Monday, March 30, 2020

This year especially, Happy National Doctor's Day!

Today, March 30th, is the day we celebrate all of our physicians on National Doctor’s Day.  This year, more than any year I expect, we are thinking very differently about what it means to be a physician - indeed, what it means to be a health care worker - in our communities, our cities, our country, and or world.  For today, all across the world, physicians, nurses, and allied health professionals are literally putting their lives on the line to take care of their patients.  They are heroes, in every sense of the word.

A few years ago, I wrote a post on National Doctor's Day that I re-read this morning.  The words that I wrote then are even more profound today, so I'd like to share them with you again today, though slightly edited for brevity's sake:

My first faculty appointment following fellowship was at the Children's Medical Center at the Medical College of Georgia in Augusta, Georgia (the hospital and university have since gone through a number of name changes and are now called Children's Hospital of Georgia and Medical College of Georgia at Augusta University, respectively).  One of the things that I remember most about my time at MCG was a plaque in the old library building dedicated to one of the school's early founders, Dr. Milton Antony.  Dr. Antony is buried at the historic "Old Medical College of Georgia" site (which is now on the National Register - see here), and I believe the plaque was originally at his burial site.  The plaque recognized Dr. Antony's contributions to medicine in the city of Augusta, the state of Georgia, and the Southeast region.  Notably, Dr. Antony founded the Southern Medical and Surgical Journal, which is still published today by the Southern Medical Association as the Southern Medical Journal. The plaque contains the following inscription:

In memory of Milton Anthony, M.D., Founder of this College.  A martyr to humanity and to the duties of his profession, during the fatal epidemic of 1839.  Cheered by Religious Faith through the Griefs and Trials of this life, he passed from the cure of the sick to the sleep of the just, amid the tears and blessings of the poor.  True to his own favorite maxim that a virtuous will is almost omnipotent, he overcame by study the defects of education and, patiently toiling to eminence, bequeathed to posterity a noble example of genius and industry, animated and directed by Patriotism and benevolence.

What impressed me then, and why I remember the plaque to this day, was the fact that Dr. Antony gave his life in service to his poor patients during a Yellow Fever epidemic in the year 1839.  How many other physicians have died, doing their duty in providing care to the sick?  How many physicians, nurses, and allied health professionals are putting their lives on the line today in this global COVID-19 pandemic?  


For many of us in health care, we were called to our respective professions because we wished to serve.  Caring for patients is one of the most ancient of callings.  Today, that calling goes beyond merely caring for our patients.  So many of our physicians today are, without even a second thought, stepping up to care for patients with COVID-19.  Some physicians have even lost their lives as a result.

Today, of all days, celebrate what these individuals are doing.  They are heroes.  Happy National Doctor's Day!  Stay safe and be well.



Sunday, March 29, 2020

"You know what to do, just do it"

General Norman Schwarzkopf once said, "The truth of the matter is that you always know the right thing to do.  The hard part is doing it."  There is nothing wrong to be afraid or anxious about making decisions, particularly during times of crisis (for a very thorough and in-depth study of this topic, see the book, "Making Decisions Under Stress: Implications for Individual and Team Training", edited by Janis A. Cannon-Bowers and Eduardo Salas).  However, the truly great leaders are the ones that rise above their fears to go ahead and make the difficult decisions.

If you have been reading my blog over the years, you know that one of my favorite television mini-series was the 2001 HBO series "Band of Brothers" (based upon the book of the same name by Stephen E. Ambrose - also one of my favorites), which was produced by Steven Spielberg and Tom Hanks.  The series tells the story of the men of E ("Easy") Company, 2nd Battalion, 506th Parachute Infantry Regiment, 101st Airborne Division from the start of their jump training in the United States and on through to the end of the European Theater of World War II.  I recently watched one of the later episodes, "The Breaking Point" which occurs shortly after the famous Siege of Bastogne during the Battle of the Bulge.  The episode is a character study of good versus bad leadership during a crisis.  The Company's Commanding Officer is 1st Lieutenant Norman Dike, who is the "bad leader" in the story, while the Company's First Sergeant (later promoted) Carwood Lipton is the "good leader."  Lipton describes Dike's shortcomings poignantly as follows:

"He wasn't a bad leader because he made bad decisions.  He was a bad leader because he made no decisions."

In both examples, the quote by General Schwarzkopf and the episode in "Band of Brothers", there is a suggestion that leaders should not succumb to the so-called "paralysis by analysis."  Some times, executive leadership requires executive action.  There are times when leaders will be forced to make a decision without limited information.  At these crucial points, they may have to make a decision based on their "gut feelings."  As the early 19th century German writer Johann Wolfgang von Goethe wrote:

"He who deliberates lengthily will not always choose the best."

