Happy Doctor's Day 2025!

National Doctor’s Day is celebrated every year on March 30th.  The first Doctor’s Day was observed more than 90 years ago, on March 30, 1933 by the Alliance to the Barrow County Medical Society in Winder, Georgia (a small town located just east of Atlanta).  Members of the Alliance selected the date to honor all physicians on the anniversary of Dr. Crawford W. Long’s first administration of anesthesia in 1842.  Of note, Dr. Long used ether during surgery to remove a tumor from the neck of James Venable.  The first Doctor’s Day was observed by sending cards to all the physicians and their spouses, and a red carnation flower was placed on the graves of deceased doctors.  

Through a series of resolutions in the years that followed, Doctor’s Day was widely celebrated throughout the southern United States, with sponsorship by the Southern Medical Association.  Eventually, a resolution was adopted and approved by both the U.S. House of Representatives and the U.S. Senate on October 30, 1990 and signed by President George H.W. Bush, designating March 30 as “National Doctor’s Day."  The red carnation remains as the symbol of Doctor’s Day.

I can honestly say that if I had the chance to do it all over again, I would still choose medicine as my life's work.  Medicine has been my passion and my calling.  Being a physician has made me a better person, and I am incredibly proud to be a member of this esteemed profession.

To all Doctor's - thank you for what you do, each and every day!

"No Easy Victories"

I was reading a Harvard Business Review article ("How to Stay Optimistic (When Everything is Awful)") just last week that referenced another article written many, many years ago by former Secretary of Health, Education, and Welfare (under President Lyndon Johnson) John W. Gardner.  The article, "No Easy Victories" was published in the journal American Statistician on February 1, 1968 and is based on a speech that Gardner gave at the American Statistical Association's annual meeting in December, 1967.

Gardner made several points about leadership in general that I thought were worth repeating here.  They fall into the following high level points:

1. It's lonely when you are in the arena.

Gardner opens (after a few introductory comments about how he came to be speaking at the American Statistical Association's meeting) with the following statements:

I cannot speak with assurance, only with concern.  I constantly marvel at the number of people outside the arena of action who know precisely how to solve our problems, and the number of people in the heat of action who lack that superhuman clarity.  

I think that Gardner provides a key point on leadership here.  First, as I've stated many, many times, leadership can be lonely (see my posts, "Reflections on leadership", "12 O'Clock High", "It's lonely at the top", and most recently, "Fortress of Solitude").  It's lonely because: (1) as a leader, you are always "on stage" in that everything you say or do can be scrutinized, questioned, evaluated, or criticized; (2) the expectations for leaders oftentimes far exceed what they can deliver; and (3) almost everyone believes that he or she could do a better job leading.  I am reminded of Theodore Roosevelt's "In the Arena" speech or Brene Brown's speech "Why your critics aren't the ones who count".  As William Shakespeare said, "Uneasy is the head that wears a crown".

2. Leaders have to make difficult choices.

Gardner talks about some of the difficulties that leaders encounter.  Foremost among these is the job of making rational choices when resources are limited (and he offers the qualification that resources "will always be limited relative to expectations").  He said:

Forced choices are of course not the only consequence of a limit on resources.  We can have our cake and eat at least some of it if we can get a higher yield from the dollars, talent, and institutional strength available to us...somewhere up the line hard decisions will be necessarily made.

As a leader, you will have to make difficult decisions at times, some of which will be unpopular.  It's important that leaders make decisions that advance the organization's mission and vision, as well as ones that are consistent with the organization's core values. 

3. Expectations oftentimes do not match reality.

I mentioned above that one of the reasons leadership can be lonely is that the expectations for leaders oftentimes far exceed what they can deliver.  The same is true for organizations.  Gardner said that most of the individuals today believe that their institutions can accomplish "just about anything".  Moreover, when these same institutions fall far short of those expectations, the natural tendency is to blame "the people who love power or money more than they love mankind".  He suggested that this mismatch between expectations and reality has created some of the mistrust and cynicism that we are seeing today in the workforce:

The modern belief that man's institutions can accomplish just about anything he wants, when he wants it, leads to certain characteristic contemporary phenomena.  One is the bitterness and anger toward our institutions that occur when high hopes turn sour...cynicism is continually fed and renewed by the rage of people who expected too much in the first place and got too little in the end.

4. Leaders will have to lead their organizations through change.

Gardner said:

Even excellent institutions run by excellent human beings are inherently sluggish, not hungry for innovation, not quick to respond to human need, not eager to re-shape themselves to meet the challenges of the times...We are going to have to do a far more imaginative and aggressive job of renewing, redesigning, revitalizing our institutions if we are to meet the requirements of today.

I am struck by how much of what was true in 1967 is still true today.  Some of the challenges that leaders faced back then are faced by the leaders still today.  However, Gardner's message is one of hope and optimism.  He ended his speech with the following statement:

The fight for a better world is a long one, a recognition that retains high hopes but immunizes against childish collapse or destructive rage in the face of disappointment...We face the gravest difficulties in the days ahead.  But if we could bring to bear on our toughest problems all of the talent and resources of this Nation we could accomplish some things that would leave an indelible mark on the history books. 

The paradox of work

You don't have to be an elite runner to feel what is commonly referred to as a "runner's high", that brief state of euphoria which can occur after either a long period of continuous, moderate-intensity exercise (classically for a long-distance run, hence the name) or even short bursts of high-intensity exercise.  Elite athletes often talk about being "in the zone", a similar term to "runner's high" that describes a state of intense focus and peak performance.  The cognitive psychologist Mihaly Csikszentmihalyi conducted research beginning in the 1970's on a similar concept that he called "flow".  Csikszentmihalyi said in 1990, "The best moments in our lives are not the passive, receptive, relaxing times . . . The best moments usually occur if a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile."

Csikszentmihalyi described flow as a state of "being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you’re using your skills to the utmost."  There's a whole body of research in the field known as positive psychology on "flow", and Csikszentmihalyi wrote an excellent book on the subject (one of many actually), now considered a classic, entitled (appropriately enough), Flow: The Psychology of Optimal Experience.

While "flow" is certainly a fascinating topic, what's perhaps most interesting to me is a related concept called the "paradox of work" based upon a study ("Optimal Experience in Work and Leisure") performed by Csikszentmihalyi with his colleague Judith LeFevre published in the Journal of Personality and Social Psychology in 1989.  Csikszentmihalyi and LeFevre gave workers (107 participants completed the study) from five large companies in Chicago an electronic pager that would beep at seven random moments throughout the day, at which time study participants were instructed to complete a short questionnaire (note that this particular method of research is called "experience sampling method" or ESM).  They described their current activity, mood, psychological state, sense of motivation, engagement, level of boredom, etc.  

The results they found were surprising.  Study participants reported feeling happier, more fulfilled by what they were doing, less anxious, and more highly motivated while they were at work compared to when they were at leisure.  In their free leisure time, they tended to feel bored and anxious.  In other words, they experienced flow more than three times as often during work compared to when they were at home away from work.  If you think about it, that at least makes some sense on the surface.  While work can be stressful at times, it can also be challenging, motivating, and fulfilling.  

