Sunday, December 31, 2017

Resolutions

It's that time of year again - here we are on the last day of 2017.  Everywhere you look, there's a post or article on making New Year's Resolutions.  Inevitably, these discussions end up with a statement providing statistical proof about how terrible we are at keeping our resolutions.  For example, I read one post this morning (from Professor Michael Roberto, one of my favorite bloggers!) that cites a LinkedIn study that showed that 63% of professionals used "To Do" lists, daily (or weekly) goals, or resolutions - not surprisingly, 41% of the items on these "To Do" lists are never completed.  I found another article from last year that stated that about 80% of all New Year's Resolutions fail by the month of February.

While I am no expert in this area, I think we are missing at least half of the process when we prepare a list of resolutions or goals for the coming year.  Just as important, and most likely to be forgotten, is the process of carefully reviewing last year's resolutions or goals and reflecting on what was accomplished, as well as what failed and the reasons for both.  Reflection helps us think more carefully about the new resolutions and goals that we make for the new year.  Did we aim too high or too low?  Did we really mean it when we listed those resolutions last year?  In other words, were we just going through the exercise or were we serious about getting down to business?  As I reflect on the resolutions that I made around this time last year, I can see definite areas where I aimed too high.  I also see some areas where I sold myself short and aimed far too low.

Once you have adequately reflected upon last year's goals and resolutions, then and only then is it time to come up with new ones for the year.  I have found it most helpful (at least for me) to write down my goals and resolutions somewhere.  I keep the list of goals and resolutions handy, so that I can refer back to them throughout the year.  I cross each goal off once I have achieved it.  I also try to come up with both short-term (monthly, quarterly, and yearly) as well as long-term (5 year) goals for myself.  The short-term goals can be modified and adapted throughout the year - for example, if something more pertinent comes along that I need to re-dedicate my time and effort towards, I will review my old list of goals and take something off.  Finally, I have found it helpful to keep the list relatively short - usually 5 to 10 short-term goals is more than enough.

Goal-setting is an important part of both your personal and professional life.  The end of one year and the beginning of the next is a great time to go through and review the progress you have made over the last year.  It's an even better time to set goals for the coming one.

As 2017 comes to a close, I would like to take this time to wish all of you a very happy, prosperous, safe, and fulfilling 2018.

Wednesday, December 27, 2017

Introverts versus extraverts

A couple of posts ago, I mentioned something called the "Lemon Juice Test" that has been used to determine whether someone is predominantly an introvert versus an extrovert.  You may be asking yourself the question, "Why does it matter?"  There seems to be a widespread belief that great leaders are always extroverts - for example, President Bill Clinton, Muhammad Ali, and Winston Churchill were all famous leaders that happened to score very high on the extrovert scale.  However, there are just as many famous leaders that were introverts - President Barack Obama, Bill Gates, Warren Buffet, Mohandas Gandhi, and Mother Teresa all score very high on the introvert scale. 


There are a number of studies that do show that extraversion is one of the best personality predictors of successful leadership (see the review by Timothy Judge and colleagues describing some of the research supporting the so-called "great man hypothesis").  U.S. Presidents are generally perceived to be more effective leaders when they are extroverts (see the article reviewing this body of research).  Unfortunately, most of the studies linking extraversion with effective leaders are highly subjective - there are few studies that show that extraversion is associated with objective measures of performance. 


Adam Grant published a very interesting study that suggested that whether extroverts versus introverts made better leaders depended on what kinds of employees these leaders were trying to lead.  In the first set of field experiments, Grant and his team found that pizza delivery stores with leaders who were rated high in extraversion consistently performed better (i.e., achieved higher profits) when employees were passive.  Conversely, when employees were more proactive, pizza delivery stores with leaders who were rated high in introversion performed better!  In the second set of experiments (conducted in the laboratory setting), passive groups achieved higher performance (in this case, the group was asked to fold T-shirts in a limited period of time, so performance was determined by the number of T-shirts that the group folded) when they were led by an extraverted leader.  Conversely, proactive groups performed better when they were led by an introverted leader. 


Why should the type of employees in the group matter?  Grant and his colleagues suggested that when the followers are passive, the shyness and quietness of the introverted leader can be interpreted as a lack of interest or boredom in the task, which then decreases the followers' motivation to perform well.  Conversely, when the followers are proactive, introverted leaders are perceived as more open and more willing to take feedback, leading to more engaged followers and better overall team performance.  In other words, when followers believe that their leaders value their contributions and input, they are motivated to perform at a higher level! 


Extraverted leaders, on the other hand, may be perceived by proactive followers as being less receptive to feedback and input.  In this case, proactive followers are less engaged and perform worse than they would otherwise.  Conversely, passive followers may need the "push" by the extraverted leader to excel. 


I know what you are thinking - and you are right.  Better performance in a pizza delivery store and/or a T-shirt folding task may not be transferable to other tasks or jobs.  You could certainly argue that these results may not be replicable when dealing with a more difficult or complicated task.  However, what I think the study shows is that context matters greatly.  More importantly, I think the study shows that introverts can still be effective leaders.  Just like extroverts, leaders who happen to be introverts will have their own unique strengths and weaknesses.  Moreover, both types of leaders will be effective when they are paired with the right teams. 




Sunday, December 24, 2017

Traditions

We have a lot of Christmas traditions in the Wheeler family, most of which my wife and I brought to our family from our childhoods.  For example, we always open up Christmas presents on Christmas morning, rather than Christmas Eve - with one notable exception.  We always let our kids open up one present on Christmas Eve, and it's always the same thing every year - a brand new set of pajamas to wear on Christmas night.  Christmas Eve day always starts with a big breakfast - usually waffles or pancakes (this year it was waffles).  We dress up and go to Christmas Eve mass either before or after dinner (the time now usually depends on what time all of the kids get home).  We always drop off a couple of plates of homemade Christmas cookies at the hospital on the way back home from dinner, usually with the staff working in the PICU or Cardiac ICU, since that is where I have spent most of my professional career.  I always read "Twas the Night Before Christmas" before the kids go to bed.  We have another big breakfast on Christmas morning - after opening up presents.  And then it's "over the river and through the woods" to Grandmother's house!

I suspect that our children will carry over many of these traditions if and when they become parents with their own children.  The beautiful thing about traditions is just that - they come from the past and uniquely tie us to our past.  The same is true for many organizations.  Traditions that have become part of the organizational culture are the bridge between the past, the present, and the future. 

Respect your traditions.  Tomorrow is Christmas.  I wish you all peace and prosperity as we close out 2017 and start a new year.  There is an old Irish Christmas blessing that I will close with:

“May the Blessings of Christmas be with you,

May the Christ Child light your way,

May God’s holy angels guide you,

And keep you safe each day.”

Wednesday, December 20, 2017

"Make it easy to do the right thing..."

I was working in the Pediatric Intensive Care Unit (PICU) last week, when I came across what I thought was a very interesting photograph






I should provide a little bit of context here, before I go further.  First, you have to understand that one of the most common (and most effective) ways that the nursing leadership of our PICU communicates general updates, announcements, and policy changes to the rest of the team is by posting information on the walls of the staff bathrooms on the unit.  As a matter of fact, most of our nursing inpatient units communicate in this manner - it is actually quite effective, believe it or not.  Second, we have had problems with toilets throughout the hospital clogging up with sanitary wipes.  As it turns out, the company that makes these commercially available sanitary wipes claim that the wipes can be flushed safely down the toilet ("safe for flushing" and "safe for septic tank").  Unfortunately, when you are dealing with a large hospital with toilets in every patient room, the number of sanitary wipes that get flushed down the toilet places a lot of stress on the sewage pipes.  Our facilities department decided to try to mitigate the problem by posting these signs above every toilet in all of the staff bathrooms. 


So back to my original story.  I was working in the PICU last week, when I came across the sign above posted in one of our staff bathrooms.  Incidentally, the toilet of this particular bathroom happened to be clogged.  We called facilities, and surprisingly enough, the toilet was clogged with sanitary wipes!  Was this a case of blatant disregard for a clear sign asking staff not to flush sanitary wipes down the toilet?  Not really.  What I ALSO found in the bathroom that day, on top of the toilet and within easy reach of anyone using it, was a package of sanitary wipes!  I went on a little expedition and walked through all of the staff bathrooms in the PICU and found the same issue - clearly legible signs stating, "Ignore the hype: Don't flush a wipe!" and right underneath them, a package of sanitary wipes!