The question then becomes, why are some leaders hesitant to make decisions - and for that matter, why are all of us sometimes hesitant to make decisions?  There are countless studies that have tried to answer this exact question, but I want to focus on just three of them.  I've covered one of these studies in a previous post ( "The Tyranny of Choice").  So, let's talk about this one first.  Sheena Iygengar and Mark Lepper published "When choice is demotivating: Can one desire too much of a good thing?" in the Journal of Personality and Social Psychology in 2000.  In their study, consumers were asked to select a gourmet jam from either a set of six types of jam or a larger set of 24-30 types of jam.  Consumers were more likely to buy the gourmet jam when confronted with a limited number of choices.  Only 3% of the consumers bought jam when confronted with the larger set of choices, while 30% of the consumers bought jam when confronted with the limited set of choices!  Moreover, the consumers reported a greater degree of satisfaction after they made their selection when confronted with the limited set of choices.  In other words, one of the reasons why we have difficulty making decisions, particularly under stressful conditions, is that we are seemingly paralyzed by the number of choices.  Based on this study then, leaders can make their jobs easier by narrowing their focus (i.e., set priorities) and limiting the number of decision choices.  Where feasible, pushing decision making authority to front line leaders and managers (see "HRO: Deference to Expertise"  and "You know what to do...") can help facilitate better decision making for the times when the executive leader has to be the one to make the decision.

The second study that I want to review speaks more to the fact that we are incredibly uncomfortable making decisions under conditions of uncertainty.  In a study by Amos Tversky and Eldar Shafir published in 1992 in the journal Psychological Science ("The disjunction effect in choice under uncertainty"), college students were offered the choice to purchase a trip to Hawaii over winter break.  There was a catch though (there's no such thing as a "free lunch" after all) - the students were told that they had taken a test before the break.  If they passed, nothing further was required.  However, if they failed the test, they would have to take the exam on the first day back from winter break.  The vacation offer was only good for one day.  Just over half of the students who passed the exam decided to purchase the vacation offer (conceivably as a reward for their test performance), while a slightly larger percentage who failed the exam decided to do so (conceivably as a consolation for failing the exam).  Here's where it gets interesting.  In a different group, students were told that they wouldn't find out their exam scores until after the offer to purchase the vacation had expired.  Less than a third of the students chose to purchase the vacation when they didn't know how they fared on the exam!  In other words, adding the element of uncertainty changed the decision to purchase the vacation offer significantly! 

As I stated above, it is rare that a leader will have access to all of the information that he or she needs to make an important decision.  However, by recognizing that (1) uncertainty makes us all uncomfortable and (2) that's completely okay is important.  Sometimes the mere recognition that uncertainty is uncomfortable is all we need to push ourselves into making a decision.  In the second part of the Tversky and Shafir experiment, students were told that they could pay money (a non-refundable $5 fee, which after all, is a lot of money for a college student) in order to delay the decision on purchasing the vacation package for a day until after they found out their exam scores.  In other words, we will go to unbelievable lengths at times, just to get more information to make decisions!  Leaders should avoid that temptation to eliminate all uncertainty and instead focus their efforts and energy on making the decision with the information that they have at hand.

The third and final study was published by Timothy Wilson and colleagues in 1993 in the journal, Personality and Social Psychology Bulletin ("Introspecting about reasons can reduce post-choice satisfaction").  Here again, college students were given the choice of two different posters showing famous works of art to hang in their dormitories.  Half of the students were asked detailed questions about why they liked or disliked one poster over the other.  The remaining half of the students were told just to pick based on their gut instinct.  Those students who went with their gut were much more satisfied with their decision several weeks later.  In other words, we may have a tendency to over-analyze decisions to the point where we make a decision that we will later regret.  Our first hunch or gut feeling really tells us how we really feel, and we should learn to pay attention.

I am not saying that we should always go with our gut instinct.  I am also not saying that we shouldn't be careful about the decisions that we make.  I am simply calling attention to the fact that leaders have to make decisions, at times when they are pressured to do so with limited time and limited information.  The best leaders acknowledge their limitations, use what information that they have to conduct a quick analysis, and then act decisively.  At times, that means going with a gut feeling.  We usually know what to do - in these cases especially, it's important to just do it.




Tuesday, March 24, 2020

Money can't buy me love, but can it buy me happiness?

I believe it was Sir Paul McCartney who said, "I don't care too much for money, money can't buy love."  Nobody said it better.  But if money can't buy love, can it at least buy happiness?  In other words, does having more money make people happy?

My wife and I have been extremely fortunate throughout our lives.  Even during the early years of our marriage when money was tight, we always knew that there was the proverbial light at the end of the tunnel.  We always knew that if things got really difficult for us financially, our family would certainly help us.  As I look back on all those years and compare them to now, I really can't say that being financially more secure has made me any happier.

We had a conversation recently about our respective retirement plans, specifically relating to the recent stock market declines related to the COVID-19 pandemic.  Watching our retirement savings fall steadily lower each day could certainly put anyone in a bad mood.  But here's the thing - that was always money for the future.  While we certainly earned the money, it was never money that we actually "saw" in our pockets.  So even if it seems like the last 5 years didn't really happen, at least from the perspective of our retirement plan, that's okay.  We will still be okay.  It may take a few years to build up our retirement, but we will be fine.