Csikszentmihalyi and LeFevre were also able to determine what specific activities the participants were engaged in when they were experiencing "flow" (i.e., when they were in the zone).  In general, participants were more likely to be experiencing "flow" when they were spending time on challenging activities, such as problem-solving or fixing things at work.  Perhaps not surprising, time spent at home watching television was typically not associated with experiencing "flow".

Even though activities conducive to flow were much more frequent at work, participants stated that they were less happy when they were at work and would rather be at home.  When they were on the job, they expressed a strong desire to be off the job, and when they were off the job, the last thing they wanted was to go back to work.  These results seem particularly counterintuitive, which is why Csikszentmihalyi and others have labeled these findings the "paradox of work" (these findings have been replicated in other studies - see, for example, the study by Stefan Engeser and Nicola Baumann in the Journal of Happiness Studies).

The logical follow-up question is how to explain these findings.  Csikszentmihalyi and LeFevre suggested that the obligatory nature of work may mask the positive experience that typically comes while experiencing a state of flow.  In other words, people make judgements based upon social convention as opposed to their actual feelings.  The concerning conclusion to this suggestion is that people will continue to try to do more of those activities (i.e. leisure activities) that provide the least positive experiences and avoid those activities (i.e. work) that do - in other words, at the societal level there will be a mass exodus from the most productive activities in favor of the leisure ones.

All of this is very interesting, if not somewhat disturbing. Csikszentmihalyi and LeFevre suggest a couple of potential ways to mitigate against the paradox.  First, they suggest that merely knowing about the paradox of work will help individuals overcome the social conventions against work.  I'm not sure if this is very realistic unfortunately.  Second, they recommend that we try to focus more on the kinds of leisure activities that generate flow and avoid the ones that don't.  While this may certainly help our overall emotional states, I'm not sure it addresses the need to motivate people at work.

I realize that this is an older study, but as I mentioned, the findings have been replicated in more contemporary studies using similar methods.  I at least thought that the study warranted further discussion.  Based on what I've learned about flow, I might suggest a couple of ways for leaders to try to create conditions at work that are conducive to flow.  First, we need to be clear about what we are trying to accomplish and provide immediate and transparent feedback.  Second, we need to make sure that individuals are appropriately matched from a knowledge and skills standpoint to the task at hand.  Challenging tasks are more conducive to flow, but only when individuals feel that they have the necessary skills to meet the challenge.  "Stretch" goals are great, but goals shouldn't be completely out of reach either.  Third, we know that focus is just as important as clarity.  Goals should be as specific as possible and limited in number and scope.  Finally, we need to provide individuals with enough autonomy that they feel as if they are in control of the situation at hand.  With these caveats in mind, we can create the conditions that will help our teams "get in the zone"!

"Real friends are useless"

We are always striving for wellbeing and happiness - what some have termed the "good life".  The ancient Greek philosopher Aristotle believed that the "good life" could be achieved by striving for what he called eudaimonia, variously translated from Greek as "wellbeing", "flourishing", or even simply, "happiness".  He also believed that we could achieve eudaimonia by striving for excellence.  

Aristotle said, "We are what we repeatedly do."  He also said, "Excellence is never an accident. It is always the result of high intention, sincere effort, and intelligent execution; it represents the wise choice of many alternatives - choice, not chance, determines your destiny"  (on a side note, the quote, "Excellence, therefore, is not an act, but a habit" is commonly attributed to Aristotle, but it was actually a statement made by the historian and author Will Durant, who was paraphrasing Aristotle).  In other words, if we continue to strive for excellence, we will achieve excellence.  It is through the pursuit (and achievement) of excellence that we achieve eudaimonia.

Dr. Robert Waldinger, Harvard Medical School physician and author of The Good Life: Lessons from the World's Longest Scientific Study of Happiness has found that our relationships (and the quality of those relationships) have an important impact on our physical and mental health.  Aristotle also talked about the importance of friendships and relationships for achieving eudaimonia.  He actually proposed a hierarchy of friendship in his book, Nicomachean Ethics, in which he writes, "Friendship is one of the most indispensable requirements of life...We consider a friend to be one of the greatest of all good things, and friendlessness and solitude a very terrible thing, because the whole of life and voluntary interactions are with loved ones."  Aristotle listed three different types (or species) of friends:

1. Friendship of utility: These friendships are based on what someone can do for another person (what someone can do for you or conversely, what you can do for someone else). For example, you may be looking for a job and need someone to "put in a good word for you" or serve as a reference. Importantly, these friendships are more transactional in nature and frequently end as soon as the use or need for the person is no longer present.  These kinds of persons have generally very little to do with character.

2.  Friendship of pleasure: These friendships are based on the enjoyment of a shared activity. For example, these kinds of friendships involve friends who you might go out for a drink with, someone you go to a sporting event with, or even someone who you enjoy a particular hobby with.  Again, these types of friendships can also end quickly, as they depend on people's ever-changing likes and dislikes.

3.  Friendship of virtue: These friendships are based more on character, and they are generally more sustained than the other two kinds of friendships.  For example, these friends are the people you like for themselves, who typically influence you positively and push you to be a better person. These are the deeper relationships that, when established, make us happier and better as individuals.

While all three kinds of friendship are important, Aristotle suggested that "friendships of virtue" are the ones that will truly help us achieve a state of eudaimonia.  He wrote that "For perfect friendship you must get to know someone thoroughly and become intimate with them, which is a very difficult thing to do."  These kinds of friendships require honesty, acceptance (of all flaws), selflessness, and perhaps most importantly, love.  Aristotle also suggested that the act of loving is better than the reciprocal act of being loved.  He wrote, "Since friendship depends more on loving, and it is those who love their friends that are praised, loving seems to be the characteristic virtue of friends, so that it is only those in who this is found in due measure that are lasting friends, and only their friendship that endures."

Arthur C. Brooks, Harvard Business School professor and author of Build the Life You Want: The Art and Science of Getting Happier (which he co-wrote with Oprah Winfrey) refers to deal friends versus real friends.  Deal friends are those individuals who we may strategically keep in contact with, as our mutual relationship may prove to be useful at some point in the future.  In other words, deal friends are what Aristotle refers to as "friends of utility" or even "friends of pleasure".  True friendship, however, is more than just camaraderie.  Our real friends are "friends of virtue".  These involve friendships built upon a foundation of mutual love.  Our real friends are the ones that we can share our truest and deepest selves with - these are the kinds of friends that we can always count on.  These are the kinds of friends that will drop everything that they are doing if and when we need them.

Brooks writes, "Deal friendships feel incomplete because they don’t involve the whole self. If the relationship is necessary to the performance of a job, it might require us to maintain a professional demeanor. We can’t afford to risk these connections through confrontation, difficult conversations, or intimacy, like we can with real friends."  Brooks goes on to suggest that "the best friends in life are the ones who can do nothing for you."  In other words, real friends are useless.  Your real friends bring you joy, even when they can do nothing for you.

