"Billions and Billions"

I recently found a website (not Amazon Prime, Netflix, or Hulu) that has all of the episodes of the 1980 television series Cosmos: A Personal Voyage, a thirteen episode series written and starring the astronomer Carl Sagan.  I believe that it first aired on public television, and there was also a book that accompanied the series.  I remember reading the book (and I think that I even owned a copy of the original hardback version), and I remember watching at least the first few episodes.  As difficult as it may seem, back then if you didn't catch an episode when it aired, you were out of luck!

I watched the first episode again, and the first half wasn't very interesting.  Basically, Sagan was flying around space in an imaginary spaceship and naming various celestial bodies like pulsars, quasars, nebula, etc.  I kept pausing the show, which jogged my memory of the first time that I watched it - I lost interest back then too!  However, I kept coming back to it, just to see if my memories of some of the episodes were in fact true.  Having watched a few episodes now, it's all coming back.  I must have watched more of the show than I thought.

What's amazing to me is how much we didn't know back then.  Sagan talks about how the dinosaurs suddenly disappeared and how scientists still didn't know the reason why.  We now believe, and there is strong evidence to support it, that the dinosaurs were wiped out when a giant meteor or comet struck the Earth.  In another episode, he talks about how some day we will be able to manipulate different sequences of DNA, in order to cure certain diseases.  Today, it's relatively straightforward to change different sequences of DNA, and gene therapy is fast becoming reality.  It's amazing when I think about how much we have advanced as a society since I was a child.  And I can only imagine how more advanced we will be as a society in the not so distant future.  

A lot has happened in the last forty plus years, and we definitely know a lot more about the cosmos now than we did back then.  For that reason, I'm not really sure why I am watching (? re-watching) a science show from 1980, other than for a feeling of nostalgia.  Perhaps I am trying to re-capture that sense of wonder that I felt back then.  I am reminded of a great lyric by the rock-n-roll artist Bob Seger, "Wish I didn't know now what I didn't know then."

The 80 hour work week

I've been working in the Pediatric Intensive Care Unit (PICU) for the past week, which is my excuse for not posting anything since May 9th.  While it was a relatively calm week in the PICU (at least on my team), I decided to take a short break from writing.  I'm looking forward to getting back into my normal cadence soon.

I am currently working on a talk that I will be delivering at the 2024 meeting of the World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS 2024).  The title of my talk was supposed to be, "Next PICU Generations: Is the quality of personal life more important than the quality of training & education?"  I was told I could change the title as a condition of my agreement to participate, particularly after I expressed concern about the topic.  I think I said something like, "I wouldn't touch this question with a ten foot pole!"  I think I settled on a compromise that hits some of the program committee's request, and I will be certain to provide a follow-up report!

Sparing the details of my presentation (since I haven't quite finished it yet), I felt that I should at least touch upon the different generations that are working in the hospital today, with a specific focus on the fact that there are a lot of misconceptions (as I mentioned in my post, "Talkin' 'bout my generation!").  One of the most common misconceptions about Millennials is that they are too focused on work-life balance and don't want to work hard.  Given the fact that Millennials will soon comprise the greatest percentage of our workforce (if they haven't actually already done so), I thought that this would be an important discussion.  Next, I wanted to talk about some of the changes that have occurred in graduate medical education and whether this has had an impact on the quality of care that is delivered in the PICU.  I've certainly had some fun putting this talk together, so I hope that it will be an interesting discussion!

Medical education and training typically consists of four years of medical school after completion of an undergraduate degree (also typically four years), followed by three to six years of residency training (depending upon the specialty) and an additional one to three years of subspecialty fellowship training (again, depending upon the subspecialty).  For example, PICU physicians complete four years of medical school, three years of pediatric residency training, and three years of pediatric ICU fellowship training.  Prior to 2003, physicians in most residency and fellowship programs worked more than 80 hours per week, with shifts often lasting 30 hours or more in the hospital.  No one seemed to be too concerned about the high number of hours spent in the hospital until some high profile deaths (the most famous was the case of Libby Zion, whose death in 1984 at age 18 years was blamed on overworked residents in the hospital) that occurred in teaching hospitals due to medical errors committed by overworked residents.  In respone to these growing concerns, the Accreditation Council for Graduate Medical Education released a set of reforms in 2003 that restricted resident physicians to a maximum of 80 hours of work per week, as well as limiting single shifts to 24 hours.  Subsequent reforms were enacted again in 2011 (capping shift lengths at 16 hours for first-year residents) and 2017 (which allowed longer shifts for first-year residents, but imposed other limits).

While these restrictions have generally resulted in better resident and fellow wellbeing, better work-life balance, and reduced burn-out, they have not had a dramatic effect on hospital outcomes.  Several studies have shown that hospital mortality, length of stay, cost of care, and incidence of complications haven't really changed much since these restrictions were put in place.  On the other hand, these restrictions have led to concerns about the quality of education and training that residents receive, particularly in surgical fields where studies have shown a decrease in the number of surgeries that residents have performed upon completion of their training.  Even if the critical threshold is not specifically known, most experts in graduate medical education agree that building sufficient expertise requires physicians to see a minimum number of similar cases or perform a minimum number of procedures (think of Malcom Gladwell's 10,000 hour rule - see also my post, "Practice makes better, but does practice make perfect?").  The question becomes whether physicians have taken care of the minimum number of similar cases or performedd the minimum number of surgical procedures by the time that they complete residency or fellowship training and become independently practicing physicians!

My background research led me to a Harvard Business Review article by the economist Anupam Jena, "Is an 80-hour work week enough to train a doctor?"  The article is based upon two research studies that Jena and his team published in Health Affairs and British Medical Journal, respectively.  Using a difference-in-differences analysis of two cohorts (one from the state of Florida and the other from a national database), Jena and his colleagues found that 30-day hospital mortality, length of stay, and cost of care did not change after the 80 hour work week was imposed in 2003.  Specifically, hospital outcomes for patients cared for by internal medicine physicians during their first year out of residency training did not change after the work hour restrictions were imposed.  In other words, these newly independent physicians apparently received enough training during their residency, even with the 80 hour work week restriction, to provide excellent care for their patients.  Jena also found that "spending fewer hours in the hospital during training had, on average, no effect on internists' hospital readmission rates or costs of care when they subsequently entered independent practice."  He further wrote, "At a minimum, the data suggest that the incremental experience gained from working more than 80 hours per week as a resident doctor doesn't generally translate into improved patient outcomes later."