I am also not naive enough to realize that what is true for my wife and I, may not be true for everyone.  As I said at the beginning, we have been incredibly fortunate.  We will be okay.  I worry about others who do not share in that fortune.  However, I am amazed that, at least anecdotally, it is those individuals who are more financially secure than we are that are the ones who are crying the loudest about the current stock market woes.  In other words, it seems that the wealthiest individuals are the ones who are most concerned about their stock market portfolio these days.

Which begs the question, does money "buy" happiness?  Are those who are wealthy happier than those who are not?  You won't be surprised (at least if you've been reading my blog) that there are a number of studies that have tried to answer this exact question.  A couple of years ago, investigators at my alma mater, Purdue University, conducted a statistical analysis using data from the Gallup World Poll that involved over 1.7 million individuals living in over 160 countries around the world.  They published their findings in the journal, Nature Human Behavior. They controlled for a variety of demographic factors, including the region and average income where individuals lived.  Subjective well-being was measured using a validated scale.  Income was measured in U.S. dollars and was adjusted for average purchasing power by region. 

What these investigators found may surprise you.  Consistent with other studies on this topic, they found that there was a positive association between subjective well-being and income.  However, this relationship peaked at a certain level of income.  As it turns out, once an individual made more than $95,000 per year, there was no further increase in a measure called "life evaluation," which really means life satisfaction.  In fact, increases beyond this salary was associated with a slight decrease in life evaluation.  These findings differed slightly by country and region of the world, but the relationships certainly held true.  Emotional well-being had an even lower peak - in other words, emotional well-being increased with income up to approximately $65,000, at which point it slightly decreased with further increases in income.  As reported by Purdue University, "This may be because money is important for meeting basic needs, purchasing conveniences, and maybe even loan repayments, but to a point. After the optimal point of needs is met, people may be driven by desires such as pursuing more material gains and engaging in social comparisons, which could, ironically, lower well-being."

So, based on this study, it would appear that money can buy happiness, but only up to a certain point.  I think the better conclusion is this - if you are doing okay, don't worry about what is happening with the stock market.  It will come back, even if it takes a few years.  Worry instead about those individuals who don't have any extra money to fall back on.  Worry about those who are much less fortunate than all of us. 


Sunday, March 22, 2020

"...all of this has happened before"

The ancient Roman philosopher-king, Marcus Aurelius wrote in his book Meditations, "Remember to bear in mind constantly that all of this has happened before.  And will happen again - the same plot from beginning to end, the identical staging."  He was referring at the time to the Antonine Plague of 165 CE, which scholars now feel was likely due to either smallpox or measles.  The virus was said to have started in the East, likely in China.  It spread quickly to the east, west, north, and south.  It crossed borders and traveled across oceans, until it became a worldwide pandemic. 

Ryan Holiday also referred to the Antonine Plague in his "Daily Stoic" blog post this past week, "The only thing that spread faster than the contagion was the fear and the rumors.  People panicked.  Doctors were baffled.  Government officials dawdled and failed.  Travel was delayed or rerouted or aborted altogether.  Festivals, gatherings, sporting events - all cancelled.  The economy plunged.  Bodies piled up."

Sound familiar?  History, as I have often said (see "Past is Prologue" and "Study the Past"), repeats itself.  These kinds of worldwide pandemics are not new - just read about the Bubonic Plague (the so-called "Black Death") during the Middle Ages, the Spanish Flu of 1918, or even the cholera pandemics of the late 19th and early 20th centuries.  The stories of these pandemics from the past are eerily familiar to those of us dealing with the COVID-19 pandemic of today.

The lesson here, which I think bears repeating.  We live in a global society.  Indeed, based on what I can tell from the pandemics above, we have always lived in a global society.  What happens in one part of the world absolutely impacts what happens on the opposite end.  That was the way it was during the Antonine Plague, the Black Death, and the Spanish Flu, and that is the way it is today.  We are all connected - in many ways, we are even more connected now than we ever have been in the past.

Any attempt to isolate ourselves from the rest of the world simply will not work.  We are all interconnected.  Just look at what has happened with our supply chains.  Why do we hear so muchg about shortages of personal protective equipment (PPE)?  Just take a guess where most of the PPE we use today is made?  China.  What about the recent concerns about a shortage of the nasal swabs that are so essential to testing for COVID-19?  Guess where they are made.  Italy.

Consider the so-called "butterfly effect" from chaos theory.  It is metaphorical for sure, but illustrative of what I am talking about here.  It states that when a butterfly flaps its wings in Brazil, there will be a tornado in Texas.  Why does this happen?  Again, speaking purely in metaphors, small events in one part of the world can have drastically different effects in another simply because we are all connected in a large-scale system.  The decisions that are local and national leaders make today will have an impact on what happens all around the world.

We would do well to remember this lesson.  "All of this has happened before."  And it will surely happen again.


Friday, March 20, 2020

"These are the times that try men's souls..."