Would you be surprised that the signs had clearly failed to encourage staff not to flush sanitary wipes down the toilet?  Not at all - a better strategy may have been to remove the sanitary wipes from the bathrooms AND only then, post the sign.  In other words, we failed here because we did not make it easy to do the right thing.


How many examples can you find where a change initiative has failed because the leadership failed to make it easy to do the right thing?  I bet you could come up with several in your own personal experience.  I came across a story that said that landscape designers often wait before placing sidewalks in a public venue in order to see how people will actually walk around:




Pretty clever, huh? Bottom line, if you want any change initiative to succeed, you absolutely, positively have to make it easy for people to do the right thing. 









Saturday, December 16, 2017

The morning huddle

My wife and I have been getting our house ready to host a holiday party for my work team - this is only the second year in our current house, so we hope that this will become an annual tradition.  Anyway, I was running some "almost last minute" errands at our friendly neighborhood Kroger store this morning, when I heard an overhead page that said something like, "Good morning Kroger team, please send a representative from your department for the morning huddle." 

Wow!  I was impressed to hear that Kroger has a morning huddle.  It certainly makes sense though - just about every industry has embraced the concept of a morning huddle, a pre-shift huddle, or a daily operations briefing.  I don't know exactly where this started, but I know that the military started conducting morning reports or daily briefings a long time ago.   Perhaps the concept came from the sporting world - before every play in football, the offense gets together in a "huddle" and talks about the next play.

Look carefully the next time that you are out and about, and I think you will find that there are numerous examples of this practice.  Restaurants do it - the manager often will pull together all of the waiting staff together before a shift to tell them about the night's specials, how many guests are coming (and how busy they can expect to be), and any other last minute items of interest.  Ritz Carlton hotels are particular well-known for the huddle concept and call their version of it, "the daily line-up."  Who knows what our current President does, but historically the President of the United States receives a morning briefing of the overnight events every morning.

If everyone else is doing it, there must be something to the morning huddle, right?  As a matter of fact, there are a number of health care organizations that have embraced the concept.  Cincinnati Children's Hospital Medical Center was one of the early pioneers for what they called the "morning safety huddle".  The morning huddle started out as a staffing huddle between nursing leadership and charge nurses (the lead shift nurse) from each of the inpatient units in the hospital.  Borrowing concepts from United States Navy aircraft carrier operations, the hospital's Safety Officer, Steve Muething, MD and others restructured the morning staffing huddle, which occurred every single day of the year, to include a briefing of significant events that had occurred overnight, the current status of the inpatient unit (from a census, acuity, and staffing perspective), and any anticipated issues for the upcoming shift (from a patient safety, flow/capacity, staffing, employee safety, or patient/family experience perspective).  More importantly, Dr. Muething and his team made the huddle multidisciplinary with the addition of a Safety Officer of the Day (SOD), a senior physician who was assigned daily responsibility for working with the lead nurses to help identify and mitigate any problems throughout the day, as well representatives from other areas of the hospital, such as Social Work, Respiratory Therapy, Supply Chain, and the Patient and Family Relations department. 

The morning huddle at Cincinnati Children's was so successful that the organization started conducting a "Daily Safety Brief" following the huddle.  The "DSB" brought together (at first, by telephone but later in person) representatives from all of the major areas of the hospital - Inpatient, Outpatient, Peri-operative Services, Emergency Services, Mental Health Services, Pharmacy, Facilities, Supply Chain, Information Services, Security, Laboratory, Radiology, Occupational Safety, and others (about 17 different departments are represented) to raise awareness and communicate any concerns for the upcoming day's operations.  Each representative again reports significant events that occurred overnight, as well as predicted events for that day.  If a problem has been identified, the representative is expected to report how the problem was identified and mitigated.  In most cases, identified problems are fixed within 48 hours.  Problems that cannot be mitigated at the local level are escalated to hospital leadership.  The name has since been changed to the "Daily Operations Brief" or "DOB" in order to reflect the fact that the focus is not just on safety, but on hospital operations as a whole.

Conducting a morning or pre-shift huddle is now considered best practice in most industries, including health care.  It doesn't matter whether you are leading and managing a large academic medical center or a small, community-based physician practice, bringing your team together to discuss key items for the upcoming day is an important part of leading an effective team.  The Children's Hospital Association has published several key tips for implementing safety huddles, which are available here.  If it's good enough for Kroger, it must be good enough for health care!

Wednesday, December 13, 2017

Have you heard about the lemon juice test?

I've been doing some reading on introverts and extroverts lately.  It all started after I read a really interesting book this past fall (actually, I listened to the book on tape while driving back from dropping my daughter off at college) called, Quiet: The Power of Introverts in a World That Can't Stop Talking by Susan Cain.  According to several leadership theories, highly charismatic, energetic, self-confident individuals make the best leaders.  In other words, the best leaders are extraverts.  As it turns out, there are studies to support this assertion.  However, there are just as many studies, many of which are discussed in Cain's book, that suggest that introverts can be great leaders too. 

As I have mentioned on several posts in the past, I score fairly high on the introvert scale.  Given the choice between going to a social gathering with a large group of friends or having a quiet evening at home reading a good book or watching a movie with my wife, I choose the latter every time.  I really don't like being the center of attention.  While I am definitely goal-oriented, I am driven more by intrinsic motivation than extrinsic motivation.  Recognition is nice to receive, but I prefer to receive it in private instead of in a public forum. 

So, am I doomed as a leader because I am an introvert?  As it turns out, the answer is definitely no.  For one, introverts can overcome some of their quiet tendencies and still be effective leaders.  Even more interesting, in many cases, an introvert leader is a great asset and preferable to an extrovert leader. 

But before I talk about introverts (and I will in an upcoming post), I have to mention something that I came across in my background research called the lemon juice test.  The test was invented by a psychologist named Hans Eysenck in the late 1960's.  The test goes something like this.  Take some lemon juice and place a few drops of it on your tongue.  Introverts salivate more than extraverts do!  Sounds hokey, right?  Well, there is a biologic explanation for how the lemon juice test works.  Eysenck's research found that the Ascending Reticular Activating System (RAS), an area of the brain (actually, the brain stem) that has important functions in arousal, sleep/wakefulness, attention, and habituation.  Chronic, overstimulation of the RAS is more common in introverts, while decreased stimulation of the RAS is more common in extroverts.  This makes sense, right?  If the RAS is stimulated all the time (as you would find in introverts), the last thing a person wants is to be in an environment or situation that causes even more stimulation of the RAS.  Conversely, if the RAS is never stimulated (as you would find in extroverts), an individual will want to seek out situations or an environment that results in stimulation of the RAS.

What does this have to do with lemon juice?  Surprisingly enough, the RAS also appears to be involved in taste perception.  More stimulation of the RAS in this case leads to greater taste perception of the lemon juice, leading to higher levels of saliva production.  Again, as introverts have a hyperactivated RAS, they will "perceive" the lemon juice taste and produce greater levels of saliva.

Eysenck was one of the first to link a biologic process with personality.  Unfortunately, later studies suggested that his theory (and the lemon juice test) was an incredible oversimplification of a very complex biological process.  Regardless, it is a pretty cool test that you can do at home.  So go out and try the lemon juice test and see whether you are an introvert or an extravert (you probably already know).  And then we will get to the discussion on whether you will make a good leader!

Sunday, December 10, 2017

"Don't pigeon hole me!"

I was really shy growing up.  I mean really shy.  I used to hate attention and would do everything possible not to draw attention to myself.  I was always quiet in elementary school, and I used to hate it when the teacher called on me.  Remember that annoying classmate when you were in school - the one who used to raise his or her hand and do everything possible to get the teacher's attention so that they could show off his or her intelligence?  Well that wasn't me.  I was exactly the opposite.  I would do everything possible to NOT get called on.  I even would try to outsmart the teacher and use reverse psychology ("maybe if I look straight at her, she won't call on me").  I eventually grew out of my shyness, but I still would call myself an introvert.  I've taken the Myers-Briggs personality test a few times, and I score very high on the introversion scale every time. 

