryan Holiday writes, "What's the most important thing in our lives?  What's the next most important thing?  What are we going to say no to so we can focus on those things?  What are we going to say no to (or yes to) in order to protect our personal happiness and peace?"

We just can't say "yes" to every opportunity, project, task, or initiative.  We have to prioritize based upon what's most important for our organization (when prioritizing our professional lives) or our own personal goals and objectives (when prioritizing our personal ones).  Prioritization forces us to do less "so that we can do more of what we care most about."  Management guru and author Stephen Covey had this to say about setting priorities, "You have to decide what your highest priorities are and have the courage—pleasantly, smilingly, nonapologetically, to say “no” to other things. And the way you do that is by having a bigger “yes” burning inside."

"Never mistake motion for action"

One of my New Year's Resolutions this year was to read a small passage from Ryan Holiday's daily devotional text, The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living.  We are almost halfway through the calendar year, and so far, I've been able to keep up with this resolution (some of my others, not so much).  One of the recent devotions came from the ancient Greek Stoic philosopher Epictetus (the passage can be found in Book 4 of his Discourses):

"I can't call a person a hard worker just because I hear they read and write, even if working at it all night.  Until I know what a person is working for, I can't deem them industrious... I can if the end they work for is their own ruling principle, having it be and remain in constant harmony with Nature."

I liked this passage a lot.  As Ryan Holiday writes, "We tend to associate busyness with goodness and believe that spending many hours at work should be rewarded."  I would expand further and suggest that we generally associate "busyness" (i.e. working hard) with being productive - in this case, "working hard" equates with "doing good work."  Unfortunately, this statement is not always true.  Far from it, in fact.  How many times do you find yourself working hard without necessarily making any progress towards things that truly matter?  It's like the proverbial mouse running in circles on a spinning wheel.  

Holiday suggests that rather than just simply "working hard", we should "evaluate what you are doing, why you are doing it, and where accomplishing it will take you.  If you don't have a good answer, then stop."  We should carefully reflect on what we are doing when we are "working hard" - are we truly "hardly working"?  In other words, are we actually getting something useful done?  If the answer to this question is "no", then we should just stop.  

Ernest Hemingway said, "Never mistake motion for action."  Similarly, Tim Ferriss said, "Focus on being productive instead of busy."  And finally, Steve Jobs said, "Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it."

Lessons from Gross Anatomy

The 1989 film Gross Anatomy starring Matthew Modine, Daphne Zuniga, and Christine Lahti came out right before I started medical school.  Modine plays a first-year medical student named Joe Slovak.  The first scene (which plays while the opening credits are rolling) shows Slovak answering questions from the members of the medical school admissions committee.  At first, Slovak answers the rather clichéd question, "Why do you want to be a physician?" with the equally clichéd answer, "Because I want to help people."  Slovak goes through a series of exhausting exchanges, including my personal favorite:

Interviewer: "What does your father do?"

Slovak: "He's a fisherman."

Interviewer: "What kind of fish does he catch?"

Slovak: "Cod"

Interviewer (whispers to himself as he writes the answer down): "Cod"

By the end of his day, Slovak responds to the same "Why do you want to be a physician?" question with a less clichéd but more humorous answer, "Because I want to make lots of money."

Here's the key point.  Almost no one in medicine today chose to enter this profession because we wanted to make a lot of money.  As a matter of fact, I could certainly make the case that if money was the sole motivation, we would have been better off choosing another career!  However, even if it's true that most, if not all of us, became physicians because we were interested in helping people (and not because of any potential future earnings), the fact that physicians make a good living (relatively speaking) was reassuring too.

I know what you're thinking.  What's he getting at here?  My point is that many of us in health care are intrinsically motivated to help and serve others.  As I have posted about in the past, there are two kinds of motivation - intrinsic motivation and extrinsic motivation.  Intrinsic motivation (also called "internal" motivation in some studies) refers to when we engage in a certain behavior or activity because we find it rewarding (the behavior or activity itself is the reward).  Extrinsic motivation (also called "instrumental" motivation in some studies) refers to when we engage in a certain behavior or activity because we want to earn a reward or avoid punishment.  Using the medical school example above, an intrinsic motivation to study to be a physician would be the desire to help people, while an extrinisc motivation would be to seek prestige or monetary rewards.