Thomas Paine, writing in his essay, The Crisis, on December 23, 1776 said, "These are the times that try men's souls."  You've probably heard that quote - it's frequently repeated.  What followed, however, is usually not.  "The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country; but he that stands by it now, deserves the love and thanks of man and woman."

We are in the midst of a crisis of epidemic (sorry for the pun) proportions.  As the CEO of our hospital said during a town hall meeting earlier this week, "Time will forever be remembered as what happened before COVID-19 and what happened after."  The events of these past several weeks (and unfortunately, the weeks to come) will be remembered for countless generations.  Some day in the future, maybe a hundred years from now, people will talk about the COVID-19 pandemic just like we talk about the Spanish Influenza pandemic of 1918.

Leaders will be measured by how they respond during this crisis.  As I stated in a previous post, "Now is the time to lead".  The great leaders will be able to tame the chaos, while the average leaders will allow chaos to take over.  I have been lucky to work with several leaders over the years who have "tamed the chaos."  Here are some of the key points that I have learned from these great leaders along the way:

1. Simplify the message:  Crisis situations are constantly changing.  What's true one minute may be very different the next.  Information, almost never complete, comes in from several different sources and at several different points in time.  Trying to put all of the pieces together in order to start making decisions about actions is literally like putting a jigsaw puzzle together, only the puzzle doesn't have any picture.  People want answers to their questions, and the answers that a leader can give are usually not the kind that the people want to hear.  The worst possible thing that a leader could do in this situation is to complicate the message.  Clear, concise, simple.  That's how a leader should communicate.

2. Be proactive as much as possible: One of the most difficult aspects of crisis leadership is that the situation continues to evolve.  Leaders in this situation find themselves reacting to each and every aspect of the situation at hand, and there is very little time to think or plan ahead.  I have found that the best leaders in a crisis situation delegate some of these decision-making responsibilities to others so that they can focus on keeping a few steps ahead of the situation.  Leaders should be proactive, rather than reactive.  Think ahead. 

3. Preserve routines and create new ones: The normal daily routines, both personal and professional are often completely disrupted during a crisis.  For example, during the current COVID-19 pandemic, schools across the country have shuttered their doors and instructed teachers to use online teaching so that students don't get too far behind.  That is incredibly disruptive - in this situation, trying to preserve some semblance of a daily routine is important.  I have heard of teachers trying to follow a similar, albeit abbreviated schedule of classes so that students recognize the normal daily routine.  If preserving the daily routine is simply not feasible, leaders should try to create new routines.  People like order.  Chaos leaders to fear - order leads to resolve and resilience.

4. Be calm and stay above the fray: The best leaders remain calm during a crisis.  The world could be falling apart (and usually is), but the leader stays calm and above the fray.  Moreover, these leaders let the people see how calm they are during a crisis.  Calmness is contagious, but unfortunately so is panic.

The early Americans had their "sunshine patriots" and "summer soldiers" (kind of like the "fair-weather fan"), but they also had leaders like George Washington.  Those were the times that tried men's souls, but now is that time again today.  We need leaders who won't shrink from their service to our country and our world.  And one day they too will "deserve the love and thanks of man and woman."

Tuesday, March 17, 2020

"All politics is local"

Their is a commonly heard saying that "all politics is local."  According to multiple sources, former Massachusetts congressman and Speaker of the U.S. House of Representatives, Tip O'Neill first coined the phrase based upon the idea that a politician's success depends to a great extent upon his or her ability to understand, and in some cases, even influence the political views and issues most important to his or her constituents.  There is an ongoing debate that politics is less local than it used to be, not just here in the United States, but all around the world.  That may or may not be true, but that's not really what I want to talk about today.


We see today, in the current worldwide crisis due to the COVID-19 Pandemic, a number of examples where, in the absence of any significant or effective leadership at the federal government level (at least in the United States), local civic leaders (state governors and city mayors) stepping up and showing what it means to be a crisis leader.  I am thinking in particular about local leaders like Governor Mike DeWine in Ohio, whose quick decision-making and control of a highly fluid and rapidly escalating situation have earned widespread praise, as opposed to the almost universal condemnation of President Donald Trump's ineffective (or in some cases, absent) leadership.  But, I don't want to talk about COVID-19 anymore either.


What I want to explore is the concept that widespread political change happens first at the local level.  There is no question that people are generally very unhappy with government.  For example, a study conducted by the Pew Research Center last year found that about slightly more than half of all Americans believe that democracy is working well.  More revealing was the finding that a majority of Americans (61%) stated that significant changes are needed in our government.  However, while it is tempting to suggest that a lot of that unhappiness has been recent, it's just not true.  In fact, the generalized unhappiness with our political system has been with us for a very long time.  One could even argue that it started at the very beginning (I am talking about during the early days with of our nation's history). 


In that same Pew Research Center study, slightly over two-thirds (67%) of all Americans had a favorable opinion of their local government (compared to only 35% of  Americans who had a favorable opinion of the federal government).  Is that because local government is more effective, or is it because local government is viewed as more concerned with the needs of their constituents?  That's hard to say for sure, and I am not a political theorist, but I suspect that may be the case.