My shyness ended up being a major liability when I was in the first grade.  I remember learning who my first grade teacher would be towards the end of the summer.  On my first day of school, however, we were told that our first grade teacher was recovering from being sick (or having surgery - I can't remember exactly) and that we would have a substitute for most of the first month or two of school.  I didn't mind the substitute so much - she seemed nice enough, but she really liked to have us read out loud during class.  I used to hate that so much, that I just would not do it.  I remember that she used to like for us to color between the lines using appropriate colors.  I thought that was a waste of time, so I would pick whatever color from my crayon box and do my best to stay in the lines (I didn't do it very well).  Suffice it to say that my first grade substitute teacher didn't think too highly of my potential as a student. 

I was placed in the lowest reading group - the "Little Pig" reading group (the name of the book we were reading - think "Sally, Dick, and Jane" only even worse).  And then, my real teacher showed up.  I remember the day like it was yesterday.  I thought that I would have a new chance with my real teacher, so I read aloud during our reading group.  She took one look at me and told me that I was in the wrong reading group.  She moved me up to the next group - this one was called the "Red Rock Ranch" reading group (again, after the name of the book).  I read aloud again, and this time she told me, "Nope, still the wrong group.  Come with me."  She then brought me to the highest reading group in our class, the "Rainbow" reading group.  I read aloud a third time and fit right in with the rest of the group.  I stayed in the highest reading group for the rest of the year.

So what's the lesson here?  Simple.  If you treat the members on your team like they are idiots, they will be idiots.  However, if you expect them to be successful, if you motivate them in the right way, and if you treat them as equals, they will respond in kind.  All of this reminds me of a book I just read called, "Mindset: The New Psychology of Success" by Carol Dweck.  Dweck says that there are two types of mindsets in this world - a fixed mindset and a growth mindset.  Individuals who adopt a fixed mindset are like my first grade substitute teacher.  According to this view, individuals are born with a certain degree of intelligence and a certain set of abilities and skills.  Effort and practice will help them improve, but only to a certain degree.  They are who they are based on their genetic make-up and environment - nothing else.  Conversely, individuals who adopt a growth mindset are like my real first grade teacher.  Everyone is born with the potential to be great.  According to this view, effort, dedication, motivation, and hard work all matter.  And they matter a lot.

As an example, Dweck tells of a study in which adults were asked to draw a self-portrait.  Next, they participated in a workshop on drawing that lasted for five days.  At the end of the five days, they were again asked to draw a self-portrait.  Just look at some of the pictures below to see what a difference the 5 days of instruction made:


 Pretty incredible, huh!?!  If these students had adopted a fixed mindset, they would have never been able to improve on their ability to draw.  They were improved, or so Carol Dweck says, because they had a growth mindset.

Clearly, my first grade teacher (the real one, not the substitute) had a growth mindset.  Perhaps she brought out the growth mindset in me too.  The important thing is that she did not pigeon hole me.  She thought I could do better at reading.  She told me I could do better.  And then when I did do better, she encouraged me even more.

Thursday, December 7, 2017

Remembrance

Someone sent me an e-mail this morning lamenting the fact that there doesn't seem to be anyone who cares that today is December 7 - National Pearl Harbor Remembrance Day.  I agreed with him, and then I saw that our flag out in front of the hospital was flying at half-mast.  I e-mailed him back and let him know that at least someone still remembered. 


Exactly 76 years ago, on that "day that will live in infamy" the United States was attacked by Japan.  We entered World War II shortly thereafter.  Today, we honor and cherish those who gave their lives in the service of their country.  But we also remember, today of all days, an entire generation who likely saved our world from ultimate destruction.  We too remember their sacrifice.


President George H.W. Bush gave a speech at the USS Arizona Memorial on the fiftieth anniversary of Pearl Harbor on this day in 1991.  I encourage all of you to watch it - it is very moving.  He ended his remarks by looking out over the water, his voice cracking as he fought back his emotions:


Look at the water here, clear and quiet, bidding us to sum up and remember. One day, in what now seems another lifetime, it wrapped its arms around the finest sons any nation could ever have, and it carried them to a better world.
May God bless them. And may God bless America, the most wondrous land on Earth.


Today, of all days, let us remember. 



Wednesday, December 6, 2017

"Don't make a living, make a life..."

Winston Churchill reportedly once said, "We make a living by what we get, but we make a life by what we give."  While I am not completely sure what Churchill had in mind when he said this, I do think that the giving is all about service to others.  Similarly, the Greek philosopher Aristotle asked a rhetorical question and then promptly answered it: "What is the essence of life?  To serve others and to do good."


Today, the Continuing Medical Education department at Cincinnati Children's Hospital Medical Center spent the morning at the Freestore Foodbank.  The Freestore Foodbank is a nonprofit organization whose mission is to "provide food and services, create stability and further self-reliance for people in crisis."  It is the largest emergency food and services provider in the Tri-State area (a 20 county area surrounding the city of Cincinnati in Ohio, Kentucky, and Indiana).  The organization purchases and collects donations of food from manufacturers, wholesalers, retailers, and government agencies before then distributing it to approximately 250 local community partners.  There are likely similar organizations in almost every city in America - in fact, Freestore Foodbank is a member of a larger organization called Feeding America


We had a great time this morning volunteering for a great cause, and I think the team enjoyed the opportunity to work together and do something fun outside of work.  Volunteering for a worthy cause is a great way to build team camaraderie.  I wonder how much money various corporate teams spend every year hiring any of a number of outside consultants or groups that have become part of a growing cottage industry of "team building" experts.  It seems to me that the time (and money) could be better spent volunteering together for a worthy cause, such as Freestore Foodbank.


During this holiday season, I encourage all of you to spend a morning or afternoon with your teams, volunteering for a charitable organization.  I guarantee that these organizations need your help - and I am 100% confident that the time will be well spent.  Imagine how much better our world would be today, if teams just gave even a few hours every quarter serving others.  In other words, don't make a living.  Make a life.





Sunday, December 3, 2017

"It's beginning to look a lot like Christmas..."

Well, even though the temperature outside is hovering around 50 degrees, it is indeed beginning to look a lot like Christmas, at least at the Wheeler house.  We started putting up our holiday decorations right before Thanksgiving, and we finished putting up our outdoor Christmas lights just this morning.  One last holiday tradition remains - Christmas greeting cards!  I have to admit, even though it is a lot of work addressing envelopes and signing all of our Christmas cards, I do enjoy hearing from old friends every year when we receive their Christmas cards in the mail.  We have made many connections over the years, and the annual Christmas card is frequently the one time every year when we renew these connections.

One of the questions my wife and I ask ourselves, just about every year, is who we are going to include on our Christmas card list.  We usually send out quite a few cards every year, but one of the key factors is whether we received a Christmas card from someone the prior year.  In other words, if we received a Christmas card from your family last year, there is almost a 100% certainty we will be including your family on our list of Christmas cards to send out this year. Surprisingly enough, psychologists have a name for this phenomenon - it's called the norm of reciprocity.

Two psychologists, Phillip Kunz and Michael Woolcott actually studied the norm of reciprocity using Christmas cards back in 1976.  The study is actually quite interesting.  Kunz and Woolcott randomly (more or less) selected 576 names from a Chicago city directory - all complete strangers - and mailed them a Christmas greeting card.  The two investigators varied the content and type of card, as well as the sender of the card.  For example, high-quality cards usually had a poetry inscription or winter scene and were printed on high-gloss paper, while low-quality cards were plain, white cardstock with a Christmas message written in red ink.  Some of the cards were "sent" from a "Dr. and Mrs. Kunz" (high-prestige), while others were signed simply "Phil and Joyce" (low-prestige).  Each card had a return address that was clearly marked.  Regardless of who sent the card or whether the card was high- versus low-quality, 117 of the recipients sent a response back to the two investigators.  In other words, nearly 20% of the recipients returned a Christmas card or note back to a complete stranger!  Some of the responses inquired how the recipients were acquainted with the senders, while others wrote back lengthy responses telling all about their family and what was going on in their lives!

