Sunday, May 31, 2020

"The Other America"

I have been thinking all day about what to post in my blog tonight.  Unfortunately, words cannot adequately describe what I am feeling right now.  I really just don't know what to say.  How many more black men and women must die before our country finally understands? 

I am not naive enough to realize that I am part of the problem.  I wish that I could tell you that I have lots of minority friends, but I don't.  I wish that I could tell you that I have stood shoulder to shoulder with others to protest what is going on in our world today, but I can't.  I wish that I could tell you that I have always stood for the rights of the minority, but I won't tell that lie.

The truth is, I have lived a life of privilege.  While I have worked hard to get where I am today, the honest truth is that I got a head start because I was born white.  It's also true that I am safer in this world tonight because I am not a black man. 

I have a lot to think about tonight.  There is a lot more that needs to be said.  There is even more work ahead of us.  We have to set this country on the right path forward. 

One of my former Leadership Cincinnati classmates shared a post that I thought was really poignant.  The late Dr. Martin Luther King, Jr gave a speech (check out a video recording of the speech here) at Stanford University on April 14, 1967, which he called "The Other America".  I don't care whether you watch it or read it, but please do one or the other tonight. 

Dr. King speaks of two America's.  One America "is the habitat of millions of people who have food and material necessities for their bodies; and culture and education for their minds; and freedom and human dignity for their spirits. In this America, millions of people experience every day the opportunity of having life, liberty, and the pursuit of happiness in all of their dimensions. And in this America millions of young people grow up in the sunlight of opportunity."  This is the America that I grew up in.

Dr. King speaks of another America too.  "This other America has a daily ugliness about it that constantly transforms the ebulliency of hope into the fatigue of despair. In this America millions of work-starved men walk the streets daily in search for jobs that do not exist. In this America millions of people find themselves living in rat-infested, vermin-filled slums. In this America people are poor by the millions. They find themselves perishing on a lonely island of poverty in the midst of a vast ocean of material prosperity."

It's sad, and more importantly, it is unacceptable that we still have two America's today.   Dr. King's words ring true today, "racism is still alive in American society. And much more wide-spread than we realized. And we must see racism for what it is. It is a myth of the superior and the inferior race. It is the false and tragic notion that one particular group, one particular race is responsible for all of the progress, all of the insights in the total flow of history. And the theory that another group or another race is totally depraved, innately impure, and innately inferior."

Some of his words are even more haunting.  He goes on about something he refers to as "white backlash" - "What I'm trying to get across is that our nation has constantly taken a positive step forward on the question of racial justice and racial equality. But over and over again at the same time, it made certain backward steps. And this has been the persistence of the so called white backlash."

You probably have heard several of the next few passages in the past 24 hours or so.  Dr. King says, "Let me say as I've always said, and I will always continue to say, that riots are socially destructive and self-defeating. I'm still convinced that nonviolence is the most potent weapon available to oppressed people in their struggle for freedom and justice. I feel that violence will only create more social problems than they will solve. That in a real sense it is impracticable for the Negro to even think of mounting a violent revolution in the United States. So I will continue to condemn riots, and continue to say to my brothers and sisters that this is not the way. And continue to affirm that there is another way."

But what has been frequently left out is the rest of this passage - "But at the same time, it is as necessary for me to be as vigorous in condemning the conditions which cause persons to feel that they must engage in riotous activities as it is for me to condemn riots. I think America must see that riots do not develop out of thin air. Certain conditions continue to exist in our society which must be condemned as vigorously as we condemn riots. But in the final analysis, a riot is the language of the unheard. And what is it that America has failed to hear? It has failed to hear that the plight of the Negro poor has worsened over the last few years. It has failed to hear that the promises of freedom and justice have not been met. And it has failed to hear that large segments of white society are more concerned about tranquility and the status quo than about justice, equality, and humanity. And so in a real sense our nation's summers of riots are caused by our nation's winters of delay. And as long as America postpones justice, we stand in the position of having these recurrences of violence and riots over and over again. Social justice and progress are the absolute guarantors of riot prevention."

It is an amazing speech, for it is as timeless today as it was over 50 years ago when he first gave it.  We have two America's.  Until we address that fundamental issue, we will never have progress.  Dr. King's words speak to all of us tonight - the question is, do we hear them?


Thursday, May 28, 2020

"Our finest hour"

There's nothing like a crisis to bring out the best in (some, but not all) leaders.  Last month, on April 5, 2020, Queen Elizabeth II of the United Kingdom did something that she doesn't do very often - she gave a televised speech broadcast to the British people. Hers was a message of hope.  She expressed gratitude to the British health care workers and essential workers, and she offered words of encouragement and resolve to everyone else.  The speech was watched by nearly 24 million television viewers and was apparently only the fifth time that she has given a speech on television in her 68-year reign.

Vogue magazine called it "the hopeful message that the world needs right now".  One of my favorite lines in her speech was this one - "The pride in who we are is not a part of our past, it defines our present and our future."  The line is reminiscent of one voiced by then Prime Minister Winston Churchill during some of the darkest days of World War II, "Let us therefore brace ourselves to our duties, and so bear ourselves, that if the British Empire and its Commonwealth last for a thousand years, men will still say, ‘This was their finest hour.’ ”

Here is the full transcript:

I’m speaking to you at what I know is an increasingly challenging time, a time of disruption in the life of our country, a disruption that has brought grief to some, financial difficulties to many, and enormous changes to the daily lives of us all. I want to thank everyone on the NHS frontline, as well as care workers and those carrying out essential roles who selflessly continue their day-to-day duties outside the home in support of us all. I’m sure the nation will join me in assuring you that what you do is appreciated, and every hour of your hard work brings us closer to a return to more normal times. I also want to thank those of you who are staying at home, thereby helping to protect the vulnerable, and sparing many families the pain already felt by those who have lost loved ones.