What happens when we try to combine both intrinsic (internal) and extrinsic (instrumental) motivation together to drive performance of a demanding, effortful activity (such as going to medical school to study to become a physician)?  One would expect that these two types of motivation would be additive or synergistic.  Unfortunately that is not the case.  Studies consistently show that extrinsic motivation can undermine intrinsic motivation, a phenomenon that psychologists and social scientists call the "overjustification effect" and economists call the "crowding out effect".  Most of these studies involve either laboratory or field experiments in which intrinsic motivation is either established beforehand or assumed, followed by the introduction of some reward (extrinsic motivation).  The problem with these studies is that the real world rarely, if ever, works this way - case in point is my medical school example above!

With all of this in mind, investigators at Yale conducted an interesting observational study a few years ago, publishing their findings in the Proceedings of the National Academy of Sciences (see "Multiple types of motives don't multiply the motivation of West Point cadets").  The investigators conducted data from nine consecutive classes at the U.S. Military Academy at West Point (11,320 cadets from all but one class from 1997 through 2006).  Each cadet participated in a survey that included questions to determine their motivation for studying at West Point and joining the Army.  Two reasons of interest were cited - an individual's desire to become an Army officer and serve his or her country (intrinsic motivation) versus an individual's desire to take advantage of the quality education provided at West Point and the career opportunities that such an education would provide (extrinsic motivation).

The investigators then looked at whether each cadet extended beyond his or her mandatory five-year tour of duty, as well as whether they had been selected for early promotion (both factors which would be consistent with "high performance").  As expected, after controlling for a variety of other factors (age, gender, race/ethicity, parental income, SAT score, entering year, etc), the investigators found that a stronger internally based (intrinsic motivation) desire to attend West Point was strongly associated with high performance (extending service beyond the mandatory minimum of five years and being promoting early).  Again, as expected (based upon the overjustification effect), cadets having both an intrinsic and extrinsic motivation to attend West Point were more likely to leave the Army after their five year mandatory minimum.  In addition, cadets having both an intrinsic and extrinsic motivation were more likely to be passed over for early promotion.  Finally, the higher the degree of extrinsic motivation to attend West Point, the less likely cadets would stay in the Army beyond five years and get promoted.  

These results are consistent with prior studies, demonstrating that extrinsic motivation can undermine intrinsic motivation and lead to lower performance.  The study is particularly important to this body of research.  As the investigators write, "It is hard to imagine a meaningul domain of human activity that does not have instrumental consequences" (again, they are using the term "instrumental" to refer to extrinsic motivators, such as money, fame, prestige, or status).  They go on to say that "because instrumental consequences cannot be eliminated from human affairs, what the results suggest is that attention should be paid to motives in addition to consequences, and that efforts be made to structure activities so that some consequences do not become motives."

How can leaders (and organizations) prevent consequences from turning into motives?  First, leaders should emphasize the organization's purpose, particularly if the organization is mission-focused, as most health care organizations are today.  Second, while instrumental consequences (extrinsic motivators) such as bonuses, raises, etc are important, leaders can also emphasize meaningful consequences that focus more on internal rewards (mastery of a skill, impact on others, etc).  Finally, and I've spoken about this before (see my post, "Holes" for more in-depth discussion of this point), when individuals have a role in shaping their work activities, they are more engaged and focused on the meaning and purpose of the work, which drives intrinsic motivation even more!

As it turns out, the opening scenes of Gross Anatomy were not all that far off from the truth.  Spoiler alert, Slovak goes on to learn about his true desires and motivation for studying to become a physician, focusing on the service aspects of the profession instead of the monetary rewards.  Like the West Point cadets who wanted to serve their countries, Joe Slovak becomes a better physician in the end.

