Monday, January 16, 2017

Remembering Dr. King

Dr. Martin Luther King, Jr was born on January 15, 1929.  Today, we celebrate his birthday and honor his legacy.  A few months ago, I had the opportunity to visit Washington, D.C. on a business trip - I went running around all the monuments and stopped by the Martin Luther King, Jr. Memorial to read a few of his quotations.  It truly is a remarkable monument to a remarkable man - it is hard to imagine what life would be like in the United States today without the work that so many of our nation's great civil rights leaders, including Dr. King, did in some of the darkest times in our history.  Here we are, just a few days shy of the final day of our nation's first African American President's second term (and arguably, if he had been allowed to run for a third term, he probably would have won).  The irony of what that means, juxtaposed with some of our nation's more recent struggles is not lost on me this MLK Jr Day.

The Martin Luther King, Jr. Memorial has a vision statement that I think summarizes very eloquently how we should celebrate Dr. King's legacy - today and in the future.  The official vision statement reads as follows:

Dr. King championed a movement that draws fully from the deep well of America's potential for freedom, opportunity, and justice. His vision of America is captured in his message of hope and possibility for a future anchored in dignity, sensitivity, and mutual respect; a message that challenges each of us to recognize that America's true strength lies in its diversity of talents. The vision of a memorial in honor of Martin Luther King Jr. is one that captures the essence of his message, a message in which he so eloquently affirms the commanding tenants of the American Dream – Freedom, Democracy and Opportunity for All; a noble quest that gained him the Nobel Peace Prize and one that continues to influence people and societies throughout the world. Upon reflection, we are reminded that Dr. King's lifelong dedication to the idea of achieving human dignity through global relationships of well being has served to instill a broader and deeper sense of duty within each of us— a duty to be both responsible citizens and conscientious stewards of freedom and democracy.

These are truly powerful words to live by - they inspire us and they challenge us.  Dr. King once said, "The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.”  We stand now in times of challenge and controversy, and now, more than ever, is when we need true leaders that can help us find our way.

We stand on the precipice of tremendous change in health care.  Dr. King also once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”  The incoming presidential administration has already promised to "repeal and replace" Obamacare (the Affordable Care Act) - whether you support the law or oppose the law, there are certain elements of the law that  have accomplished a lot of good. 

I think Dr. King would have been proud of all the things that we have accomplished since his death.  But we still have a long way to go.  Today, we are reminded of how much we have accomplished and how much work there is left for us to do.  Thank you, Dr. King. 

Thursday, January 12, 2017

Broadway Joe's Guarantee

Forty-eight years ago today (January 12, 1969), "Broadway Joe" Namath delivered on his personal guarantee, and the New York Jets upset the Baltimore Colts in Super Bowl III, 16-7.  Super Bowl III was actually the first time that the professional football championship was officially called the "Super Bowl" and pitted the American Football League (AFL) champions, the New York Jets, against the National Football League (NFL) champions, the Baltimore Colts.  The Colts, coached by legendary Hall of Fame coach Don Shula and Hall of Fame quarterback (and perhaps the greatest quarterback to ever lace up the high-top cleats!) Johnny Unitas, were heavily favored to win the game.  Unitas had been hurt for most of the season, and the Colts were led by back-up quarterback, Earl Morall (who would go on to win the Most Valuable Player award that year).  Morall actually started the Super Bowl, but was later replaced by Unitas because of an ineffective offensive performance.


Most football experts, fans, and sports writers felt that the players in the AFL, as a whole, were less talented than the players in the NFL.  The Colts were considered, at that time, "the greatest football team in history" (which, given the success of the Green Bay Packers in the 1960's, is saying a lot!) and Norm Van Brocklin, head coach of the Atlanta Falcons (an NFL team) was said to have told a reporter, "This will be Namath's first professional football game."  Namath had been asked about the point spread a countless number of times in the days leading up to the game.  Finally, he had enough when a heckler at a sports banquet in Miami three days before the game pushed him to the edge and he told the press, "We're going to win the game.  I guarantee it."  And, in one of the greatest upsets in the history of professional football (and arguably, one of the greatest upsets in all of sports), Namath led the Jets to their first (and only) Super Bowl victory.  Namath ended up the game with 17 completions on 28 passing attempts for a total of 206 yards, no touchdowns, and no interceptions.  Neither quarterback for the Colts was very effective (Morall threw three interceptions, Unitas threw one interception late in the game).