As it turns out, recipients were more likely to send back a response if the card was high-quality or the sender was high-prestige.  I suspect that some people were likely too embarrassed to ask how they knew the sender and felt obligated to return the gesture.  Moreover, some recipients likely saw some utility in "keeping on the good side" of the high-prestige sender.  What matters most, I think, is the simple fact that so many recipients did actually respond. 

Type "norm of reciprocity" into Google and you will likely find examples and suggestions on how you can use the "norm of reciprocity" to your benefit - say in a negotiation, as one example (think "quid pro quo" or "you scratch my back, I scratch your back").  I agree there is merit in learning about the "norm of reciprocity" - however, in this holiday season, perhaps when our world most needs it, I am reminded of the simple lesson that there is something uniquely special and reassuring in our human nature that feels some sort of obligation to return a simple act of kindness.  As Aesop said, "no act of kindness, no matter how small, is ever wasted."  Let us all remember the "norm of reciprocity" this holiday season and beyond.

Wednesday, November 29, 2017

Critical Mass

Today I woke up to a "Breaking News" text message that NBC had fired "The Today Show" anchor, Matt Lauer due to accusations of "inappropriate sexual behavior" from multiple women.  At the same time, Minnesota Public Radio fired long-time radio personality Garrison Keillor (creator of the show, "A Prairie Home Companion") for similar allegations.    There have been a number of famous men in the last few weeks whose careers have ended due to allegations of sexual harassment or improper conduct.  I suspect that there will be more to come.  We seemed to have reached a "tipping point" where this kind of behavior is no longer tolerated - it is about time.

I read a very interesting article in Time magazine by Jay Newton-Small entitled, "What happens when women reach a critical mass of influence" based on her recently published book, "Broad Influence."  I would encourage all of you to take a look - it really is quite amazing.  Newton-Small claims (and she provides a number of examples to back her point) that an organization's tolerance for sexual harassment ends abruptly when women comprise between 20% to 30% of the organization (i.e., there is a "tipping point" at about 20-30%).  For example, when there were at least 20 female Senators, the U.S. Senate reformed the Pentagon's sexual harassment policies.  When 25% of Hollywood producers were women, the so-called "casting-couch culture" of Harvey Weinstein was brought to an unceremonious end.  When one-third of the White House press corps were women, a number of media moguls were accused of sexual harassment (see Fox's Roger Ailes, among others).  The 20% to 30% tipping point appears to apply to racial and ethnic diversity as well.  Shortly after the U.S. Supreme Court's landmark decision to desegregate schools in the 1954 Brown v. Board of Education, sociologists recommended that a "critical mass" of minority students should be introduced into schools.   

If 20% of the workforce is a "critical mass", we have a long way to go, especially with regards to racial and ethnic diversity.  There is no question that we are better and stronger through diversity.  As former President George H.W. Bush (who, incidentally, was also recently accused of inappropriate behavior) said:

We are a nation of communities...a brilliant diversity spread like stars, like a thousand points of light in a broad and peaceful sky.

It really is a beautiful metaphor.  We are a "nation of communities" but unfortunately, we don't always act that way.  Perhaps we can only become like the "thousand points of light" when we reach that "critical mass" of 20-30% diversity in positions of leadership.  We will only reach that "critical mass" when we are deliberate and explicit with our diversity goals.  As leaders, we need to place individuals from different backgrounds in positions where they have the opportunity to grow and develop.  We need to provide the mentorship to assure their success.  It has to start somewhere, and now seems to be an opportune moment.  Please help build that "critical mass" so that we can all reach our greatest potential.

Sunday, November 26, 2017

"You're fired!"

I know what you are thinking - and you are wrong!  I am not writing a blog that has anything to do with the television show "The Apprentice" or any of its stars.  Nope, this post is about something completely different.

I was sitting in front of the television yesterday watching my alma mater, Purdue University, win the Old Oaken Bucket by beating our rivals from Indiana University in the last football game of the season.  The win meant that Purdue is now "bowl eligible" with a 6-6 win-loss record (unfortunately, Indiana is not "bowl eligible" since the loss gave them a 5-7 record).  It was a great win for Purdue's first year coach, Jeff Brohm.  What is even more impressive is that just last year, with almost the same group of players, Purdue finished the season with a 3-9 record.  In fact, the last time Purdue went to a bowl game was in 2013.  Basically, Purdue has had a long string of very unimpressive football teams coached by a succession of not so impressive (at least based on their win-loss records at Purdue) head football coaches.  It got me thinking - what is so special about Coach Brohm that he seems to have turned the Purdue football program around?  Okay, I know.  One season does not make a successful program, but there is hope.  Does a head football coach really mean that much?  Can a new head football coach really have that much of an impact?

Consider this point even further.  Most college football programs ended their seasons this past weekend, and just like every year at about this time, several head football coaches were fired because of their lack of success.  Some of the notable ones include the head football  coaches at Texas A&M, Tennessee, Arkansas, and Florida - pretty impressive list given the fact that most of these colleges have historically had strong, competitive football programs (Tennessee and Florida have even won multiple national championships).  Keep your eye on the sports world, there will be a succession of firings and hirings over the course of the next couple of weeks in what has become affectionately termed, the "annual college football head coaching carousel."

So back to my original question - what can all of these colleges expect from a brand new head football coach?  Will a change in head coach bring back the glory days of old for the likes of Tennessee, Florida, Texas A&M, and Arkansas?  Believe it or not, this particular issue has been studied fairly extensively.  And, the results of the studies that have been done will likely disappoint all of you rabid Volunteer, Gator, Aggie, and Razorback fans.  E. Scott Adler, Michael Berry, and David Doherty conducted an analysis of coaching changes from 1997 to 2010, the results of which were published in the journal, Social Science Quarterly (see the link here).  The performance (in terms of wins and losses) of football programs that replaced their head coach were compared directly with programs who retained their head coach.  Surprisingly (maybe), changing the head coach of historically poorly performing teams (think Purdue's football team last year) had little, if any, effect on the program's win-loss record.  Football programs with a little more success (think Tennessee, Florida, Texas A&M, and Arkansas) actually did worse after a head coaching change.  As it turns out, the results of this study have been replicated in other sports too (for a summary, see the link here), including professional football, soccer, basketball, and hockey.  Even more important (unless you love sports!), studies in the business world, where a CEO is replaced instead of the head coach, have similar results too!

So what gives?  As Josh Bersin writes in a post for Forbes magazine, it's not all about the CEO (or in our previous examples, it's not all about the head coach).  At least in the business world, a focus on leadership strategy is infinitely more important to the overall success of the organization than any one individual CEO.  Bersin offers the following best practices from his analysis of multiple organizations:

1. High-performing organizations directly link leadership strategy to business strategy.  In other words, successful organizations link their leadership development strategy with the overall mission, vision, and values of the organization.  Developing a strong team of leaders at multiple levels throughout the organization is really the key to success here.

2. High-performers develop leaders at all levels.  Again, successful organizations foster leaders at all levels through talent management, succession planning, and leadership training.  Interestingly enough, successful organizations empower their front-line leaders to make decisions that are in the best interest of the organization as a whole (this is a great example of the High Reliability Organization principle of "deference to expertise").

3. High-performers invest in leadership development.  Here, the most successful CEO's focus on developing front-line leaders.  If it's important to the CEO, it's important for the CEO's direct reports, and so on.  The CEO that is fully engaged with leadership development will build a strong group of leaders that will assure the organization's success.

Would these best practices translate to success on the football field or basketball court?  I don't know.  But they are definitely what can make or break just about any other kind of organization.  So next time you are ready to call for your favorite football team's head coach to be fired, or for that matter, the CEO at your organization, remember that leadership transitions at the top of the organization don't always work out for the best.  However, if the new CEO follows these leadership best practices, maybe he or she will be successful in taking the organization to new heights.

Saturday, November 25, 2017

By request...

