Chimpanzee War

We can learn a lot about human behavior by studying other animal species, particularly primates.  Humans are indeed part of the primate family.  Chimpanzees are one of our closest animal relatives, sharing close to 98% of our DNA.  In fact,  if you consider just the portions of our genome that code for proteins, we share 99% of our DNA with chimpanzees - most of the differences in our DNA involve portions of the genome that do not code for proteins.  It's believed that Homo sapiens (that's us) shared a common ancestor with chimpanzees over 6-7 million years ago.

I first mentioned a book by the late primatologist Frans de Waal called Chimpanzee Politics in a blog post in 2019 ("A cup of Joe, rough sandpaper, a soft chair, and a clipboard is all you need").  The book is about animal behavior, specifically the group behavior of the chimpanzees living at the Royal Burgers Zoo in Arnhem in the Netherlands.  During a study that lasted for several years, de Waal described a number of Machiavellian tendencies of the group, leading to his "Machiavellian intelligence hypothesis" (also known as the "social brain hypothesis" or "social intelligence hypothesis"), which posits that the challenges involved in navigating complex group dynamics in society is a major driving force in the evolution of human intelligence.  In order to succeed within social groups, individuals must strike a balance between cooperation and competition with the other individuals in the group, resorting to what some refer to as "soft skills" rather than brute force.  Apparently, the book has been highly recommended by a number of management and leadership experts, and it was reportedly very influential on former U.S. Speaker of the House New Gingrich during the 1990's.  It's a fascinating book that is well worth the investment of time, and I added it to my Leadership Reverie Reading List in 2022.  

I mention Chimpanzee Politics in the context of a recent CNN article that I read by Taylor Nicioli ("Chimpanzees in Uganda are in a ‘civil war,’ and researchers are unsure how it will end").  Nicioli's article is, in turn, based on a new research study published in the journal Science ("Lethal conflict after group fission in wild chimpanzees").  Apparently, scientists working with the Ngogo Chimpanzee Project in Uganda’s Kibale National Park have observed the start of a "civil war" between two sub-clusters of what was once a single, albeit large group of chimpanzees living there.

Wars have been fought throughout history for all different kinds of reasons.  The "cultural marker hypothesis" claims that differences in ethnicity, religion, language, and other cultural markers anchor group identity in such a way that favors cooperation and cohesion between members within the group and competition and even outright hostility to members outside the group.  One problem with the "cultural marker hypothesis" is that it fails to explain how conflict occurs inside a group, such as a revolution or civil war.  As the scientists working with the Ngogo Chimpanzee Project have recently found out, shifting allegiances and rivalries can occur within a group as well, even to the extent that can generate intra-group conflict and fracture the group.  

Aaron Sandel, the co-director of the Ngogo Chimpanzee Project and lead author on the Science paper, and the research team analyzed more than 20 years of data and identified three key stages that led to the fission of the group and eventual lethal aggression: (i) an abrupt shift from cohesion to polarization that created two distinct sub-groups or clusters within the greater group; (ii) a slow (2 year) period of increasing avoidance between the two groups; and (iii) lethal aggression between the two sub-groups or clusters.  

The chimpanzees at Ngogo were part of a single, large group when the study first began in 1995.  Despite belonging to the single, large group, there were two distinct sub-groups or clusters, which the researchers called the Western cluster and the Central cluster.   While members within each cluster spent more time together, they did interact with members of the other cluster.  Until around 2014, about 30% of individuals switched clusters from one year to the next.  The two clusters shared the same territory, as well as the same set of reproductive partners - 44% of infants were conceived by males and females belonging to different clusters.  

There was an episode occurring on June 24, 2015 in which two groups of males from the Western and Central clusters approached each other near the center of the territory.  The males from the Western cluster ran away when the males from the Central cluster chased them, and for the next six weeks, both clusters avoided each other.  Nicioli writes, "The once close-knit group of chimps were suddenly treating each other like strangers."  Sandel remembers fellow researcher John Mitani, "What's going on?" Mitani replied, "I don't know."  Sandel says, "And that also stuck with me, because this is one of the world’s experts on chimps. He’d studied these chimps for two decades. But we were seeing something new."