I would compare Namath's "guarantee" to Babe Ruth's "called shot" (Ruth famously pointed towards the outfield bleachers during an at-bat in the fifth inning of Game 3 of the 1932 World Series at Wrigley Field, against the Chicago Cubs).  I would ask, are these examples of incredibly talented and confident individuals who made bold, visionary statements that rallied their teammates, or are these examples of two individuals who were overly confident, bordering on conceit, and in the end just got plain lucky?  No one ever talks about the individuals who made similar gestures or remarks but did not or could not deliver (there are a number of cases throughout sports history).  There are certainly examples of players making promises or guarantees about how hard they will work to get a victory - a great example (and a great story) that comes to mind is when Tim Tebow, after a humiliating loss to the University of Mississippi, 31-30, claimed in a post-game interview:


I promise you one thing.  A lot of good will come out of this.  You will never see any player in the entire country play as hard as I will play the rest of the season.  You will never see someone push the rest of the team as hard as I will push everybody the rest of the season.  You will never see a team play harder than we will the rest of the season.


These words have been immortalized on a plaque outside the University of Florida's football stadium.  The Gators went on to win the rest of their games that year, including a 24-14 victory over Oklahoma to win the National Championship.  THAT, I think, is a better "guarantee" than either Namath's or Ruth's.  Tebow had a vision for where he wanted the team to go (winning the College Football National Championship) and made a promise to do everything that he could humanly do in order to get there - not by himself, but with his teammates.  The speech was inspirational and rallied his team together, and they did amazing things in the end.  Don't get me wrong, I think Namath's "guarantee" is a great story.  His team clearly rallied around him to get the victory in the end.  But I think there are a number of examples of statements like this that have been made, only to serve as a rallying cry for the other team, the opponent!  It would be hard to use Tebow's version of a "guarantee" as a rallying cry for the other team. 


I see similar parallels with the use of aspirational or "stretch" goals (what Jim Collins would call a "Big Hairy Audacious Goal" or BHAG).  In this context, if used carefully and not excessively (in terms of "over-the-top" - ness), I do think that stretch goals can be used as rallying cries for transformational change.  But in my experience, if stretch goals are used again and again for every transformational change or quality improvement effort, individuals get tired very easily with them (and they become the "flavor of the month" or the "next greatest thing" and can be counterproductive).  Use them sparingly - with change efforts that really matter (for example, President Obama's cancer "moon shot" is a great example of an appropriate use of a BHAG).  Stretch goals must be consistent with the organization's overall vision, otherwise they will fail.  Finally, the stretch goals must involve something that the organization is passionate about (e.g., curing cancer, eliminating patient harm, etc.).   


Organizations should be bold and visionary, but they should be bold like Tim Tebow and NOT like Joe Namath.



Monday, January 9, 2017

A catchy name is not enough!

I read a great blog post this afternoon called, "A Mug Full of Change", and I couldn't agree any more with the message that the author was trying to convey.  He starts by talking about how every night, before going to bed, he empties the loose change from his pocket and tosses it in his "change" mug (in this case, change referring to quarters, dimes, nickels, and pennies).  In a moment of reflection, he realizes that the mug is actually from a change (i.e. quality transformation) initiative that his organization had run a few years back.  He goes back to work the next day and is explaining the irony of the whole episode to one of his co-workers, in this case, an employee who had been with the company for nearly 30 years.  The employee laughs, points to the cabinet in his cubicle and slides the door back to reveal "literally a wall full of mugs" from change initiatives from the past.

Why is it that we feel the need to label major initiatives with a catchy label?  It is pervasive in a number of industries, including health care.  For example, there are a number of health care organizations who are (rightly) focusing on reducing serious harm events, such as central line infections, pressure ulcers, and codes outside the intensive care unit.  The ultimate goal for these patient safety initiatives are to reduce the number of these serious harm events to zero.  Pair the word "zero" with any number of words, and you have the name of any of a number of patient safety initiatives at a number of major health care organizations across the United States.  It doesn't just involve patient safety.  I have heard phrases like the "Triple Aim" (Institute for Healthcare Improvement) to describe the goal of improving population health, reducing cost, and increasing patient experience.  Add a fourth goal of improving the provider experience, and you now have the "Quadruple Aim".   