Jena and his colleagues were careful not to generalize their findings to surgical patients, arguing that the decrease in the number of surgeries performed during residency due to the 80 hour work week could have an adverse impact on outcomes after graduation.  However, Rachel Kelz and her colleagues published a similar study in the journal, Annals of Surgery ("Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons") that addresses this question.  Dr. Kelz found that the 80 hour work week restrictions did not have a significant effect on 30-day mortality following surgery using a Medicare database of close to 1.5 million patient encounters, though she did find some impact on length of stay, duration of the procedure, and costs of care.

These three studies are incredibly important, but they are not sufficient to make any definitive conclusions.  It's tempting to argue that physicians are less experienced when they graduate from residency and fellowship, but these three studies suggest that may not necessarily impact the care that they provide.  It could be that those of us who completed residency training prior to the 80 hour work week saw more patients and performed more procedures than what was necessary to become competent physicians.  I think more studies are necessary, and I suspect that this will be an important discussion for many years to come.

L2M

I mentioned in my last post about how I've been an Indiana Pacers fan since childhood.  Game 1 of the Eastern Conference Semi-Finals did not go well for us.  During a very close game, the game officials made a couple of critical and questionable calls during the closing minutes of the game that arguably had a significant impact on the game's outcome.  With the game tied 115-115 in the final minute, the Pacers stole an errant pass and turn-over, but the referees whistled a kicking call on the Pacers (which did not occur, by the way).  Knicks ball.  A few seconds later, the Knicks scored to take a 118-115 lead that they would never relinquish.  Former NBA Coach and television commentator Stan Van Gundy said this about the kicking call, "That is shocking.  You never see that call at this point in the game. I mean, never."  The Pacers challenged the call, but lost it.  After the game, the NBA admitted that they got the call wrong.

I am never one to argue that a game is lost over bad officiating.  However, in this case, the wrong call resulted in a potential five point swing.  The Pacers would have likely scored on a fast break to take a 117-115 lead.  Instead, they fell behind by three points.  And that is a tough pill to swallow.

Sports talk radio was all over this story, both on my afternoon commute yesterday and the morning commute today.  What was news to me, though, was that the NBA recently started analyzing the final two minutes of every game, specifically to review the officiating calls that were made.  It's called a "L2M" or "Last Two Minute" report, and the NBA has been issuing them since March 2015.  Effectively since the 2017-2018 season, the NBA has issued a L2M for any game in which one team’s lead over the other is three points or fewer at any point during the last two minutes of the fourth quarter or overtime.  The NBA states that the purpose of the L2M reports is to increase transparency and accountability, as well as to build a greater awareness and understanding of the rules and processes that govern the game of basketball.  As the sports talk radio hosts also emphasize, given the closer ties with professional sports associations and sports gambling, the added layer of transparency provided by these reports is also of significant importance.

My interpretation is that the L2M reports are all about the High Reliability Organization principle of "Preoccupation with Failure".  I don't believe for a second that the NBA is trying to specifically become a High Reliability Organization.  They are just trying to improve how their game officials referee their games!   Remember, High Reliability Organizations (HROs) do not consider failures as things to avoid at all cost.  Rather, HROs believe that failures represent opportunities to learn and improve their systems.  As Thomas Watson, founder of International Business Machines (IBM) once said, "If you want to increase your success rate, double your failure rate."  Individuals in HROs report their mistakes, even when nobody else is looking!  HROs do not punish individuals who make mistakes.  On the contrary, in many cases, individuals who report their mistakes are often rewarded!

By publicly acknowledging their officiating mistakes, particularly in the most critical portions of a close game, the NBA is stating that they (1) made a mistake, (2) will learn from the mistake, and (3) will take the necessary steps to prevent those same kind of mistakes in the future.  What the NBA chooses to call transparency, accountability, and awareness is really what I would call the HRO principle of "Preoccupation with Failure".  Oh, and incidentally, there were four key errors from the Pacers-Knicks Game 1 the other night listed in the official L2M report.

Be like the Worm...

I really enjoy Chicago sports.  I consider myself a die-hard Chicago Cubs fan, I really like the Chicago Blackhawks, and I am very excited about what the Chicago Sky and the Chicago Bears did in their recent respective drafts.  However, I've never really been a huge fan of the Chicago Bulls, mostly because I grew up watching (and loving) my hometown team, the Indiana Pacers.  When I was young, the Pacers were the only professional sports team in Indianapolis (the Colts were the Baltimore Colts until 1984 and the WNBA didn't even exist).  Regardless of whether I like them or not, I have to admire and respect what the Bulls did during the 1990's.  They were by far the best team of that decade, and there is a pretty strong argument that they were one of the greatest teams of all time.  One of their most unusual players (and at times, an absolute disaster both on and off the basketball court) was Dennis Rodman, aka "The Worm".  

Just consider Rodman's resume.  He was selected to the NBA All-Defensive First Team seven times, and he won the NBA Defensive Player of the Year twice.  He led the NBA in rebounds per game a record seven years in a row (despite being "only" six feet seven inches tall).  He won five NBA World Championships (two with the Detroit Pistons and three with the Chicago Bulls).  He was selected to Naismith Memorial Basketball Hall of Fame in 2011 and to the NBA 75th Anniversary Team in 2021.  His No. 10 jersey was retired by the Detroit Pistons.  He was one of the best defensive players in NBA history, and he is arguably the best rebounding forward ever to play the game.  

He only averaged more than 10 points per game (PPG) once, during his second year in the league with the Detroit Pistons.  During his three-year tenure with the Chicago Bulls, he averaged 5.5, 5.7, and 4.7 PPG, respectively.  The Bulls didn't need him to score, but he was an integral member and important contributor to the team's overall success.  He understood his role, and he played it extremely well.

If you watch the docuseries "The Last Dance", pay attention to Episode 3, which covers Rodman's time with the team in depth.  He approached rebounding very scientifically.  He studied film extensively - and what he studied most intensely was what happened to the ball when opposing players missed the basket.  There is a famous video of former teammate Isiah Thomas discussing Rodman's approach to rebounding.  Rodman apparently used to stand by the basket during warm-ups, just to watch how the ball came off the rim.  Of course, his teammates just thought he was being lazy, and when they asked him what he was doing, he told them.  "I am counting your spins."  He would know how many spins the ball would make in the air after each player shot the ball.  He used that information to try to better predict where the ball would end up, so that he could position himself in exactly the right spot to make the rebound.  

Rodman would apparently go the gym late at night with his friends and ask them to shoot, just so he could study how the ball moved off the backboard or rim.  Michael Jordan, arguably the greatest player in history, once called Rodman "one of the smartest guys I played with."  Rodman was the best at rebounding because he worked the hardest to perfect his craft.