Sandel believes that single event "planted the seeds of polarization" that eventually led to the group's downfall, which is what the data subsequently showed.  From 2015 to 2018, the two clusters became more distinct.  The Western and Central clusters began to coalesce in separate territories - what was once the center of the larger group's shared territory became a distinct border between the two clusters.  After 2015, all of the infants born in the group were conceived by males and females from the same cluster.  

Beginning in 2018, males within the Central cluster began to conduct "patrols" towards males in the Western cluster, and aggressive interactions became more frequent.  After 2018, Western chimpanzees began to attack and kill males from the Central cluster.  Beginning in 2021, lethal aggression expanded to infants.  The single group had permanently splintered into two.

What was notable to me from this study was that the Ngogo group had grown significantly in size over the course of the study.  By the time that signs of group disharmony appeared around 2015, there were over 200 chimpanzees in the group, which far exceeded the size of other chimpanzee groups reported elsewhere.  The research team also had noted that five adult males and one adult female had died after exhibiting clinical signs of illness, just before the event in June, 2015.  The loss of even weakly connected nodes in the overall network could have disrupted the social network.  There was also a change in the alpha (dominant) male in 2015, which also coincided with the first separation of the two clusters.  Either explanation is possible, but the research team will likely never know for certain.

Sandel and his team concluded, "If chimpanzee groups can polarize, split, and engage in lethal aggression without human-type cultural markers, then relational dynamics may play a larger causal role in human conflict than assumed."  Moreover, while it is tempting to attribute polarization between groups to ethnic, religious, or political differences, Sandel and his fellow researchers suggest, "Focusing entirely on these cultural factors overlooks social processes that shape human behavior - processes also present in one of our closest animal relatives.  In some cases, it may be in the small, daily acts of reconciliation and reunion between individuals that we find opportunities for peace."

"Why the U.S. spends so much on healthcare"

Andrew Mollica and Anna Wilde Mathews wrote an interesting article for The Wall Street Journal recently in order to help explain why the U.S. spends so much on healthcare compared to all of our peer countries.  They first cite well-known statistics that Americans spend more on healthcare than anyone else in the world.  Healthcare expenditures account for approximately 18% of the U.S. Gross Domestic Product.  We spend, on average, about twice as much money per person (approximately $14,775 per person per year) on health care every year compared to other large, wealthy countries (approximately $7,860 per person per year) (see "How does health spending in the U.S. compare to other countries?"), which once prompted legendary investor and CEO of Berkshire Hathaway Warren Buffet to call health care costs "the tapeworm of economic competitiveness".

According to data (from 2023) from the Center for Medicare and Medicaid Services and The Commonwealth Fund, here is how every dollar is spent on U.S. healthcare:

As you can see, Americans spend about 10 cents per every dollar on administrative costs.  While that doesn't sound like much, it's about five times more than the average that other countries spend on administrative costs.  The United States also spends as much on administrative costs as it does on long-term care costs, which is also a mismatch compared to what other countries spend on long-term care.  For example, Sweden spends 22x as much on long-term care compared to what it spends on administrative costs.

While I think Mollica and Mathews oversimplify what is in reality a more complicated issue, here are the factors that they say make U.S. healthcare the most expensive in the world:

1. Prescription drugs cost a lot more in America

"Most other nations force drugmakers to accept lower rates, while the U.S. government generally doesn't."

2. Big hospitals can charge higher rates because of consolidation

"Many cities and communities are now dominated by a single hospital system, partly because hospitals have been merging in recent years.  The consolidation has given hospital systems leverage to command higher rates during negotiations with health insurers.  The insurers would lose business if powerful hospitals shut them out."

3. The U.S. spends far more than outer countries on administration

"The costs include functions like billing, claims processing and customer service."

4. Labor costs are higher

"American doctors and nurses generally make more than their counterparts in other countries."

5. Americans are using more healthcare

"Healthcare utilization has grown faster than prices in the most recent years."

Five for Impact...