Together we are tackling this disease, and I want to reassure you that if we remain united and resolute, then we will overcome it. I hope in the years to come everyone will be able to take pride in how they responded to this challenge, and those who come after us will say the Britons of this generation were as strong as any, that the attributes of self-discipline, of quiet, good-humored resolve, and of fellow feeling still characterize this country. The pride in who we are is not a part of our past, it defines our present and our future.

The moments when the United Kingdom has come together to applaud its care and essential workers will be remembered as an expression of our national spirit, and its symbol will be the rainbows drawn by children. Across the Commonwealth and around the world, we have seen heartwarming stories of people coming together to help others, be it through delivering food parcels and medicines, checking on neighbors, or converting businesses to help the relief effort. And though self-isolating may at times be hard, many people of all faiths and of none are discovering that it presents an opportunity to slow down, pause and reflect in prayer or meditation.

It reminds me of the very first broadcast I made in 1940, helped by my sister. We as children spoke from here at Windsor to children who had been evacuated from their homes and sent away for their own safety. Today, once again, many will feel a painful sense of separation from their loved ones, but now as then, we know deep down that it is the right thing to do. While we have faced challenges before, this one is different. This time we join with all nations across the globe in a common endeavor. Using the great advances of science and our instinctive compassion to heal, we will succeed, and that success will belong to every one of us. We should take comfort that while we may have more still to endure, better days will return. We will be with our friends again. We will be with our families again. We will meet again. But for now, I send my thanks and warmest good wishes to you all.

We do have better days ahead of us.  There are still difficult challenges to be faced, but we will face them with resolve and grit.  We will get through this pandemic.  And we will be better for it.  Our generation will be remembered for what we do today.  And many years from now, our grandsons and granddaughters will read about COVID-19 and say that this was our finest hour.

Wednesday, May 27, 2020

Hungry, hungry hippos

I don't do this very often, so please indulge me at least this once.  I would like to re-visit one of my old blog posts - in this case, a post entitled from Did he really say "Shut up and listen"? way back on November 30, 2016.  The developmental economist Ernesto Sirolli (and founder of the Sirolli Institute) wrote a book called "Ripples from Zambezi" about the lessons that he learned while working with over 250 communities in Africa, Australia, and North America over the course of his 30 year career.  The book can be summarized by the sentence, "In the same way that you can't lead a horse to water, you can't force economic development on people who don't want to be 'developed' according to someone else's ideas."

Sirolli gave a wonderful TED talk in 2012 ("Want to help someone? Shut up and Listen!") in which he tells of an early experience working in an Italian non-governmental organization (NGO) in Zambia in the 1970's.  As he tells it, "Every single project that we set up in Africa failed."  As I posted in 2016:

He tells one particularly poignant story of an early project that involved teaching the local African population how to grow food.  The NGO brought Italian seeds to southern Zambia in order to teach the locals how to grow Italian tomatoes and zucchini.  The area was located along the Zambezi River, and Sirolli tells how the tomatoes grew to two or three times the size of even the best tomatoes in Italy.  He goes on to say how the locals really weren't that interested in learning how to grow tomatoes and zucchini.  They tried paying them, which did work for some, at least on occasion.  Sirolli and his team were obviously very frustrated with the Zambians, but "instead of asking them how come they were not growing anything, we simply said Thank God we're here!"  The Italian aid workers were really proud of how well the tomatoes and zucchini were growing - "just think what we can accomplish here!  We will save the Zambian people from starvation."  But then, overnight, 200 hippos came out from the river and ate all the tomatoes and zucchini.  "And we said to the Zambians, My God, the hippos!  And the Zambians said, Yes, that's why we don't try to grow things along the river."  The Italians asked why the Zambians didn't warn them of the hippos.  "And the Zambians said, You never asked!"

Sirolli tells the story much better than I can - just check out the TED talk.  But here's my point.  The quickest way for any change initiative to fail is to ignore the perspectives and experiences of the experts on the front line (see HRO: Deference to Expertise).  These front line experts understand the contextual factors that will greatly determine whether the change initiative succeeds or fails.  

Context is defined in general terms as the collection of individual, organizational, and environmental factors that both directly and indirectly impact the success of any change initiative.  Context can encompass things such as the willingness of the organization to change, as well as the organization's ability to adapt to the new change itself.  It can even include the leadership skills of the organization's leadership team, as well as their expertise in quality improvement and change management.  Some of my former colleagues at Cincinnati Children's Hospital published a systematic review of research articles that show that context is critically important to the success of quality improvement initiatives in health care (see article here).  Using this background information, they developed what they call a Model for Understanding Success in Quality (MUSIQ) and, perhaps most importantly, showed that their model could be used to significantly increase the chances of successful improvement (see here and here).

Looking back at Ernesto Sirolli's story - what were the contextual factors that were important to the success of their change initiative in Zambia?  It seemed that the Zambians weren't willing to change, at least at first.  As the Italian NGO learned later, the Zambians knew that the NGO's workers were making the wrong assumptions.  They forgot the very important contextual factor of the hungry, hungry hippo.  "Why didn't you tell us?" - "You never asked us!"  

