Friday, April 29, 2022

It's Fifth Friday!

Today is Friday, April 29, which is officially the fifth Friday of the month.  Having five Fridays in a month only happens about four times every year.  When I was a pediatrics resident at the Naval Medical Center in San Diego, we used to celebrate every "Fifth Friday" by canceling afternoon clinic and gathering together for a barbecue, a friendly game (usually basketball or volleyball), and enjoying our time together with all of the members of our health care team.  It was a great tradition, and one that I wanted to continue after leaving the Navy.  Unfortunately, I was never really in a position of authority to actually make every "Fifth Friday" an actual event.

A few years ago, I found myself in the right kind of position to start celebrating "Fifth Friday" at our hospital.  We started off by alternating every "Fifth Friday" with either breakfast or lunch.  We started off with just our physicians, but in later iterations we invited all of the member's of our hospital medical staff (physicians, dentists, optometrists, advanced practice nurses, physician assistants, nurse anesthetists, and clinical psychologists), as well as all of the physicians in training (medical students, residents, and clinical fellows).  For me, it was always a great time to meet with everyone and express my gratitude for everything that they did to make our hospital a great place to work.

After leaving that institution, I started a similar "Fifth Friday" celebration at my new hospital.  Despite everything that has happened with the COVID-19 pandemic, we have gained momentum and the celebration is usually well attended.  My goal is to continue to push the envelope on this and expand this to the rest of our hospital workforce at some point in the future.  

"Fifth Fridays" are a great excuse to dedicate some time to team-building, celebration, and stress relief.  Given the growing epidemic of burnout in health care, these kinds of events are needed more than ever!  I recognize that there are many, many other things that hospital leaders can and should do to help alleviate stress and burnout, but I think our Fifth Fridays are at least a start.  

Happy Fifth Friday to all!

Thursday, April 28, 2022

Lessons in humility

There's an old Mac Davis song with a rather interesting title, "It's hard to be humble" with an even more interesting first line, "Oh Lord it's hard to be humble, when you're perfect in every way."  Unfortunately, Mr. Davis provides a very good example of hubris, not humility.  As I have stated before (on numerous occasions), humility is an important and indispensable characteristic to leadership.  I will agree with Mr. Davis on one point though, humility can be difficult.

I bring up the topic of humility today in response to a superb article written by David Leonhardt in today's New York Times, "The Power of Humility".  Leonhardt's article is timed perfectly with tonight's NFL Draft, and he opens his article with, "Tonight at the Caesars Forum Conference Center near Las Vegas, thousands of people will gather for an annual demonstration of human overconfidence."  Wow - what gives?  He goes on, "I recognize that many readers of this newsletter are not football fans.  Still, I think the draft is worth a few minutes of your attention, because it turns out to be a delightful case study of human hubris, one with lessons for other subjects, like the economy and COVID-19."  Okay, now you have my attention Mr. Leonhardt!

Fundamentally, the NFL Draft is no different than what most employers do nearly every day - recruiting and choosing which job candidates to hire for an open position.  What is different about the NFL Draft is that the employers (in this case, the team owners, general managers, and coaching staffs) have more information about each prospective candidate than any other employer.  College football players entering the draft are subject to an intensive process which is far beyond what most employers do.  An individual player's performance is judged on the field by thoroughly reviewing game films from their college careers.  They are run through a battery of physical and mental tests (you can test yourself with what the NFL teams use - the Wonderlic test - here) at an event known as the NFL Combine.  They are interviewed by coaches and general managers.

Despite having all of this knowledge, NFL teams notoriously fail when it comes to making the right choice.  Just take a look at the following chart from Leonhardt's article today, showing the top quarterbacks that were selected in the Draft (including the #1 overall pick, Heisman Trophy winner Baker Mayfield):










As you can see, if teams had the opportunity to repeat the 2018 NFL Draft, Josh Allen would likely have been the first quarterback taken.  As a matter of fact, Josh Rosen, Sam Darnold, and Baker Mayfield will likely sit on the bench this year.  Imagine spending all of that money on a bust!  Unfortunately, teams more often than not fail to make the right pick.  Most of the best quarterbacks in the NFL right now were actually drafter after other quarterbacks who haven't performed as well.  And then there is the example of Tom Brady (likely the greatest NFL quarterback of all time), who was selected by the New England Patriots with the 199th pick of the 2000 NFL Draft.