My wife and I recently went on a Spring Break trip to California.  Our first stop was one of our favorite places in the world to visit, Coronado, California.  We spent Easter weekend there before driving north about six hours to visit the Central Coast region of California.  We toured the beautiful Hearst Castle in San Simeon and did a wine tasting at the Hearst Ranch Winery.  After a couple of days in the Central Coast, we drove back down to San Diego and stayed for a few days at a hotel in Rancho Bernardo, where we briefly lived now almost 30 years ago.  It was a great trip!  We both needed the break, and we spent a lot of time resting, relaxing, and reminiscing.  Even better, we spent a lot of time just talking, which is something that we don't always get to do with both of our busy professional lives.

During one of our deeper conversations, my wife asked me, "Who would you say are the five individuals who've had the most impact on your life?"  

Her very thought-provoking question led me to ask one important clarifying question, "Do you mean impact on my personal life, professional life, or both?"  

She responded, "Your life.  Both.  Your life is both your personal one and professional one."

Spoiler alert.  I'm not going to share my list with you today.  First, it was really hard for me to narrow my list to just five.  I've been blessed with having known several individuals in my life who've made a significant impact on who I am today, including my family of course.  And, as I've shared several times in these blog pages, I've been fortunate to have a number of individuals who've provided me with mentorship throughout both my personal and professional life.  Second, because I had to limit my list to just five, I don't want to offend anyone for having left them off my list.  Third, and perhaps most importantly, the list really wasn't the point of my wife's question.  She just wanted me to think about all of the individuals in my life who've made a difference for me.

What was really nice about this exercise is that once I started to think about who would be on my list, I remembered a number of individuals who've made an impact on my life that I have forgotten over the years.  I remembered a few teachers who always supported me and challenged me to be a better version of myself.  I also remembered a few of my coaches, some of whom were also my teachers in school.  As I reflected, there were some individuals in my life with whom I had relatively little contact with when you look at my life in total, yet these same individuals made such an incredible impact on the person who I've become today that it was hard not to consider them for my list.

I found this exercise to be very meaningful, and I think you will too.  Think about all the individuals that you've encountered in your life and the impact that they have made on you.  Just for the purposes of this exercise, include only the people who've you personally encountered.  Leave out famous individuals who have inspired you - these individuals are important too, but I want you to focus on just the individuals you lived and who you encountered during your own life.  Now try to limit the list to just five.

I hope you find this exercise to be as rewarding for you as I did.  I want to thank my wife for asking the question and inspiring this blog post.  She knows that she is on my list!

No, really...eat your ice cream!

As I mentioned in a recent post, I recently finished reading Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life by Ezekiel Emanuel.  Dr. Emanuel is a well-known medical oncologist, bioethicist, health policy researcher, and author of several books, though he is perhaps best known for being the chief architect of the 2010 Affordable Care Act. I heard him talk about his latest book about how to live a full and healthy life during a radio interview during my morning commute, and I was intrigued enough to order the book from my local public library.

I enjoyed reading Dr. Emanuel's book.  His central argument is that at some point around the age of 75 years, most people experience meaningful declines in creativity, productivity, and overall vitality.  Extending life far beyond that point can diminish the quality of life and seems counter to the purpose of living.  His approach to wellness emphasizes quality over quantity (living a healthy and meaningful life as opposed to simply focusing on extending the number of years lived).  Living a healthy and meaningful life is like ice cream.  It's meant to be enjoyed before it all melts away!

Dr. Emanuel argues against what he calls the "Wellness Industrial Complex", which  prescribes complicated regimens that often conflict, while at the same time promising us a longer and more productive life.  He argues that we spend too much time following "wellness" recommendations that may only add a few extra days or months to our life, and that we could better spend that time enjoying our life in the here and now.  Dr. Emanuel writes that "with so much health and wellness advice out there, it can be nearly impossible to differentiate the valid, reliable, and effective from the speculative, deceptive, and just plain stupid.  Even when the advice is scientifically sound, it's often extraneous, misrepresented, or misused."  

His approach is much simpler and can be summarized with six simple rules:

1. "Don't be a schmuck"

Dr. Emanuel defines "being a schmuck" as anyone who takes unnecessary risks.  He says, "One of the best and easiest things you can do for your wellness is not take stupid risks."  "Stupid things" include smoking, drinking alcohol, doing drugs, or not taking your vaccines.  He also adds to this list engaging in activities such as extreme mountaineering (e.g., climbing Mount Everest).  The risk of dying while climbing Mount Everest is on the order of 1 in 100.  The risk of death increases to 1 in 25 for climbers over the age of 59 years - "almost nothing can be schmuckier than that."

