"Stay away from easy..."

I was always taught by my parents and coaches to always be a good sport.  While winning was important, what was even more so was how a player or team won.  And if you ever happened to be on the losing side of things, acting with grace, humility, and respect was part of good sportsmanship too.  Unfortunately, not everyone places as high of a premium on good sportsmanship.  There are many athletes and coaches who subscribe to a "win at all costs" philosophy.  Apparently former professional tennis player Andy Roddick isn't that kind of athlete.  

When Andy Roddick retired from professional tennis in 2015, he had an overall professional record of 615-213 with 32 career titles (including the 2003 U.S. Open) and a former number one ranking to his list of accomplishments.  However, I will always be most impressed by what Roddick did in the 2005 Italian Championship.  He was the top seed in the tournament, but he was defeated in the quarterfinals by Fernando Verdasco in three sets (6-7, 7-6, 6-4).  During the second set, Roddick was leading 5-3 with triple match point.  In other words, he would have three chances to win the point and move on to the next round.  The line judge called Verdasco's serve out, which would have given Roddick the match win.  Roddick, however, insisted that the ball was in, forcing the umpire to reverse the call, giving the point to Verdasco (see a video clip here).  Verdasco would go on to win the game, the set, and the match.  Notably, Verdasco would lose in the next round. 

Unfortunately, as I stated, not everyone in Roddick's shoes would have insisted that the ball was in.  His sportsmanship ultimately cost him the match (and likely a lot of money as a result).  It's tempting to ask whether Roddick could have been accused of cheating if he hadn't argued for the correct call.  It would have been tempting to just look the other way and ignore the fact that the referee had made the wrong call.  But he didn't.  He was 100% honest in that situation, which is both admirable and honorable.

Unfortunately, a lot of individuals not only look the other way, but they also outright cheat.  Even the so-called experts that study cheating have been accused of being dishonest.  For example, the Harvard psychologist Marc Hauser once wrote an article entitled "Costs of Deception: Cheaters Are Punished in Rhesus Monkeys", but he later resigned from his position when the U.S. Office of Research Integrity concluded that he had falsified and manipulated the data to better support his conclusions (see the Scientific American article, "Why we cheat" by Ferric Fang and Arturo Casadevall).  More recently, two investigators who have studied and published on cheating and dishonesty, Dan Ariely and Francesca Gino, have been accused of fabricating some of their data (see "They Studied Dishonesty. Was Their Work a Lie?" by Gideon Lewis-Kraus published in The New Yorker magazine). 

Unfortunately, cheating, defined by Fang and Casadevall as acting dishonestly to gain an advantage, is far more common than perhaps realized.  I finished a book last year by the physician and scientist Csaba Szabo entitled Unreliable: Bias, Fraud, and the Reproducibility Crisis in Biomedical Research.  The overall gist of the book can be summarized with one simple statement.  As many as 90% of published biomedical studies may be irreproducible (see also the paper published in 2005 by John Ioannidis in the journal PLos Medicine, "Why most published research findings are false").  In other words, if another scientist tried to replicate the results of a previously published study by following the exact methods that were reported by the original scientists who first published the study, it's almost certain that he or she would not be able to do so!  Dr. Szabo suggests that there are three likely explanations.  The original scientists publishing the study made an honest mistake, used questionable statistical methods to analyze their data, or outright fabricated their results.

Given the cuts in research funding at the federal level, the pool of grant dollars available to fund academic research is getting smaller, even while the number of researchers who are competing for those dollars is increasing.  Academic fraud and dishonesty is likely to become even more commonplace.  Moreover, with the advent of artificial intelligence tools, such as ChatGPT, cheating even outside the research world is becoming more prevalent (see James Walsh's article in New York magazine, "Who wouldn't cheat?").