Please don't misunderstand me - all of these initiatives, every single one, is absolutely the right thing to do in health care today.  These are the right goals to set for ourselves.  Many of these initiatives have been relatively successful.  However, I do agree with the author (Ken Miller) of "A Mug Full of Change" - the need to brand every single change initiative with a catch-phrase is not necessary and may, in fact, be counterproductive.  Miller offers several reasons why in another related post, "What's in a Name?":

1. Catchy names often lead to the "Flavor of the Month" syndrome.  It's as if the employees are saying, "Here we go again.  Another month.  Another quality improvement project."  By translation, the "Flavor of the Month" syndrome leads to "initiative fatigue," which is a killer of change.

2. Labeling the change initiative creates a target.  As our Board of Trustees Chair likes to say, "The only people who like change are babies with wet diapers."  There are going to be nay-sayers.  By labeling the change initiative, you have essentially given them a target.  "I have X."  "Here we go again - X."  "This month, X.  Next month, Y."  The nay-sayers may even change the words around that turns what was meant to be positive into a negative ("Tomorrow's medicine today" becomes something like "Yesterday's medicine today" as one example that I have heard during my career).

3. By naming the change initiative, we separate the label from the actual work.  More time and energy is focused on the branding than the actual execution of the work. 

4. At times, we spend more time and energy launching the campaign with the catchy brand that not enough energy is left for us to do the actual improvement work.  Miller says it's like we are celebrating BEFORE the work is even started!

5. Miller doesn't list this one, but I think that at times, the catchy name assumes a life of its own.  It becomes so all encompassing, that people just get sick of hearing about it.

So what does Miller recommend?  Above all else, avoid the temptation to use a catchphrase or trendy label for your next change initiative.  Don't create T-shirts or have big parties until the work is done.  People will get excited about change - there are other ways to motivate and inspire.  Leave the change mugs for exactly their original intended purpose - to collect loose coins!

Sunday, January 8, 2017

A really great book..."When Breath Becomes Air"

I just finished a really great book, called "When Breath Becomes Air" by Paul Kalanithi.  Paul Kalanithi was a neurosurgery resident when he was diagnosed with terminal lung cancer (a rare form that has no relationship to cigarette smoking).  I had read several good reviews of the book, and I had talked to a few friends who highly recommended it.  I sat down this morning, on one of those rare days when I had some time to myself, and read the book from cover to cover.  I couldn't put it down.  Perhaps the book meant more to me because I am a physician, and the book really talks about the unique and special relationship between a physician and his or her patient.  But I think that there is a lot more in this book than just medicine - it is really a book about how to live one's life.

Paul Kalanithi was an English literature major in college, later when on to get a Master's degree in the history and philosophy of science before finally attending medical school.  He was nearing the completion of a long, hard residency training program in neurosurgery, with a bright future ahead of him and seemingly just within his grasp when he was diagnosed with cancer.  He spent the final years of his life continuing to be a good husband, becoming a father, finishing his residency, and writing this book.  The book was published shortly after his death.

The title comes from a poem by Baron Brooke Fulke Greville in "Caelica 83":

You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
      Reader! then make time, while you be
      But steps to your eternity.

While the book is packed with quotes and lessons, there is one that I think is pertinent to leadership (among many):

You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

In other words, vision.  Set a vision for your future and take the steps needed to get there.  There is so much in this book, and I cannot hope to do it justice.  So I will just finish by saying, if you can only read one book this year, make it this one.

Thursday, January 5, 2017

"If"

About three years ago, I came across a poem by Rudyard Kipling, a famous British author and Nobel Laureate (he won the Nobel Prize in Literature in 1907 at the age of 42) who is perhaps best known for writing the collection of children's stories published as The Jungle Book.  The poem was written for his son, John, and offers paternal advice for how one should live a life:

 If you can keep your head when all about you
 Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
  But make allowance for their doubting too;
If you can wait and not be tired by waiting,
  Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
  And yet don’t look too good, nor talk too wise:

If you can dream—and not make dreams your master;
  If you can think—and not make thoughts your aim;
If you can meet with Triumph and Disaster
  And treat those two impostors just the same;
If you can bear to hear the truth you've spoken
  Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
  And stoop and build ’em up with worn-out tools:

If you can make one heap of all your winnings
  And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
  And never breathe a word about your loss;
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!”