If you want a couple of great examples of really effective political leadership, check out two of the books on my 2020 Leadership Reverie Reading List - A Prayer for the City by Buzz Bissinger (he also wrote the book "Friday Night Lights" about Texas high school football that was made into a movie and a television series) and Our Towns: A 100,000-Mile Journey into the Heart of America by James and Deborah Fallows.  The two books are quite different, but they both support the idea that effective political change happens first at the local level.


A Prayer for the City tells the story of a big-city mayor, Ed Rendell, took office in 1992 at a time of significant unrest and turned things around.  At the time, the city of Philadelphia was on the verge of bankruptcy and dealing with violent crime, racial unrest, a failing public school system, and the flight of the middle-class to the suburbs.  Rendell's leadership calmed the tension, jumpstarted the economy, and rescued the schools, and turned the city around.  Bissinger had unprecedented access to Governor Rendell for three years, and tells the story of Philadelphia's dramatic turnaround through the lives of five Philadelphia citizens.  The Publishers Weekly said, "Bissinger's unflinching report is an inspirational saga for those who care deeply about the crisis of America's cities."  I would agree.


The husband and wife team of James Fallows and Deborah Fallows is both different in scope and similar in concept in their latest book, Our Towns: A 100,000-Mile Journey into the Heart of America.  Over the course of nearly five years (2012-2017), the couple flew in their single-engine Cirrus SR-22 plane all across America, visiting mostly small towns, as well as a few large cities, such as Columbus, OH, Los Angeles, CA, and Charleston, WVa.  They visit 29 towns across the United States.  The two authors alternate chapters, so you get a little bit different perspective on each city that they visited.  The book becomes, on the one hand, a travel diary, and at the same time is a documentary of life across America.  They describe both the challenges and successes of local leaders in both large cities and small towns. 


It is perhaps not too surprising that no mayor has ever gone directly from city hall to the White House.  Mayors Pete Buttigieg and Bill de Blasio are only the latest two mayors to fail in that attempt.  But I can't help but wonder that are small towns and cities are functioning like laboratories of democracy.  If what they say is true, that all politics are indeed local, then it is at the local level where political change can and will happen first.





Sunday, March 15, 2020

"Now is the time to lead"

Those of you who regularly read my blog (thank you, by the way!) know that I am a huge fan of the Antarctic explorer, Ernest Shackleton (see, for example, previous posts "The Last Voyage of the Endurance""To the Edges of the Earth...", and most recently "A tale of two leaders").  Briefly, Shackleton was an Irish explorer who made several trips to the continent of Antarctica, including a trip with the British explorer, Robert Scott from 1901-1904 (the so-called Discovery Expedition), his own Nimrod Expedition of 1907-1909, at which time he and his three companions established a new "Farthest South" record at 88°S latitude (just 97 miles from the South Pole), and his ill-fated Imperial Trans-Antarctic Expedition from 1914-1917, which he is perhaps most famous for now.

It was on Shackleton's last voyage that his ship, Endurance, became trapped in pack ice and was slowly crushed.  He and his crew camped and walked across sea ice and launched their three lifeboats to ultimately reach Elephant Island, at which time Shackleton and a few companions traveled in one of the remaining lifeboats to South Georgia Island to seek help.  The rest of the crew were rescued successfully.  It is one of the greatest tales of heroism from the Age of Exploration, and Shackleton is one of the best examples of the kind of leadership that is needed during a crisis.  Incidentally, Shackleton made one last trip to Antarctica in 1921, but he died of a heart attack while his ship was at South Georgia Island.

On one of his darkest days, on the morning of April 11, 1916, Shackleton was preparing to leave the pack ice with his men in their lifeboats (Dudley Docker, Sir James Caird, and Stancomb Wills) on their desperate attempt to reach Elephant Island.  Shackleton recalled, "It was a day that seemed likely to lead to no more days.  I do not think I had ever before felt the anxiety that belongs to leadership quite so keenly."  Simply put, Shackleton was scared and nervous.

Shackleton had personally recruited each and every man that was on the expedition.  Recall that the recruitment advertisement that he used before the voyage stated as follows (although, to be completely transparent, no such advertisement has ever been found):

"Men wanted for Hazardous journey.  Small wages, bitter cold, long months of complete darkness, constant danger.  Safe return doubtful.  Honor and recognition in case of success."

Having personally recruited his men, Shackleton felt directly responsible for their well-being and for their survival.  In other words, he, as the leader, was taking full responsibility and accountability for what was about to happen.  That point, better than any other statement, truly explains the "anxiety that belongs to leadership" and the "loneliness of leadership" that so many leaders during crisis situations report and describe.  As the English playwright, William Shakespeare famously wrote in his play, Henry IV, "Uneasy lies the head that wears the crown."