“Be the sun, not the salt”

It never fails - whenever the sun comes out, so do the people!  Every year, as the days start to get longer again after the long, dark winter, sun worshipers awake from their winter hibernation and flock to the beach in an annual rite of Spring.  Is it the sun or the proximity to water that we desperately crave?  I could argue either way (see one of my old posts "The Blue Marble Project" and the book, Blue Mind by Wallace Nichols for a brief discussion of the evidence), and I for one have always enjoyed the sun and the water!  However, today I want to focus on our natural inclination towards sunlight.  Light from the Sun gives us positive energy (both literally and figuratively) that sustains life on our planet.  

Clearly, there is undoubtedly some kind of mystical force to explain our attraction to light.  Just ask yourself what you do whenever you walk into a dark room - I bet the first thing that you do is turn on the light!  What do we always say whenever we are trying to complete a difficult task or juggle all of the things we have to do in our personal and professional lives?  It's usually some version like, "There's a light at the end of the tunnel."  What do we say about individuals whose happiness and joy always seem to bring out that same joy in others?  "She just lights up the room" or "She brightens my day."  

There's a scientific explanation here - it's called a "heliotropic effect".  The ancient Greeks knew that the different parts of a plant (leaves and flowers) "move" towards the Sun (the name was later changed to "phototropism" since the plants moved towards light rather than just the Sun).  As it turns out, humans are just like plants!  Well, sort of.  We tend to gravitate towards positive energy (metaphorically, "light") and avoid negative energy (metaphorically, "dark").  Kim Cameron, who co-founded the Center for Positive Organizations at the University of Michigan, says that "all living systems have an inherent tendency towards positivity".  Cameron uses light as a metaphor for positive energy (see his TED talk, "The universality of the heliotropic effect").  

Harry Cohen talks about "heliotropic leadership" in his TED talk (he also coined the phrase, "Be the sun, not the salt").  "Heliotropic leaders" are individuals who are kind, honest, authentic, compassionate, grateful, and positive.  They are the leaders who inspire us, empower us, challenge us, and motivate us to do more than what we thought was possible.  "Heliotropic leaders" are servant leaders and place the needs of their teams and organizations above their own.   

Kim Cameron, writing with Emma Seppälä in a recent Harvard Business Review online article, states that heliotropic leaders' "greatest secret is that, by uplifting others through authentic, values-based leadership, they end up lifting up both themselves and their organizations."  Heliotropic leaders "demonstrate and cultivate virtuous actions, including forgiveness, compassion, humility, kindness, trust, integrity, honesty, generosity, gratitude, and recognition in the organization. As a result, everyone flourishes."

Harry Cohen writes, "Some people are like the sun on our leaves….and others are like salt water poured on our roots! One sustains our life, the other stresses us out!  Hence, Be the Sun, Not the Salt."

"Our life is what our thoughts make it."

I came across a review by Beverly Gage of a new Harry Truman biography by A.J. Baime in The New Yorker magazine a few weeks ago that caught my attention.  The review started with a really powerful opening sentence:

Americans today seem to believe that we live in especially exhausting political times.  But the rhythms of our moment - pandemic, protest, pandemic, election, insurrection, pandemic, invasion of Ukraine - have nothing on the Truman era.

Okay, that sounds intriguing.  Several years ago, I read the David McCullough biography and can certainly appreciate that Truman became the President under difficult circumstances (you probably remember that Truman was FDR's last Vice President and became President when Roosevelt died at the beginning of his fourth term, learning of the existence of the atomic bomb for the very first time only just after becoming President).  I even remember the famous newspaper photograph of Truman holding a copy of the Chicago Tribune headlines on the morning after the 1948 Presidential Election announcing, ""Dewey Defeats Truman" (incidentally, Truman won that election):

I guess I don't remember learning in school that the late 1940's were as politically charged as today.  But then, Gage explains further:

Between April, 1945, when Franklin D. Roosevelt's death thrust Harry S. Truman into office, and January, 1953, when Truman handed the Presidency to Dwight D. Eisenhower, the war in Europe ended, Hitler killed himself, the United States dropped two atomic bombs on Japan, the Cold War began, the state of Israel came into being, the Soviet Union developed its own nuclear weapons, China underwent a Communist revolution, the West created NATO, the world created the United Nations, and the Korean War began.  One could go on.