"Clear the Mechanism"

A few weeks ago, I sat down and finally watched the 1999 movie "For Love of the Game" starring Kevin Costner and the late Kelly Preston.  The movie is based on a book by the author Michael Shaara with the same title (Shaara also wrote the book, The Killer Angels, which was made into one of my all-time favorite movies, "Gettysburg").  The movie follows the perfect game performance of aging star baseball pitcher and future Hall of Famer Billy Chapel, played by Kevin Costner, as he deals with the pressures of pitching in Yankee Stadium in his final outing by calming himself with memories of a long-term relationship with Jane Aubrey, the character played by Kelly Preston.  It's actually a really good movie.

There's a scene at the beginning of the movie, when Chapel takes the mound to start the last game of a losing season for the Detroit Tigers as they play against the New York Yankees, who are trying to win the game in order to make the play-offs.  He is trying to warm-up for the game amidst all of the noise and confusion (with many fans even yelling and screaming at him).  In order to quiet the noise and focus on the task at hand, he whispers to himself, "Clear the mechanism".  Everything suddenly becomes quiet.  The fans behind home plate become blurry, and the only things that he sees in sharp clarity are the batter and catcher.  It's a powerful scene and a great reminder of the need to focus on the task at hand.

Legendary baseball play-by-play announcer Vin Scully has a cameo appearance as the play-by-play announcer in the movie (which I found interesting, since he spent most of his career calling games for the Dodgers, not the Yankees).  At one point, he quotes the famous line from Rudyard Kipling's poem "If":

If you can keep your head when all about you are losing theirs...

There's another line from the Kipling poem that doesn't appear in the script, but I think it certainly applies:

If you can force your heart and nerve and sinew to serve your turn long after they are gone, and so hold on when there is nothing in you except the will which says to them: 'Hold on!'

Chapel fights through all the pain of his long and storied baseball career to do the unthinkable - pitching a perfect game in his final start!  He throws a perfect game (no hits, no walks, no runs) by his incredible ability to ignore everything that is going on around him and concentrating on the player in the batter's box.  It is his focus by "clearing the mechanism" that gives him the stamina to fight on and finish the game.

Focus is a very powerful thing.  But here's the catch - it takes effort to focus.  Focus is an active activity, not a passive one.  There are a number of ways to improve your focus and "clear the mechanism":

1. Create a distraction-free work zone - When possible, we should eliminate clutter in our normal workspace.  I like the Lean 5S model (sort, set in order, shine, standardize, and sustain) to organize a workspace.  5S achieves “a place for everything and everything in its place.”  In addition, sometimes it's helpful to designate an area where distractions are minimized that is separate from our usual workspace.  For example, I know some hospitals that have set aside areas on inpatient units designed for staff to relax and recuperate while they are taking a break away from the bedside (these are called "Tranquility Rooms", "Serenity Rooms", or "Meditation Rooms").  We can't focus when we are overly stressed!

2. Practice mindfulness and meditation - We can help "clear the mechanism" with a variety of techniques, such as mindfulness, meditation, or prayer.

3. Set clear goals and priorities - When everything is a priority, nothing is a priority.  We should set clear goals (I like SMART goals), and as leaders we can limit the number of goals that we set for ourselves and for our teams.  Prioritization is important here too.  If something is not a priority for the organization, we shouldn't be dedicating time and resources on it.

4. Embrace single-tasking - Multi-tasking is a fallacy.  Study after study has proven that we can't focus on more than a few things at a time, at least if we are trying to do something well.  Dedicate time and resources to just one single task at a time, and in the long run, you will save time and reduce mental strain.

The ability to focus is an important skill for leaders and their teams.  We should not try to do everything, but instead we should do one thing very well.  The late Steve Jobs was particularly adept at this skill.  He said, "People think focus means saying yes to the thing you've got your focus on.  But that's not what it means at all.  It means saying no to the hundred other good ideas that there are.  You have to pick carefully.  I'm actually as proud of the things we haven't done as the things I have done.  Innovation is saying no to 1,000 things."

"Clear the mechanism" and in an instant, everything fades away and out of the picture.  "Clear the mechanism" will help you get the job done.  "Clear the mechanism" will help you get the job done well.

"Leaders are dealers in hope..."

I wanted to build upon my recent post "Hope is not a strategy...or is it?" and talk a little more about hope.  One of history's greatest military leaders, Napoleon Bonaparte, reportedly once said, "Leaders are dealers in hope."  Former Secretary of Health, Education, and Welfare (under President Lyndon Johnson) John W. Gardner wrote in his book On Leadership, "The first and last task of a leader is to keep hope alive - the hope that we can finally find our way through to a better world - despite the day's action, despite our own inertness, shallowness, and wavering resolve."  What does it say when two very different leaders from two very different times and two very different worlds basically say the same thing?  My take is that leadership is about creating and fostering hope.

The Harvard Business School professor Arthur C. Brooks writes a weekly column for The Atlantic magazine (online), "How to Build a Life".  In his piece from September 23, 2021 ("How to be more hopeful"), Brooks mentions Medal of Honor recipient and Vietnam Prisoner of War Vice Admiral James Stockdale and what business author Jim Collins (perhaps best known for his superb book Good to Great) has described as the Stockdale Paradox.  Collins asked Stockdale how he made it through more than seven years of captivity during which time he was beaten, tortured, starved, and denied medical care.  Stockdale replied, "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."  Stockdale showed incredible resilience, which prompted Collins to ask him about the POW's who didn't survive the ordeal.  Stockdale quickly answered that they were the ones who were most optimistic, "They were the ones who said, ‘We’re going to be out by Christmas.’ And Christmas would come, and Christmas would go. Then they’d say, ‘We’re going to be out by Easter.’ And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they died of a broken heart … This is a very important lesson. You must never confuse faith that you will prevail in the end—which you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be" (emphasis mine).  

Hope is a very powerful thing.  While many people tend to use hope and optimism interchangeably, they are two distinct emotions.  Two psychologists reported in a 2004 study in the Journal of Social and Clinical Psychology that "hope focuses more directly on the personal attainment of specific goals, whereas optimism focuses more broadly on the expected quality of future outcomes in general."  Optimism is a belief (which may, in fact, be a false one) that "everything is going to be okay."  Hope does not make that assumption and instead is a conviction to take the necessary steps to make things better.  Hope, according to a study published in 2013 in the journal Psychological Reports, is "having the will and finding the way."  That same study found that high-hope employees are 28% more likely to be successful at work and 44% more likely to enjoy good health and well-being.  Hope is our super power!