I thought long and hard about what to write about this weekend.  There were several great topics with a lot of potential that came to mind - Thanksgiving and gratitude, rivalry week in college football, transitions of power (see the recent transition in leadership in the country of Zimbabwe or all the college football head coaching changes announced this week), Presidential leadership (or in our case, the lack of Presidential leadership).  My wife, our youngest daughter, and I drove down South this past Wednesday for Thanksgiving (we met our other three kids in Atlanta - they all flew!).  Along the way, we stopped at a fast food restaurant right off the interstate.  There was a long line at the drive-through window (actually, they had two lines going side by side).  There were two workers taking orders on iPads and collecting payment by credit card.  They took my name down, so when it was our turn to drive up to the window, the worker in the restaurant confirmed my name and handed us our order.  Great efficiency and a really strong example of process improvement.  I thought about writing more on that episode.  However, I received a tweet on this same Wednesday afternoon that "requested" a post on a memo that the hospital administrators at Parkland Memorial Hospital sent out to their employees shortly after President John F. Kennedy died.  So here it goes, by request!

Both President Kennedy and Texas Governor John Connelly were brought to the Emergency Department of Parkland Memorial Hospital on the afternoon of Friday, November 22, 1963 (fifty-four years ago this past Wednesday).  Two days later, Kennedy's accused assassin, Lee Harvey Oswald, was brought to Parkland after being shot as well.  While Governor Connelly survived, as everyone knows, both Kennedy and Oswald died.  While hospitals like Parkland Memorial Hospital deal with trauma victims every single day, very few are forced to deal with such high-profile trauma victims as a Governor, U.S. President, and assassin, all in the span of two days.  In response, the hospital administration sent out this letter:
The letter is very well written and acknowledges the unique situation that the employees at Parkland Memorial Hospital dealt with in just the short span of two days.  We see here a great example of crisis leadership, and I think there are probably three takeaway lessons for health care leaders today.

First, point #7 above is critically important.  Even during a crisis, hospitals have to function as they normally do - patients still come and go, families and visitors still come and go.  The rest of the world does not stop, just because one particular health care organization is in the middle of a crisis.  I remember my own personal experience of a mass casualty emergency when I was in the Navy.  Our hospital was dealing with a mass influx of trauma patients as a result of a airplane crash.  But even while our emergency department and operating room suites were dealing with the trauma victims, our labor and delivery unit was still delivering babies, and our nursery was still dealing with a sick newborn.  Life goes on - even during a crisis.

Second, and even more important, health care leaders must show gratitude.  When?  The best answer is "all of the time."  However, showing gratitude with a public acknowledgement of thanks is absolutely essential after a crisis (ideally as soon as possible after the crisis has started to subside - though some would say that gratitude is important throughout the crisis).  Here, the administration of Parkland Memorial Hospital acknowledged the very unique situation that their teams of physicians and nurses experienced during those two long days in November, 1963.  Remember that the nation was mourning the death of a very much beloved President.  Parkland employees were dealing with more than that - the assassination of a U.S. President was the most important news of the day, so they also had to contend with the news media from around the world.  Gratitude, even a simple "Thank you", tells the entire organization that the leadership understands and acknowledges what their teams are dealing with.  The display of gratitude should be meaningful and from the heart.  The display of gratitude should be personal and public. 

Third, as soon as possible after the crisis has passed, organizations absolutely must gather the facts and conduct a thorough After Action Report of their experience.  No matter what the cause, there is a lot to learn from how an organization functions during a crisis.  Leaders should never let an opportunity to learn from a crisis go to waste.  I suspect that Parkland Memorial learned a lot about how their hospital functioned with two very high profile trauma victims.  They likely learned a lot about how their media relations team functioned with an extremely stressful set of circumstances.  The key for any organization is to leverage what is learned in a crisis and improve upon their response for the next time.

Sunday, November 19, 2017

"Sometimes the hardest thing and the right thing are the same..."

One of the toughest things that I have experienced in my professional career as I have transitioned into leadership roles is that I can no longer leave some of the most difficult decisions to someone else.  It is a fact of life, leaders frequently are called upon to make really tough, and at times unpopular, decisions.  There is absolutely no getting around the fact that you can't please everyone all the time - at times, making the tough decision, even if it's the right decision, can make members of your organization very angry and frustrated (usually their anger is directed towards the leader who made the decision!).  Major Richard Winters, one of the main characters in one of my favorite television series, "Band of Brothers" once said, "If you're a leader, you lead the way.  Not just on the easy ones, you take the tough ones too."


Dan Rockwell, who writes a blog called "Leadership Freak"", says "The way you make unpopular decisions is as important as the decisions themselves."  Leadership is more about humility, transparency, and integrity than it is about making decisions.  He goes on to list several tips on how to be respected, even when making a difficult and unpopular decision.  Here are some of my favorite ones:


1. Adopt a relaxed, gentle, welcoming demeanor.  Breathe deep.  Smile.  Gentle eye-contact.
2. Be a learn-it-all, not a know-it-all.
3. Reject the trappings of position and authority.  When you pull rank, they close down.
4. Include others as early and as often as possible.
5. Share information prolifically - secrets lead to fear and manipulation.
6. When you can't share information, explain why.
7. Answer public concerns quickly, directly, and publicly.


One additional caveat, even when you follow these tips, you as the leader will still be subject to criticism.  Here, I have found that the Stoic philosopher, Epictetus was exactly right.  Whenever he was criticized, he said, "If that person really knew me and my flaws, they'd have said something much, much worse."  In other words, take the criticism for what it really is - feedback on how to improve the next time you have to make a difficult and potentially unpopular decision.





Tuesday, November 14, 2017

Clear the deck

I have been very lucky to have great mentors throughout every stage of my career, and with great mentorship always comes with great advice.  What was the best advice that I ever received?  Well, it's hard to say exactly, but "Don't overcommit yourself - learn to say No" immediately comes to mind.  Unfortunately, I didn't really learn to say No until much later in my career.  I ended up okay, but I do think that things would have been much easier for me if I had politely said No a little more often.

As it turns out, "learning to say No" is actually an important skill!  Camille Preston wrote a fantastic article for Fortune magazine in 2014 called "Why saying no gets you ahead".  The key message is that overcommitting yourself will decrease your productivity, prevent you from reaching your actual goals, and increase the risk of professional burn-out.  Preston offers seven tips to help you learn to say No:

1. Implement a 24-hour pause period.  In other words, wait 24 hours before you say Yes.  Think it over carefully - if you still want to accept that invitation to write a textbook chapter or serve as the project leader on that major quality improvement initiative, then go ahead and say Yes.  The 24 hours will give you the necessary time to think things over carefully.  And just about every decision can afford to wait for 24 hours.

2. Say no with grace and authority.  Be polite, but firm.  Don't beat around the proverbial bush.  If you don't want to do something, kindly thank the individual for the invitation but say no (and mean it). 

3. Simplify your commitments.  If your commitments don't help you ultimately attain your professional goals, then give them up (see more below).  As Preston states, "If you don't enjoy it, aren't fulfilled by it, or it doesn't help you personally or professionally, stop doing it."

4. Create white spaces on your calendar.  There are always going to be lunch dates, after hours presentations, or conferences that you don't want to attend.  Do yourself a favor - don't go to them.

5. Minimize the meetings.  Too many meetings are not helpful.  Most meetings are not productive anyway.  If it doesn't come with an agenda and pre-work, it probably isn't worth the investment of your time.

6. Notice the "should".  Volunteer and service activities are great opportunities - but you should be doing them because you want to do them and NOT because you think it will help your career if you do.

7. Set your boundaries, and stick to them.  Don't answer e-mails, text messages, or telephone calls after work or on the weekends.  More importantly, don't ask the members of your team to do so either. 