2. "Talk to people"

Dr. Emanuel writes, "It's important to cultivate family, friends, and other social relationships for a long, healthy, and happy life."  I've posted a lot about the so-called "Loneliness Epidemic" several times in the last year (see, in particular, my posts, "The Loneliness Epidemic", "To be of importance to others is to be alive...", and "We all need the human touch...").  There are now a countless number of studies that provide convincing evidence that fostering and maintaining close personal relationships through marriage, family, and friendships is one of the most important drivers of happiness and vitality.  The Harvard Study of Adult Development provides important evidence on this point.  Robert Waldinger, who has led the study for over two decades, states, "The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health.  Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation."

Relationships matter even more than one's heredity (see the article "Good genes are nice, but joy is better" in the Harvard Gazette or Waldinger's TED talk "What makes a good life" for more).  The psychiatrist George Vaillant led the Harvard Study from 1972 until 2004.  He said, "When the study began, nobody cared about empathy or attachment.  But the key to healthy aging is relationships, relationships, relationships."

Dr. Emanuel says that there are two great things about social relationships.  "First, unlike exercise, there's no strenuous exertion today for payback decades into the future.  Good social relations are good for you now.  [Second], initiating conversations is also generous.  It's good for you, and it's good for the people you talk to, so you can be virtuous just by starting a conversation."

3. "Expand your mind"

Dr. Emanuel recommends that we should stay mentally sharp through continuous learning, curiosity, and mental engagement.  He writes, "Be a mensch" and offers the American patriot Benjamin Franklin as an example.  "When I say, 'Be a mensch,' what I want to communicate is that the purpose of your life should not just be to live longer. It should be greater than that; it should be trying to make the world a better place. Benjamin Franklin said it best when he said, 'The noblest question in the world is, What good may I do in it?' That’s part of what being a mensch is."  At the age of 70 years, Benjamin Franklin crossed the Atlantic for the seventh time to serve as America's first ambassador to France.  During his Atlantic crossing, he mapped the Gulf Stream in order to improve the speed by which ships could travel across the oceans.  Once he arrived in France, he invented bifocals and developed the prototype for a new type of ship's anchor.  

There's an important caveat here though.  We shouldn't spend our time working through the daily crossword or Wordle.  Having a variety of intellectual pursuits is far more important.  We should try new hobbies, learn to play an instrument, or join a book club.  Dr. Emanuel suggests learning how to cook a new recipe - "This is a wellness trifecta.  It requires complex mental tasks as you plan the recipe, physical tasks as you go about the kitchen to organize the food, and then, if you invite friends over and have a meal together, it promotes social relationships."

4. "Move it"

We've all heard recommendation #4 before - regular exercise is critical to our overall physical and mental health.  Dr. Emanuel suggests that we focus on three types of exercise - aerobic exercise (like running or walking) for our heart and lungs, strength training for our muscles and flexibility, and balance training to maintain a healthy core.  Importantly, he suggests that "more is not always better" - there's no added benefit to vigorously exercising for more than 150 minutes a week.  He says, "The time you spend overexercising is time you could devote to more meaningful activities, like volunteering in your community or talking with your best friend as you walk through a forest."

5. "Eat your ice cream"

Recommendation #5 was the longest chapter in the book, and the one that I thought was the most interesting.  Dr. Emanuel says, "We have to do wellness behaviors for years and decades if they are going to do any good.  Constant deprivation requiring great expenditures of willpower are not the way to wellness.  Indeed, people who constantly diet with willpower fail at it and never lose weight."  Or worse (and the studies suggest that dramatic swings between weight gain and weight loss are really bad for your health), they gain all the lost weight back.  He suggest beginning by stopping the bad stuff - stop drinking sodas and other sugary drinks.  Similarly, cut down (or eliminate) salty snacks, packaged cakes, and cookies.  An occasional indulgence is acceptable, but we should try to limit our consumption of these items as much as possible.  