Don't make the same mistake in your next change initiative.  Ask, and more importantly, listen to the experts.  Learn about the important contextual factors BEFORE starting any new change initiative.  And most importantly of all, never, never forget about the hungry, hungry hippos!

Sunday, May 24, 2020

The chimes of freedom

Yesterday, I referenced a famous poem by the 16th Century English poet John Donne called "For Whom the Bell Tolls".  Today, I want to continue along that theme.  The poem's first line says it all, "No man is an island."  We are all connected in this world.  What happens to the people of China has a direct impact on what happens to the people of the United States.  The last line of the poem drives home the message that we all have value, no matter who we are or where we live.

COVID-19 has had worldwide impact, both in terms of the number of lives lost as well as the overall impact of the response to the pandemic on the global economy.  COVID-19 is certainly unique in terms of how much impact it has had on all of us - we are experiencing something that hasn't occurred for over 100 years (at least since the 1918 Influenza Pandemic that killed over 50 million individuals).  COVID-19 has not been unique in terms of how it has disproportionately impacted certain segments of our population.  According to the latest statistics from the CDCBlacks, Hispanic/Latin X, and Native Americans have significantly higher rates of COVID-related hospitalization and mortality compared to Whites.  Unfortunately, these kinds of data are not new or unique to COVID-19.  Across a number of health-related measures, including life expectancy, infant mortality, teen birth rates, and HIV diagnosis, Blacks and Hispanic/Latin X fare far worse than Whites.

The American singer/songwriter and winner of the 2016 Nobel Prize in Literature, Bob Dylan, wrote a song called "Chimes of Freedom".  Dylan apparently wrote the song shortly after the assassination of President John F. Kennedy.  The song tells the story of how Dylan and a companion sought shelter from a lightning storm in a doorway at sunset, and through the song he expresses solidarity with the downtrodden and oppressed.  It is absolutely one of the most beautiful songs ever written, at least in my opinion, and it has been covered by a number of famous artists, including The Byrds, Bruce Springsteen (who called it, "one of the greatest songs about human freedom ever written"), U2, Youssou N'Dour, and Jefferson Starship. 

Dylan's chimes of freedom toll for the rebel, the rake, the luckless, the abandoned, and the forsaken.  They toll for "the aching ones whose wounds cannot be nursed".  They toll for "the countless confused, accused, misused, strung-out ones an’ worse."  They toll for "for every hung-up person in the whole wide universe."

The freedom bells ring for all of us.  White, black, brown, yellow, and red.  So tomorrow on Memorial Day, please remember that we are all one in this great big world.  And perhaps, as we remember the ones who have died for our country, maybe we will remember that they have died for all of us.  Not just the ones who look like us, talk like us, or live like us.  They died for all of us.



Saturday, May 23, 2020

The tolling of the bells

This coming Monday, May 25, 2020, we will honor all of those who gave their "last full measure of devotion" to lay  "so costly a sacrifice upon the altar of freedom".  We recognize all of those men and women who died in the service of their country.  This year, perhaps more than any other in recent memory, words like "service" and "sacrifice" take on a fuller and greater meaning for all of us.

As of this morning, according to the World Health Organization more than 300,000 men and women have died of COVID-19.  According to the Centers for Disease Control and Prevention, there have been more than 1.57 million cases of COVID-19 in the United States with just below 100,000 deaths to date.  Some of the men and women who have died became infected with SARS-CoV-2, the coronavirus that causes COVID-19 while taking care of patients with COVID-19.  We may never know the exact number of health care workers impacted by COVID-19, but we do know that in the month of April alone, there were at least 133 COVID-related deaths among health care workers in the United States and United Kingdom.  So, this Memorial Day, we honor their service and sacrifice as well.

There is no question that the vast majority of individuals infected with the SARS-CoV-2 virus have a minor, self-limited illness.  It is also true that the last major worldwide pandemic that was at least comparable to the current one (the 1918 Influenza Pandemic) was much more severe in terms of the number of individuals infected worldwide (500 million, representing around 1/3 of the entire population at the time) and number of deaths (50 million).  But we cannot ignore - we should not ignore - the staggering loss of human life that has occurred since the beginning of this pandemic.  Can you recall any time in recent history that 1,089 deaths on a single day from any single cause was considered "reassuring"?  People are still dying, every day, in staggering numbers.

For all of these reasons, and more, this year more than any other, Memorial Day 2020 is a special day of remembrance.  Therefore, I hope that you will indulge me by allowing me to spend the next couple of posts on who we need to remember and why.

We are all connected to each other.  I think that the COVID-19 pandemic has proven that assertion.  I am reminded of a poem by the English writer John Donne called "For Whom the Bell Tolls".  The poem inspired both a Pulitzer Prize winning novel (although controversially, the prize was never awarded) by Ernest Hemingway and a song by the heavy metal band Metallica.  The poem's message is an appropriate one for today:

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend's were.
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

In three words, the poem's message is this - we all matter.  Three hundred thousand lives matter.  It matters not for which of those lives the funeral bells toll on Memorial Day, for they toll for you and I.



Wednesday, May 20, 2020

"When you're ready to quit, you're closer than you think."

Robert "Bob" Parsons is an American entrepreneur, billionaire, and philanthropist who is perhaps best known for founding GoDaddy Inc. in 1997.  He sold approximately 70% of GoDaddy and resigned his position as CEO in 201, and he stepped down as the Executive Chairman in 2014.  Parsons and his wife started The Bob & Renee Parsons Foundation in 2012 and joined The Giving Pledge in 2013, an initiative started by Bill and Melinda Gates and Warren Buffett that requires signatories to commit at least half of their fortunes to charity.