Preston's third tip reminds me of a wonderful story about Warren Buffet (Warren Buffet's three-step strategy).  Apparently, Warren Buffet was giving some career advice to his personal pilot, Mike Flint.  He told Flint to write down his top 25 career goals.  Next, he asked Flint to look over his goals and circle the 5 most important ones.  At this point, Flint had two separate and distinct lists - the first one listed his top 5 most important career goals, and the second one listed 20 other goals that weren't as important to him.  Buffet asked his pilot to explain what the two lists meant to him.  Flint replied that the top 5 goals were the ones that he would focus most of his time on achieving, while the next 20 were the ones that he would keep on the backburner and get to them as soon as he could.  Buffet emphatically said that he should forget about the next 20 goals and "avoid them at all costs."  These goals would only distract him from achieving his top 5 most important ones.

Learning to say No is one of the most important things that a leader can do to "clear the deck."  As Steve Jobs once said, "It's only by saying No that you can concentrate on the things that are really important."  So, do yourself (and your team) a HUGE favor - clear the deck by learning to say No.




Saturday, November 11, 2017

Courage, Honor, and Commitment


We celebrated Veteran's Day yesterday at the hospital.  The annual Veteran's Day Recognition Ceremony is one of my favorite events of the year.  I was honored this year to give the keynote address.  The text of my address follows below: 

My friends and colleagues, I have never been comfortable being called a veteran.  I never served in combat.  And in all of my time in the Navy, I never once set foot on a ship that was more than 100 yards from shore.  But please don’t misunderstand me – I have NEVER been more proud to have served in our nation’s military.  If I am reluctant to call myself a veteran, it is because I place an infinitely greater value on the contributions of those men and women who either put themselves in harm’s way or were willing to do so.  If I am slightly uncomfortable standing before all of you on Veteran’s Day, it is because I gave less to our nation than I received in return.

Our time in the Navy lasted only 9 years – six years on active duty and three years in the Reserves.  It all started at the Naval Reserve Center in Indianapolis, Indiana, where I received my commission and took my oath.  I spent 6 weeks in Newport, Rhode Island between my first and second year of medical school at Officer Indoctrination School (affectionately known as “knife and fork” school – if you don’t believe me, please consider that during my free time there, I became a certified PADI Open Water Scuba Diver and learned how to sail).  During my third year of medical school, I worked in the Neonatal Intensive Care Unit at Naval Hospital San Diego.  I loved it there so much that I spent three additional years there after finishing medical school completing my residency training in pediatrics.  I spent the next three years as a general pediatrician at the Naval Hospital Guam and the Naval Hospital Camp Lejeune, with several short stints as a general medical officer and advisor to the U.S. Army Corps of Engineers on the island of Kosrae, in the Federated States of Micronesia.    I came to Cincinnati as a Pediatric Critical Care Medicine Fellow and remained in the Reserves, so it was back to the Naval Reserve Center in Indianapolis for my last 3 years before my honorable discharge.  The highlight of my time in the reserves, aside from working at Cincinnati Children’s Hospital, was a medical humanitarian mission trip to El Salvador. 

Aside from all of the great memories that we shared and all of the close friendships we made, my time in the Navy taught me the meaning of duty and service.  I carry in my pocket a coin marked with three words – Courage, Honor, and Commitment – the three Core Values of the United States Navy.  But in actual truth, I do not need a coin to remind me of these words, for they are imprinted in my memory and etched in my heart.  They have remained with me all of these years and will be there until the end of my days.  General Douglas Macarthur once said, in a farewell speech that he gave at West Point shortly before he died, “Unhappily, I possess neither that eloquence of diction, that poetry of imagination, nor that brilliance of metaphor to tell you all that they mean.”  And here I paraphrase – but I will try now.

Courage
The legend of LT John F. Kennedy and PT-109 during World War II is well-known.  Perhaps less well-known is that Senator Kennedy won the 1957 Pulitzer Prize for his book, Profiles in Courage.  The book provides 8 examples of Senators throughout history (at least up until 1957) who defied both the opinions of their political party as well as their constituents to do what they thought was right.  In many cases, these Senators were greatly criticized and lost their reputations as a result.  That, ladies and gentlemen, is Courage.  Standing up for what you think is right, even when what you think is right isn’t necessarily what everyone around you thinks is right.  It is a rare thing to see this kind of courage in the political world today. 

Perhaps one exception.  I don’t care whether you were for or against the Affordable Care Act, but for most of Barack Obama’s presidency, the Republicans in the Senate were waiting for the chance to repeal it.  They recently had their chance – the odds were greatly in their favor.  It came down to one final vote.  And Senator John McCain, a former US POW and Navy war hero, cast his vote against the wishes of his party.  While a number of government officials, members of the press, and his constituents praised him for standing up for what he believed in, individuals in his own political party, including the President of the United States, publicly condemned him.  Courage.  Doing what you think is right, even when you may suffer criticism or loss of reputation as a result. 

Honor
When I think of the word, “Honor” I think of men and women like Vice Admiral James Stockdale.  You may remember Admiral Stockdale as the Vice Presidential running mate for Ross Perot during the 1992 Presidential election.  In my opinion, Admiral Stockdale is better remembered for what he did much earlier in his career.  Stockdale’s A-4 Skyhawk was shot down during a combat mission over North Vietnam on September 9, 1965.  He was captured and spent over 7 1/2 years as a Prisoner of War as the senior naval officer at the famous Hanoi Hilton (incidentally, Senator John McCain was also held there).  Stockdale was routinely tortured and denied medical care.  Stockdale created a code of conduct for all of his fellow prisoners (which is still taught today) that established secret communications and rules of engagement while being tortured.  Once, when he was told that he would be paraded in public, he slit his own scalp and face with a razor to purposely disfigure himself so that he would not be used as a tool of propaganda.  Stockdale was awarded the Congressional Medal of Honor for his extraordinary leadership, courage, and honor.  He said of his time as a POW, “I never lost faith in the end of the story, I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I would not trade.”  I will say it again, “I would not trade.”  Honor means doing the right thing, “even if it means dying like a dog when no one’s there to see you do it.” 
Commitment
If you ever get a chance to do so, I highly recommend the movie, “Men of Honor” starring Cuba Gooding, Jr and Robert DeNiro.  The movie tells the story of Master Chief Petty Officer Carl Brashear – the first African American to attend AND GRADUATE from the US Navy Diving and Salvage School.  Now remember that President Harry Truman desegregated the Navy in 1948 – Brashear graduated from Dive School in 1954.  He routinely faced hostile prejudice and overt racism – and on a number of occasions, he received death threats if he tried to finish dive training.  But he persisted, and he graduated.  His career was distinguished, and he eventually rose to the rank of Chief Petty Officer.  In January 1966, while salvaging a nuclear bomb that was lost in the ocean following a mid-air collision between a B52 bomber and KC-135 tanker, Chief Brashear sustained serious injuries to his left leg, which was later amputated.  Despite being an amputee, he returned to full active duty and diving and became the first African American (and the first amputee) to become a US Navy Master Diver.

To say that Master Chief Brashear was committed to the Navy is a vast understatement.  Despite all of the odds against him (prejudice, racism, and even the loss of his leg), he never gave up his dream of becoming a US Navy Master Diver.  Commitment means never, ever giving up.  It means staying true to a cause that is bigger than you.  It means being like Master Chief Carl Brashear.

So.  Courage.  Honor.  Commitment.  If you live by these core values, or really any of the core values of our Armed Forces - no matter what you do in your life, you will be successful.

Before I close, I hope that you will indulge me for a couple of more minutes.  Every year on Veteran’s Day, I read a letter to myself that was written a very long time ago to a Mrs. Bixby.  The contents of the letter perfectly summarize what it means to serve your country – what it means to have courage, honor, and commitment.  The letter reminds me of why we do what we do, so I would like to read it now.  You may have heard it before – there’s actually a famous scene in the movie “Saving Private Ryan” in which General George Marshall reads the same letter:

Dear Madam,

I have been shown in the files of the War Department a statement of the Adjutant General of Massachusetts that you are the mother of five sons who have died gloriously on the field of battle.

I feel how weak and fruitless must be any word of mine which should attempt to beguile you from the grief of a loss so overwhelming.  But I cannot refrain from tendering to you the consolation that may be found in the thanks of the Republic they died to save. 

I pray that our Heavenly Father may assuage the anguish of your bereavement, and leave you only the cherished memory of the loved and lost, and the solemn pride that must be yours to have laid so costly a sacrifice upon the altar of Freedom.