We should avoid processed foods.  Dr. Emanuel favors consumption of fermented foods such as yogurt (plain yogurt, not the kind with all the added sugar), kimchi, cottage cheese, miso, and sourdough bread.  These are all healthy foods which can maintain a healthy microbiome (all the beneficial bacteria that normally live in your gastrointestinal tract).

Dr. Emanuel also suggests limiting our alcohol consumption to one to two drinks per week and always with someone else.  He suggests that most Americans don't get nearly enough fiber, and he generally recommends against most, if not all, of the dietary supplements that have become far too popular in the last several years.  Finally, he reviews a few studies that suggest that eating ice cream can actually be healthy, but as in all things, with moderation (this was my favorite recommendation!).

6. "Sleep like a baby"

Sleep is not optional!  Most of us need around seven to eight hours of uninterrupted sleep per day.  Dr. Emanuel recommends against sleeping aids such as melatonin.  "There are other things you can do to sleep better: Sleep in a cool, dark room.  Don't look at your phone for the hour before.  The dinner glass of wine can disrupt your sleep.  Don't take a nap or consume caffeine after 2 pm."

Dr. Emanuel says, "Wellness is important, but it's not the end goal of life.  It is a way for you to live the kind of life that you want to live.  Wellness shouldn't be difficult. It's not about self-denial, being perfect, or trying some crazy biohack.  Don't waste valuable time chasing the latest fad just to add time later when, by the nature of aging, you won't be in optimal health anyway.  Remind yourself what makes life meaningful and joyful, and try to make the world a better place. That will help you live well..."

"Don't be a schmuck.  Be a mensch.  And really, eat your ice cream!"

Fortune favors the bold...

An interesting news article came by Chief Healthcare Executive came across my desk a few months ago announcing that "thousands of employees at hospitals and health systems have lost jobs in recent months."  Hospital leaders are citing mounting financial pressures, the impact of grant terminations from the National Institutes of Health, uncertainty in federal funding for graduate medical education, looming cuts in Medicaid programs, and increased supply chain expenses as reasons to cut labor costs, which is the largest expense for hospitals and health systems.  By cutting labor costs, hospitals can decrease pressure on their operating margins, at least in the short-term.  Whether this is the right move for the long-term future sustainability of these organizations remains to be seen.

Last year, I wrote a post about corporate lay-offs entitled "Nobody every cut their way to greatness...", in which I stated "There are actually a number of studies that show that lay-offs are frequently deleterious for the organization, with a so-called "dirty dozen" of detrimental effects.  I then cited one particularly well-known study from the aviation industry ("Airline downsizing and its impact on team performance") that provided concrete evidence of these twelve adverse effects to corporate lay-offs.  Given the current state of the world in which we live, I wanted to re-visit this topic and provide additional supportive evidence suggesting that in our VUCA world, organizations are better off if they "double down" and focus on growth and efficiency at the same time.

Ranjay Gulati, Nitin Nohria, and Franz Wohlgezogen studied 4,700 public companies during three past global recessions (1980-1982, 1990-1991, and 2000-2002), specifically analyzing their strategy and performance during the three years prior to the recession, the recession years themselves, and the three years after the recession (see "Roaring Out of Recession" from the March 2010 issue of Harvard Business Review).  Seventeen percent of the companies did not survive the recession - they either went bankrupt, were acquired, or became private.  Most of the surviving companies were able to partially recover, but the recovery was particularly slow.  Nearly 80% of the surviving companies had failed to regain their pre-recession growth rates for sales and profits three years after the recession.  Surprisingly, nine percent of the companies not only survived through the recession, they flourished afterwards, outperforming their rivals by at least 10% in terms of growth rates in sales and profits.  But again, it wasn't the companies that cut costs faster and deeper than their competitors that flourished - actually, these companies were the ones that had the lowest chance of surviving through the recession.