Annie McKee, who at the time was a senior fellow at the University of Pennsylvania Graduate School of Education (and author of How to Be Happy at Work) shared in her 2008 Harvard Business Review article "Doing the Hard Work of Hope" an important point made by her close friend, Father Vladimir Felzmann: Hope = Faith + Hard Work.  She writes, "Hope is an experience that allows us to:

• Tap into optimism (we will get through this)
• Find a feasible vision for the future (No delusions! Be reasonable)
• Discover efficacy (I, or we, can make this happen!)."

Note that optimism is "Faith" in Father Felzmann's equation above.  McKee goes on to say that "Hope is nothing without courageous action."  Dane Jensen, writing for the Harvard Business Review ("Sustaining Hope in Uncertain Times") adds an important caveat.  Jensen writes, "The final component of hope - and the one that makes it resilient - is an ability to make peace with the fact that we cannot control or predict the future despite our vivid imagination and best laid plans. When things don't go according to plan, cultivate the ability to see adversity as an inflection point rather than a reason to abandon hope."

During these uncertain and turbulent times, it is our job as leaders to cultivate and foster hope.  It's important to remember, though, that hope is both an emotion and an action.  Without action, it's just optimism, and that's not enough.

The Big Switch

You've probably noticed that I have been posting a lot about the author Nicholas Carr lately.  I have read several of his articles, blog posts, and books over the course of the last several months, and I believe his commentary on both the positive and negative consequences of the Information Age are incredibly relevant in society today.  One of his older books, The Big Switch: Rewiring the World, from Edison to Google, compares and contrasts the commoditization of electric power in the early 20th century with the rise of cloud computing (instead of storing applications on your individual PC, everything is stored in a central data warehouse) in the 21st century.  

Just as electricity was turned into a utility by centralizing and standardizing power generation, the shift of data storage, computing power, and software services to centralized, remote data centers is turning computing into a utility.  And, similar to what happened with electric power, the commoditization of computing will fundamentally change how organizations operate by reducing the need to own and maintain IT infrastructure (see also Carr's Harvard Business Review article "IT doesn't matter" and book Does IT Matter?) and making technology more accessible.  

Carr introduces his thesis at the beginning of the book, writing, "We see the interplay of technology and economics most clearly at those rare moments when a change takes place in the way a resource vital to society is supplied, when an essential product or service that has been supplied locally begins to be supplied centrally, or vice versa.  Civilization itself emerged when food production, decentralized in primitive hunter-gatherer societies, began to be centralized with the introduction of the technologies of agriculture. Changes in the supply of other important resources - resources as diverse as water, transportation, the written word, and government - also altered the economic trade-offs that shape society.  A hundred years ago, we arrived at such a moment with the technologies that extend man's physical powers.  We are at another such moment today with the technologies that extend our intellectual powers."

Carr chose to begin his history of electrical power with Burden's Wheel, a water wheel believed to be one of the largest and certainly the most powerful vertical water wheel ever built, used to power the Burden Iron Works located on the Hudson River near Troy, New York.  The wheel, which was built by Henry Burden around 1836, measured 62 feet in diameter and 22 feet in breadth and weighed over 250 tons!  When moving at full speed at two-and-a-half revolutions per minute, the wheel produced 500 horsepower of energy to fully run the Iron Works.  Burden's Wheel was apparently the inspiration for the first ever Ferris Wheel, built by George W.G. Ferris at the 1893 World's Columbian Exposition in Chicago.  Ferris was educated at the Rensselaer Polytechnic Institute in Troy.  On a side note, several of the temporary buildings that were designed and built in the neo-classical style by the famous architect Daniel Burnham were painted white, and as a result, the Exposition site was nicknamed the "White City" (see also the wonderful book by Erik Larson, The Devil in the White City: Murder, Magic, and Madness at the Fair That Changed America).  The "White City" was apparently the inspiration for the Emerald City, the city in L. Frank Baum's The Wonderful Wizard of Oz.

In the early Industrial Age, every factory had to have its own source of power (i.e., Burden's Wheel at the Burden Iron Works), which significantly increased the costs associated with doing business.  Starting around 1900, individuals like Samuel Insull, one of the early entrepreneurs in the electrical power industry (for those of us who live in Chicago, Insull founded Commonwealth Edison, Inc, better known as ComEd) and Thomas Edison, recognized that a better option would be to centralize the generation of electricity and then distribute it to the factories.  Carr writes, "Manufacturers came to find that the benefits of buying electricity from a utility went far beyond cheaper kilowatts.  By avoiding the purchase or pricey equipment, they reduced their own fixed costs and freed up capital for more productive purposes."  The national power grid was born from the efforts of Insull, Edison, and others.

Carr next launches into a history of early computers in the so-called Information Age.  What's striking to me is how short-sighted the early pioneers in the computer industry were given what happened with the electrical power industry.  For example, the Harvard physicist Howard Aiken who helped design IBM's first programmable computer dismissed as "foolishness" the idea that there would be a big market for computers.  The scientists who developed the UNIVAC computer in the 1940's believed that the United States would need no more than a half dozen or so computers, primarily for military and scientific applications.  Indeed, IBM's Thomas Watson said in 1943, "I think there is a world market for about five computers."  I still remember when my parents purchased our first home desktop computer - it may have been a TI-99/4A (basically, a keyboard that connected to a regular television that had about 16K memory and required a regular tape recorder and cassette tape to permanently save anything), but I am not 100% sure.  Fast forward several years later to when my wife and I had school-age children of our own, we always had a desktop computer in our house.  Now, the mobile telephones that we carry with us everywhere we go have about 1 million times the memory of the computers used during the Apollo space program!

Thanks to the Internet and advances in modern computing, we now have instant access to information at our fingertips.  Carr sees that the same thing that happened at the turn of the 19th century with the electrical power grid today is happening today with the computer industry - we have democratized and commoditized information.  He writes, "What happened to the generation of power a century ago is now happening to the processing of information.  Private computer systems, built and operated by individual companies, are being supplanted by services provided by a common grid - the Internet - by centralized data-processing plants.  Computing is turning into a utility..."  

In regards to technology, there are always going to be optimists and pessimists.  It's fairly easy to see that Carr takes a more pessimistic view of technology, as he provides a counterviewpoint to so-called "techno-utopianism" in all of his writings.  Arguing for the optimists, Nicholas Negroponte, author of the 1995 book, Being Digital wrote, "Digital technology can be a natural force drawing people into greater world harmony."  The Internet was once felt to be a tool that would increase the diversity of thought and opinion, but it probably has done the reverse!  Harvard Law School professor and author Cass Sunstein argues for the pessimists, suggesting that the Internet, and in particular, social media, have only pushed us further apart (see his article on ideological amplification).  As I have suggested in a number of previous posts (see, in particular, "Why the past 10 years of American life have been uniquely stupid..." and "Familiarity breeds contempt..."), Carr feels the same way as Sunstein.