I have always enjoyed reading Dan Ariely's research and lay publications, and I have posted about his findings several times in the past.  His research on dishonesty is very interesting, but unfortunately I don't think it would be right to discuss his research, given some of the accusations that have come out in recent years.  In his book, The (Honest) Truth About Dishonesty, he suggests that almost everyone cheats.  And while he does not deny that the data in some of his research was fabricated, he denies personally doing so and stated that he unknowingly used and published falsified data.  

Dr. Szabo offered a few recommendations on how to address academic fraud and research dishonesty.  First, he stated that we should have stricter oversight and mandate that data is open and available to all.  Given the level of competition in academic research, that could be a tall order.  Second, he suggested that we should institute more transparent peer review.  Peer review is the process by which a scientist's peers review a submitted manuscript for scientific accuracy prior to the manuscript becoming published.  Unfortunately, even peer review has been called into question as of late (see the article published in The Wall Street Journal by Kevin McCaffree and Colin Wright).  Third, Dr. Szabo suggests that we shift funding from individuals to institutions, so that these same institutions can provide better oversight and have less of an incentive for dishonesty.  Finally, he suggests that we criminalize serious and deliberate fraud.  All of these are reasonable recommendations, but they will likely be difficult to implement.

So back to my original question, "Why do we cheat?"  I guess I can't answer that question fully, at least right now.  Dr. Christian Hart summarized what he calls a tripartite theory of dishonesty for Psychology Today.  Basically, cheating, lying, and dishonest behavior occurs as a function of (1) the expected utility (i.e. benefit) of lying is marginally high, (2) the expected external disutility risk of lying (the probability and consequences of being detected) is low, and (3) the expected internal disutility of lying (guilt, regret, shame, effort) is low.  It seems, therefore, that we can decrease the incidence of cheating, lying, or behaving dishonestly by decreasing the rewards associated with the behavior and by increasing the chance of catching someone lying or cheating.  I'm not sure we can significantly alter the internal regret, shame, or guilt from lying.  I do know that the more we reward honest behavior, individuals will act more honestly in the future.  Many of Dr. Hart's recommendations fit with those suggested by Dr. Szabo.  At the end of the day, it seems prudent to follow Scott Alexander's advice, when he said, "All good is hard. All evil is easy. Dying, losing, cheating, and mediocrity is easy. Stay away from easy."

“Make no little plans…”

I first mentioned the American architect and urban designer Daniel Burnham in my discussion of The Big Switch by Nicholas Carr.  I've come to appreciate Burnham more now that I have been living in Chicago.  As I shared in my post ("The Big Switch"), Burnham served as Director of Works for the 1893 World's Columbian Exposition (also known as the Chicago World's Fair), held from May 1 to October 30, 1893 to celebrate the 400th anniversary of Christopher Columbus' arrival in the Americas in 1492.  The city of Chicago's official flag has commemorated the Columbian Exposition with one of its six-pointed stars (the other three stars commemorate the Great Chicago Fire of 1871, the Chicago World's Fair of 1933, and Fort Dearborn, the original settlement first built in 1803 on the Chicago River near present-day Chicago).

Burnham was a major proponent of the Beaux-Arts architectural movement, a style taught at the École des Beaux-Arts in Paris, particularly from the 1830s to the end of the 19th century.  The Beaux-Arts style drew upon French neoclassicism, but also incorporated influences from the Renaissance and Baroque styles, using modern materials, such as iron and glass, and later, steel.  

The Chicago World's Fair had several important influences on later history (in addition to being the site of the first ever Ferris Wheel).  One major highlight was that the inventors Nikola Tesla and George Westinghouse showcased their alternating current (AC) system, effectively winning the "war of the currents" against Thomas Edison's direct current (DC).  The Chicago World's Fair proved that electricity generation could be centralized and distributed over long-distances, both safely and efficiently using Tesla's and Westinghouse's system.  Prior to that time, individual factories had to generate their own power using massive localized steam-powered generators.  While Edison lost the "war of the currents", both he and Samuel Insull (who later founded Chicago's Commonwealth Edison) realized that centralizing electrical power generation could be advantageous.  It was this shift that changed electrical power generation from a highly decentralized, localized, private manufacturing cost to a centralized, shared, and easily accessible public utility (hence, Carr's "big switch").