Loneliness.  Anxiety.  All leaders feel them during the best of times and even more so during the worst of times.  Crisis leadership is especially prone to the anxiety and loneliness of leadership.

The question is what can leaders do to stave off some of the anxiety and loneliness of leadership?  Here are some important considerations.

1. Leaders aren't alone in their feelings of loneliness.  It happens to all leaders - for example, the Harvard Business Review reported in 2012 that more than half of CEO's report being lonely in their roles as leaders.  Just search "loneliness of leadership" on Google - I just did and there are about 17,400,000 results!  Recognizing that all leaders can feel lonely, anxious, or scared, particularly during a crisis, is important.

2.  Being lonely isn't the same as being alone.  With the obvious exception of leaders who find themselves in a similar situation as Ernest Shackleton's experience, most leaders, even in a crisis, will have individuals who they can talk to for guidance, mentorship, and support.  Even if it's a fellow CEO or leader at a competitor, there are always other individuals who leaders can go to for support.

3.  Acknowledge loneliness and anxiety.  We all succumb to these feelings.  Acknowledge and recognize that no one is perfect.  Acknowledge and recognize that even leaders will make mistakes.  It's all okay.

We can't all be leaders like Ernest Shackleton. But if we proactively acknowledge and recognize that fact, we will be okay.  As Canadian Prime Minister, Justin Trudeau, said in a commencement address to New York University on May 16, 2018:

"In every generation, leaders emerge because they one day awake to the realization that it's not up to someone else to fix this problem, or take up that cause.  It's up to them.  So now is the time to lead."

"Now is the time to lead."  Even if you are anxious, feeling lonely, or scared.  Lead.




Wednesday, March 11, 2020

"Study the Past"

The last time I was in Washington, D.C., I passed by the National Archives Building while going on a late afternoon run.  There are two 10 foot tall statues on either side of the entrance on Pennsylvania Avenue carved out of Indiana limestone.  Past is an old man who is gazing down and holding a closed book that represents history.  The inscription on the pedestal is from the ancient Chinese philosopher, Confucius and reads, "Study the Past" (Incidentally, Confucius' entire quote says, "Study the past if you would divine the future"). 


Future is a young woman gazing outward, presumably toward the future, who is holding an open book that symbolizes what has yet to be written.  On the pedestal is an inscription from William Shakespeare's play, The Tempest, "Past is Prologue" (again, the entire quote is "What's past is prologue").  Both statues symbolically mean that the past history sets the context for the present and the future.  In other words, "Those who cannot remember the past are condemned to repeat it." 


I've mentioned these statues before in a previous post (see "Past is Prologue").  They came to my mind earlier this past week when I was listening to a podcast called "The History of Rome" - today's episode (which actually first aired several years ago) talked about the ancient Roman concept of a dictator.  Merriam-Webster's online dictionary defines the word "dictator" in one of three ways:

1. A person granted absolute emergency power

2. One holding complete autocratic control

3. One ruling in an absolute and often oppressive way

It is the first definition that applies to ancient Rome, and it is this definition that I am particularly interested in today.  Here, in this context, during the days of the Roman Republic, a dictator was an official who was entrusted with the full authority of the government to deal with either a military crisis or other important and specific duty.  Once the crisis was over, the dictator would give up power, returning governmental authority back to the Roman Senate.  And for the most part, at least up until the time of Julius Caesar, this is exactly what happened. 

Why was there a need for a dictator?  Conceptually, the ancient Romans believed that in a time of crisis, decisionmaking was best placed in the hands of one individual.  It is the ultimate in the "High Reliability" concept of "Deference to Expertise" - in other words, decisions should be made by those who are closest to the action and are in the best position to know, see, and understand what's going on at any given moment.  The Romans shifted from a democratic style of leadership and management to what has frequently been called a "command and control" type of leadership (see the typology by Keith Grint and others here).

Why does all of this resonate with me today, of all days?  One word.  COVID-19.  Many hospitals across the United States have implemented their Disaster Management/Emergency Preparedness plans by shifting to what is known as Incident Command.  Incident Command is a standardized approach to command, control, and coordination of a disaster response.  It provides a common hierarchy that brings all of the resources under one or a few operational leaders.  The hierarchical structure of Incident Command is designed to place critical decisionmaking in the hands of a small number of key individuals who receive critical information from a number of specialized groups that report up through key channels. 

Today's "Incident Command" structure is akin to the ancient Roman Republic's dictator - to be used only in an emergency and once the crisis has passed, followed by a return to normal operations.  As it turns out, "Command and Control" is truly an ancient concept.

It's just one more example of what we can learn when we read about and learn from the past.  Study the past to prepare for the future.  And what is past is truly, today of all days, prologue.

Saturday, March 7, 2020

"The agony of defeat"

If you've read any of my previous blog posts, you know that I love sports.  When I was in the Boy Scouts of America, I earned just about every merit badge that involved sports that you could possibly earn.  My high school offered a number of physical education classes, and I think I took every single one of them, including an advanced weight training class that was offered as "independent study."  I even earned a college degree in a major called "Movement and Sports Science" that included classes in sports psychology, the history of sports, and exercise physiology.  I am addicted to sports - unfortunately, I am not particularly good at them! 