Yours, very sincerely and respectfully,
Abraham Lincoln.

Thank you for indulging my annual Veteran's Day tradition.  Thank you for allowing me to speak to you all today.  And most of all, thank you for your service.  God bless you all.  And God bless the United States of America.

Wednesday, November 8, 2017

We are only human

I took an oath (both literally and figuratively) on the day that I graduated from medical school.  On that day, I became a physician.  I learned, as many of my colleagues have learned, that being a physician is not just something that you do - it is who you are every hour, every day, every year.  Being a physician doesn't stop when I leave the hospital and come home. 

I will admit that over the years, I have missed some important events at home.  I remember one particular year that I promised my son that I would be home in time to take him and his sisters out trick-or-treating on Halloween.  I specifically remember breaking a few speed limits on the way home so that I would be able to keep my promise.  My wife remembers that moment too.  Fortunately, on that particular occasion, I made it home in time from the hospital, and I was able to keep my promise.  But there were other moments that I wasn't able to do so.  Being a physician doesn’t stop when you go home.

I recently read a post on LinkedIn that really bothered me.  The individual who wrote the post was telling of an episode in which one of her family members was sick and in the hospital.  She asked her boss for some time off, and in this case, her boss said no.  I know what you are thinking - and you are absolutely right.  Could a boss really be that callous?  Would someone really do that? 

As it turns out, there was a similar story in my past too.  My son spent a little over three weeks in the Newborn Intensive Care Unit when he was born - he was very sick.  I was about five months into my third year of medical school.  As fate would have it, I was actually rotating in the same Newborn Intensive Care Unit where my son ended up being a patient.  My son's physicians and nurses were incredible.  They took great care of him - indeed, they saved his life - and they took great care of my wife and I.  To this day, we still keep in touch with my son's physician every Christmas.  I particularly remember the physician I worked with that month (who ended up being my son's attending physician too) telling me to take the rest of the month off.  He would make sure that things would be okay.  However, once the end of the month came, I was scheduled to start a three month rotation in Internal Medicine.  I remember going to the Dean's office of the medical school to ask for some time off.  We still weren't sure how long our son was going to be in the hospital, so I wanted to at least ask for one month off (remember, this was before there was any such thing as family leave, and medical students didn't have vacation time).  Regrettably, the Dean of Student Affairs was not very understanding.  He really couldn't understand why I would want to take some time off - he even asked if my son was really that sick.  I remember telling him that we were told that my son was sick enough that the odds of him surviving were only about 20-30%.  I remember telling him that I wanted to be with my son and my wife, so that I would be there with them at the bedside in case he didn't make it.  He eventually agreed to let me have some time off. 

So yes, there are people out there who are really that callous.  Some of them are even physicians.  You don't have to tell me that we are only human.  We make mistakes - even the best physicians.  But I hope that I will never make the mistake of being so callous to those on my team.  As leaders, we need to take care of our people.  We all have personal lives.  We all have things that are important to each and every one of us.  Our job as leaders is to make sure that we give the individuals on our teams the time that they deserve to take care of all the things that happen in their professional lives, as well as their personal ones. 

We are physicians - every minute, every hour, every day.  But we must remember that we are humans too.

Saturday, November 4, 2017

Classic rookie manager mistakes

I know I usually don't post anything on Saturdays (especially during college football season!), but I came across an interesting post on my Twitter feed earlier today.  Dushka Zapata confessed to making "8 classic mistakes" of a first time manager (many of which I have made too, as I explain further below each mistake);

1. "I felt I needed to know everything."  There is absolutely no way that a new leader can know everything about his or her job.  Leadership consultant, writer, and former Navy officer David Marquet made a similar mistake when he was assigned command of the USS Olympia, a Los Angeles class attack submarine (as told in his book, Turn the Ship Around).  Before taking command, he studies all of the blueprints on the USS Olympia until he knew every wire, every control switch, and every piece of equipment on the entire ship.  He reviewed the personnel files of every one of his officers and crew members, until he felt like he knew enough to predict how they would perform under stress.  He felt confident that he knew more about his new command than anyone else on the ship.  The only problem - a few days before he was scheduled to assume command of the Olympia, his superior officers told him that he would be taking command of another submarine, the USS Santa Fe, instead.  It was only after he gave an order for the helmsman to do something that was not possible for the USS Santa Fe to do (but something the USS Olympia could have easily done) that he figured out that he could never hope to know every facet of every crew member's job on the ship.  It was only after learning the lesson that he could not know everything - indeed, it was better for the ship that he didn't know everything - that he achieved success.

2. "I gave more work to employees who were already good."  Superstar team members are perhaps a new leader's greatest asset.  Unfortunately, new leaders often have the tendency to give the most difficult assignments to their superstars.  Even worse, these same leaders keep giving assignments to their superstars.  The result?  The superstars are overloaded and fail to live up to their potential and the new leader's expectations.  More importantly, the other members of the team fail to develop to their potentials as well.  Spread the wealth!  Give assignments to your superstars, your high potentials, and the members on the team who need "stretch assignments" so that they can develop their skills, knowledge, and expertise.

3. "I didn't adapt my style to the needs of people who reported to me."  There are a number of leadership styles (known by a seemingly infinite number of names, depending upon the author) - the best leaders "flex" their styles to the individual needs of the situation and their team members.  Some members of the team will need more encouragement and assistance than others.  Some team members will respond better to a "top-down" or "authoritative" leadership style, while others may respond better to a "bottom-up" or "coaching" leadership style.  The important point is that there is no such thing as a "one-size fits all" approach.   

4. "I felt betrayed when people left."  There will always be turnover when a leader begins a new position.  More importantly, if a new leader is doing a good job, his or her team members will be heavily recruited to become leaders themselves!  Don't be offended by team members who depart - it's not always about loyalty, and it should not be viewed as a personal affront to your leadership.

5. "I felt like the happiness of people who reported into me was my responsibility."  Leaders are responsible for making sure that their employees are engaged, motivated, and inspired to give their best performance.  But leaders need to understand and appreciate that there is more to happiness than employee engagement and work-life balance. 

6. "I was bad at delegating."  Of all of the rookie manager mistakes discussed so far, this one is probably the worst!  Our CEO pulled me aside after one of our leadership team meetings and asked if there was anything wrong - he thought that I seemed less engaged.  In truth, there had been a lot going on in the hospital, and I was texting back and forth with one of my team members.  When I discussed this particular incident with my coach, she asked why I didn't just delegate my responsibilities during the leadership team meetings to one of my associates.  I realized that she was absolutely right!  Delegating most of my responsibilities to one of my associates serves two purposes.  First, I can be fully engaged during our leadership team meeting.  Second, and perhaps more important, my associates now have a development opportunity (and an opportunity where I am not far away to provide assistance, if necessary).

7. "I made the company a priority over the person." I just finished reading Simon Sinek's book, Leaders Eat Last.  There is a tradition (actually, it's an expectation) in the military that the officers eat after the enlisted - in other words, leaders place the needs of their team members above their own.  It's a clichĂ© that an organization's greatest asset is its people - clichĂ© or not, it's the absolute truth.  Never, never, NEVER place your own needs above those of your team members.  More importantly, the company doesn't come first.  The people do.

8. "I wanted everyone to be the same." There is strength in our diversity.  Each and every member on our team brings a different set of skills, knowledge, and expertise to the job.  Each and every member on our team brings a different and unique personality and life experience to the team.  New leaders should embrace this diversity.  Don't expect everyone to be the same.  More importantly, don't hope that everyone will be the same. 

Wednesday, November 1, 2017

"United we stand..."

You have probably heard most of the teamwork clichĂ©s that I am about to recite.  Perhaps some of their power lies in the fact that they are so easily remembered.  Most of these have been repeated so many times that it is almost impossible to know who said them first.  Here are some of my favorites:

Teamwork makes the dream work (author unknown).

If you want to go fast, go alone.  If you want to go far, go together (apparently an old African proverb).

You can do what I cannot do.  I can do what you cannot do.  Together we can do great things (maybe not as well known, but a great quote from Mother Teresa).