Burnham helped to design all of the buildings at the World's Fair in the neoclassical style.  All of the buildings were covered in something known as white staff, a kind of artificial stone primarily used to cover temporary buildings (the majority of the buildings at the World's Fair were temporary).  The white buildings gave the World's Fair its nickname, "The White City" and apparently served as inspiration for L. Frank Baum's "Emerald City" in his book, The Wonderful Wizard of Oz.

There is a quote from Daniel Burnham that I really love.  He once said, "Make no little plans.  They have no magic to stir men's blood and probably themselves will not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will never die, but long after we are gone will be a living thing, asserting itself with ever-growing insistency. Remember that our sons and grandsons are going to do things that would stagger us. Let your watchword be order and your beacon beauty. Think big."

Burnham certainly was thinking "big" when he dreamed up the design of the so-called "White City".  And Nicholas Carr's book suggests that some of the changes incorporated as a direct result of the 1893 Columbian Exposition created a "big switch" in how power was distributed to manufacturing organizations, which subsequently played a major role in furthering the Industrial Age.  As leaders, we too need to "think big" and dream of the future, aiming high in both our hopes and dreams, making big plans instead of small ones.  By thinking big and aiming high, we can help architect a better future for our organizations and for society at large.

Relationships are built on trust...

I recently posted (see "Self-trust is the first secret of success...") about a model of trust presented in the book, The Speed of Trust: The One Thing That Changes Everything by Stephen M.R. Covey, former CEO of the Covey Leadership Center.  I introduced the topic in a post from last November, "Change happens at the speed of trust..."  Again, Covey compares trust to the well-known ripple effect, in which waves start out small at the center and become larger and more powerful as they move and expand outward.  He describes five "waves of trust" to drive home the point that trust begins with oneself and expands outward to relationships, organizations, the market, and society.  I'll cover the second Wave of Trust in today's post, which Covey calls Relationship Trust.  

As I've stated in the past (and to paraphrase the Greek philosopher Aristotle), we are "political animals".  And by "political animal" I mean that we are social.  That is how we evolved.  That is how we operate in today's society.  "Politics" really describes how people in a group make decisions, even when those people in the group want different things or don't agree.  "Politics" is all about relationships.  When there is trust in relationships, there is going to be give and take.  When people in a group trust each other, they are more willing to compromise so that the group can make the best decision for the group.

Covey writes, "People tend not to trust people who don't trust them."  In other words, if there is not trust in a relationship, there is probably no relationship.  Or at least one that works effectively.  Henry Stimson, former US Secretary of State under President Herbert Hoover in the late 1920's said, "The surest way to make a man untrustworthy is to distrust him and show your distrust."

Relationship Trust relies upon establishing credibility through Character and Competence.  Note that Covey is building upon the concepts discussed in his first Wave of Trust (Self-Trust) here.  Character depends upon a leader's Integrity and Intent, while Competence depends upon a leader's Capabilities and Results (see my last post for more explanation on each of these Core Elements of Credibility).

In order to build (and/or repair, if it is broken) Relationship Trust, Covey discusses 13 actionable behaviors grouped into the two domains of Character and Competence (or some mix of both):

Behaviors in the Character domain:

1. Talk straight.  Be honest, simple, and transparent in conversation.  Do not distort facts or leave false impressions.  Don't manipulate people.

2. Demonstrate respect.  Be kind and fair.  Do not "fake respect" by showing concern only for those who can do something for you.  Follow the Golden Rule ("Do unto others...").

3. Create transparency.  Be real and genuine.  Avoid hidden agendas.  Do not withhold information that can be helpful to getting the work done.  Err on the side of disclosure.

4. Right wrongs.  Don't use "fake apologies" (do not justify or rationalize wrongs).  Admit mistakes.  When you are sorry, say you are sorry and mean it.  But then go one step further and make right what is wrong.