Wow, okay, now I understand.  My point is that due to a cognitive bias known as the "recency bias" or "recency effect" (the tendency to favor recent events over historical ones), we tend to believe that no one else has ever had it as difficult as we have in the past two years.  Please don't misunderstand me - I am not at all saying that the last two years haven't been challenging.  They have been incredibly challenging.   We've just been through (and technically it's not even over yet) the kind of global pandemic that hits once a century.  And there is no question that society is struggling with racial and social injustice, divisive politics, and challenging economic times.  My point is that other generations have experienced similar challenges, even if they aren't the exact challenges that we've faced the last two years.

I want to make another point.  We can learn a lot by reading history.  For example, one of the best ways for leaders to learn how to deal with challenging times is to read how other leaders in the past have dealt with the challenges of their generation.  I've talked about this concept before in previous posts (see "Past is Prologue" and "Study the Past").  "All of this has happened before", and unfortunately, because history does repeat itself, it will happen again.  What better way to learn how to lead in difficult, challenging times than through reading history?

So, how did old "Give 'em Hell Harry" do it?  Well, for starters, he was an optimist at heart.  Truman once said, "A pessimist is one who makes difficulties of his opportunities and an optimist is one who makes opportunities of his difficulties."  He also said, "Men make history and not the other way around."  Truman was thrust into a maelstrom and largely prevailed - he made history - because he saw the challenges facing him as opportunities.  

Throughout history, the optimists have been the ones who have prevailed during the most difficult, challenging times.  Going back all the way to ancient Rome, the emperor and Stoic philosopher Marcus Aurelius said, "Our life is what our thoughts make it."  Marcus Aurelius was a reluctant leader and held one of the most powerful political positions in the world when he became the last of the so-called "Five Good Emperors".  He would have preferred to study his Stoic philosophy.  We are fortunate that he left us with his Meditations, in which he described the virtues of self-restraint, duty, respect for others, and justice.  Indeed, "our life is what our thoughts make it" - if we choose to focus on the positive aspects in our lives (optimism) versus the negative ones (pessimism), our lives will be so much better.  

Drs. Emma Seppälä and Kim Cameron wrote in a recent Harvard Business Review online article, "The greatest predictor of success for leaders is not their charisma, influence, or power.  It is not personality, attractiveness, or innovative genius.  The one thing that supersedes all these factors is positive relational energy: the energy exchanged between people that helps uplift, enthuse, and renew them...When leaders display positive relational energy, it catapults performance to a new level."  Positive energy and optimism are what we need in our leaders during challenging times like the present.

One last point, and it's particularly important.  I am not talking about being superficially and falsely positive.  We have to be realistic, but there is a way to do so while remaining optimistic.  Positive energy and optimism doesn't mean that we turn a blind eye to our current realities.  I go back to what leaders like Viktor Frankl, Holocaust survivor and author of Man's Search for Meaning (one of the best books that I've ever read) said, "“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”  Or former Vietnam Prisoner of War James Stockdale, who said, “I never lost faith in the end of the story, I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I would not trade.”  Or Mother Teresa, who said, "I alone cannot change the world, but I can cast a stone across the waters to create many ripples."  Positive energy.  Optimism.  Attitude.

 

I want to leave with one last quote.  The French writer Voltaire said, “The most important decision you make is to be in a good mood.”  How much better leaders would all of us be if we chose to be model the positive energy, attitudes, and optimism of leaders like Harry Truman, Viktor Frankl, James Stockdale, and Mother Teresa?

The role of the Chief Quality Officer

There is a common saying that you hear a lot these days, "If you've seen one hospital's organizational structure, you've seen one hospital's organizational structure!"  Having worked at two independent, free-standing children's hospitals, two children's hospitals affiliated with adult health care systems, and three military hospitals (you'd think they would be structured the same, right?), I can say for certain that this statement is absolutely the case!  While not universally true, the typical executive positions (Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, Chief People Officer, Chief Nursing Officer, etc) are generally quite similar from hospital to hospital.  In contrast, the Physician Executive role varies the most from hospital to hospital.