If Rodman had tried to make his living scoring baskets, he probably wouldn't have lasted very long in the NBA (and maybe he wouldn't have even played in the NBA).  He understood his role and how best he could contribute to the team.  Just as in basketball, in any organization there are going to be superstars and role players.  If you happen to be a role player, be the best at that role that you can possibly be (see my previous posts on this exact point, "I play not my eleven best, but my best eleven", "He's the glue", and "In search of David Ross").  Be like the Worm.

Turning around the ship...

I was recently asked to give a talk on High Reliability Organizations to our foundation and marketing teams.  Normally this would be a relatively straightforward request for me, as I have several prepared or "canned" talks on this subject.  However, I was asked to talk about how the HRO principles apply to non-clinical areas.  To be more specific, our foundation and marketing teams wanted to learn how to apply HRO principles to think differently and work more effectively at their jobs.  So, I spent the allotted time (about 20 minutes) without mentioning safety at all.

The question really is whether HRO principles can be applied so that organizations can perform at their best and not just at their safest.  In my opinion, High Reliability Organizations can also be called "High Performing Organizations."  The five characteristics, which include Deference to Expertise, Preoccupation with Failure, Sensitivity to Operations, Commitment to Resilience, and Reluctance to Simplify (and I previously added a sixth characteristic, Comfort with Uncertainty and Chaos to this list), help organizations to operate at the highest level of performance.  I have studied "high performing organizations" in a variety of different industries, including health care, and I consistently find that these organizations operate at the highest levels of safety, efficiency, consistency, and success.

As an example, I mentioned the book Turn The Ship Around! by David Marquet.  I've mentioned this book a couple of times in the past (see "Classic Rookie Manager Mistakes", "The definition of power is the transfer of energy...", and "The power of empowerment"), and if you haven't read it yet, it's definitely worth a look.  Marquet assumed command of the USS Santa Fe, a nuclear-powered submarine which was perhaps one of the worst commands in the fleet.  Using what you will recognize essentially as High Reliability Organizations leadership principles, Captain Marquet turned the USS Santa Fe into one of the best commands in the fleet.  Prior to Captain Marquet, the reenlistment rate on the USS Sante Fe was well below the average for the rest of the Navy (only three members of the crew reenlisted the year before Captain Marquet took over - by the time Captain Marquet finished his tour as the Commanding Officer (CO), thirty-three sailors signed up for another tour of duty, far above the Navy's average).  Similarly, on average, about two or three officers on a submarine will ultimately go on to become CO's.  During Captain Marquet's tenure, nine out of his fourteen officers eventually became submarine CO's.  

One of Marquet's key concepts is "pushing authority to information".  In most organizations, decisionmaking authority is based upon rank or hierarchy.  However, most of the key information necessary to make those decisions is at the lowest ranks, i.e. on the front-lines.  In most organizations, information is pushed to authority (up the chain of command to those who have the authority to make decisions).  Marquet "flipped the script" so that authority was pushed to information - in other words, he gave decisionmaking authority to those individuals on the front-lines who had access to the information needed to make those decisions.  Sound familiar?  It's exactly what High Reliability Organizations would call Deference to Expertise!  

As you read Marquet's book, you will recognize several of the key principles that define highly reliable organizations.  Similarly, if you study high performing organizations, you will find that almost all of them are also High Reliability Organizations.

The Last Toast

Just over 82 years ago, on April 18, 1942, a group of 16 B-25B Mitchell medium bombers, each with a crew of five, launched from the flight deck of the aircraft carrier USS Hornet.  They were led by Army Lieutenant Colonel James Doolittle, who was later awarded the Congressional Medal of Honor for leading the mission.  The "Doolittle Raid" was conceived shortly after the Japanese attack on Pearl Harbor on December 7, 1941 as a way to boost American morale following that devastating surprise attack.  Navy Captain Francis S. Low, Assistant Chief of Staff for anti-submarine warfare is credited with the idea for the attack.

The plan required an aircraft that would be able to take-off from the flight deck of an aircraft carrier with a cruising range of 2,400 nautical miles carrying a 2,000 pound bomb load.  The B-25B Mitchell had a range of about 1,300 miles, so the bombers had to be extensively modified to hold nearly twice their normal fuel reserves.  Early flight tests with the B-25B Mitchell suggested that it could be successfully launched from the short runway of an aircraft carrier.  The plans further called for the planes to bomb Tokyo and then fly on to China, with the likely landing spot of Chongqing.

The 16 modified bombers with their respective five-man crews (80 pilots and crew) and support personnel departed on the USS Hornet and Task Force 18 left San Francisco, California on April 2, 1942.  They joined Task Force 16, commanded by Vice Admiral William "Bull" Halsey a few days later.  The USS Enterprise and her escort cruisers and destroyers with Task Force 16 would accompany the Hornet in order to provide air cover and support, as the Hornet's normal complement of fighters could not be launched from its flight deck that was crowded with the 16 bombers.  

At approximately 0738 on the morning of April 18, while still 650 nautical miles away from Japan, the task force was spotted by a Japanese patrol boat, which radioed an attack warning to Japan before the boat was sunk.  Doolittle and the Hornet's captain decided to launch the B-25Bs immediately, 10 hours (and 170 nautical miles) earlier than planned in order to maintain some element of surprise.  All sixteen aircraft safely launched, even though none of the pilots had ever flown off the deck of an aircraft carrier.  They flew in groups of two to four aircraft at wave-top level in order to avoid radar detection.  Despite encountering some light anti-aircraft and a few enemy fighters, all 16 bombers reached Tokyo safely and released their bombs.  

One bomber was running very low on fuel and had to head towards the Soviet Union to avoid ditching in the East China Sea.  The remaining 15 bombers flew towards China, all running low on fuel and flying in deteriorating weather conditions.  A lucky tail wind allowed all 15 bombers to reach the coast after 13 hours of flight and either crash-landed or bailed out (they didn't have sufficient fuel to reach Chongqing).  One crewman died during the bailout.  In the end, the bombers flew just around 2,250 nautical miles!

Sixty-nine airmen escaped capture or death (three were killed in action).  The Chinese people who helped them were later tortured or executed by the Japanese (an estimated 250,000 Chinese lives were taken by the Japanese Imperial Army during the search for the Doolittle raiders).  Eight raiders were captured by the Japanese, and their fate would not be known until 1946 (three were executed, 1 died in captivity, and 4 were repatriated).  

Doolittle believed that the mission had failed - they had inflicted relatively minor damage and had lost all 16 aircraft.  He expected a court martial upon return to the United States.  Instead, he was promoted two grades to Brigadier General and received the Congressional Medal of Honor.  All 80 raiders were awarded the Distinguished Flying Cross.