TEAM.  me (author unknown, but often frequently used as a slogan on the practice jerseys of basketball teams).

There's no 'I' in 'Team' (author unknown, but this quote is particularly interesting - during his Hall of Fame induction speech, legendary basketball player, Michael Jordan, famously quipped that while there was no "I" in "Team", there was an "I" in "Win."  Interestingly enough, earlier during his playing career, Jordan reportedly once said, Talent wins games, but teamwork and intelligence wins championships).

United we stand, divided we fall (this quote is often erroneously attributed to Abraham Lincoln, who actually said in a famous speech during his first Presidential election campaign, A house divided against itself cannot stand.).

The last quote is actually from a famous story from ancient Greece (one of Aesop's Fables) called the "Four Oxen and the Lion" that provides an important lesson on teamwork.  Aesop tells how a lion used to hunt in a field where there also lived four oxen.  The lion had tried, on a number of occasions, to attack the four oxen, but whenever he attacked, they would flick their tails to warn each other and then form a circle, head (and horns) out.  One day, after the lion had attacked several times unsuccessfully, the oxen started quarreling with each other, and each walked away into separate corners of the field.  The lion, in turn, attacked them one by one and ate them all.  United we stand, divided we fall.

There is a similar story, again one of Aesop's Fables, of a man who had three sons who often quarreled with each other.  The man decided to teach his sons a lesson, so he brought them a bundle of sticks.  He asked them to break the sticks in half.  Each of his sons tried unsuccessfully - the bundle of sticks was too strong to break.  The last son threw the bundle to the ground in disgust and said, We can't do it.  The father picked up the bundle of sticks, separated the sticks, and easily broke them in half, one by one.  He then looked at his sons and said, My sons, if you work together - if you are united, you will be as this bundle.  Nothing can ever break you.  However, if you keep working alone and are divided, you will be broken as easily as one of these sticks.  In other words, United we stand, divided we fall. 

There is one final example.  The ancient Spartans were some of the strongest warriors (for a great illustration, see the movie, 300 about the Battle of Thermopylae between King Leonidas of Sparta and Xerxes I of Persia).  Apparently, one of the most revered weapons that a Spartan warrior carried was his shield.  Shields were often passed down from one generation to the next as family heirlooms.  Soldiers who lost their shields in battle were dishonored and often punished severely, even by their own families.  The ancient Greek historian, Plutarch, famously tells a story of a Spartan mother who tells her son as he is leaving for war to return home either with your shield or on it (there is a scene in the movie 300 that uses this quote - the wife of King Leonidas tells him, Come back with your shield or on it).  Why was the shield so important?  The shield was fundamental to the battlefield tactics of the Spartan army.  The Spartans would group together and use their shields defensively to form a tight, impenetrable phalanx from which they could use their spears to kill their attackers.  The shield was fundamental to their teamwork.  In other words, together they would be impossible to defeat.  United we stand, divided we fall.

The message from all of these quotes and stories is the same.  Indeed, it is a universal truth - teamwork is critical to the success of any organization.  Leaders can't be successful on their own, and in reality, without the team, there is no such thing as a leader.    There are countless examples of professional sports teams who have gone out to acquire free agent superstars - on paper, these teams look like they would be unstoppable.  The truth?  Many times these teams have resulted in losing seasons.  Why?  The superstars could not work together as a team.  The same is true for any organization - if your top talent can't work together, your organization will fail.  Leadership turns teams of superstars into winning organizations.  United we stand, divided we fall.

Sunday, October 29, 2017

"Oh Lord it's hard to be humble..."

The author and management consultant, Patrick Lencioni (one of his most well-known books is the leadership fable, The Five Dysfunctions of a Team) once said about humility, For organizations seriously committed to making teamwork a cultural reality, I'm convinced that the 'right people' are the ones who have three virtues in common - humility, hunger, and people smarts.  In other words, humility is one of a select number of key leadership traits.  Successful organizations need leaders who are willing to sacrifice their own self-interests for the interests of the greater organization.  In other words, successful organizations need servant leaders.  Servant leaders, almost by definition, are humble leaders. 

As it turns out, research shows that humble leaders improve overall employee engagement and job performance.  Unfortunately, humility is sometimes associated with weakness.  However, nothing can be further from the truth.  Humble leaders fully recognize their strengths and weaknesses, as well as the strengths and weakness of the members of their teams.  Angela Sebaly, author of The Courageous Leader said, Humility is about minimizing the self and maximizing the bigger purpose you represent.  She goes on to explain further, When you think about humility in that way, it becomes a vital competency in leadership because it takes the focus from the 'I' to 'We.' Leaders with humility engage us and give us a sense of identity and purpose.

Humility can be a tough thing to learn, especially for leaders who are accustomed to personal success (which in many cases is why they have been given leadership opportunities in the first place).  The important thing for these leaders to remember though is that success is indeed fickle.  Success doesn't last forever.  Simon Sinek, author of the book, Start with Why: How Great Leaders Inspire Action (the TED talk by the same name is one of the most viewed TED talks of all time) offers a very poignant example of this in his most recent book, Leaders Eat Last.  He tells the story of how a former Under Secretary of Defense had been invited to give a speech.  During his speech, he paused to take a drink of coffee.  He noticed, perhaps as a number of members of the audience noticed, that he was drinking from a Styrofoam coffee cup:

"You know," he said, interrupting his own speech.  "I spoke here last year.  I presented at this same conference on this same stage.  But last year, I was still an Under Secretary," he said.  "I flew in here in business class and when I landed, there was someone waiting for me at the airport to take me to my hotel.  Upon arriving at my hotel," he continued, "there was someone else waiting for me.  They had already checked me into the hotel, so they handed me my key and escorted me up to my room.  The next morning, when I came down, again there was someone waiting for me in the lobby to drive me to this same venue that we are in today.  I was taken through a back entrance, shown to the greenroom and handed a cup of coffee in a beautiful ceramic cup. 

But this year, as I stand here to speak to you, I am no longer the Under Secretary," he continued.  "I flew here coach class and when I arrived at the airport yesterday there was no one there to meet me.  I took a taxi to the hotel, and when I got there, I checked myself in and went by myself to my room.  This morning, I came down to the lobby and caught another taxi to come here.  I came in the front door and found my way backstage.  Once there, I asked one of the techs if there was any coffee.  He pointed to a coffee machine on a table against the wall.  So I walked over and poured myself a cup of coffee into this here Styrofoam cup," he said as he raised the cup to show the audience. 

"It occurs to me," he continued, "the ceramic cup they gave me last year...it was never meant for me at all.  It was meant for the position I held.  I deserve a Styrofoam cup.  This is the most important lesson that I can impart to all of you," he offered.  "All the perks, all the benefits and advantages you may get for the rank or position you hold, they aren't meant for you.  They are meant for the role you fill.  And when you leave your role, which eventually you will, they will give the ceramic cup to the person who replaces you.  Because you only deserved a Styrofoam cup."

What an incredible story!  I wonder if the Under Secretary in Sinek's story was a humble leader when he first spoke at the conference and received the "VIP treatment."  Perhaps it was only when he noticed that he had been drinking from a Styrofoam cup the following year at the conference when the lesson of humility was learned. 

Apparently, Dwight D. Eisenhower, hero of World War II and the 34th President of the United States of America, used to carry a copy of a poem by Saxon White Kessinger in his pants pocket.  The poem is called The Indispensable Man and goes like this:

Sometime when you're feeling important;
Sometime when your ego's in bloom;
Sometime when you take it for granted,
You're the best qualified in the room.

Sometime when you feel that your going,
Would leave an unfillable hole,
Just follow these simple instructions,
And see how they humble your soul.

Take a bucket and fill it with water,
Put your hand in it up to the wrist,
Pull it out and the hole that's remaining,
Is a measure of how much you'll be missed.

You can splash all you wish when you enter,
You may stir up the water galore,
But stop, and you'll find that in no time,
It looks quite the same as before.

The moral of this quaint example,
Is to do just the best that you can,
Be proud of yourself but remember,
There's no indispensable man.

Humility.  It is an indispensable characteristic of leadership.  Even if it is hard to be humble...