The pessimists typically use terms such as fragmentation, polarization (or even hyper-polarization), balkanization, and single-mindedness when talking about the impact of information technology on today's society.  At the extreme, they even use terms such as fanaticism, radicalization, and extremism.  However, there are additional downside risks with the "big switch" from traditional IT systems to cloud-based systems.  Carr addresses the potential security concerns (though even with the most advanced cybersecurity systems, traditional IT infrastructure is at risk as well), the potential loss of control, and the concentration of power in a few large, dominant companies such as Amazon, Google, and Microsoft.  

I am trying to keep an open mind, but the more I read, the more I find myself leaning towards the side of the pessimists.  When it comes to any argument, it's important to keep a balanced view for as long as possible, so that you can listen to both sides equally.  I've probably spent too much time reading what the pessimists have to say, so it's probably time to read more about what the optimists are saying (I could probably start with Marc Andreessen's Techno-Optimist Manifesto).  I've at least read all of Nicholas Carr's books, which makes it an even better time to move on to a new viewpoint.

Aequanimitas

I came across an essay written by the 19th century physician William Osler with a Latin title ("Aequanimitas").  Dr. Osler was one of the "Big Four" founders of Johns Hopkins Hospital and is often called the "Father of Modern Medicine" for his many contributions to the profession.  Someone once called him "one of the greatest diagnosticians ever to wield a stethoscope."  He was an author, a historian, and best of all (in my mind), a lover of books!  

Dr. Osler was born in Canada and attended medical school at the Toronto School of Medicine and McGill University Faculty of Medicine in Montreal.  He trained with the famous physician Rudolph Virchow in Germany before returning to McGill University as a faculty member in 1874.  He apparently started the first journal club there (still used in academic medicine today), and he left McGill to become Chair of Clinical Medicine at the University of Pennsylvania in 1885.  He left Penn to help found Johns Hopkins Hospital in 1889, and "Aequanimitas" was his farewell address delivered to the graduating medical class at Penn.

"Aequanimitas" was first published as a pamphlet in 1889 and later appeared in a collection of Osler's essays entitled Aequanimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine in 1904.  The pharmaceutical company Eli Lilly & Company apparently gave away more than 150,000 copies of the book to medical school graduates from 1932 to 1953.

The word aequanimitas is the Latin word for equanimity and refers to staying calm and composed.  Osler advocates two essential qualities for physicians in the essay, imperturbability and equanimity, which he defined as coolness and presence of mind under all circumstances.  The medical ethicist Daniel Sokol suggested in a 2007 British Medical Journal article suggests that the essay answers the age old question, "What makes a good doctor?"

I think it's appropriate that Dr. Osler begins his essay with a quote from the ancient Stoic philosopher Marcus Aurelius, "Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted."  While I am not completely certain, I would bet that Dr. Osler was a Stoic too!  Stoicism emphasizes both imperturbability (unable to get upset or overly excited) and equanimity (mental calmness, composure, and evenness of temper, especially in a difficult situation).  These are the qualities that Dr. Osler highly valued in a physician.  Importantly, this did not mean that physicians shouldn't be emotionally detached from their patients and uncaring.  Instead he emphasizes that stillness and calm will foster confidence and trust by a physician's patients. 

I think imperturbability and equanimity apply to leadership too.  When everything is falling apart, a true leader is defined by their ability to stay calm amidst the storm.  The best leader in a crisis is one who can embrace the chaos and guide their team through uncertainty.  Calmness and stillness will foster confidence and trust.  Calmness and stillness are also contagious.  When the other members of the team see a leader who is calm and composed, they too will respond with calmness and composure.

I will end this post with two quotes by two great leaders who also led during times of chaos, uncertainty, and crisis.  Winston Churchill said, "Difficulties mastered are opportunities won."  Dr. Martin Luther King, Jr said, "The ultimate measure of a man is not where he stands in the moments of comfort, but where he stands at times of challenge and controversy."  Aequanimitas.

Who is the greatest?

As a sports fanatic, I always watch the Super Bowl, even if my favorite team isn't playing.  I also enjoy watching the television commercials, and there was a time when our family used to rate the quality of each commercial!  If you watched Super Bowl LIX a few weeks ago, you may have noticed a commercial by NYU Langone Hospital, which showed several hospital leaders playing football.  At the very end, former New York Giants wide receiver Victor Cruz says, "Seriously, you guys are the best...", to which one of the hospital leaders replies, "We sure are."  Cruz then says, "At the health system stuff."  The advertisement then makes the statement that NYU Langone was ranked #1 for quality care in the United States.

We know that NYU Langone paid at least $8 million on the 30-second advertisement, which is the going rate for television commercials airing during the Super Bowl.  One of the physicians who appeared in the ad said that the commercial took almost nine hours to record.  The question that is being asked is whether it was appropriate for a not-for-profit hospital to spend over $8 million on a commercial advertisement.  Just as important (at least in my opinion), Michael Millenson, a journalist for Forbes magazine, asked whether the claim of being #1 was accurate (see his article, "NYU Langone Super Bowl Ad Claimed 'We're #1,' But Where's Scorecard?").

If you really paid close attention during the commercial, you may have caught the reference shown at the bottom of the video during the final 2 seconds of the commercial, stating "2024 Vizient Quality and Accountability Ranking.  Ranked #1 out of 115 participating comprehensive academic medical centers."  Vizient, Inc. started out as a group purchasing organization, which allows member hospitals to secure volume discounts on supplies and other purchases, though more recently the organization has started a consulting practice to help hospitals improve the quality of care that they deliver at lower costs.  I went to their website (see "Vizient announces 2024 top performers in clinical quality"), which lists NYU Langone Hospital as one of 14 top performers in clinical quality in the comprehensive academic medical center category.  While they are listed first, it's not clear that they were ranked first, as no numerical ranking is provided.  Vizient states that they based their ratings on their own clinical database, as well as publicly available data from the HCAHPS survey (patient and family experience survey data) and the CDC's National Healthcare Safety Network (patient safety and outcome data).  

Notably, NYU Langone Hospital is also listed as a Honor Roll hospital by U.S. News and World Report.  Importantly, USNWR stopped providing overall numerical rankings for hospitals last year.  I am sure that the recognition that NYU Langone Hospital is well deserved, and they should certainly be proud of both these achievements.  Unfortunately, neither the Vizient study nor the USNWR survey tell me with any degree of confidence whether NYU Langone Hospital is the greatest hospital, in terms of providing the best in clinical care.  As I've mentioned at least a couple of times in the past (see "Do hospital rankings matter?" and most recently, "The first step is to clearly define the problem..."), It's impossible to clearly define "greatness" by any one or even a set of measures.  I wonder if we should even try.

A few years ago, a group of physician scientists and experts in outcomes measurement assigned a grade (think A, B, C, D, or F) to the various hospital rankings and ratings systems that are commonly used (these findings were published in the online journal, NEJM Catalyst in an article titled, "Rating the Raters: An Evaluation of Publicly Reported Hospital Quality Rating Systems").  Importantly, no rating system received an A (the top grade) or F (a failing grade).  The highest grade received was a B, by USNWR.  The authors of the study concluded, "Each rating system had unique weaknesses that led to potential misclassification of hospital performance, ranging from inclusion of flawed measures, use of proprietary data that are not validated, and methodological decisions.  More broadly, there were several issues that limited all rating systems we examined: limited data and measures, lack of robust data audits, composite measure development, measuring diverse hospital types together, and lack of formal peer review of their methods."  Notably, the Vizient ranking was not included in this study.