After the war, the Doolittle Raiders held a reunion almost every year from the late 1940's until 2013.  Every year, they would perform a roll call and toast their fellow raiders who had died during the previous year.  Specially engraved silver goblets, one for each of the 80 raiders, were used for this annual toast.  The goblets of those who had died were inverted (each raider's name was engraved on the goblet twice, so that it could be read right side up or upside down).  The goblets and a special bottle of cognac (a 1896 Hennessy VS cognac, 1896 being Doolittle's birth year) were held at the site of the annual reunion at the United States Air Force Academy until 2006, after which time they were transferred to the National Museum of the United States Air Force at Wright-Patterson AFB in Dayton, Ohio.  I visited the museum at some point afterwards, and the display of these goblets was a very special memory.

On April 18, 2013, a final reunion for the last four surviving raiders was held at Eglin Air Force Base (only one surviving raider failed to attend due to poor health).  The final toast took place at the National Museum on November 9, 2013, preceded by a B-25 flyover, with three raiders - Richard Cole, Edward Saylor, and David Thatcher in attendance.  The 1896 bottle of cognac was opened, and the "final toast" was given by Cole: "Gentlemen, I propose a toast to those we lost on the mission and those who have passed away since.  Thank you very much and may they rest in peace."  Saylor would die in 2015, while Thatcher died in 2016.  Richard Cole, Doolittle's co-pilot, was the last surviving raider and died on April 9, 2019 at the age of 103.  Shortly after his death, his family and Air Force dignitaries gathered together to turn over his silver goblet, thus closing the book on a famous chapter of American military history.

Mike and Mary Anne

I came across an article the other day (see "Why Mike Mulligan and His Steam Shovel Still Charms All Ages" by Janice Harayda) about the children's book Mike Mulligan and His Steam Shovel that I vividly remember from my childhood.  

It's an old book - I was surprised to learn that it was actually written and illustrated by Virginia Lee Burton in 1939.  I'm not sure if the book is still as popular today, but I know that my own kids enjoyed reading it too.  According to a 2007 online poll by the National Education Association, the book is listed as one of the "Teacher's Top 100 Books for Children."  

The story is about Mike Mulligan, owner of Steam Shovels, Inc and his steam shovel, which he affectionately named Mary Anne (whose name is apparently a reference to the real life Marion Power Shovel Company).  Mike Mulligan used to brag that Mary Anne "could dig as much in a day as a hundred men could dig in a week" (though he had never proven this).  Mike and Mary Anne soon face competition from more modern gasoline, electric, and diesel-powered shovels, and so they end up finding work in a small town that wants to build a new town hall.  Mike offers to dig the cellar in a single day, even though the town's selectmen think that it would take 100 men the entire week to do so!  He even goes as far as saying that if Mary Anne doesn't finish the work in a day, the town won't have to pay them.  

Everyone has doubts, including Mike.  But in the end, Mary Anne finishes the job in a single day!  Unfortunately, Mike forgot to build a ramp to get Mary Anne out.  No one knows what to do, but eventually a little boy suggests that they could build the new town hall around Mary Anne, converting her into the boiler.  Mike Mulligan could then be the janitor.  And that's just what happened in the end!

It's a wonderful story, and reading it again after so many years brought back a lot of memories.  I guess I never thought that the story could be a metaphor for technological change!  Samuel Arbesman wrote an article for The Atlantic entitled, "Lessons About the iPhone, Courtesy of a Depression-Era Children's Book".  As Arbesman writes, "In Mike Mulligan, inexorable technological progress renders Mary Anne an outdated machine...but Mike Mulligan simply can't bear to get rid of his beloved Mary Anne, even when the rest of the steam shovels are discarded."  

Mike and Mary Anne have one last hurrah, and then they get to spend the rest of their days together doing something completely different.  It's a happy ending after all.  As so often happens, there's a deeper meaning in this simple story from a classic story book.  Perhaps technological change doesn't have to be a zero-sum game.  Maybe there's an opportunity to re-use or re-purpose the old technology for something different.  

Draft Day

I wanted to make a few comments and observations on the most recent NFL Draft, which took place in Detroit last week.  I've always found the process of how NFL teams evaluate players quite interesting, particularly since the result rarely goes exactly according to plan.  A few years ago, Tom Servo looked at several years of the NFL Draft and found that 50% of players drafted in the first round develop into solid NFL starters for their teams, which decreased to 33% for players drafted in the second round.  After that, the percentages dropped by half over each subsequent round (third round -16%, fourth round - 8%, etc).  Servo said, "Odds are not high you will become a difference maker in the NFL... no matter where you're taken."  Moreover, only 30% of drafted players actually end up on a NFL roster!  Add to those less than impressive statistics the fact that arguably one of the greatest players in the history of the NFL - Tom Brady - was drafted in the sixth round of the 2000 NFL Draft at pick #199! 

Michael Roberto, a Bryant University business school professor, blogger (see "Professor Michael Roberto's Blog"), and author, posted last week (before the 2024 NFL Draft) his own analysis of how well the NFL does at picking talented players (see "The NFL Draft: Are Teams Getting Better at Selecting Talent?").  He compared drafts in the 1970's and 1980's to drafts in the two most recent decades and found:

1. Teams are selecting more quarterbacks in the first round compared to past drafts.  Notably, a record-high six quarterbacks were selected in the opening round of the 2024 NFL Draft!  The quarterback has become in the last decade or so the most important position in football, so the fact that teams are drafting more quarterbacks in the first round is not a surprise.

2. Consistent with the statistics above, despite the ubiquitous use of sophisticated data analytics and psychological testing, teams are not any better at picking stars today than they were in the 1970's and 1980's.  From 1970-1989, 50% of the quarterbacks selected in the first round from 1970-1989 made at least one Pro Bowl (the NFL's version of the All-Star Game).   From 2000-2019?  You guessed it - 50% of quarterbacks selected in the first round made the Pro Bowl at least once. 

3. The chance of selecting a Super Bowl winning quarterback is very low.  Again, from 1970-1989, 8 of the 38 (21%) quarterbacks selected in the first round were the starting quarterbacks on Super Bowl championship teams compared to only 5 of 56 (9%) quarterbacks selected in the first round from 2000-2019.  The fact remains that the most elite quarterbacks (which are very hard to predict) generally win multiple Super Bowls.  For example, five quarterbacks have won 36% of the Super Bowls ever played (Brady, Bradshaw, Montana, Aikman, and Mahomes), and twelve quarterbacks have won 60% of the Super Bowls ever played!   

Unfortunately, things don't quite work out as well as they did in the 2014 film "Draft Day" starring Kevin Costner, the late Chadwick Boseman, and Jennifer Garner.  I've posted about the movie a couple of times in the past (see "Vontae Mack No Matter What", "Attitude > Talent", and "All you need is faith, trust, and a little pixie dust..."), and it's a really good movie in my opinion.  But it's fiction.