Parsons recently posted what he calls, "My 16 Rules" on his blog.  They are actually pretty good, so please check them out for yourself.  I was particularly impressed with his rules #2 and #3.  Both of these rules state essentially the same thing, and I could certainly summarize both with the well-known quip, "Quitters never win and winners never quit!"

Rule #2 states, "Never give up!" It's important to keep pushing until the job is done.  Parsons says, "If it was easy, everyone would be doing it, and you wouldn't have an opportunity."   

I like Rule #3 even better, which says, "When you're ready to quit, you're closer than you think."  Parsons recalls an ancient Chinese proverb that is absolutely perfect.  It says, "The temptation to quit will be greatest just before you are about to succeed."

I am reminded of the epic boxing match between Muhammad Ali and Joe Frazier on October 1, 1975 (the "Thrilla in Manila").  Ali and Frazier had boxed twice before (Frazier had won the first match in 1971 to become the undisputed heavyweight champion, while Ali won the second match in 1974).  The third match would again determine the heavyweight boxing champion and was called the "Thrilla in Manila" based upon Ali's boast that the fight would be "a killa and a thrilla and a chilla, when I get that gorilla in Manila."  

The fight started early in the morning, but even at 10 AM the conditions were unbelievably poor for a 15-round boxing match (the temperature at ringside in the aluminum-roofed Phillippine Coliseum was estimated to be about 120°F).  One of Frazier's ringside staff members said, "It was so intensely hot, I've never before felt heat like that in my life.  Not a breath of air - nothing. And that was sitting there.  Can you imagine being in the ring? I don't know how they did it."

The fight lasted 14 rounds and is widely considered one of the greatest fights in boxing history.  Ali clearly took over the fight in the later rounds, partly due to the fact that Frazier's eyes had almost swollen shut (Frazier's team was unable to apply ice bags to his face between rounds due to the oppressive heat - the ice continued to melt!).  Both men were exhausted, and perhaps both men were beat.  Unbeknownst to Frazier's team, Ali had told his manager, Angelo Dundee to cut off his gloves after the end of the 14th round, but Dundee refused.  Instead, it was Frazier's manager, Eddie Futch who stopped the fight, telling his boxer, "It's all over.  No one will forget what you did here today."

Ali wanted to give up.  He would tell his biographer, Thomas Hauser later, "Frazier just quit before I did.  I didn't think I could fight anymore."  In other words, he was tempted to quit and tried to do so - his manager simply did not let him.  

Times are tough.  We are all dealing with unbelievably hard circumstances and are being asked to do things that we've never had to do in the past.  Some of the decisions that we are being asked to make are incredibly difficult.  The easiest thing would be to just quit.  But we shouldn't.  Because we are just about ready to turn the corner and succeed.


Saturday, May 16, 2020

Shazam!

Before the days of cable television and "The Cartoon Network," "Nickelodeon," and "The Disney Channel," the best time to watch cartoons was on Saturday mornings.  I remember waking up on Saturdays and going downstairs to our family room to watch all of my favorite cartoon shows on television.  Some of my all-time favorites (that I would still legitimately watch today!) were "Scooby-Doo, Where Are You?""Laff-A-Lympics""The New Adventures of Flash Gordon""Looney Tunes" and "Merrie Melodies", and "Super Friends".  There were other shows too, like  "The Banana Splits""Sigmund and the Sea Monsters", and "Land of the Lost"

I remember one show in particular called "The Shazam!/Isis Hour".  The first half of the show was about a superhero named Captain Marvel (actually, there have been two different superheroes named Captain Marvel by different comic book companies - DC Comics' Captain Marvel, also known as Shazam! and Marvel Comics' Captain Marvel, which is why there were two movies starring Captain Marvel characters that came out within the past two years), based upon a Superman-like character named Captain Marvel or Shazam! and his alter ego, Billy Batson.  The second half of the show, "The Secrets of Isis" focused on a female superhero based on the Egyptian goddess, Isis, whose alter ego was a high school science teacher named Andrea Thomas.  Andrea Thomas would become the superhero Isis when she touched an amulet that she wore around her neck and recited the incantation, "Oh mighty Isis!"  The teenage Billy Batson would change into the superhero Captain Marvel whenever he shouted the phrase, "Shazam!"  I loved it!

What I never understood, though, is why Billy Batson traveled around the country in a RV (a 1973 Dodge Open Road motorhome) with his guardian "Mentor" (this story arc was never featured in the comic book).  What was really cool is that "Shazam!" was actually an acronym that explained that Captain Marvel got all of his superhero powers from six immortal elders (see a trailer from the show here):

S - the Wisdom of Solomon
H - the Strength of Hercules
A - the Stamina of Atlas
Z - the Power of Zeus
A - the Courage of Achilles
M - the Speed of Mercury

What a way to encourage a kid to learn about Greek, Roman, and Egyptian (the superhero Isis) mythology!  I had no idea (at least at that age) who most of these gods/goddesses were, but I remember talking about them with my parents and looking them up in our Encyclopedia Brittanica!