It's clear that these rating systems do actually matter, particularly when patients have a choice of where they can go to seek care.  Unfortunately, hospitals spend a lot of money on responding to these surveys, and I do wonder how much "gaming the system" goes on when they do provide their internal quality data.  Most of the ratings systems aren't very transparent with their methods, which has also led to further questions on their overall accuracy.

Regardless, I do think that NYU Langone Hospital deserves our congratulations, particularly when it's widely acknowledged that the system was in near collapse in the mid-2000's.  I've talked about the hospital's remarkable turnaround in my post "Elevators, M&M's, dust balls, and toilet paper", which is further detailed in a book by William Haseltine, World Class: A Story of Adversity, Transformation, and Success at NYU Langone Health.  However, I do agree with some of the critics who've called into question whether it's appropriate for a not-for-profit hospital to spend $8 million on a one-time television advertisement.  

Suffice it to say, I don't have a lot of confidence in any rating system, as I don't think it's possible to rank a hospital accurately, even when using a whole set of validated measures.  For that matter, I don't think it's possible to define "greatness", at least when it comes to clinical quality.  But that's a topic for another post...

Safety First!

I went to the construction site for one of our new ambulatory centers a few days ago to celebrate an important milestone with the team.  There are a few well-known milestones in construction - groundbreaking (putting the shovel to the ground), topping off (sometimes called topping out, which is when the last beam is put into place at the top of the building), watertight (sometimes called wind and watertight, which is when the building has effectively been sealed off from the weather and interior work begins), owner handoff (when construction is completed and the builder hands the building off to the owners), and of course, the grand opening.  There are probably a few that I'm missing, but nevertheless, in this case, we were celebrating reaching the watertight milestone.

We toured the facility and thanked the construction team.  I was impressed to learn that the construction team was getting ready to celebrate 365 days without a safety event (they were actually just one day short when I toured the site).  Of course, that particular milestone caught my attention.  I asked for further information on their milestone.  The threshold for that particular metric was any safety incident that caused an injury severe enough to result in lost or restricted worktime.  We then talked about our staff injury metrics, which are very similar.  We track Occupational Safety and Health Administration (OSHA)-recordable injuries (any staff injury that requires medical treatment above first aid) and DART (any staff injury resulting in days away, restricted, or transferred from the usual work assignment).  

Unfortunately, workplace injuries in the health care industry are all too common, and surprisingly our OSHA-recordable injury rate and DART rate far surpass most other industries.  We believe that it's hard to keep patients safe when our staff don't feel safe.  Therefore, we have designed our Staff Safety program to closely mirror our Patient Safety program.  While the injuries and specific interventions are different, the safety culture that we are trying to build and develop is exactly the same for patients and staff.  For too long, hospitals have considered patient safety issues, such as central line infections or pressure ulcers as unavoidable, particularly in hospitals that care for the most complicated patients.  The same belief was true for staff safety.  Most hospitals now have thankfully adopted a different stance.

It may be a long time before we reach the milestone of 365 days without a staff safety event.  However, that doesn't mean we shouldn't try.  The health care industry has a lot to learn from other industries, such as commercial aviation, nuclear power, and construction.  This week happens to be National Patient Safety Awareness Week - what is your organization doing to keep your patients and staff safe?

What's holding you back?

There are at least a couple of books that I've known about for a long time through recommendations from friends, colleagues, and family members that I am hoping to finally read this year.  I recently crossed off The Hitchhiker's Guide to the Galaxy by Douglas Adams right before the winter holidays.  I know that Adams wrote a few more, but I don't know if I will pick any of them up this year.

I've always wanted to read Zen and the Art of Motorcycle Maintenance by Robert Pirsig.  It's supposed to be a fictionalized autobiography that apparently has more to do with philosophy than it does motorcycle repair.  Apparently Pirsig created the title as a play on words of another book by Eugen Herrigel published in 1948, Zen in the Art of Archery by Eugen Herrigel, which is an attempt by Herrigel to understand Zen Buddhism through the sport of archery. Pirsig himself explained that, despite its title, his book "should in no way be associated with that great body of factual information relating to orthodox Zen Buddhist practice. It's not very factual on motorcycles, either."  The book has sold over 5 million copies since its original publication in 1978, which is impressive considering the fact that Pirsig received over 120 rejections by book editors before someone finally accepted it for publication.

In the book, Pirsig talks about what is known as the South Indian Monkey Trap.  At least that's what I've been told - I hope to find out soon enough!  I am not sure there was ever really such a thing, but then again, I have no way to either prove or disprove it.  The "monkey trap" is simply a hollowed out coconut with a small hole, just large enough to accommodate a monkey's open hand.  However, if the monkey makes a fist inside the coconut, the hole won't let the monkey pull its hand out of the coconut.  Hunters would "bait" the coconut with a piece of fruit (e.g., a banana), tie the coconut to a tree, and then wait.  We are told that the monkey would try to grab the piece of fruit and would never let go of it, such that the monkey would be "trapped".  The hunter would then be able to capture the monkey.  

The moral of the story is that the monkey's greed for the fruit led to its easy capture.  The next logical question then, what is the version of the "South Indian Monkey Trap" in your life?  What are you refusing to give up that's holding you back from making progress?  What idea, practice, or habit that you just can't seem to give up is preventing you from being the best version of you?

Two words - Wait and Hope

When I was growing up, I remember watching an animated version of Alexandre Dumas' The Count of Monte Cristo.  To be honest, the only part that I really remember was when the main protagonist, Edmond Dantès, is locked up in prison and meets his mentor, the Abbé Faria, an Italian priest and polymath who teaches him mathematics, science, theology, arts, literature, philosophy, and languages during the decade or so that they try to dig a tunnel below the prison walls to make their escape.  

Several years ago, I picked up a copy of the book and read it for the first time.  It's a great story with so much more to it than what I had remembered from my childhood.  Over the years, I've watched the different film versions of the book, including the 2002 version starring Jim Caviezel as Dantès, legendary actor Richard Harris as Faria, and Guy Pearce as Fernand Mondego, one of the story's main antagonists.  

During a recent flight home from a trip to London, I watched the 2024 French language version of The Count of Monte Cristo (Le Comte de Monte-Cristo).  I thought the movie was excellent.  While the novel is far too complex to be fully adapted to film, I thought this version came the closest to the story as originally told by Dumas.  

Both the novel and the 2024 film end with a quote that I thought was really important.  I don't want to spoil the story, but at the very end, Dantès looks upon his closest friends and departs with the message that "All human wisdom is contained in these two words - wait and hope."  It's a powerful reminder to all of us that patience, perseverance, and faith are the keys to leading through adversity.