Leonhardt references one of his earlier articles in the Times (this one written on the morning of the 2020 NFL Draft), which referenced a study by the economists Cade Massey and Richard Thaler (incidentally, Thaler won the Nobel Prize in Economics in 2017).  Massey and Thaler studied the NFL Draft and analyzed a player's performance with where they were selected in the draft.  They found that teams were notoriously bad at selecting players.  They found that the chance that a player at a given position (e.g. quarterback, wide receiver, or offensive lineman) turned out to be better than another player at the same position drafted next was only 52% (basically a coin toss, or better yet, dart-throwing monkeys).

Massey said, "Even the smartest guys in the world, the guys who spend hours with game film, can't predict this with much success.  There's no crime in that.  The crime is thinking you can predict it."  Take for example the New York Jets (a team that hasn't been to the Super Bowl since Joe Namath played in Super Bowl III in 1969).  They traded away four of their draft picks in the 2018 NFL Draft in order to move  up only three spots to the sixth pick.  Who did they select with that pick?  Quarterback Sam Darnold, who as you can see in the figure above, has simply not been worth it (he's not even playing for the Jets anymore).  

As Leonhardt points out, the NFL Draft provides us with a lesson in humility and hubris.  Experts simply cannot predict an individual player's performance as well as they think.  As it turns out, what is true for football experts is true for most experts in many other fields.  We do not predict as well as we think, whether the prediction involves what the stock market will do, who will win the next presidential election, or even what will happen during a global pandemic.  Leonhardt writes, "The world is frequently messier and harder to understand than people acknowledge. We tell ourselves artificially tidy stories about why something happened and what will happen next."

If NFL teams can't accurately predict a player's future job performance, even with the mountain of information that they possess on each player, how do you expect employers in other industries will fare with picking top talent?  As it turns out, we are not as good as we think either.  And that is probably okay, as long we acknowledge it.  Humility is better than hubris.  As Albert Einstein once reportedly said, "A true genius admits that he/she knows nothing."

Wednesday, April 27, 2022

Revolutionary love

My wife and I recently went to the beach for a week of rest and relaxation.  Our idea of "fun" is to do absolutely nothing.  We both usually bring a few books along, and this time was no exception.  I ended up reading three books (one of which I had started before we left) - a gigantic 1,000 page biography on Winston Churchill (Churchill: Walking with Destiny by Andrew Roberts), which I thoroughly enjoyed (this was the one I had already started); an older book on game theory (Thinking Strategically by Avinash Dixit and Barry Nalebuff); and a dystopian novel that is apparently the first in a trilogy (The Dandelion Insurrection by Rivera Sun).  

I spend most of my time reading non-fiction.  Lately, or so it seems, the novels I've read are from the post-apocalpytic or dystopian genre (what's that say about me?).  Here are some of the recent ones: The Postman by David Brin, which was made into a movie starring Kevin Costner and Will Patton, New York 2140 by Kim Stanley Robinson, and The Road by Cormac McCarthy, which was made into a movie starring Viggo Mortensen.  Unfortunately, while I enjoyed the story, there was something about The Dandelion Insurrection that just didn't click with me.  Regardless, the major theme of the book was powerful and poignant for our time.  

Towards the beginning of the story, one of the main characters, "The Man from the North" wrote to his followers, "In a time of hate, love is a revolutionary act."  Wow!  If ever there was a time for revolutionary love, we are living in one.  The statement was so powerful that I wanted to dig a little deeper into its meaning.

I came across a TED talk by the filmmaker, lawyer, and activist Valarie Kaur, who gave a TED talk entitled, "3 lessons of revolutionary love in a time of rage" in 2017 and founded the Revolutionary Love Project.  One of her friends was killed in a hate crime after September 11, 2001, prompting her to document hate crimes against Muslims and Sikhs in the United States, which resulted in an award-winning documentary, Divided We Fall: Americans in the Aftermath.

Kaur defines revolutionary love as follows:

“Revolutionary love is a well-spring of care, an awakening to the inherent dignity and beauty of others and the earth, a quieting of the ego, a way of moving through the world in relationship, asking: ‘What is your story? What is at stake? What is my part in your flourishing?’ Loving others, even our opponents, in this way has the power to sustain political, social and moral transformation. This is how love changes the world.”