So, what is there to learn from the NFL Draft?  Despite the amount of time and money spent on evaluating players, it's still a bit of a roll of the dice whether a player will turn out to take a team to proverbial promised land of a Super Bowl Championship.  I suspect that the same is true about picking leaders in organizations.  As Michael Roberto writes, "Beware of the hype around various talent evaluation tools.  Yes, analytics can be helpful, as can other new tools for evaluating talent.  However, we should be skeptical of those who claim that these new tools and methods can dramatically improve our ability to identify top talent."  

"I am the master of my fate..."

It’s been a busy week working in the hospital this week, so I decided to post one of my favorite poems. It’s by the English writer, William Ernest Henley and it's called "Invictus" (recited by the actor, Morgan Freeman here).  Henley suffered from tuberculosis that invaded his bone, requiring amputation of his left leg below the knee at the age of 12 years (incidentally, one of Henley's close friends was the author Robert Louis Stevenson, who wrote Treasure Island - the character of Long John Silver was inspired in part by Henley).  Nelson Mandela is said to have recited the poem to his fellow prisoners while he was a incarcerated at Robben Island prison (depicted in the movie, Invictus, starring Morgan Freeman and Matt Damon, about the 1995 Rugby World Cup, Nelson Mandela, and the rugby player Francois Pienaar):

Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find me, unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.

I think the poem speaks for itself.

"Apes alone weak...Apes together strong!"

I'm probably dating myself here, but I am old enough to remember when the "Planet of the Apes" science fiction media franchise first started with the 1968 film starring Charlton Heston, Roddy McDowell, and Kim Hunter.  Okay, technically, I was too young to see the movie when it was first released, but I remember seeing a lot of the sequels that aired from 1970 to 1973, the live action television series, which aired in 1974, and the animated series which aired in 1975.  I also remember all the action figures, lunch boxes, and other toys that were associated with the movies.  I really enjoyed Tim Burton's 2001 remake, "Planet of the Apes", and I've seen at least a couple of the films in the most recent reboot.  There are a lot of commercials out right now about the latest installment, "Kingdom of the Planet of the Apes", due to be released in a couple of weeks.

I never realized, however, that the entire media franchise started with a 1963 novel by the French writer Pierre Boulle.  Boulle also wrote the 1952 book The Bridge Over the River Kwai, which was made into a superb 1957 movie "The Bridge On the River Kwai" starring William Holden and Alec Guinness.  I actually read his Planet of the Apes novel a month or so ago while at the beach.  I have to say that it was excellent, even if the original movie didn't exactly follow the storyline (although I have to say that the movie mostly stayed true to the novel with a similar, though slightly different, plot twist at the end).  There are a surprising number of lessons about leadership in both of Pierre Boulle's novels (and the movies based on them - see my previous post, "The Bridge Over the River Kwai Syndrome" for more on that novel and movie), which I guess is not too surprising given that Boulle was a French soldier and spy during World War II.

As it turns out, I am not alone in seeing the potential for leadership lessons in the "Planet of the Apes" media franchise.  See, for example, Leroy Ford's Medium post "20 Leadership Lessons from Planet of the Apes" or Joel Eisenberg's Medium post "The Caesar Legacy: Politics and Leadership From Julius to Apes" for just two examples.  Certainly there are a number of political themes in the series as well, as noted by Eisenberg in his post.  I am also fascinated by how different leaders use power and politics to their advantage in the book and movies - not all powerful leaders are dictators, again as eloquently demonstrated in the movies.  I am also deeply interested in the different ways that members of a group interact.  I am reminded of several recent books on this topic, including Blueprint: The Evolutionary Origins of a Good Society by the American sociologist and physician Nicholas Christakis (which I read during the same beach vacation and discussed in a previous post), Groupthink: Psychological Studies of Policy Decisions and Fiascoes by the psychologist Irving Janis, who first coined the term and described the concept of "groupthink", and lastly the excellent book, appropriately enough for the present discussion, Chimpanzee Politics by the scientist Frans de Waal.  

I've always believed (and stated on a number of occasions) that leaders can learn a lot about leadership by reading about other leaders throughout the course of history.  The "Planet of the Apes" media franchise reminds me that we can also learn a lot about leadership through reading fiction or even through watching movies!  It's a lesson that I need to remind myself again from time to time, and it was actually the point of my second ever blog post, "What can we learn about leadership from a movie?"  The answer to that question is, a lot more than you think!

Pavlov's Dog

There's a better than average chance that most of you have heard about Pavlov's Dog.  If you happened to take an Introduction to Psychology class at any point in your life, it's almost a certainty that you've heard about Pavlov and his dog.  Pavlov, in this case, was a Russian physiologist (his full name was Ivan Pavlov) who is perhaps best known for his experiments that led to the concept known as "Classical Conditioning", even though he won the 1904 Nobel Prize in Physiology or Medicine for his work studying digestion.  

Apparently it all happened by accident.  Basically, while conducting experiments that would eventually lead to his Nobel Prize, he noticed that dogs started to salivate whenever his assistants walked into the laboratory.  He was interested in the role of the salivary gland in digestion, and his research team would bring different edible and non-edible items into the lab to see how much saliva would be produced and if there were any differences in its chemical composition.  Soon, the dogs would begin to salivate even before they were presented with food.  Pavlov realized that the dogs had learned to salivate whenever they saw the white lab-coats of his research assistants, which they had come to associate with food.  In other words, they were "conditioned" to respond to the lab assistants by salivating.  He then conducted a series of experiments involving a bell, and eventually "conditioned" his dogs to salivate whenever they heard the sound of a bell. 

I won't go into further details - you can read all about "Classical Conditioning" on the Internet or in any introductory psychology textbook (here's a short video reenactment that also explains Pavlov's experiments).  And while you are at it, be sure to read about “Operant Conditioning” too - I always mix them up and I’m sure that I’ve done so again here!

I was recently reminded of Pavlov's experiments by our dog at home.  He likes to chew on sticks and pine cones outside.  He frequently tries to bring these sticks or pine cones inside our house, which of course we would rather not let him do (there's nothing harder to clean-up than a pile of tiny twigs).  I am quite proud of the fact that I can catch him when he comes inside, place my fingers deep inside his mouth, and pull the stick or pine cone out before he starts to chew it.  Of course, after a few times getting caught, he's figured out how to run away and make me chase him.

So, guess what happens now?  He almost always tries to bring in a stick or pine cone from outside, because he thinks it's a lot of fun to have me chase him around our house!  I can see him waiting for me at our back door, and as soon as I open the door, he bends down and picks up a stick that he has hidden underneath his paw.  My wife just rolls her eyes and tells me not to let him inside if he picks up the stick!