Some physician executive positions have the same role but with different titles in different organizations - Chief Medical Officer, Chief of Staff, and Vice President of Medical Affairs are three common examples that typically cover similar roles.  However, at times the scope of a position with the same title (Chief Clinical Officer, Chief of Staff) may differ significantly between different hospitals.  Things get even more confusing when you start to look at academic medical centers.

One role that I am seeing more frequently at hospitals is the position of Chief Quality Officer (CQO).  I found an interesting article in the Journal of Healthcare Management (from a few years ago), "Winning at Quality and Safety: Do You Need a Chief Quality Officer".  The author, John Byrnes, first asked whether the CQO needed to be a physician.  He believed that it did, though in full disclosure, he is a physician.  His main justification is that "physicians are more open to advice and recommendations from peers and colleagues."  Given that 80% of clinical quality and costs are directly impacted by the decisions made at the bedside or orders written by clinicians, having a respected colleague and peer advocate for standardization and evidence-based care, both of which are associated with better quality and lower costs, is very important.  While I agree that physicians respond better to colleagues than other clinicians (and even more so compared to health care administrators), I think Dr. Byrnes discounts too much the care that nursing and allied health providers provide - they have a huge impact on quality and cost too!  In addition, advanced practice providers (nurse practitioners and physician assistants) make clinical decisions and can write orders (the extent of the order varies from state to state), so they have to be convinced to standardize and follow evidence-based guidelines too.  

Regardless of who is in the role, Byrnes suggested that the role of CQO is a full-time job that requires a full-time commitment.  He also provided what I thought was an excellent road map for the first 5 years or so of a CQO's tenure.  

1. Design a quality and safety program that adopts the same level of discipline and vigor as your financial management system.  Byrnes recommends embedding quality and safety into the organization's strategic plan.  Quality and safety metrics should feature prominently in the annual goal and incentives for every leader throughout the organization. 

2. Establish quality and safety reporting with the same scope as your financial reporting system.  In my experience, the hospitals that are close to being High Reliability Organizations are the ones where the executive leadership team and board pay just as much time and attention to quality and safety metrics as they do the financial ones.  

3. Develop a safety program that eradicates preventable errors.  There are a number of evidence-based, best practices for reducing the likelihood of errors at the bedside.  CQO's should be well-versed in safety science, and these error-prevention techniques should be taught to all clinicians and employees at the organization.

4. Improve clinical outcomes by eliminating preventable complications, readmissions, and mortality for your 20 to 30 most common diagnosis-related groups.  Every organization has about 30 diagnoses that cover 70-80% of their patient population.  These are the diagnoses that are most amenable to standardization and evidence-based care through clinical practice guidelines.  

W. Edwards Deming, one of the leading figures in the early years of quality improvement, said, "It is not enough that top management commit themselves for life to quality and productivity.  They must know what it is that they are committed to - that is, what they must do.  These obligations cannot be delegated.  Support is not enough; action is required."  Having a CQO working directly with both the hospital's executive leadership team and the board to set the right tone and keep quality and safety top of mind is foundational to becoming a High Reliability Organization.  

D-Day

I don't always repeat my posts, but I was reminded earlier this morning that today was the 78th anniversary of D-Day, the first day of the Allied Forces' liberation of Europe during World War II.  I went back and looked at this post from June 6, 2017, and while a lot has happened between then and now, the underlying message is still the same.  I hope you enjoy it (and apologies for the repeat).

Today is June 6.  Over seventy years ago today, on June 6, 1944 (D- Day) Allied Forces began the largest amphibious military assault ever conducted on the coast of Normandy, France.  Over 160,000 American, British, and Canadian troops, as well as soldiers from Australia, Belgium, Denmark, Free France, Czechoslovakia, Greece, Netherlands, Norway, Poland, and New Zealand landed at Omaha Beach, Utah Beach, Sword Beach, Juno Beach, and Gold Beach.  Planning for D-Day had started almost a year earlier under the leadership of the Supreme Allied Commander Europe, General Dwight D. Eisenhower.  D-Day marked the beginning of the end - the liberation of Europe from Nazi Germany. 