Gulati, Nohria, and Wohlgezogen described four different strategies that the firms they studied could employ during a recession:

1. Prevention-focused companies: Focus on avoiding financial losses and minimizing downside risks (i.e. primarily a defensive strategy)

Gulati, Nohria, and Wohlgezogen write, "Confronted by a recession, many CEOs swing into crisis mode, believing that their sole responsibility is to prevent the company from getting badly hurt or going under."  These CEOs work to reduce operating costs by eliminating discretionary spending, lowering head count, postponing new investments (including research and development, capital investments, and new lines of business), and preserving cash.  Unfortunately, these companies typically make across-the-board cuts ("Every department needs to reduce head count by 10%").  Rather than learning how to operate more efficiently, these organizations end up trying to do more with less.  Unfortunately, these cost-cutting measures often create pessimism and lower morale within the organization (see "Airline downsizing and its impact on team performance" mentioned above).  Employees lose trust in the organization and the leadership, which will take a long time to rebuild (if at all).  Few prevention-focused companies do well in the long run, and most do not even survive.  

2. Promotion-focused companies: Focus on making investments that maximize upside benefits (i.e. primarily an offensive strategy)

Some leaders pursue growth opportunities every chance that they get, even during a recession.  They use the recession as the proverbial "burning platform" in order to push through changes in the organization.  They continue to make strategic investments, and they often leverage the fact that many companies are cutting back on investments and talent acquisition to grow their own organizations.  Gulati, Nohria, and Wohlgezogen find that "Organizations that focus purely on promotion develop a culture of optimism that leads them to deny the gravity of a crisis for a long time."  In the end, these organizations are blindsided by poor financial results, as the changes required to become more efficient are implemented too late, or even not at all.  Only 26% of the promotion-focused organizations significantly outperform their rivals after a recession.

3. Pragmatic companies: Focus on making targeted investments (i.e. offensive play) AND minimizing downside risks to avoid financial losses (i.e. a defensive play)

The CEOs at pragmatic companies recognize that cost-cutting measures are necessary to survive through a recession, but they also know that strategic growth is equally important.  Balance is their goal - they try to decrease costs and increase revenue at the same time.  Gulati, Nohria, and Wohlgezogen found, "Companies typically combine three defensive approaches - reducing the number of employees, improving operational efficiency, or both - with three offensive ones: developing new markets, investing in new assets, or both."  Nine different combinations of approaches are therefore possible.  However, the most successful approach combines (1) improving operational efficiency with (2) developing new markets AND investing in new assets.

In other words, as Gulati, Nohria, and Wohlgezogen emphasize, "Companies that attend to improving operational efficiency fare better than those that focus on reducing the number of employees."  While layoffs reduce costs quickly, they undoubtedly make recovery more difficult later.  As I stated above, it's hard to earn back trust after layoffs, and the cost - both in terms of the trust factor and the actual monetary costs - are higher in the long run, as organizations often find themselves having to rehire new workers to replace the ones that they laid off during the recession.  

4. Progressive companies: Similar to the pragmatic companies, but focused on maximizing both financial upside benefits (through more than just targeted investments) as well as cutting financial losses

After a recession, companies that make investments in both existing and new businesses, while at the same time, focusing aggressively on operational efficiency, are usually the most successful organizations in the long run.  Gulati, Nohria, and Wohlgezogen write, "Companies that respond to a slowdown by re-examining every aspect of their business model - from how they have configured supply chains to how they are organized and structured - reduce their operating costs on a permanent basis.  When demand returns, costs will stay low, allowing their profits to grow faster than those of their competitors."

As Ranjay Gulati noted in a more recent follow-up article (see "Investing in Growth Through Uncertainty"), the combination of an offensive and defensive approach has been found over and over again to be the most successful strategy during an economic downturn.  Walter Frick adds ("How to Survive a Recession & Thrive Afterward"), "Some layoffs are inevitable in a downturn...However, the companies that emerge from crisis in the strongest shape relied less on layoffs to cut costs and leaned more on operational improvements."  Making targeted investments in growth, even during a time of uncertainty, is equally important.

Hell's Kitchen

There is a long-running and popular reality cooking show starring chef Gordon Ramsay that first aired on Fox on May 30, 2005 called "Hell's Kitchen".  Chef Ramsay is notoriously abrasive and demands perfection on the show, often yelling profanity at the contestants.  There's no doubt that his famous temper is used for entertainment value, and there are some reports that he is much nicer in private.  However, there's likely at least some truth on how he acts, and many in the culinary industry claim that his behavior is more often the norm than the exception, labeling it part and parcel of the "kitchen culture".