I've suddenly realized that I've "conditioned" our dog to pick up a stick every time that he wants to come inside!  Actually, if I think about it, he may actually have "conditioned" me to chase him, because I find myself doing that all the time now, regardless of whether he has a stick in his mouth or not.  Who's Pavlov and who's the dog in this situation?

If “conditioning” really develops this easily, I can now fully appreciate why "change" is so difficult for folks.  Just as important, given the ease with which we are "conditioned" (and regardless of whether that is of the "classical" or "operant" variety), it makes sense that we should be able to establish new habits and behaviors just as easily as it is to hold on to our old ones.  As I've frequently said, leadership often requires being able to lead and manage change.  Managing change is the law of leadership!  It doesn't take much to establish deeply ingrained habits and behaviors.  Don't believe me?  Just remember Pavlov's Dog.

Are you in a "velvet rut"?

There's a saying that a rut is a grave with both ends kicked out.  The American tycoon J. Paul Getty once wrote, "It shouldn’t be very difficult for anyone to resist the temptation to force himself into the pattern of the structured man. One needs only to remember that a groove may be safe – but that, as one wears away at it, the groove becomes first a rut and finally a grave."

Building on a similar theme, I recently came across an older "Daily Stoic" blog post that described something called a "velvet rut".  The "velvet rut" describes the situation in which an individual feels stuck in a comfortable but unfulfilling routine.   It sounds fairly similar to the concept of "quiet quitting" in which individuals just "go through the motions" at work, lacking the motivation to do anything above and beyond the bare minimum necessary to get through their work day.  What separates the two, however, is the fact that individuals in a "velvet rut" are otherwise doing okay, they simply don't feel challenged or inspired in their work.  They are usually content with the work and may even be fairly successful at their job.

If you find yourself in a "velvet rut", perhaps it's time to start looking for what kind of job or work would challenge you, inspire you, or push you out of your comfort zone.  It can be scary to leave a job where you are comfortable, but I suspect that if stay in the "velvet rut" for too long, you may find yourself becoming a "quiet quitter".  Step "into the arena" and be ready to "get your ass kicked".  For as Hunter S. Thompson asked, "Who is the happier man, he who has braved the storm of life and lived or he who has stayed securely on the shore and merely existed."  Lastly, remember Dr. Martin Luther King, Jr's admonishment that "the ultimate measure of a man is not where he stands in moments of convenience and comfort, but where he stands at times of challenge and controversy.”

Look. Listen. Feel.

I just finished completing my online training for the American Heart Association's Pediatric Advanced Life Support (PALS) course, something which I have had to periodically do throughout my career.  Whenever I do take this course, I always think back to the very first time that I learned CPR as a Boy Scout.  We were taught then (and it's still taught now) that whenever you find someone lying unconscious, you should check for the presence of a pulse and determine if they are breathing.  The phrase "Look, Listen, and Feel" summarized exactly how you were supposed to go about doing it.  "Look" for the rise and fall of the chest, indicating that the person is breathing.  "Listen" for air blowing out of the person's mouth and nose.  "Feel" for the presence of a pulse.

I was struck that this "Look, Listen, and Feel" phrase is a great analogy for leadership too!  First, "Look" - there is no better way to check in on your team's wellbeing than to actually go to where they are and ask them how they are doing.  Lean/Six Sigma and the Toyota Production System calls it "Going to the Gemba" ("gemba" is a Japanese word that translates into "the actual place"), though others have called it "management by walking around".  

Once you are at the gemba, the next step is to "Listen" to your team.  Ask them if there is anything that you, as their manager, could be doing to support them better.  Ask them if they have all the resources (including time) to be able to effectively do their jobs.

The third and final step is perhaps the most important.  "Feel" for the members of your team by getting to know them as individuals - what are their strengths, what motivates them the best, what challenges are they experiencing in their professional and personal lives.  In other words, show them that you care about who they are as individuals.  

"Look, Listen, and Feel" is a great way to remember three important aspects of leadership.

Blueprint

A trip to the beach after Easter has become an annual rite of Spring for my wife and I.  It's always a great time to relax, recharge, and rejuvenate after the long, cold Winter.  It's also a great time to catch up on some reading!  This year, I finished a book called Blueprint: The Evolutionary Origins of a Good Society by the American sociologist and physician Nicholas Christakis.  I've mentioned Dr. Christakis and his research a couple of times in the recent past (see "How 'Bout Them Cowboys?", "Happy is contagious", and "Peer Pressure"), and his previous book Connected that he co-wrote with his colleague James Fowler is on my 2024 Leadership Reverie Reading List.  

According to his website, his research focuses on two main topics (1) the social, mathematical, and biological rules governing how social networks form (“connection”), and (2) the social and biological implications of how they operate to influence thoughts, feelings, and behaviors (“contagion”).  His book Blueprint builds upon his earlier book Connected, focusing primarily on his first research topic - the rules that govern how networks within a society form.  

Christakis adds to the already significant body of research encompassing what has come to be known as the "evolution of cooperation" (a term coined by the scientist Robert Axelrod and which I have also posted about in the past - see, in particular, "Tit for Tat").  This entire field seeks to answer the question, "In a world governed by natural selection and "survival of the fittest", being selfish pays - why then do we cooperate with each other?"

Christakis states, "It's not our brains or brawn that allows us to rule the planet.  It's the human ability to construct societies."  He further suggests that there is a "social suite" that is encoded within our genes and therefore naturally present in all our societies that represents a "blueprint"  for how humans can and do form stable societies.  His "social suite" includes the capacity to have and recognize individual identity, love for partners and offspring, friendship, social networks, and cooperation, preference for one's own group, and social learning and teaching.  He then describes a number of successful societies throughout history and explains how the "social suite" played a major role in determining their success and longevity.  These range from shipwrecked crews (for example, he compares and contrasts two ships that wrecked on the same island - the Grafton and Invercauld - which had incredibly different outcomes, as told by the author Joan Druett in her masterful book Island of the Lost, and he also talks about the fate of the mutineers of the HMS Bounty on Pitcairn Island) to artificial societies that formed as part of a sociological experiment (for example, the Robbers Cave experiment). 

Christakis writes, "Our good deeds are not just the products of Enlightenment values.  They have a deeper and prehistoric origin."  In other words, as mentioned above, the "social suite" is genetically encoded.  In a way, we are predestined to form stable societies, even though at times we do not.  The book is incredibly optimistic and inspiring at the same time.  The book was difficult to read at times (particularly in the middle), but overall I found it to be very interesting and worth a look!