Tony Blair’s On Leadership

My wife and I recently spent a week in London, and we had a fabulous time!  We both attended our first Premier League football match (Arsenal vs. Manchester City), and we toured almost all of the major venues.  My favorites were St. Paul's Cathedral (amazing!), Windsor Castle, and the Roman baths in the city of Bath.  Being a history buff, I also enjoyed our "behind the glass" tour of the Winston Churchill War Rooms (it was actually the second time I've been to the War Rooms).  We also toured Parliament, which was very interesting.  As we walked out through the Gift Shop, I noticed a book by former British Prime Minister Tony Blair called On Leadership: Lessons for the 21st Century.  As soon as we got back to our hotel, I ordered the book through our local public library back at home.

If I were being honest, I thought that Blair provided some important insights on what it means to be a leader.  However, I was slightly disappointed that he focused, at times, on how to be a leader in government (which is a main focus for his institute, the Tony Blair Institute for Global Change).  In an interview with Raju Narisetti (McKinsey & Company) for the book, Blair said, "There are lots of books about how to be a better CEO or a better football coach.  But no one, as far as I know, who's been in a senior position in government has written a book that's literally just simply about the challenges of governing."

Blair draws extensively from his own political career to illustrate many of the concepts that he feels are important to being a good Leader (he emphasizes that being in the position of leader is not the same thing as being a Leader, and he always capitalizes the word Leader throughout the book to emphasize that concept).  While there are certainly some key insights that can be applied to leadership in general, he always talks about how to apply these principles to being a Leader in politics.

The book's description on Amazon.com is very specific:

Sir Tony Blair learnt the precepts of governing the hard way: by leading a country for over ten years.  In that time he came to understand that there were certain key characteristics of successful government that he wished he had known when he started.  Now Sir Tony Blair has written the manual on political leadership that he would have wanted back in 1997...

I would be remiss if I didn't at least credit Blair for providing some general leadership principles that can be applied to being a good Leader more generally (and outside of the world of politics).  First, Blair emphasizes the importance of vision, communication, and decisiveness. These three characteristics are definitely important foundational principles for leadership.  He also spends a lot of time talking about the need for adaptability (and a little patience), especially in times of change.  Given the turbulent world we live in today, Blair also talks about the need for Leaders to find the appropriate balance between holding firm beliefs (and staying true to their own values), while being open to new ideas.  Throughout the book, he highlights the importance of building teams, connecting with and inspiring others, and making tough choices, while managing both risks and responsibilities.  .

There are some additional key insights that I would also like to highlight.  Perhaps most importantly, Blair provides a very good discussion on what is meant by leadership.  He describes leadership as follow:

Standing in front of a crowd that is expecting to be pleased but instead being prepared to displease it.  Spelling out the truth rather than the shibboleth.  Persuading, not placating, the audience that is not naturally on your side.  Addressing the head and not the heart of those who are.  The willingness to take not just the mantle but what goes with it should that mantle be worn seriously: the criticism as well as the adulation, the necessity of a decision and not simply debate; of substance as well as shine; of advancing and not just being; of action and not mere analysis; to resolve the problem and not simply articulate it.  And to keep going even when it looks like defeat is as plausible an outcome as victory; to retreat tactically, but never strategically.  This is leadership.  And to realise that giving people what they want is not the goal of leadership.

Blair also talks about how difficult it is to be a Leader in today's world.  He writes, "Leaders have the courage not to go with the flow.  They speak up when others stay silent.  They act when others hesitate.  They take the risk, not because they fail to identify it as risk but because they believe a higher purpose means the risk should be taken."  He mentions a quote by Chinggis (or Genghis) Khan, who said about leadership that, "Conquering the world on horseback was easy; the hard part was when you had to dismount and govern."

As I mentioned above, Blair talks about three key principles that are the bedrock to leadership - having a vision, communicating well, and being decisive.  Remember that a vision is the ultimate goal or idea that leaders have for the direction of their organization. The ultimate goal or idea becomes the basis of a strategy, which plans how the organization can reach its vision.   Blair writes, "The word strategy derives from the Greek strategia - meaning generalship.  Without it, there is no leadership...Its presence does not guarantee success; but its absence pretty much guarantees failure."

Blair dedicated an entire chapter to the importance of technology.  For example, he talks about leaders who are hesitant about the application of technology (I'm thinking in particular of artificial intelligence) versus those who see technology as an important part of the future of an organization that should be embraced.  I mentioned the Luddites in my post "The Glass Cage".  Blair mentions the Luddites in his chapter on technology, writing:

If there's another lesson to be learnt from the Industrial Revolution in particular, and history in general, it's that such things [referring to technological advances, like artificial intelligence], once invented by human ingenuity, are never disinvented by  human anxiety.  The machine-breaking Luddites of the early nineteenth century tried to hold back the tide of change.  They failed.

Blair then suggests what leaders can and should do, writing:

The answer, therefore, is not to resist or deny the revolution, but to understand it fully, to access its opportunities and mitigate its risks.  Don't let fear or the inevitable campaigns against this revolution create hesitation.  Let the sense of the opportunities energise the spirit of change.

Blair believes that rather than creating more problems and hassles for Leaders, technology is going to vastly improve leadership.  He goes on to suggest that, because of the technological advances that are occurring, it is indeed a great time to be in leadership.  These words are reassuring to me, especially given all of the challenges that we, as leaders, have faced in the last couple of years.

There are some other points that Blair mentioned in his book that I will likely re-visit in future posts.  For now, I will end this post, as I frequently do, with a quote.  In this case, the quote (by Tony Blair) perfectly encapsulates what it means to be a Leader in today's world.  Blair said, "The art of leadership is saying no, not yes."

Familiarity breeds contempt...

There is an old saying that has been around for hundreds, if not thousands, of years: "Familiarity breeds contempt."  The earliest known source that I can find is from the sixth century BCE in one of Aesop's Fables, "The Lion and the Fox".  A fox happens to meet a lion in the forest one day and is shy and afraid, because the fox had never encountered a lion before.  The fox runs away and hides.  The next day, the fox runs into the same lion a second time, but instead of running away, the fox stands behind a tree and watches the lion carefully and closely.  The fox encounters the lion for a third time later, but this time stands proudly in front of the lion and asks, "What's going on?"  We are led to believe that the fox becomes too comfortable with the lion and ends up getting eaten as a result.  Familiarity, in this case, caused the fox to let his guard down, when he definitely should have been more careful around the "King of the Jungle".

The question I would ask is whether this ancient proverb is, in fact, true.  As we get to know a complete stranger, are we more apt to like the individual more or less?  Conventional wisdom would suggest the former.  Nicholas Carr, who is becoming one of my favorite authors as of late, writes about this very subject in his most recent book, Superbloom: How Technologies of Connection Tear Us Apart (based partly on an article he wrote for The Boston Globe in 2017, "How tech created a global village - and put us at each other's throats").  Carr starts with the premise that since the invention of the telegraph in the 19th century, there's been an attitude that advances in communication technology would promote social harmony.  In other words, the more we know each other, the better connected we become as a society.  