If you can talk with crowds and keep your virtue,
  Or walk with Kings—nor lose the common touch,
If neither foes nor loving friends can hurt you,
  If all men count with you, but none too much;
If you can fill the unforgiving minute
  With sixty seconds’ worth of distance run,
 Yours is the Earth and everything that’s in it,
  And—which is more—you’ll be a Man, my son.


If you are a baseball fan, and most certainly if you are a Boston Red Sox fan, you will recognize the text of this poem.  Kevin Spacey recited the poem in a video tribute to David Ortiz ("Big Papi").  The video was played at Fenway Park during Ortiz's retirement ceremony. 

There are a few lines that I particularly find inspirational.  First, the line "If you can keep your head when all about you are losing theirs and blaming it on you" speaks directly to leadership during a crisis.  During a crisis, the most effective leaders stay calm, cool, and collected.  There is enough going on around the leader and his or her team, and the last thing that the team needs is to see their leader stressed out or panicked.

Second, "if you can dream - and not make dreams your master" also resonates.  Dreams are good - they provide a vision or objective for an individual to achieve.  However, individuals should not focus so much on their dreams that they lose sight of their reality.

Third, "if you can meet with Triumph and Disaster, and treat those two imposters just the same" refers back to the first line.  You can't tell whether things are going well or poorly by the look on a good crisis leader's face.  These leaders respond to success or failure in a similar way.

Finally, "if you can fill the unforgiving minute with sixty seconds' worth of distance run, yours is the Earth and everything that's in it" means (to me) that if you push hard, work hard, and set stretch goals for yourself and for your team, success will come.  I enjoyed this poem the first time I read it, and I keep a copy handy to quickly read from time to time. 

Tuesday, January 3, 2017

"Row the Boat"

Did anyone else watch the Cotton Bowl (Western Michigan versus Wisconsin) football game yesterday?  As I was watching the game, I noticed several fans holding signs that said, "Row the Boat."  I even noticed that the Western Michigan football players had a set of oars on their helmets, and the front of the helmet had a sticker that said, "Row."  I was curious - the mascot for the Western Michigan football team is the Bronco.  Last time I checked, broncos were horses and had absolutely nothing to do with rowing.  So, I did what everyone else does when they have a question - I searched the Internet!

Apparently, Western Michigan's football coach, P.J. Fleck, created a team slogan ("Row the boat") based upon his philosophy for football, and life.  Based on how successful Western Michigan was this year (they were undefeated until they lost a close game yesterday to Wisconsin), I would say that the philosophy is a good one.  His coaching staff, his players, the student body, and the school's fan base bought into the philosophy as well.  Basically, "Row the Boat"comes down to three parts.  First, in order to row a boat, you have to have a set of oars.  The oars represent "what you bring to life."  An individual can choose either to place the oar in the water or out of the water, but in order to move the boat forward, the oar has to be in the water.  The second part of the philosophy is the boat itself, which represents "what you are willing to give up for something that you have never had."  The third part of the philosophy is a compass.  Every boat has to have a compass to navigate on the water.  In the "Row the Boat" philosophy, the compass helps one to figure out what direction they are going (in other words, what direction one needs to go to successfully fulfill his or her goals in football, and in life). 

As Coach Fleck describes in a videotaped interview on ESPN, he developed the philosophy after his infant son died of a heart condition on February 9, 2011.  He describes the philosophy as a "never give up mantra."  He goes on to explain that when you are rowing a boat, you actually face backward.  "You can't see the future.  You can only see the past, which is the only thing that you can't change.  But you have to learn from the past to create a better future."  What a powerful metaphor for football, and more importantly, for life!  Coach Fleck's name has been mentioned for several college head coaching jobs, but I hope he sticks around for at least another year at Western Michigan!