"A science of uncertainty and an art of probability..."

William Osler once said, "Medicine is a science of uncertainty and an art of probability."  I suspect that Dr. Osler, one of history's greatest physicians, would agree that medicine, as both art and science, requires both customization as well as standardization.  Please let me explain.

I've posted about the need for standardization medicine in the past (see, for example, "The History of Standardization - 200 BC to 1945" and, in particular, "HRO: Sensitivity to Operations").  Here is what I had to say about standardization in a very early post from 2016 referring to a common complaint that I hear (still) from a lot of physicians equating "standardization" with "cookbook medicine":

I whole-heartedly agree that "patients are not widgets" and that "we shouldn't practice cookbook medicine."  Standardization, one of the key elements in operational excellence, is NOT "cookbook medicine."  There is simply no justification for why we should not standardize the care of common conditions (e.g. management of diabetic ketoacidosis, acute chest pain, or acute asthma exacerbation) or processes (e.g. care and maintenance of central lines, urinary catheters, surgical time-outs) - these are the kinds of conditions and processes that should be managed the same way, every day, by each and every member of the health care team.  With the care of common conditions, there is some room to maneuver, so to speak.  For example, if a patient deviates from the expected clinical course, then and only then should we deviate from a standardized treatment protocol.  However, there is no reason why we should deviate from standardized protocols for surgical time-outs, shift hand-offs, or maintenance of central lines.

With that in mind, I came across a great argument for standardization from former Marriott Hotels CEO Bill Marriott.  He said, "Mindless conformity and the thoughtful setting of standards should never be confused.  What solid SOPs do is nip common problems in the bud so that staff can focus instead on solving uncommon problems."  It makes such great sense when you think about it.  Why would you want to waste limited brainpower on the tasks that are straightforward, easy, and simple?

A similar analogy applies to leadership in general, specifically in what is known as the contingent theory of leadership, which states that effective leadership is dependent upon the situation at hand.  Rather than using the same leadership style for every situation, apply the best style to the what the situation requires or dictates.  The same concept applies to problem-solving!  I'm thinking in particular about Keith Grint's wicked versus tame problem framework.  Wicked problems require a different kind of approach, while so-called tame problems can be easily solved using common, standard approaches.

Just as important, as Henry Ford said, "If you think of standardization as the best that you know today, but which is to be improved tomorrow; you get somewhere."  In other words, protocols and SOP's can be changed, when there is evidence that suggests a better way of doing things.  High reliability organizations, as learning organizations that emphasize continuous improvement, will always modify or adapt their protocols when necessary.  

Cookbooks are incredibly useful tools in the kitchen!  The same is true for standard operating procedures, care guidelines, and protocols in the hospital.  The important consideration, however, is knowing when to apply them and when to change them.  Maybe that reflects part of the art of medicine?

The SAT Problem

Nope, this post is not about what's wrong with the Scholastic Aptitude Test, more commonly known as the SAT!  It's about a specific problem that appeared on the SAT in 1982, in which everyone, including the test writers, answered the problem incorrectly.  The question is shown below:

Okay, what is your answer?  If you answered "B" you are in great company.  If the radius of the smaller circle, Circle A, is 1/3 the radius of the larger circle, Circle B, then it only makes intuitive sense that Circle A will rotate 3 times as it moves around the circumference of Circle B.  Unfortunately, that's not the right answer!  The correct answer is that Circle A will rotate 4 times, which is not even an option listed in the question above - which is why no one answered it correctly, even if you knew the right answer!  Apparently three individuals (out of around 300,000 total exam participants) wrote back to the College Board, the organization that conducts the SAT exam, pointing out the error.  The question had to be thrown out, and the entire exam rescored that year!

Just to prove it to yourself, take a printout of the diagram and cut the diagram into 2 separate circles of different sizes. Place them like the question shows and carefully try to rotate Circle A around Circle B and count the number of revolutions it has done around it. It would be 4, not 3!  Better yet, start with two ordinary quarters, as shown in the video here.  Rotate one quarter around the circumference of the other quarter - but do so slowly, so that you can see how many rotations the quarter completes as it passes around the other one.  As you will see for yourself, the quarter rotates twice as it passes around the other quarter, even thought both quarters are exactly the same size!

What's even crazier (again, watch the video here) is that if you convert the circumference of Circle A in the original problem to a straight line and then rotate Circle B along the straight line, it does so three times!  In other words, there is something about rotating around a circle that changes the number of rotations.  Lastly, try this next one.  If you view the number of rotations of Circle A around Circle B from the perspective of Circle B (i.e. imagine you are standing on the surface of Circle B) or even vice versa, you will note that Circle A rotates just three times instead of four!

The mathematical proof of the answer to this problem, at least as I understand it, is that from start to end, the center of the moving coin (Circle A in the original problem) travels a circular path. The circumference of the stationary coin (Circle B in the original problem) and the path of the center of the moving coin (Circle A) form two concentric circles. The radius of the outer circle is the sum of the two coins' radii.  In other words, the circumference of the path of the moving center of Circle A is equal to 2π multiplied by the radius of Circle A plus the radius of Circle B.  Watch the video here again for a pictorial explanation of this same point (and see also a similar problem known as Aristotle's Wheel Paradox).  

If you really want to be gobsmacked, consider how this coin rotation paradox applies to the number of days it takes for the Earth to rotate around the sun (with day, of course, defined as the rotation of the Earth).  Again, when viewed from an external perspective (i.e. that of a distant observer in outer space), it looks like it actually takes 366.25 days for the Earth to rotate around the sun, instead of what we consider a calendar year as 365.25 days (the former length of time is called a sidereal year).

My point here is to use mathematics to demonstrate one of the defining characteristics of a High Reliability Organization (HRO), the principle of "Reluctance to Simplify".  Leaders in High Reliability Organizations know that the simplest explanation is not always the correct one.  They take the next necessary step to dig deeper into the problem, in order to come up with the right solution (not the wrong one). 

"Slow is smooth and smooth is fast!"

The U.S. Navy SEALS, one of the U.S. military's special warfare units and an example of a High Reliability Organization has a saying that I really like - "Slow is smooth and smooth is fast!"  It makes a lot of sense when you really think about it in depth - slow and deliberate action leads to efficiency, which saves time in the long run (which creates speed)!  When you do things the right way the first time, you avoid making mistakes and having to go back to repeat the same task over again.  

There's a version of this saying that is much older, and I am sure you've heard about it already.  "Haste makes waste."  My sources tell me that this proverb can be traced back to 1542, when it was first noted in the English scholar Nicholas Udall's translation of "Apophthegmes" by Erasmus of Rotterdam (note also that an apophthegm is a concise saying or a short statement).  The version that appeared in this translation is slightly different and one I actually like better.  "More haste, less speed."  

