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

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

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

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

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

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

I think the poem speaks for itself.

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

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

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

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

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

Pavlov's Dog

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

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

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

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

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

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

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

Are you in a "velvet rut"?

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

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

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

Look. Listen. Feel.

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

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

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

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

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

Blueprint

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

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

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

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

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

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

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

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

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

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

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

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

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