Okay, again, I know what you are thinking!  "Where is he going with all of this?"  There are two points actually.  The first point is the importance of having a mentor (just like Billy Batson's "Mentor").  You may recall that the word "mentor" again comes from Greek mythology.  The Greek Mentor was a friend of Odysseus, who instructed Mentor to look after his son, Telemachus, when Odysseus left for the Trojan War (read about this story in Homer's Odyssey).  Mentor's job was to protect and guide the young Telemachus.  If you are familiar with the story, you will remember that the Greek goddess, Athena, appeared as Mentor to help Telemachus during a particular trying time in his life.  Anyway, having a mentor upon whom you can rely and trust is a great thing!  It doesn't matter what stage of your life or how far you go in your professional career, it's important to have a mentor and rely upon your mentor.  I have been fortunate to have several great mentors throughout the different stages of m career, and to this day I often will go to them for advice and support (one of my mentors is now even my boss!). 

The second point I'd like to make is the importance of having role models or personal heroes (just like Billy Batson's "six immortal elders").  As Ryan Holiday wrote in a recent "Daily Stoic" blog post, "It's easy to get busy and get pulled off course by life...we are all influenced by the tempo of our times.  So it's key then, if you want to be good and do good, that you have a kind of North Star in your life that keeps you centered.  A role model who draws you back on course when the events of life or the drift of inertia subtly misdirect you."

The ancient Stoic writer Seneca gave this advice to a friend, "Choose someone whose way of life as well as words, and whose very face as mirroring the character that lies behind it, have won your approval.  Be always pointing him out to yourself either as your guardian or as your model.  There is a need, in my view, for someone as a standard against which our characters can measure themselves.  Without a ruler to do it against you won't make crooked straight."

Just as Billy Batson relied upon his Mentor to guide him along through the daily challenges of life, his alter ego relied upon the six immortal elders for all of his powers.  Moreover, at different parts of the show, Billy (as the teenager struggling with being an adolescent in a changing world, not as Captain Marvel) would speak with the six immortal elders to seek their advice.  We all need mentors, and we all need our version of the six immortal elders.  We may not be able to speak directly with our role models and heroes, but we can read about them and learn how they navigated different challenges in their lives. 

I will end with two quotes (I promise - just two) about mentorship and role models.

"Show me a successful individual and I'll show you someone who had real positive influences in his or her life.  I don't care what you do for a living - if you do it well I'm sure there was someone cheering you on or showing the way.  A mentor."  - Denzel Washington

"When you see a role model, what you see is a person who has the courage to be who you wish you could be.  Stop wishing and just be." - Anonymous


Wednesday, May 13, 2020

"Being approximately right most of the time is better than being precisely right occasionally"

It's a sad but true fact that leaders are humans, and as all humans do, leaders make mistakes.  Leaders of organizations everywhere (and when I say "everywhere", I truly mean every single organization in every single industry in every single country, except maybe Antarctica - which technically isn't a country - all over the world) are making mistakes dealing with the COVID-19 pandemic.  Nothing like this pandemic has ever been seen, at least in the last hundred years (for the most recent lessons learned, see the 1918 Influenza Pandemic).  It's not like leaders can open up a textbook in their reference library or search for "How to deal with a worldwide pandemic and economic shutdown" on Google.

Every leader will look back at the decisions that he or she made during this crisis and say (likely in a number of cases), "If I had to make that decision all over again, I probably would have decided this instead."  The same statement could be made for leaders in any crisis situation.  Case in point.  During the 1914 Imperial Trans-Antarctic Expedition, the leader of the expedition, one of my personal heroes, Ernest Shackleton, made a decision to proceed despite warnings from several whalers at the Grytviken Whaling Station on the island of South Georgia that pack ice conditions in the Weddell Sea were worse than they had ever seen.  Shackleton and his crew departed in their ship, the Endurance, on December 5, 1914, and almost immediately, they encountered the severe pack ice conditions.  Shackleton would say, "I had been prepared for evil conditions in the Weddell Sea, but had hoped that the pack would be loose. What we were encountering was fairly dense pack of a very obstinate character."  Just a few weeks later, the Endurance became trapped in the pack ice, and the rest, as they say is history (if you don't know the rest of the story, please check out my previous posts on Shackleton: The Last Voyage of the Endurance"To the Edges of the Earth...", and Now is the time to lead).

In retrospect, perhaps Shackleton's decision wasn't the best decision to make under the circumstances that existed at that time.  Some will argue, fairly I might add, that leaders like Shackleton succeed on expeditions like the Imperial Trans-Antarctic Expedition exactly because they proceed in the face of danger.  The key point here is that Shackleton was an incredibly resilient leader who could quickly adapt and lead through a crisis to turn failure into success (in this case, not the successful completion of the expedition's goal but having all of the expedition's crew survive and return to England).  The important lesson for us is that resilient leaders learn from their mistakes and become even better leaders in the end.  Shackleton became exactly the kind of leader that his crew needed in incredibly difficult circumstances.

The Pulitzer-prize winning journalist and author Charles Duhigg recently wrote an article in The New Yorker comparing the leadership response to the COVID-19 pandemic in Seattle versus New York City.  I highly recommend the article, but in essence, the take-home message is that the crisis leadership team in Seattle followed the Centers for Disease Control and Prevention pandemic leadership playbook (see the CDC's Field Epidemiology Manual), while the crisis leadership team in New York City did not.  Duhigg's main point is about communication (the CDC's Field Epidemiology Manual dedicates an entire chapter to just communication entitled "Communicating During an Outbreak or Public Health Investigation").  Perhaps the most important recommendation is to identify a consistent spokesperson with a "Single Overriding Health Communication Objective" that is repeated at the beginning and the end of every communication with the public.  In addition, the designated spokesperson should "acknowledge concerns and express understanding of how those affected by the illnesses or injuries are probably feeling."  Empathy is incredibly important.