5. Show loyalty.  Give credit when credit is due.  Don't take credit for something that you didn't do.  Speak up about people as if they were present, even when they are not.  Do not disclose someone else's private information for your own personal gain.

Behaviors in the Competence domain:

6. Deliver results.  It can be hard to measure results, so take the time to develop the metrics of success up front and at the beginning.  Make things happen.  Be on time and on budget.  Don't make excuses when you fall short of the goal.

7. Get better.  Adopt a continuous improvement mindset.  Be open to growth (have a "growth mindset").  Don't be afraid to make mistakes, but when you do make a mistake, learn from it.  As Dee Hock, founder of Visa said, "You learn nothing from your successes except to think too much of yourself.  It is from failure that all growth comes, provided you can recognize it, admit it, learn from it, rise above it, and then try again."

8. Confront reality.  Address the tough issues head on.  Be realistic, but also optimistic.  Learn from Admiral Stockdale and the "Stockdale Paradox").

9. Clarify expectations.  Create a shared vision and agreement up front.  Make sure roles and responsibilities are understood.  Develop a RACI.  Know who has the authority and accountability.  Blaine Lee, author of The Power Principle, said, "Almost all conflict is a result of violated expectations."  Be clear about what you are trying to do, then do it!

10. Practice accountability.  Practice 200% accountability ("I am responsible for my actions and for that of others").  Don't avoid or shirk responsibility, particularly if you are a leader.  Be clear on how you will communicate progress or lack thereof.  Follow Jim Collins' "window and mirror metaphor" - "When things go well, you look through the window; when things go wrong, you look at the mirror."  In other words, give credit for win to the team and take the blame for the loss.  Or as the Russian proverb goes, "Success has many fathers, while failure is an orphan."

Behaviors that fall in both (Character and Competence) domains:

11. Listen first.  We were born with two ears and one mouth.  We should be listening twice as much as we are talking!  Actively listen.  Be present.

12. Keep commitments.  Follow through on your promises. Never (and I mean "NEVER") overpromise and underdeliver.  

13. Extend trust.  Make trust a verb instead of a noun.  Warren Bennis said, "Leadership without mutual trust is a contradiction in terms."  To be a leader, you have to trust your teams!

Day one of the next 250 years...

I've been reading about the recent completion of the Basílica Sagrada Família with great interest.  As you may recall from my post "Cathedral Thinking" last year, this famous church (and UNESCO World Heritage site) in Barcelona was designed by the Catalan architect Antoni Gaudí.  Construction began on the church on March 19, 1882 under the direction of the architect Francisco de Paula del Villar y Lozano, though Gaudí took over when Villar resigned in 1883.  The project would become Gaudí's magnum opus, and he would devote the remainder of his life to the project.  At the time of his death in 1926, only about a quarter of the church construction was complete.  After over 144 years, the central Tower of Jesus Christ was completed on February 20, 2026, and it was inaugurated and blessed by Pope Leo XIV June 10, 2026 during his visit to Spain, coinciding with the centenary of Gaudí's death, as originally planned.

One hundred and forty-four years is definitely a long time, until it's realized that most of the famous churches and other structures from antiquity took far longer to complete.  For example, the Great Wall of China took over 2,000 years to build.  Angkor Wat, the temple complex in Cambodia took over 400 years to build.  Westminster Abbey in London required nearly 500 years to build.  St. Peter's Basilica in Rome required 120 years of construction. The Notre Dame Cathedral in Paris required over 100 years to finish.  It's clear that even with modern construction and engineering, 144 years is not too far out of the ordinary.