As I recently learned, the "kitchen culture" is actually part of the overall design of something known as the "kitchen brigade" (or "brigade de cuisine"), a system of organizing the kitchen staff and operations in order to maximize efficiency.  The system was first designed by the French chef and restaurateur Auguste Escoffier in the early 20th century.  It's a hierarchical and highly structured system that assigns specific roles to specialized staff in order to reduce chaos, ensure consistent quality, and allow for smooth operations, particularly when the restaurant is very busy.  There is a clearly defined chain of command, in which the executive chef ("Chef de cuisine") is responsible for the overall management of the kitchen.  The executive chef is responsible for creating the menu and new recipes (often with the assistance and/or approval of the restaurant manager), purchasing raw food items, training apprentices, supervising the rest of the kitchen staff, and maintaining a clean, sanitary, hygienic environment.  The "Sous Chef" is the second in command and receives orders directly from the executive chef, while all the remaining roles follow.

The executive chef serves as the "captain of the ship", and his or her orders are not to be questioned.  On most ships, the captain is ultimately responsible for everything that occurs on the ship, good or bad.  There was once a tradition of the captain "going down with the ship" in battle.  It's become a metaphor for any rigid, hierarchical system in which commands are issued from the top and meant to be followed without question.  When I was a medical student, the "captain of the ship" mentality was prevalent on most clinical teams, but particularly in the operating room, where the attending surgeon was deemed the "captain of the ship" (the "ship" being the operating room).  There was even a legal doctrine in the United States called "captain of the ship" doctrine, in which the attending surgeon was responsible - and legally liable - for every action of every other member on the operating team.  Thankfully, those days are long past.  Neither the legal doctrine nor the mentality of the attending physician as the "captain of the ship" is common today.  Those of us in health care have learned that a highly functioning team in which each and every member contributes and feels free to speak up ("psychological safety") is more engaging, more collaborative, and most importantly, leads to better outcomes.

So, it naturally begs the question that if surgical teams have figured out that a less hierarchical, rigid chain of command is better for patient outcomes, why can't those in the restaurant industry adopt the same mentality?  I've heard at least one chef say, "We all learned this way.  If it worked for us, why can it work for the next generation?"  Notably, I used to here that exact same rationale in medicine. 

Unfortunately, it's not just a "captain of the ship" mentality that is the problem.  The "kitchen culture" is downright toxic.  The New York Times recently featured a number of articles detailing the allegations of physical and mental abuse by Executive Chef Rene Redzepi at the world famous restaurant Noma in Copenhagen, Denmark.  The first article appeared on March 7th (see "Punching, Slamming, Screaming: A Chef's Past Abuse Haunts Noma, the World's Top-Rated Restaurant").  Just a few days later, the New York Times reported that Rene Redzepi had resigned after 23 years at the restaurant.

The toxic "kitchen culture" is not unique to Noma or to the fictional kitchen depicted in the television show, "The Bear".  Robin Burrow, a former lecturer in management and organizational behavior at Cardiff University in the United Kingdom has studied the toxic "kitchen culture" (see "Yes, Chef: Life at the vanguard of culinary excellence" and "Bloody suffering and durability: How chefs forge embodied identities in elite kitchens") and found that bullying and physical abuse are not only common, they are normalized as part of what someone has to go through in order to become an executive chef.  Burrow says, "Chefs who neglected to suffer had little claims to membership of the culinary community in the truest sense.  They were not true and proper chefs."

I wonder if haute cuisine could learn a few things from health care?  Better yet, it seems like the culinary community could learn some important lessons from high reliability organizations, such as the nuclear power industry, commercial aviation, or U.S. Navy aircraft carrier flight operations.  The stakes in a restaurant are certainly not "life and death" as in these other industries, but the stakes are just as important.  Operating a restaurant requires efficient and timely operations.  It's time that they abandon the toxic "kitchen culture" and focus on high reliability organization theory!

The fox, the hound, and the body...