The CDC's Field Epidemiology Manual also recommends that the lead spokesperson should be a scientist!  Duhigg relates a conversation he had with former acting CDC Director, Dr. Richard Besser, who said, "If you have a politician on the stage, there's a very real risk that half the nation is going to do the opposite of what they say."  Seattle's lead spokesperson was a scientific expert, while New York City's lead spokesperson was Mayor Bill De Blasio.

With this in mind, dear reader, consider who has been the lead spokesperson for the federal government's COVID-19 response.  At times, it has been either Vice President Pence or President Trump's son-in-law, Jared Kushner.  Most of the time, the lead spokesperson has been President Trump himself.  How has that gone?  If you haven't been paying attention, consider his suggestion that disinfectants or bleach could be used to kill coronavirus in patients.

As I have mentioned several times in previous blog posts, great leaders, especially those who lead during a crisis, lead by example.  Again, as Charles Duhigg suggest in his New Yorker piece (again referencing the CDC's Field Epidemiology Manual), if the recommendation is that the public should be wearing face masks at all times, the lead spokesperson during all press conferences should model that behavior by wearing a mask too.  Again, look what has happened on the national stage.  Vice President Pence refused to wear a face mask during a tour at the Mayo Clinic.  Yesterday, The Wall Street Journal reported that the White House directed officials to wear face masks at all times inside the building, except when sitting at their own desks.  Incidentally, the White House also reported that "President Trump and Vice President Pence aren't expected to start doing so."  Again, leaders lead the way.

Finally, I will close with a quote that Scottish epidemiologist John Cowden wrote in a 2010 article published in the journal Emerging Infectious Disease, "Being approximately right most of the time is better than being precisely right occasionally."  What is true for epidemiology is also true for crisis leadership.  Leaders will make mistakes.  They are human.  The important point is that the great leaders, like Shackleton, learn from their mistakes and do better the next time.

Monday, May 11, 2020

Everyone's working for the weekend?

Don't ask me how my brain works.  While I was trying to think of how to start this blog post tonight , I kept going back to a memorable line in the opening scene of one of my all-time favorite movies, Francis Ford Coppola's 1972 classic, "The Godfather".  Apparently there is a Sicilian tradition that a Mafia boss cannot refuse a request on his daughter's wedding day.  Don Corleone ("The Godfather") tells an individual, "Some day - and that day may never come - I will call upon you to do a service for me."  He then grants the request (and much later in the movie calls for the service as payment).  Why I was thinking of that line, I don't know.  Maybe it reminded me of "Once upon a time..." (or even, "A long time ago in a galaxy far, far away") - who knows.  Perhaps I thought of this line because it seems like the end of the COVID-19 pandemic will never come.  Regardless of how things seem right now, I can assure you that the pandemic will eventually end, and when it does, the world will be a much different place.

As I read through different articles on the state of the world economy, it's becoming ever more apparent that we need to prepare for a new state of normal after COVID-19.  I suspect that after nearly 2 months of remote working from home, there will be calls from both employers and employees to explore remote working as a more permanent thing.  Organizations, including those in health care, will begin to experiment with different staffing models.  I can't help but wonder whether some of these different staffing models have been tried before in the past (as they say, "Past is prologue").  

One of the strangest work experiments I've ever come across was something that the Soviet Union tried almost a century ago.  It started on a Sunday - the Sunday of September 29, 1929 to be exact.  Joseph Stalin believed that he could increase productivity by completely doing away with the weekend.  While that doesn't seem all that revolutionary - several organizations work all 7 days of the week - Stalin's concept of a continuous work week was completely bonkers.  He completely threw out the Gregorian calendar (which defines the first day of the week as Sunday and the last day of the week as Saturday) and created a new Soviet calendar that had five days per week!  He called it, nepreryvka, or “continuous working week."  Saturdays and Sundays were completely abolished.  

With the new Soviet calendar, workers were divided into five groups, and each group was assigned one day off.  Therefore, on any given day, four-fifths of the population was working.  Stalin thought that productivity would take-off like Sputnik (okay, bad analogy since Sputnik came long after Stalin, but you get my point).  The problem was that a worker's friends and family members could be assigned to a completely different day off from work, so in some cases, husbands and wives never saw each other.  Stalin's new calendar failed miserably.  Just two years later, he tried to change the calendar to six working days, but by 1940 that experiment had failed too.  

The writer, Judith Shulevitz described Stalin's failed experiment in an article in the November 2019 issue of The Atlantic.  She goes on to lament the loss of the 40 hour work week (who works forty hours anymore?).  Organizations are continually tinkering with the work schedule in order to maximize productivity and minimize expenses.  The problem is that the schedule that maximizes productivity may not always be the best schedule for the individual worker.

Undoubtedly, some of us will want to continue to work from home once the shelter-in-place orders subside.  Workers need to feel safe, and those workers who are at a higher risk of COVID-19 or (depending on whether children return to school) those workers who struggle with child care issues may choose to continue to work from home.  However, I know of others who have remained productive while working at home but feel socially isolated and would choose to return to work.  It's incumbent upon organizations to find ways to meet both their needs as well as the needs of their employees.  We would do well to remember the failed experiment known as nepreryvka.  We would do well to assess the impact of new staffing and working models on productivity, as well as things like employee satisfaction and work-life balance.