As I discussed in last year's post, the concept known as "cathedral thinking" describes the mindset in which long-term projects or goals are initiated for the sake of or for the benefit of future generations. Gaudí knew that he wouldn't live long enough to see the final results of his dream for the Sagrada Família.  Importantly, "cathedral thinking" applies to more than just physical objects.  The U.S. Senator Raphael Warnock recently wrote a book called The Crooked Places Made Straight: Reflections on the Moral Meaning of America.  In the introduction to his book (the title of which, appropriately enough, is "America, The Grand Cathedral"), Warnock uses the same analogy to describe the work that lies ahead for the United States of America, particularly as we celebrate the first 250 years since our nation's founding on July 4, 1776.  He writes, "I reflected that America is like a glorious cathedral, 250 years in the making.  Yet, after all these years, we're still wrestling and toiling to build this grand cathedral of freedom and democracy."  He then cites a passage from the poem "Let America Be America Again") by Langston Hughes:

America never was America to me

And yet, I swear this oath - America will be!

Senator Warnock concludes his book by returning to the "cathedral thinking" analogy.  He writes, "Our grand cathedral is 250 years in the making.  It is majestic, mighty, and full of possibility; yet it remains unfinished. At a time when our country is so deeply divided, I urge us to recognize the danger of our divisions, of allowing demagogues with no vision to deepen the chaos and tear down what has been built with blood and sacrifice.  I urge us instead to lean toward the moral work that can and must be done and to ask ourselves what kind of nation we want.  I urge us to imagine a future full of hope for everyone.  The future Isaiah [the Old Testament prophet] laid out so dearly: Every valley shall be exalted, and every mountain and hill brought low.  The crooked places shall be made straight, and the rough places smooth.  The glory of the Lord shall be revealed, and all flesh shall see it together (Isaiah 40:4-5)."

Yesterday was a celebration of America's first 250 years.  Today, we look forward to our next 250 years.  We still have work to do, for this grand cathedral of ours is not complete.  Today is day one of the next 250 years.  Let us commit to finish the work ahead.

"Baseball, hot dogs, apple pie, and..."

When I was growing up in the 1970's, there was a popular Chevrolet commercial that basically said that the four things that defined what it is to be an American were baseball (often referred to as America's national pastime), hot dogs (and never - I mean never- with ketchup), apple pie ("American as apple pie"), and of course, owning a Chevrolet.  I don't know about the Chevrolet part, even though my parents often owned Chevrolet automobiles.  Regardless, I have been reflecting a lot on what it truly means to be an American the past couple of months, even more so as we have been getting closer to the 250th anniversary of our nation's founding on July 4, 1776.  Certainly "America" means more than just "baseball, hot dogs, and apple pie" right (I won't even comment on the fact that this was a television commercial for a major automobile manufacturer).  

I was fortunate enough to experience July 4, 1976, the American Bicentennial, when I was growing up. The journalist Kyle Smith, who is about the same age as me, has similar memories about that time in our nation's history.  In a recent article for the Wall Street Journal (see "The Bicentennial was a better birthday than this"), Smith writes, "To be 10 years old on July 4, 1976, was pure exhilaration and, as it turned out, the last time American culture was truly overwhelmed by patriotic devotion."  While the issues of the day were certainly different from the ones we struggle with today, American society in 1976 was similar to our present day, at least in terms of the general mood.  We were still emerging from the shadows of the Vietnam War and the Watergate scandal.  Trust in institutions, particularly in government ones, was at historic lows, at least up to that point in history.  The 1973 OPEC oil embargo had caused long lines and high prices at the gas pumps, leading to years of inflation.  Just a year earlier, soon-to-be Senator Daniel Patrick Moynihan wrote in his essay "What have we learned", "In no one thing has the American civic culture declined more in recent decades than in the symbols of love of country, and of manly or womanly pride in the nation."  I think it's fair to argue that Americans were just as cynical in 1976 as they are now.  And yet, we came out in full force to celebrate our nation's 200th birthday.  The colors red, white, and blue were everywhere.  I remember all the parades, pageants, historical re-enactments, and celebrations on television.  They called it the "Spirit of 1976" (see the famous painting by A.M. Willard of the same name below) and it was magical.  