"Ike" wrote a letter to his troops on the morning of June 6 that is powerful in both words and meaning.  His message went as follows:

Soldiers, Sailors, and Airmen of the Allied Expeditionary Force:

You are about to embark upon the Great Crusade, toward which we have striven these many months. 

The eyes of the world are upon you.  The hopes and prayers of liberty-loving people everywhere march with you.

In company with our brave Allies and brothers-in-arms on other Fronts, you will bring about the destruction of the German war machine, the elimination of Nazi tyranny over oppressed peoples of Europe, and security for ourselves in a free world.

Your task will not be an easy one.  Your enemy is well-trained, well-equipped, and battle-hardened.  He will fight savagely.

But this is the year 1944.  Much has happened since the Nazi triumphs of 1940-41.  The United Nations have inflicted upon the Germans great defeats, in open battle, man-to-man.  Our air offensive has seriously reduced their strength in the air and their capacity to wage war on the ground.  Our Home Fronts have given us an overwhelming superiority in weapons and munitions of war, and placed at our disposal great reserves of trained fighting men.  The tide has turned.  The free men of the world are marching together to victory.

I have full confidence in your courage, devotion to duty, and skill in battle.  We will accept nothing less than full victory.

Good luck!  And let us all beseech the blessing of Almighty God upon this great and noble undertaking.

Ike's words are inspirational.  By expressing his confidence in his men, he in turn instills confidence in the Allied forces just before they head into battle.  His message is clear - "we will prevail."

Ike's letter is well known.  But Ike had a back-up letter that he wrote that same morning, "just in case."  His alternative letter is perhaps less well known, but it is also instructive:

Our landings in the Cherbourg-Havre area have failed to gain a satisfactory foothold and I have withdrawn the troops.  My decision to attack at this time and place was based upon the best information available.  The troops, the air and the Navy did all that Bravery and devotion to duty could do.  If any blame or fault attaches to the attempt it is mine alone. 

The lesson here?  Ike said it clearly in both letters.  The credit for the victory goes to the team.  The blame for the loss goes to the leader.  A good leader gives the credit for success to his or her team.  The good leader accepts full responsibility for any failure. 

Speed read

President Harry Truman once said, "Not all readers are leaders, but all leaders are readers."  Retired U.S. Marine Corp General James Mattis added, “If you haven't read hundreds of books, you are functionally illiterate, and you will be incompetent, because your personal experiences alone aren't broad enough to sustain you.”  There is no question that reading is an important part of any leader's ongoing professional development.  To this end, every branch of the United States military publishes a professional reading list every year.

However, I would like to mention one important caveat.  Professional reading should emphasize quality over quantity.  The ancient Roman Stoic philosopher Seneca wrote in On the Tranquility of the Mind, "What's the point of having countless books and libraries, whose titles could hardly be read through in a lifetime.  The learner is not taught, but burdened by the sheer volume, and it's better to plant the seeds of a few authors than to be scattered about by many."

I recently came across an article by Drs. Paula Schwanenflugel and Nancy Flanagan Knapp in Psychology Today entitled, "So Much to Read, So Little Time!"  It's an interesting article that is directly relevant to the current discussion.  They estimated that 1.9 million new books were published last year alone, so there is just no way for the average human, who reads about 200-400 words per minute, to be able to everything that is directly relevant to his or her profession.  But what if we could somehow increase the amount of words that our brains can process in each minute?

Enter Evelyn Wood, an American educator and entrepreneur who developed a "speed reading" technique that could increase the amount of words read per minute by a factor of 3-10, while at the same time preserving the same level of reading comprehension.  One of Wood's students once claimed that she could read the entire novel (about 690 pages) Gone with the Wind in less than an hour!  If that sounds too good to be true, it's because it is too good to be true.  The available research (reviewed in an article referenced by Drs. Schwanenflugel and Knapp) generally supports the idea that readers can read much faster after being trained in these speed reading techniques, but they do so at the sacrifice of reading comprehension.

I am sure that "speed readers" would argue with me that their comprehension doesn't suffer.  I would argue back, "Why does it matter?"  Are you reading these books quickly because you want to brag about how many books you have read, or do you actually enjoy reading them and digesting them slowly so that you can fully understand and comprehend what the authors of the books you read are trying to say?  Quality clearly is better than quantity here.  