Remember, it's important to take the time to do things carefully and accurately, because rushing through a task often leads to mistakes and errors.  Even when it comes to decision-making, it's wise to remember that thoughtful consideration yields better outcomes.  Instead of rushing to complete a project, it's better to proceed with caution and attention to detail.  As we try to become more efficient in our organizations, it's essential to strike a balance between speed and accuracy.  Haste makes waste.  Slow is smooth and smooth is fast.

Row, Row, Row Your Boat...

It seems like ages since I actually went to see a film in a movie theater.  It's not that I don't enjoy watching movies, it's just so much easier to watch them at home these days.  I do want to see "The Boys in the Boat" based on the book of the same name by Daniel James Brown (which I've written about in a previous post called "Row the Boat").  One of my former CEO's actually purchased copies of the book for the entire senior leadership team, because it provides so many great lessons on leadership.  The story is about the University of Washington rowing team and their quest to compete in the 1936 Summer Olympics in Berlin.  As you probably guessed, the success of a rowing team depends to a great extent on how well the group of eight rowers work together and synchronize how they pull on the oars.

"Row the Boat" has become such a common metaphor for leadership and teamwork, largely because it is perfectly captures the sentiments of what is required for a group or team to succeed.  A few months ago, I came across an article in Harvard Business Review by Peter Bregman ("Execution is a people problem, not a strategy problem").  The article's tagline is "A process for getting the right people aligned."  Bregman writes that "however hard it is to devise a smart strategy, it's ten times harder to get people to execute on that strategy...in other words, your organization's biggest strategic challenge isn't strategic thinking - it's strategic acting."  Strategic acting, or execution, depends upon having everyone in the group acting in alignment with each other, i.e. "rowing the boat in the same direction." 

If a picture is worth a thousand words, Bregman's figure below is worth at least 10,000!  He perfectly captures the "Row the Boat" sentiment here:

He writes, "To deliver stellar results, people need to be hyperaligned and laser-focused on the highest-impact actions that will drive the organization's most important outcomes."  Bregman outlines a series of steps called the "Big Arrow Process":

Define the "Big Arrow"

First, leaders have to define the "Big Arrow" which Bregman defines as the most important thing that a team or organization has to achieve within the next 12 months in order to drive the strategy forward.  He provides a series of questions that if the answer to each is "yes", then the "Big Arrow" is likely the right one:

    1. Will success in the Big Arrow drive the mission of the larger organization?

    2. Is the Big Arrow supporting, and supported by, your primary business goals?

    3. Will achieving it make a statement to the organization about what's most important?

    4. Will it lead to execution of your strategy?

    5. Is is the appropriate stretch?

    6. Are you excited about it? Do you have an emotional connection to it?

Identify the Highest-impact People

Second, leaders have to identify the individuals within their team or organization who are most essential to achieving the goal, i.e. the ones who will have the highest impact on the "Big Arrow".  These are the key influencers and boundary spanners in the organization whose full engagement will be critical to success.  

Determine the Area(s) of Focus

Third, strategy acting or execution needs to be laser-focused.  There will always be competing priorities, but here leaders need to identify which priority will have the largest impact on achieving the team's or organization's objectives.  

Collect and Review Data

Bregman also emphasizes the importance of coaching, and I agree.  However, leaders need to know what to coach their highest-impact people on.  Here measurement of performance towards achieving the "Big Arrow" is important.  Here, leaders can also use data to identify and then remove obstacles to achieving the goals of the team or organization.  

In a survey of 400 global CEO's published in Harvard Business Review by Donald Sull, Rebecca Homkes, and Charles Sull (see "Why Strategy Execution Unravels - and What to Do About It"), the most commonly cited challenge to executing strategy was lack of alignment (40% of respondents), followed closely by failure to coordinate across units (30% of respondents).  In other words, when organizations don't all row the proverbial boat in the same direction, they end up failing to achieve their goals and objectives.  There's no way that the University of Washington team could have (Spoiler Alert) won an Olympic Gold Medal in 1936 without being aligned or coordinating with each other.  The same, of course, is true for any team or organization.

"I am legend"

I've mentioned my love of reading several times in the past, and I've also mentioned (I think) that I mostly read non-fiction books.  However, I have to admit that I also really enjoy reading dystopian fiction.  Perhaps I will give a list of my favorite dystopian fiction stories at some point in the future.  These stories are interesting to me, because (1) they usually are very well written, (2) they generally involve an interesting story, and (3) they frequently reveal a lot about human behavior, both the good and the bad.  We've sort of lived through our own dystopian story these past couple of years with the COVID-19 pandemic, and what is clear to me that times of crisis reveal a great deal about one's character and resilience.  Some individuals fold during times of stress, while others seem to rally and find ways to persevere.  Rather than living through another pandemic, we can learn so much about resilience and perseverance by reading dystopian fiction.

I just finished the novella I Am Legend by Richard Matheson.  The story was written in 1954, and it's been adapted into three movies over the years: The Last Man on Earth (1964), starring Vincent Price, The Omega Man (1971), starring Charlton Heston, and I Am Legend (2007), starring Will Smith.  The novella also apparently was an inspiration for George Romero's classic Night of the Living Dead (1968).  For example, Romero said when talking about the creation of his movie, "I had written a short story, which I basically had ripped off from a Richard Matheson novel called I Am Legend."  The highly acclaimed author Stephen King said, "Books like I Am Legend were an inspiration to me."

The story takes place in 1976 Los Angeles, California after an apocalyptic war and global pandemic (similar to World War I and the 1918 Influenza Pandemic).  Richard Neville is seemingly the "Last Man on Earth" and is left to fend for himself.  The pandemic has killed the rest of the human population and has turned infected survivors into "vampires".  During the day, Neville is free to roam around the city, and every night he barricades himself inside his house and occasionally fights off attacking "vampires" (the vampires seem more like zombies, in my opinion).

It was hard for me to put the book down.  It's very well written, and the story was really interesting.  I think that there are two major difference between the most recent movie version, which I also thoroughly enjoyed, and the book.  First, the book focuses more on how the main character, Richard Matheson, reacts to his forced solitude.  It's a great character study, as we get to see how Neville hits the proverbial rock bottom and then slowly recovers over time to eventually demonstrate incredible resilience.  Second, the book ends with a great plot twist that is very different than the movie.  The book ends with the sentence, "I am legend."  I won't spoil why.  The book is fairly short (about 175 pages in length), and it's a superb story on a subject that is more relevant to me, now that we've been through the COVID-19 pandemic.  I highly recommend it!