I am reminded of another great metaphor - this time, not a football team, but a book.  Our CEO recently asked our hospital leadership team to read a book by Daniel James Brown, called "The Boys in the Boat".  The book tells the story of a college rowing team (the University of Washington) who went on to win the Olympic gold medal in rowing at the 1936 Berlin Olympics.  It really is a great story, but it is even a greater metaphor on leadership and teamwork.  I see a lot of parallels between this book and Coach Fleck's leadership philosophy, and I think there is a lot to learn from both.  I highly recommend the book (I recently heard that the book is going to be made into a movie, but please do yourself a favor and read the book first!).  Meagan Flores offered these leadership lessons from the book on her blog:

1. A great team must share a vision.
2. Overcoming adversity makes the team stronger.
3. Excellence comes from focus.
4. Don't micromanage.
5. Empower your team with the courage to change strategy.
6. Hold people accountable.
7. Plan, execute, monitor, repeat.
8. Goals must be aligned across the team.
9. Let it run.

There are many more blog posts on "The Boys in the Boat" - I won't list all of the quotes, lessons, or tidbits of information here, but I encourage you to check them out (just search "leadership lessons" and "boys in the boat").  Better yet - just read the book.  And watch Western Michigan football!

Sunday, January 1, 2017

"The Gate of the Year"

Another year is in the books!  It is really hard for me to believe that 2016 is over and that we are already in the year 2017.  My oldest daughter last week asked each of us at the dinner table what was the best part of the past year.  As we looked back, a lot happened for us this past year.  My wife and I celebrated our 25th wedding anniversary.  We bought a new house, sold our old house, and moved (in that order).  There were several family trips, several college tours, and several visits with friends and family.  All things considered, it was a pretty good year for our family, even if it was a difficult year for our country (indeed, our world).

I have always been fascinated by the New Year's holiday.  The start of a new year is a chance to reset, refresh, re-focus, and re-energize.  The start of a new year is an opportunity to look back on what was accomplished in the past 12 months, as well as what was not accomplished.  The start of a new year is a time to set goals for the next 12 months.  With this in mind, there are a few goals that I set last year that I attained, as well as a few that I failed to reach.  One of my goals was to start a blog - check!  Although I slacked off after a good start last January, I think I ended up the year with a good finish.  Writing is something I enjoy, and this blog has been a great chance for me to practice my writing skills and reflect on things that I have heard and learned. 

I have read a lot of articles, blog posts, and editorials in the past couple of days looking forward to the end of what many would say has been a bad year.  We - all of us around the world - have been through a lot this last year, and some would argue that our best days are behind us now.  Quite the contrary, I look forward to the next year with faith in humanity, a hope for peace, and a love for one another.  There is no doubt that we have our differences, but I firmly believe that the bonds that we share are stronger than our differences.  There is more that unites us than separates us.  We have more reasons to be optimistic than pessimistic. 

Today at Mass, our priest read a passage from a speech by King George VI.  The year was 1939, and England was on the brink of defeat.  England had declared war on Nazi Germany in September, shortly after Germany had invaded Poland.  It was tradition for the King to address the British Empire at the start of a New Year.  As immortalized in the 2011 movie, "The King's Speech", King George VI hated public speaking - indeed, it terrified him.  He had dealt with a speech impediment for his entire life, and he was naturally shy, introverted, and reserved.  In fact, he had reluctantly become King only when his older brother David had abdicated the throne.  He delivered a speech by radio on Christmas Eve from the royal country home at Sandringham:

A new year is at hand. We cannot tell what it will bring. If it brings peace, how thankful we shall all be. If it brings us continued struggle we shall remain undaunted.

He then read a passage from a poem that his daughter, Princess Elizabeth (now the Queen of England), had given him.  The poem is called "The Gate of the Year" or "God Knows" and was written by the British poet, Minnie Louise Haskins. 

And I said to the man who stood at the gate of the year:
“Give me a light that I may tread safely into the unknown.”


And he replied:
“Go out into the darkness and put your hand into the Hand of God.
That shall be to you better than light and safer than a known way.”


So I went forth, and finding the Hand of God, trod gladly into the night.
And He led me towards the hills and the breaking of day in the lone East.


The speech united the nation in a common cause.  The speech inspired a nation to continue the struggle for freedom.  As our priest said today, let us too, at the start of the new year, 2017, put our hand into the Hand of God and find our way.