Are you a slow reader?  Don't worry about it.  The important thing is that you are reading to grow and develop as a leader. 

Don't break the chain

Jerry Seinfeld is one of the most successful comedians of all-time.  The television network Comedy Central lists Seinfeld among the top 100 comedians of all-time (for the record, he is ranked at #12, just behind Johnny Carson and ahead of Robin Williams).  He was the co-creator, co-writer, and star of the television series Seinfeld, which ran from 1989 to 1998 and is widely regarded as one of the greatest and most influential sitcoms of all time.  The show led the Nielsen ratings in seasons six and nine (the final season), and finished in the top two every year from 1994 to 1998.  Only two other television shows, I Love Lucy and The Andy Griffith Show finished their runs at the top of the Nielsen ratings.  At the height of the television show's (and his) success, Seinfeld made over $267 million in 1998.  What is even more impressive is the comedian's consistency from year to year.  His level of consistency and high performance is something we can both aspire to, learn from, and model.

What is the secret to Seinfeld's success?  It's pretty simple to describe and boils down to three words - "work and though and preparation".  It's certainly not a mystery that hard work can and often does lead to success.  Unfortunately, there's not a 1:1 correlation between how hard you work and how successful you ultimately become, but there is no question that success doesn't come without hard work.  Is there anything else that Seinfeld can teach us?

As it turns out, the comedian shared at least one of his secrets with an aspiring comedian named Brad Isaac.  In an interview with Lifehacker, Isaac told of how he approached Seinfeld one night after a performance and asked him if he had any tips that he would be willing to share.  Isaac told Lifehacker:

He said the way to be a better comic was to create better jokes and the way to create better jokes was to write every day.

He told me to get a big wall calendar that has a whole year on one page and hang it on a prominent wall. The next step was to get a big red magic marker. He said for each day that I do my task of writing, I get to put a big red X over that day.

“After a few days you'll have a chain. Just keep at it and the chain will grow longer every day. You'll like seeing that chain, especially when you get a few weeks under your belt. Your only job is to not break the chain.”

Just like that, Seinfeld's strategy for achieving consistently high performance has come to be called the "don't break the chain method" of habit formation.  I've found this particular method to be incredibly useful in both my own personal and professional lives.  As a matter of fact, I've even posted about the advantages and disadvantages of this technique in the past (see "The Big Red X" and "All Things Must Pass").  

Consistency is one of the keys to high performance.  The top performers in virtually any field or endeavor are usually the ones who show up and work hard each and every day, regardless of how they feel or what else is going on in their lives.  Top performers don't let a bad work-out, performance, or day at work compound - they show up for their next one and keep pushing forward.  Consistency.  Resilience.  Persistence.  These characteristics are what usually separate the top performers from their peers.

Seinfeld's "don't break the chain" strategy works because it focuses our attention on the process, not the performance.  As James Clear (author of the book Atomic Habits) writes, "It’s not about how you feel, how inspired you are, or how brilliant your work is that day. Instead, it’s just about “not breaking the chain.”  However, there are a couple of important caveats to make this strategy work.

Whenever you are trying to establish a new habit, it's best to focus on just one habit.  In other words, don't try to change everything all at once.  As an example, if you are trying to develop a healthy lifestyle (which could involve regular exercise, a health diet, avoiding and reducing stress through meditation, etc), it's best to focus on just one aspect of that healthy lifestyle first (say, exercising every day as opposed to starting a regular routine of daily meditation).  Similarly, it's important to start with small change first.  You simply cannot go out an run a marathon tomorrow - you have to build up to it.  Start with small, incremental change, but make sure that the change is continuous and incremental!  

Progress towards your goal should be visible.  You should keep track of your daily performance by using some sort of tracking tool.  Jerry Seinfeld used a calendar, but there are also apps available to help you achieve your goals.

We are more successful at establishing habits when we share our goals with others.  For example, if you are crossing off each day that you successfully do something (e.g. exercise for 20 minutes or read a chapter in that long novel you've been wanting to read forever) on a calendar (see above), it's helpful to post that calendar where others can see it!  Making your progress visible to others does two things.  First, you will be more engaged when you know that others are watching you.  Second, your family members or peers will support you and encourage you more when they can see your daily progress towards a new habit.