For example, a New York Times columnist celebrated the laying of transatlantic Western Union cables in 1899 by writing, "Nothing so fosters and promotes a mutual understanding and a community sentiment and interests as cheap, speedy, and convenient communication."  Guglielmo Marconi wrote in 1912 that his invention of the radio would "make war impossible, because it will make war ridiculous."  Later, John J. Carty, an engineer at AT&T said in a 1923 interview that the telephone would "join all the peoples of the earth in one brotherhood."  The Canadian writer and philosopher Marshall McLuhan, perhaps most famous for coining the phrase "the medium is the message" as well as predicting the World Wide Web nearly 30 years before it was invented, suggested in his book The Gutenberg Galaxy that the new era of communication would create a "global village", bringing us all closer together as one society.  Finally, Meta's Mark Zuckerberg suggested in 2012 that Facebook was more than a business, it was on a social mission to make the world a better place, writing, "People sharing more creates a more open culture and leads to a better understanding of the lives and perspectives of others."

As Carr points out in the Boston Globe article, if greater communication brings people together more, then we should be seeing greater harmony (in Carr's words, "a planetary outbreak of peace, love, and understanding"), not less.  It's fairly obvious who Carr blames for the current state of affairs.  Social media, rather than bringing us closer together as Zuckerberg hoped for in 2012, has only pushed us further apart.  

Carr refers to social media in Superbloom by stating, "As a machine for harvesting attention, its productivity is unmatched.  As a machine for bending the will, it is a triumph of efficiency.  In engineering what we pay attention to, it also engineers much else about us - how we talk, how we see other people, how we experience the world."  And more often than what was previously the case, our society spends more time communicating in the virtual world via social media than they do in the real world.  He suggests that "a full fifteen years before the arrival of COVID-19, people were already choosing lockdown."  

The abundance of research also tells us that greater communication doesn't lead to greater social harmony.  The evidence tells us that (1) people are more willing to share information on social media that they wouldn't share in person or in other modes of communication (called the online disinhibition effect); (2) the more we know about someone, the less we like them (see Michael Norton's article, "Less is more: The lure of ambiguity, or why familiarity breeds contempt" as one example of many similar studies).  A group of British researchers labeled this "digital crowding", stating "With the advent of social media, it is inevitable that we will end up knowing more about people, and also more likely that we end up disliking them because of it."  We have become like the fox in Aesop's Fable.  We would do well to remember that things didn't go to well with the fox in the end. 

The Death of Command and Control

If you've ever read up on the research on human motivation, you've probably encountered Maslow's Hierarchy of Human Needs or Herzberg's Two Factor Model.  There's also a good chance that you've heard about the work by Douglas McGregor in the 1950's and 1960's on Theory X and Theory Y.  As it turns out, McGregor was actually a student of Abraham Maslow, who was actually a contemporary of Frederick Herzberg.  McGregor developed and introduced his model in his book, The Human Side of Enterprise, first published in 1960.  Notably, leadership expert Warren Bennis once said of McGregor, "Just as every economist, knowingly or not, pays his dues to Keynes, we are all, one way or another, disciples of McGregor."

What's important to know about McGregor's theory is this - while Theory X generally has a negative view of workers, Theory Y generally has a positive one.  Theory X believes that the typical worker or employee has little ambition, avoids responsibility, and is focused primarily on achieving their own personal goals and interests.  Theory Y, in contrast, believes that the typical worker or employees is internally motivated, enjoys their job, and works hard to better themselves without a direct reward in return.  

Leaders and managers who subscribe to the Theory X viewpoint, then, will rely upon a more authoritative, top-down/hierarchical approach.  They will use punishment and rewards to motivate their workers or employees.  They will develop and enforce (again through punishment and/or rewards) strict policies and procedures that are to be followed as routine.  Conversely, leaders and managers who subscribe to the Theory Y viewpoint are more democratic in their approach.  They believe that in a positive workplace culture that emphasizes autonomy (with accountability), responsibility, and "deference to expertise".

It's important to realize that McGregor saw both Theory X and Theory Y as two ends along a continuum.  Consistent with situational leadership theory developed by Paul Hersey and Ken Blanchard or contingent leadership theory developed by Fred Fiedler, the most effective leaders would at times use both methods, depending on the specific needs or context of the situation.  It's also not too hard to figure out which theory the most prevalent leadership approach used today is based upon - there was actually an article ("Beyond Theory Y") published in 1970 in the Harvard Business Review that again emphasizes that both approaches can and likely should be used, depending on the specific needs of the situation at hand or the problem to be solved.

So why then are their articles touting the "death" of Command and Control (see for example, "Command and Control is Dead" or "Command and Control Leadership is Dead" or "The Death of Command and Control: Why Old-School Leadership is Killing Your Team's Potential")?  Command and Control (C2) refers to a leadership and management approach traditionally used in the military, but it has also been used in non-military organizations as well.  The "Command" part of C2 refers to the process of directing, issuing orders, and providing leadership for a particular group, project, or operation.  The "Control" part of C2 refers to the process of monitoring compliance with policies and procedures (and enforcing them) and ensuring the proper execution of orders and tasks.  As you can probably guess, C2 is more top-down, hierarchical, and authoritarian/autocratic and definitely leans more toward the Theory X approach.

Kathy Miller Perkins wrote an excellent article for Forbes magazine ("Shift Your Leadership Style: Guidelines for Agile Leadership"), in which she outlines the exact approach that McGregor recommended all those years ago.  She writes, "Steering through the complex waters of modern leadership requires more than a single, go-to approach.  It demands the skill to adapt swiftly, changing your leadership style on the fly to tackle constantly shifting conditions and challenges."  In short, the leader's in today's VUCA (or BANI) world need to be agile, and agile leadership, consistent with both situational leadership theory and contingent leadership theory, includes "Command and Control".  

Perkins lists a number of situations where a more autocratic or C2 approach may be preferred:

1. Agile leadership during a crisis: "When navigating through treacherous waters with reefs and storms, you may need a crew that follows your orders as an experienced leader."

2. Agile leadership in highly predictable environments: A C2 approach can be most effective with work that is highly predictable, well-defined, and repetitive in nature.  Perkins gives the example of a manager at a fast-food restaurant, where setting clear expectations and ensuring compliance with standard operating procedures, rules, and regulations can drive efficiency and high performance.

3. Agile leadership in regulated environments: Again, with tight regulatory environments, a C2 approach may be preferred over other approaches, particularly when variation from standards can result in significant problems for the organization.

Perkins concludes her article by stating, "Leadership in this century is not about clinging to a single, comfortable style but about developing the situation awareness and flexibility to switch between approaches as the context demands."  Rather than being dead, "Command and Control" leadership is here to stay, even if used relatively sparingly and for specific situations or contexts.