Friday, May 8, 2020

"Amateurs talk strategy. Professionals talk logistics."

It's almost a truism that commonly cited quotes were never really said by the individual who is often credited with them.  Case in point is the title of today's post.  General Omar Bradley (famous World War II general, one of only five 5-star Generals in the history of the U.S. Army, and former Chairman of the Joint Chiefs of Staff) is often credited with saying it, though he likely never did say the exact quote.  There was a passage in his autobiography, A Soldier's Story that is similar, "For military command is as much a practice of human relations as it is a science of tactics and a knowledge of logistics."

Former U.S. Marine Corps General Robert Hilliard Barrow (General Barrow was the 27th Commandant of the Marine Corps from 1979 to 1983 and served for a total of 41 years in the Marine Corps) was interviewed by the San Diego Union Tribune on November 11, 1979 and apparently said, "Amateurs talk about strategy and tactics.  Professionals talk about logistics and sustainability in warfare."

Regardless of who said it, if anyone, it summarizes a really important point.  While there are many definitions of strategy, tactics, and logistics (and these three concepts, particularly strategy and tactics are often confused), here are my favorites.  "Strategy" describes the overall objective - the destination, if you will - and how a team is going reach that objective.  "Tactics" describe the specific actions that will be required to meet the overall objective.  "Logistics" describes the process by which the right people are placed in the right position at the right time to execute the tactics necessary to successfully achieve the strategic objective.

While "strategy" defines the long-term goals, "tactics" are much more concrete, specific, and detailed (in this context, the initiatives that will be completed to reach the objective).  The ancient Chinese military strategist, Sun Tzu wrote in The Art of War, "Strategy without tactics is the slowest route to victory.  Tactics without strategy is the noise before defeat."  But Sun Tzu also had an important comment to make about logistics.  He said, "The line between disorder and order lies in logistics."

Strategy, tactics, and logistics truly represent the sine qua non of leadership.  Management guru Tom Peters said, "Leaders win through logistics.  Vision, sure.  Strategy, yes.  But when you go to war, you need to have both toilet paper and bullets at the right place at the right time.  In other words, you must win through superior logistics."

King Philip II of Macedon (father of Alexander the Great) reportedly was once leading his army on a campaign and stopped to make camp for the night.  As he prepared his orders, one of his aides stopped him and told him that the location for the army's camp lacked sufficient pasture for the army's horses and pack animals.  Philip II reportedly cursed and said, "O Hercules, what a life I lead if I am obliged to live for the benefit of my asses!"

During business school, I participated in a simulation called "The Beer Game."  The "Beer Game" was developed by an individual named Jay Wright Forrester at the MIT Sloan School of Management in 1960 and is probably the best illustration of the importance of logistics.  I first learned about the "Beer Game" in the book "The Fifth Discipline" by Peter Senge.  There are a number of simulations available for free online, but essentially individuals play the game as a brewer, a distributor, a wholesaler, or a local retail store.  The game's objective is simple in concept, but difficult in execution - keep up with the changing customer demand for beer.  By playing the game, individuals will learn firsthand the concept of the "Bullwhip effect".  If players master the art of supply chain logistics, they will win the game.  It's actually a lot of fun to play, and you learn a lot about logistics while doing so!

Logistics is just as important as strategy and tactics.  And the best leaders worry about logistics as much as, if not more than, strategy and tactics.

Wednesday, May 6, 2020

"The first wealth is health"

I was reading an article by a highly regarded health economist from Harvard named William Hsiao (highly regarded is probably a vast understatement) who started his article with the following statement:

"Despite spending almost twice as much as Australians, Canadians, Japanese, and many Europeans, Americans suffer from lower life expectancy, higher infant mortality rates, and a higher prevalence of heart disease, lung disease, and sexually transmitted infections.  This reflects the deep dysfunction in the U.S. health care system."

Okay.  Really?  I can be convinced, with not a lot of effort, that the U.S. health care system (some would argue that we don't really have a system at all) deserves at least a share of the blame for the lower life expectancy and higher prevalence of heart disease, but can when we start pointing fingers at whose to blame for the higher prevalence of sexually transmitted infections, I'm not sure we can say it's because of the dismal state of our health care system.

Let me be clear.  I am not saying that we don't have major issues with the U.S. health care delivery system.  As the late Walter Cronkite once said, "America's health care system is neither healthy, caring, nor a system."  But I am not sure that the success or failure of a nation's health care system can be directly measured by its life expectancy or infant mortality rate, and certainly we shouldn't measure how effective a health care delivery system is by the incidence of sexually transmitted disease. 

Just today, I refilled a prescription for a chronic medication that I've been taking for several years (for my cholesterol).  As many of you know, I recently moved started a new position in a new city, so this was the first time I refilled my prescription on my new health insurance plan.  When I spoke with the pharmacy, they told me that the prescription would cost me about $180.  I thought that was a little strange, especially since it was listed on our pharmacy plan's drug formulary.  So, I called my health insurance hotline and spoke directly with one of the customer service representatives.  When I told her the price of my medication, she was surprised.  However, she confirmed that it was indeed going to cost me $180.  She then recommended that I go to a website, download a coupon, and pay for the drug on my own.  That is exactly what I did.  How much did it cost me? Thirty-five dollars.