I really like the "don't break the chain" method, and I've used it several times in my own personal and professional life.  Case in point, when I first started this blog, I committed to trying to post something at least every Sunday and Wednesday.  As you may have noticed, I've been posting fairly regularly and even more frequently than that!  The ancient Greek philosopher Aristotle said, "We are what we repeatedly do.  Excellence, then, is not an act but a habit."  The British author and philosopher James Allen said, "The law of harvest is to reap more than you sow. Sow an act, and you reap a habit. Sow a habit and you reap a character. Sow a character and you reap a destiny."  And whatever else you do, don't break the chain!

"Football is life!"

Okay, I can't wait for the next season of the Apple TV+ television series "Ted Lasso" to begin later this summer.  I haven't been a huge football (the sport called soccer here in the U.S.A.) fan in the past, though watching the series peaked my interest.  I've recently started watching the English Premier League and following the Everton Football Club (because that's Paul McCartney's favorite club!).  The season just recently ended, and Everton just narrowly missed relegation (the bottom three teams get sent down to the next level below the Premier League, which I think is called the English Football League).  

Football fans are highly devoted to their clubs.  They often get in shouting matches with opposing fans, and in some cases, they even get violent with each other!  So, with that as context, the question is how deep does the "hatred" for rival teams in English Football go?  A group of psychologists asked this exact question, asking whether fans of say of Manchester United would help a fan of Liverpool F.C. in an emergency (these two highly successful teams are apparently arch-rivals - kind of like University of Michigan versus Ohio State fans!).

The study (published in the journal, Personality and Social Psychology Bulletin) followed the methodology of a now classic study ("From Jerusalem to Jericho: A study of situational and dispositional variables in helping behavior") by John Darley and Daniel Batson (I like to call this the "Good Samaritan" study - for details, see my post "Who is my neighbor?").  Basically, male undergraduate students at Lancaster University were recruited to participate.  Importantly, all of the participants were self-identified Manchester United F.C. fans.  They were told that they would be participating in a study of football fans' love of the sport.  They were "primed" to think about Manchester United F.C. (by answering a number of questions in an interview setting) before being instructed to walk across campus to another building for the next part of the study.  While walking towards the other building, one of the members of the research team (acting as the victim) came jogging by and pretended to fall and hurt his ankle.  The victim was either wearing a non-descript T-shirt, a Manchester United T-shirt, or a Liverpool F.C. T-shirt.  Three hidden observers then rated how each subject responded noting whether participants noticed the accident and whether they stopped to help.

Study participants were more likely to help the victim wearing a Manchester United F.C. T-shirt, stopping to help 85% of the time versus only 31% of the time when the victim was wearing a plain T-shirt.  However, they weren't any less likely to stop to help a victim who was wearing a Liverpool F.C. T-shirt, stopping 30% of the time (again, compared to 31% of the time when the victim was wearing a plain T-shirt).  The researchers concluded that belonging to the same social group (in this case, Manchester United fans) increases the likelihood of stopping to help someone.  

The research team repeated the study, this time cueing in on the fact that study participants were football fans (in other words, the question and interview "primed" the participants to think about football in general and not specifically on Manchester United).  Again, belonging to the same social group increased the likelihood that the participants stopped to render assistance to the victim (Manchester United T-shirt: 80% stopped; Liverpool F.C. T-shirt: 70% stopped; Plain T-shirt: 22% stopped).

Social bonds are incredibly powerful!  Just go back to a post from a couple of years ago, "Why didn't you tell me about the 'Jeep Wave'?".  Here is what I said then about finding out that I was part of the special group of Jeep Wrangler owners:  "All we really need in this world is something to be a part of - whether it is a family, a community, a club, or a team.  We just want to belong to something.  What a great gift for a team leader - that feeling of togetherness that we are all here for one purpose, one goal, one mission.  There is a collective vision that keeps pushing us towards our ultimate goal, and as a team, we can achieve great things together."