This year seems different.  I could be wrong, but I don't think the American Sesquicentennial (250th year) will be anything quite like what we experienced in 1976.  It certainly hasn't been that way yet.  And that is unfortunate.  While we were perhaps just as divided and cynical in 1976, I think we were a lot more patriotic then compared to now.  We still were proud of "America" as a concept.  We still hoped for and believed in the so-called "American Dream" ("If you work hard, you will get ahead").  Last year, a Gallup poll found that a record-low proportion of Americans described themselves as "extremely" or "very proud" to be American.  In that same poll, 11% of respondents said that they were "only a little" proud and 9% claimed that they were "not at all" proud to be Americans.  According to a recent AP-NORC poll, only one-third of Americans still believe in the "American Dream".  More than half of those polled don't even believe it still exists.  Many Americans feel that our best days are behind us.

The journalist Matthew Continetti recently reported in the Wall Street Journal (see "America's Posterity Problem") on significant declines in patriotism and national pride among younger generations of Americans.  Continetti reported the results of an American Enterprise Institute survey ("America at 250: Surveying Change and Continuity on Civic Values") that showed most Americans understand the importance of our founding, which we celebrate today, and that most of us living here agree that America stands for something special.  Unfortunately, that sentiment is far from universal among Generation Z, represented by Americans born 1997 and 2012.  Overall, 65%% of Americans said that our country is a nation unlike any other, though only 52% of Gen Z Americans felt that way.  Similarly, in the same 2025 Gallup poll mentioned above, just 41% of GenZ Americans claimed that they were "extremely" or "very proud" to be an American, by far the lowest of all the generations surveyed.

I don't know how to fix this malaise.  Perhaps it can't be fixed.  But I don't want to feel that way.  I still am proud to be an American.  I still believe in the "American Dream".  And I still believe that better days are still ahead for all Americans.  Yes, we have problems.  We are more politically divided, and we have lost the ability for civic discourse.  Our economy is getting weaker.  The world is becoming more dangerous.  Some have claimed that the era of American hegemony is over.  But we still have the core ideals that are written in the preamble of our Declaration of Independence, one of the greatest documents ever to be written: all men (and women) are created equal, that they are endowed with certain inalienable rights, and that therefore, the just powers of government must be derived from the consent of the people.  As then President Calvin Coolidge said in a speech delivered in Philadelphia on the 150th Fourth of July Celebration, "Amid all the clash of conflicting interests, amid all the welter of partisan politics, every American can turn for solace and consolation to the Declaration of Independence...whatever perils appear, whatever dangers threaten, the Nation remains secure in the knowledge that the ultimate applications of the law of the land will provide and adequate defense and protection."

Do yourself a favor.  If you haven't read it before, take this opportunity, on this the 250th anniversary of its signing, to read our nation's Declaration of Independence.  If you have read it in the past, take a moment to read it again.  

I will leave today's post with one more memory.  I grew up going to Purdue University football games (my parents were season ticket holders for almost fifty years I think, and I also attended Purdue as an undergraduate in the late 1980's).  One of the pregame traditions at Purdue's Ross-Ade Stadium was a reading of a tribute to America called "I am an America" by the "voice" of the Purdue All-American Marching Band, prior to the playing of the national anthem:

I am an American.  That's the way most of us put it, just matter of factly.  They are plain words, those four: you could write them on your thumbnail , or sweep them across this bright autumn sky.  But remember too, that they are more than just words.  They are a way of life.  So whenever you speak them, speak them firmly, speak them proudly, speak them gratefully.  I am an American.  

"What kind of leader makes for a great President?"

For the past several years, I've been reading at least one biography (occasionally more than just one) of all the U.S. Presidents in order, starting with George Washington.  It all started with a book club that I joined at the Cincinnati Mercantile Library.  The book club kept on pace with a six biographies every year, but unfortunately now that I am living in Chicago, I haven't been keeping to that same schedule.  I am currently on our 33rd President, Harry S. Truman (though technically, I read David McCullough's excellent biography of Truman several years ago).  I am hoping to finish up in the next year or two.