Bear with me for just a moment.  I want to talk about two great films today.  The first film is the 1981 Disney full-length animated feature, "The Fox and the Hound".  The story is loosely based upon a novel by Daniel Mannix of the same name and tells the story of the unlikely friendship between a red fox named Tod and a hound named Copper.  As they both grow older, they struggle with the fact that they are meant to be enemies.  At one point in the story, they do in fact become enemies.  In the film's final minutes, Copper gets into a fight with a bear and is almost killed by it. Tod comes to his rescue and joins the fight, only to fall down a waterfall with the bear.  As Copper approaches Tod as he lies wounded in the lake below, his owner Amos, a hunter, appears, ready to shoot Tod. Copper positions himself in front of Tod to prevent Amos from doing so, refusing to move away.  Amos realizes that Tod had saved both his life and the life of his dog and decides to spare Tod.  As he walks away with Copper, Tod and his former best friend share one last smile before parting for good.  In the final scene, Copper lies down to take a nap, smiling as he remembers fondly the day he first met Tod.

As one blogger on Medium writes, "Friendships can be the cornerstone of our lives, providing support, joy, and companionship. However, not all friendships stand the test of time...Time marches on and always has a way of changing things, especially people. Sometimes the changes create chasms that can no longer be crossed and the challenges you were once able to tackle head-on with your friend become insurmountable."

The second film is the 1986 film "Stand by Me", a coming-of-age drama directed by the late Rob Reiner.  The film was based on a novella , The Body, written by Stephen King, and it's title comes from the song, "Stand by Me" by artist, Ben E. King.  The film (and novella) takes place in King's fictional town of Castle Rock on Labor Day 1959, although the film begins when author Gordon "Gordie" Lachance reads a newspaper article about the death of his childhood best friend, Chris Chambers in 1985.  The rest of the film is a flashback memory to when Gordie was 12 years old, and he (played by the actor Wil Wheaton) and his three friends (played by River Phoenix, Corey Feldman, and Jerry O'Connell) set out on an adventure to find the dead body of another missing boy.  "Stand by Me" is an enjoyable story, a great song, and an even better film!  It's one of my absolute favorites.

I have always remembered the film's ending, when Gordie (once again in 1985 and now played by the actor Richard Dreyfuss) talks about his childhood friendships with reverie.  When talking specifically about his best friend, Chris, who has recently died, he says, "Although I haven't seen him in more than ten years, I know I'll miss him forever. I never had any friends later on like the ones I had when I was twelve. Jesus, does anybody?"

Unfortunately, I too lost track of many, if not most, of my childhood friends.  I think that happens to most of us.  People do, in fact, change - for a variety of reasons.  Sometimes, as two friends (or even a group of friends) grow older, they grow apart.  Oftentimes, neither side is to blame.  It just happens.  According to a Dutch study published in the journal Social Networks, over a period of seven years the average size of personal networks is remarkably stable (see my posts, "Dunbar's number" and "It's a small world after all...").  However, during that same period of time, we replace the large majority of our close personal contacts and friendships with new ones.  We maintain only about 30% of our original casual contacts over those seven years and just under half of our close friendships.

I've posted a lot about the so-called "Loneliness Epidemic" in the last year (see, in particular, my posts, "The Loneliness Epidemic", "To be of importance to others is to be alive...", and "We all need the human touch...").  There's another scene about halfway through "The Fox and the Hound".  Tod's adoptive human mother, the Widow Tweed has realized that a fox is better off living in nature and not in captivity.  She drives Tod out to the forest and lets him go.  As she is driving back home, she recites the poem:

Remember how we used to play?

I recall those rainy days

The fire’s glow that kept us warm

And now I find, we’re both alone

Goodbye may seem forever

Farewell is like the end

But in my heart is a memory

And there you’ll always be

The key point here is that we should cherish the memories of friends long lost.  They will always be a part of our lives, and we should keep them in our hearts forever.  Just as important (and perhaps even more so), we shouldn't find ourselves alone because of those lost friendships.  Personal connections and friendships are important to our overall health.  As both the Widow Tweed and Gordie find out, while it's hard to move on, lost friendships can be replaced with new ones.  As Genesis 2:18 reads, "It is not good for man to be alone."  I will re-visit this topic in an upcoming post soon...