One of my favorite television shows growing up was ABC's "Wide World of Sports".  Even if you don't like watching sports, it's a good bet that you've at least heard the show's iconic opening sequence voiced by the legendary sports broadcaster, Jim McKay (McKay hosted the show from 1961 through 1998).  The show preceded the Entertainment and Sports Programming Network (better known as ESPN) by almost two decades (ESPN's first broadcast occurred in 1979), and one could argue that ESPN was modeled on the success of the "Wide World of Sports."  The show covered all manner of sporting events, everything from Acapulco Cliff Diving to Bull Riding to Demolition Derby to Figure Skating and everything in between.  The script for the opening sequence said it all - "Spanning the globe to bring you the constant variety of sports," which also introduced us to the now commonly used phrases, "the thrill of victory" and "the agony of defeat."  I still get chills when I hear it, even today.


Watch the opening sequence.  While the montage of sports clips that accompanied the phrase, "the thrill of victory" often changed, the clip that accompanied the phrase, "the agony of defeat" never changed.  Today is actually the 50th Anniversary of that particular scene. 


Vinko Bogataj was a ski jumper from Yugoslavia who had entered a ski jumping event in Obsterdorf, Germany on March 7, 1970.  ABC's Wide World of Sports was there to cover the event.  The weather conditions on that particular day were absolutely atrocious.  A light snow had started to fall at the beginning of the competition, but by the time of Bogataj's third and final jump, the snow had started to fall quite heavily and the wind had picked up significantly.  Bogataj realized midway down the ramp (i.e. too late!) that the conditions were too dangerous and that he was going too fast.  He tried to change his center of gravity in order to slow down, but instead he lost his balance and crashed to the ground.  According to a later interview, Bogataj tried to get up to repeat the jump.  Wisely, officials forced him to go to the hospital, where he was later released, suffering only a mild concussion and a broken ankle.


Bogataj was later asked to attend the 20th Anniversary celebration honoring the Wide World of Sports in 1981, where he received a standing ovation (even Muhammad Ali asked for an autograph!).  The sports clip has become so famous that there was even a term (from comedian Rich Hall's book, Sniglets) "agonosis" that refers to the syndrome of tuning in every week to the Wide World of Sports just to watch the "agony of defeat" clip.  Bogataj returned to competitive ski jumping in 1971 but was never able to replicate the success he had achieved prior to the crash, nor the fame he had achieved as a result of it.  He later retired and eventually became an instructor and even coached the 1991 World Champion Franci Petek. 


I know what you are thinking.  "Great story, but what's the leadership lesson?"  Well, besides being a great story (that happened 50 years ago to the day), there's a great lesson here.  What was the first thing that Bogataj said after crashing?  "Can I get up and try again?" I am paraphrasing, but after an absolutely horrible crash, the first thing he wanted to do was get up and try again.  The easiest thing to do after failing at something is to quit.  As the saying goes, "Quitters never win, and winners never quit."  Did you fail?  Fine.  Learn from it.  And then get back up and try again.


We are all human.  That means that we all make mistakes, and we all fail.  Even the best among us have failed.  But what separates greatness from just plain old good is that the great ones view the times that they failed as an opportunity to learn and get better.  The great ones turn "the agony of defeat" into the "thrill of victory." 


As I frequently do, I will end this blog with a few of my favorite quotes on failure.


"Success is not final, failure is not fatal; it is the courage to continue that counts."  Winston Churchill


"When you take risks you learn that there will be times when you succeed and there will be times when you fail, and both are equally important."  Ellen DeGeneres


"Failure isn't fatal, but failure to change might be."  John Wooden

Wednesday, March 4, 2020

Death by Meeting

You've all heard it.  In fact, you've probably all said it.  "That meeting was a waste of time!"  Or, "That's an hour out of my life that I will never get back."  I know I've said both in the past.  We hear a lot about so-called "meeting hygeine", but the actual execution often falls short.  And in the end, we find ourselves sitting in meetings that seem to never end and worse yet, don't seem to have a point.

A few years ago, Patrick Lencioni, an author who has written extensively on leadership and management, wrote a book called Death by Meeting, which tells the story of a busy corporate executive (all of his books have a similar theme, called a "leadership fable" in which he tells a fictional story to describe and teach important management lessons) who finds he is wasting way too much time in all-day meetings.  Full disclosure, I have not read the book.  However, I think the concepts that he discusses are appropriate.

Now, I am going to tell my own "leadership fable."  Imagine you are a busy health care executive.  Your hospital is focusing on a set of quality metrics that support your strategic plan, which of course is consistent with your mission, vision, and core values.  You have scheduled a meeting to review these metrics with the rest of your team, as you will need to be presenting these metrics to the Board next week. 