I've learned a lot of history while reading biographies of the 45 men (unfortunately, no woman has ever served as our nation's chief executive) who have served as U.S. President.  More relevant to this blog, I've learned a lot about leadership in general.  With that in mind, I read an interesting article ("What kind of leader makes for a great President?") in the Wall Street Journal the other day by Colleen Shogan.  Shogan served as the 11th Archivist of the United States from 2023 to 2025, and she currently serves as the CEO of In Pursuit, a new initiative from More Perfect, to look back upon our first 250 years and "distill its most timeless lessons to inspire and inform our future."  

Shogan asked historians, journalists, military leaders, and civic leaders (including former U.S. Presidents and First Ladies) to identify one lesson from our nation's Presidents and First Ladies and write an essay about it.  She found that "the most consequential American leadership has rarely been loud or ideological.  Instead, it has relied on character, restraint, discerning judgement and a capacity to distinguish between compromise and moral surrender."  Shogan felt that four leadership qualities stood out among all of the other lessons:

1. "The importance of character"

Shogan writes, "Character shapes decisions most clearly when stakes are high and outcomes are uncertain.  Character can serve as a mitigating factor in the face of disaster, while the absence of character often has the opposite effect."

2. "The importance of soft power"

We all know U.S. Presidents who have tried to be effective by exercising what is known as hard power, which is best defined as the ability to coerce others to do what you want through threats, force, or financial leverage.  In contrast, soft power is the ability to persuade and attract others to voluntarily align with your goals through shared culture, values, and policies.  The most successful Presidents and First Ladies didn't have to rely upon hard power.

3. "Compromise with principles"

Shogan writes, "The role of compromise is critical in a democracy, but with an important caveat: Compromise untethered from principled leadership corrodes democratic legitimacy rather than preserving it...The lesson isn't that leaders should refuse compromise.  Rather, they must know what is morally nonnegotiable and understand why.  When compromise becomes an end in itself, it weakens both leadership and legitimacy."

4. "Learning from failure"

Failure is an opportunity to learn, and Shogan suggests that "leadership is often honed by failure...Failure clarifies what success obscures.  It exposes weak assumptions, tests cherished institutions, and forces citizens to confront uncomfortable truths."

I've just found my new favorite podcast!  There is a lesson for every President and many of the First Ladies (see the website here).  There is an essay, audio, and video for every single lesson on leadership.

It's déjà vu all over again...

The Yankee legend and baseball Hall of Famer Yogi Berra famously once said, "It's like déjà vu all over again!"  It's one of his most famous Yogi-isms, which he said after watching Yankee teammates Mickey Mantle and Roger Maris hit back-to-back home runs during the 1961 baseball season (this was the season that Maris broke Babe Ruth's longstanding record for most home runs hit during a single season).  The phrase is now a colloquialism used when someone is experiencing a situation that feels like an exact repetition of something that happened in the past.

Eric Poon, Andrew Rosenberg, Adam Landman, and Tejal Gandhi published an article this past year that asked whether we are experiencing a "déjà vu" moment with the implementation of artificial intelligence (AI) in health care (see "Déjà Vu? How Might Lessons Learned from Electronic Health Record Implementation Apply to Artificial Intelligence?").  Poon, Rosenberg, and Landman are the Chief Information Officers from Duke University Health System, Michigan Medicine, and Mass General Brigham, respectively, while Gandhi is the Chief Safety and Transformation Officer at Press Gainey.  They offer several recommendations on how we should be applying lessons learned from the widespread adoption and implementation of electronic health records (EHRs) to the implementation of AI in health care today.  