I know what you are thinking.  I should feel fortunate that (1) I am only on a cholesterol medication, (2) I have health insurance, and (3) I can afford both the $35 as well as the $180.  But what does it say when there is a five-fold difference in cost and it is the self-pay that was the least expensive?  If you want to argue that point as a marker of the state of our health care delivery system, then go right ahead.

The current COVID-19 pandemic is also revealing some of the problems in our health care system.  However, again, is it the responsibility of the health care delivery system to manage public health and welfare?  If so, we should be spending our health care dollars in vastly different ways (see additional discussion on this point here).  If we are going to be measured by the prevalence of sexually transmitted infections, again we should be spending our money on things like prevention and education as opposed to treatment. 

I agree with the philosopher, Ralph Waldo Emerson, that "the first wealth is health."  When people are healthy, they are more productive members of societies, in many, many different ways.  Public health is absolutely important - it is the lifeblood of any nation.  Perhaps, in a post-COVID world, public health and health care delivery will be linked more closely together, and maybe we will invest (similar to the countries mentioned above, I might add) just as much on developing our public health and welfare systems as we do on our health care delivery system.

Sunday, May 3, 2020

"All the world's a stage..."

When I was young, I used to mix up a lot of metaphors (see "You can lead a horse to water, but you can't teach him to fish").  It happened so often at the family dinner table, it became like a running joke (which, if my grade school memory is correct, is an example of a simile and not a metaphor!).  Regardless of how bad I screwed metaphors up, however, one thing became quite clear (maybe "crystal clear" or "clear as day") to me, metaphors are used all time ("they are as numerous as the stars in the sky").  

One of my favorite metaphors of all time was one used by the playwright, William Shakespeare in the play, As You Like ItIf I were being completely honest though, I first heard it in a song by one of my favorite musical group, Rush, in the song, Limelight ("All the world's indeed a stage, we are merely players, performers, and portrayers!").  Metaphors convey meaning and understanding in a highly efficient way.  

As one literary expert writes (see Writer's Edit), "Metaphors can convey meaning and conjure up images, thoughts and feelings in a reader’s mind with just a few simple words. Sometimes instead of using a few sentences or a paragraph to describe something, a metaphor can provide a stronger description with a lasting impact. This also allows the reader to use their imagination and interpretation and become more engaged in your writing. A metaphor can be used to set a scene, express a mood or even just to get straight to the point and not lose a reader in a paragraph of descriptions when a simple metaphor can show the reader so much more."

Leaders use metaphors too.  In his first Inaugural Address, President Franklin D. Roosevelt said, "I assume unhesitatingly the leadership of this great army of our people dedicated to a disciplined attack upon our common problems."  He wasn't talking about leading an army to war.  Rather, he was talking about becoming President during the Great Depression and leading the American people back to prosperity.

There have been TED talks, business articles, and entire books written about the power of analogy and using metaphors in a leadership context.  What's the evidence that using metaphors and analogies really work?  In other words, is there evidence showing that metaphors and analogies actually "convey meaning and conjure up images, thoughts, and feelings...with just a few simple words"?  If you've ever read my blog, you know that I wouldn't ask that kind of question without knowing the answer!  

Just over forty years ago, two investigators at the University of Michigan (Mary Gick and Keith Holyoak) reported their findings in the journal, Cognitive Psychology.  They used a well-known problem called "Duncker's radiation problem" (named after the psychologist, Karl Duncker, who is perhaps most famous for the Candle problem).  Basically, the problem is as follows.  A doctor has a patient with a malignant tumor, and for whatever reasons, radiation is the only treatment option.  Using radiation will kill the tumor cells but will also damage the surrounding healthy tissue.  Using a lower dose of radiation will prevent damage to the healthy tissue but won't kill the cancer cells.  What's the solution to this doctor's treatment dilemma?

Only about 10% of the study population were able to come up with a solution on their own.  Gick and Holyoak used the following analogy to help study participants come up with the solution:

A small country was ruled from a strong fortress by a dictator.  The fortress was situated in the middle of the country, surrounded by farms and villages.  Many roads led to the fortress through the countryside.  A rebel general vowed to capture the fortress.  The general knew that an attack by his entire army would capture the fortress.  He gathered his army at the head of one of the roads, ready to launch a full-scale direct attack.  However, the general then learned that the dictator had planted mines on each of the roads.  The mines were set so that small bodies of men could pass over them safely, since the dictator needed to move his troops and workers to and from the fortress.  However, any large force would detonate the mines.  Not only would this blow up the road, but it would also destroy many neighboring villages.  It therefore seemed impossible to capture the fortress.  However, the general devised a simple plan.  He divided his army into small groups and dispatched each group to the head of a different road.  When all was ready, he gave the signal and each group marched down its road to the fortress so that the entire army arrived together at the fortress at the same time.  In this way, the general captured the fortress and overthrew the dictator.

Does that help you come up with a solution?  As it turns out, reading this story before presented with the radiation problem only increased the percentage of subjects coming up with the solution to 30% (better than 10% for sure, but still not that great!).  However, when the subjects were given a hint that the solution to the radiation problem could be found within the story, the solution rate increased to an almost perfect 92%!    

Can you figure the solution out?  By using multiple low-intensity rays converge from multiple different locations on the tumor, such that the total dose of radiation hitting the tumor would kill it without damaging any of the surrounding healthy tissue.  In other words, exactly like how the general was able to move his army down multiple different roads to attack the fortress!

Leaders can and should use stories, analogies, and metaphors in order to effectively communicate.  There is a power to analogical thinking.  Just be careful not to mix up the metaphors!