Sound familiar?  I bet that you have either been involved in a similar kind of meeting in the past, either as the busy health care executive who needs to review the quality metrics or even the team member who needs to report the metrics to your immediate supervisor.  It all sounds very reasonable, right?  And if your hospital is like just about every other hospital around the country, there are regularly scheduled meetings just like this that occur, depending on the metric, weekly, monthly, or quarterly. 

Here's a good question though.  How much time goes into the preparations for a meeting like this?  Well, a few years ago, Michael Mankins wrote a blog post for the Harvard Business Review in which he analyzed how many hours were spent every year on a weekly meeting just like the one I described.  I was talking about it to a colleague a week or so ago and tried to find it.  Luckily, another blogger I follow named Michael Roberto (if you don't follow him, you should!) wrote about Mankins post earlier this week.

So, how many hours do you think were spent every year on the weekly meeting in Mankin's analysis?  Well, the busy executive spent 7,000 hours per year meeting with direct reports and preparing for the weekly meeting (that seems like a lot, but if each health care executive has to report on different metrics, you can understand how roughly 135 hours are spent preparing for one weekly meeting).  Now, consider the fact that each of the executive's direct reports have to meet with each one of his or her direct reports to prepare for that same meeting.  And so on.  And so on.  It all cascades down to the front-line leaders and managers.  Now how many hours were spent?

Would you believe 300,000 hours per year?!?!?  On one weekly meeting that is probably, at best, a report out and nothing more?  It seems almost inconceivable.  But then when you look at the cartoon graphic on the blog and really focus on what Mankin is saying, it seems fairly accurate.  Now THAT is what I call "Death by meeting!"

Think of how much money gets wasted - by just one hospital - every year to prepare for that one weekly meeting.  Mankin goes on to write, "Research shows that 15% of an organization's collective time is spent in meetings.."  Unfortunately, that percentage has increased every year since 2008. 

How can we stop wasting precious time and money on meetings?  Professor Roberto recommends asking five key questions BEFORE scheduling any kind of meeting:

1.  What is the purpose of the meeting?  What are we trying to achieve? 

2.  Who should attend this meeting?  Who does NOT need to be there?

3.  How should we structure the meeting?  How will that structure help us achieve the outcomes we desire?

4.  What pre-work should participants do, and what materials should we distribute in advance, so that we use our meeting time efficiently? 

5.  How do I plan to follow up so as to insure that we do what we say we are going to do after the meeting?  What will I do if we don't achieve the results we expect as a result of decisions taken during the meeting?

These five important questions are an important and fundamental aspect for good meeting hygiene.  Perhaps if we used these questions more, we would waste less time, energy, and money and avoid "Death by meetings."

Sunday, March 1, 2020

"In like a lion, out like a lamb,,,"

Today is March 1st!  If you are like me, you were probably thrown off a little by the fact that yesterday was February 29th (it just felt like it should have been March 1).  The year 2020 was a "Leap Year" when we have to adjust the calendar to make sure that everything stays consistent with the rotation of the Earth around the sun and all (it takes 365 and 1/4 days!).  Well, as the saying goes (by the way, I have no idea where the saying comes from and neither does the Internet), the month of March comes in like a lion and goes out like a lamb.


When you think about the saying, it makes sense.  We are finishing up winter (Spring doesn't officially begin until later in the month), so the weather can still be cold and snowy, at least if you live in that kind of climate (which, I do).  By the time March 31st rolls around, Spring is here and the weather generally is much milder, like a lamb. 


March came in like a lion in more ways than one.  We are dealing with a worldwide coronavirus outbreak (it's not officially a pandemic yet, but it's basically a pandemic).  Stock markets worldwide are in turmoil, largely as a result of fears about the coronavirus epidemic.  Worldwide supply chains have been disrupted.  Hospitals have drug and equipment shortages to deal with as they prepare for increasing numbers of individuals infected with the coronavirus (the infection is officially called COVID-19).  Fear and anxiety is getting worse every day, especially following the announcement that a second individual in the U.S. has died of COVID-19.  Travel restrictions are in place.  There is talk about canceling the upcoming 2020 Summer Olympics in Tokyo. 


The U.S. Presidential election cycle is off to its usual craziness.  There are still more Democratic candidates than there are fingers on my left hand (or my right hand too, I guess).  People are talking about the current frontrunner, Senator Bernie Sanders, in a similar way to how people talked about then candidate Donald Trump in the 2016 Republican primaries ("Anyone but Trump!").


Will March go out like a lamb?  Well, that remains to be seen, but I can tell you how to increase the chances that the end of March will be like a lamb, and not like a lion.  One word.  Leadership.  Now is the time for our nation's leaders - really, our world leaders - to do what they can to "Tame the Chaos".  Now is the time for our leaders to step forward and "be like Musgrave and not like Dalgarno.  Now is the time for leadership.  Whether we get it or not, remains to be seen.  But if we don't, you can almost be 100% sure March will still be roaring like a lion. 


I can't finish without one final literary reference, as I think it will certainly apply to our present situation if our leaders don't step forward.  "Beware the Ides of March..."