The authors cite statistics showing that the widespread adoption of EHRs have contributed to an estimated $150 billion per year in health information technology spending in the U.S. alone.  That would certainly be okay if EHR implementation was associated with significant improvements in quality of care, patient safety, and clinician productivity, though the results here have been mixed at best.  In addition, the EHR (perhaps unfairly) is often cited as a major cause of burnout amongst health care workers.  Suffice it to say, there are likely some lessons that we can learn from EHR implementation that are translatable to adoption of AI.

The authors first begin with discussing the key differences between the era of EHR implementation and now.  First, the HITECH Act of 2009 provided substantial financial incentives for hospitals and providers to adopt EHRs and included delayed penalties for failing to do so.  These incentives and delayed penalties pushed health care organizations to adopt EHRs in a short period of time.  While some executive leaders are mandating AI adoption and use, to date at least, there have been no federal mandates or incentive programs to do so.  Rather than following the EHR "big bang" approach to widescale adoption, AI implementation could occur in a more phased and flexible manner.  That being said, while EHR implementation occurred in a top-down fashion, the bottom-up adoption of AI could outpace what organizations are actually ready to implement, particularly in the absence of an overall roadmap to help guide AI implementation.  

Second, the overall computer literacy of the health care workforce is quite different today compared to when EHRs were first rolled out.  Technology, including AI, already plays a major role in our personal and professional lives.  For example, smartphones are ubiquitous now - they were much less so back when EHRs were being implemented.  In addition, many health care workers are likely already using AI in some form at home (and in work).  However, while the workforce is likely already facile and comfortable with technology, the levels of burnout amongst health care workers is high enough that they will have diminished capacity and interest to take on additional work.  There is also significant concerns that AI could replace humans when it comes to certain clinical tasks, leading to fears about some clinical jobs being eliminated (I've discussed this topic to some extent recently - see my post, "Is AI going to replace us?").

Third, as I alluded to earlier, the pace of change in regards to AI implementation is likely going to be much faster.  EHR technology evolved slowly over decades, and up until the HITECH Act, implementation was relatively slow and infrequent.  AI technology, in contrast, is proliferating at a much faster pace and has been particularly fueled by interest in industries outside of health care.  

Poon, Rosenberg, Landman, and Gandhi discuss five key lessons learned based on their collective (and extensive) experience and the available literature on EHR and AI implementation:

1. Respect the Human Element

Processes and workflows need to be designed in advance for optimal efficiency and use.  Automating a flawed process will only perpetuate inefficiencies and lead to frustration.  A key lesson from EHR implementation comes from the human factors field - the distinction between work-as-imagined or work-as-prescribed versus work-as-done.  AI systems should be designed so that they are intuitive, user-friendly, and tailored to the specific needs of the end users.

2. Build Strong Organizational Governance

Particularly during the early days of EHR implementation, governance was loose and decentralized.  Robust governance around AI implementation will be crucial so that we do not end up with tools with overlapping and redundant capabilities that interoperate poorly with each other.  The "problem to be solved" should be identified beforehand, rather than bringing in a technology first and finding a problem to be solved later.

3. Adapt Leadership and Culture to Enable Change

Retired Marine Corps General and former Secretary of Defense James Mattis once wrote, "A leader's role is problem solving.  If you don't like problems, stay out of leadership."  I would paraphrase General Mattis slightly, and say that a leader's role is about leading and managing change.  If you don't like change, stay out of leadership!  Upfront investments to prepare both leaders and teams to deal effectively with the rapid pace of change involving AI technology will pay huge dividends in the long-run.

4. Ready the Workforce for an AI-Enabled Future

Many health care organizations failed to invest in computer literacy and typing skills when they made the shift from paper-based medical records to electronic ones.  We should not repeat that mistake.  Health care organizations should invest in AI and digital literacy in order to adequately prepare the workforce and fully leverage the benefits of AI.

5. Avoid Short-term Hype and Build for the Long Term

Remember that it's a marathon, not a sprint.  AI is here to stay.  Health care organizations should commit to measuring the impact of AI implementation.  If an AI tool is not working, these same organizations should be prepared to either modify the tool or move on from it.