“Love calls us to look upon the faces of those different from us as brothers and sisters. Love calls us to weep when their bodies are outcast, broken or destroyed. Love calls us to speak even when our voice trembles, stand even when hate spins out of control, and stay even when the blood is fresh on the ground. Love makes us brave. The world needs your love: the only social, political and moral force that can dismantle injustice to remake the world around us – and within us.”

“To pursue a life of revolutionary love is to walk boldly into the hot winds of the world with a saint’s eyes and a warrior’s heart – and pour our body, breath, and blood into others.”

Perhaps all of this is a little too deep for a beach read, but I was absolutely mesmerized by it all.  Given everything that is going on in our world today (and I won't catalog them here, as all you have to do is watch the evening news), we need revolutionary love.  It could be the only thing that keeps our world from falling apart.

I occasionally get accused of politicizing too much (see "A Brief Hiatus" from July, 2020).  You can certainly choose to ignore this post.  But I ask you, before you do, to just take a moment to peer deep inside your own heart and ask yourself, "What can I do to make this world a better place?"  I bet that your answer sounds a lot like revolutionary love.

"In a time of hate, love is a revolutionary act."

Monday, April 25, 2022

GoRuck

A few weeks ago, I watched an in-flight movie on a trip to a medical conference in San Diego called The Standard.  The movie is now available on Hulu, Amazon Prime, and YouTube.  Apparently there is an organization called GoRuck that claims to sell the world's toughest "rucking" gear (according to the company's website, "rucking" is "just walking with weight on your back").  GoRuck was founded in 2008 by a former U.S. Army Special Forces Green Beret named Jason McCarthy.  The company employs about 150 Special Forces veterans.

The organization also sponsors and runs a series of training clubs and competitions, including "GoRuck Selection", a self-proclaimed "world's toughest endurance event" in which competitors spend just over 48 grueling hours being tested by a group called the Cadre (all veterans of U.S. military Special Forces).  The event is patterned after the U.S. Army's Special Forces Selection.  The movie, "The Standard" is about one of the "GoRuck Selection" events (Class 019).  Only the toughest competitors (about 2%) finish the entire 48 hour competition.  The movie was tough to watch, as these competitors go through hell and back.  What's incredible is that the "GoRuck Selection" provides competitors with just a glimpse into what Special Forces soldiers go through during their 24-day selection (if you want to learn more, check out "Chosen Soldier: The Making of a Special Forces Warrior" by former Navy SEAL Dick Couch).

I have been told that the selection process for any branch of the U.S. military's special forces (U.S. Navy SEALs, U.S. Army Rangers, U.S. Army Special Forces are perhaps the best known examples) requires more mental fortitude and resilience than physical strength and endurance.  For example, one of the recurring themes in "The Standard" movie was that individuals often can go far beyond the point of physical exhaustion.  As the American psychologist and philosopher William James said, "Most people never run far enough on their first wind to find out they've got a second."

I've posted about this concept before (see "Winnie the Pooh and the Navy SEALS").  William James wrote in The Energies of Man ""Beyond the very extreme of fatigue and distress, we may find amounts of ease and power we never dreamed ourselves to own; sources of strength never taxed at all because we never push through the obstruction."  Former Navy SEAL David Goggins calls it "the 40% rule". Simply stated, the "40% rule" states that when your brain is telling you that you can't go on anymore, you are really only 40% done.  Deep down, your body can handle more stress and you can face even greater challenges.

All of this - the "40% rule" and "The Standard" is really about something that we call resilience.  I won't argue that any of us will ever come close to pushing ourselves to the point that the U.S. Navy SEALs or U.S. Army Special Forces seem to do on a daily basis.  But as leaders, we should be able to appreciate that we can do more than we think.  Our teams can do more than they think.  Maybe it really is about "mind over matter".  That "never give up" attitude is something that we all can and should aspire towards - we should commit to resilience.

Sunday, April 24, 2022

Be compassionate...

Rasmus Hougaard, Jacqueline Carter, and Marissa Afton recently wrote a nice article on the subtle, but important differences between empathy and compassion in an online article for the Harvard Business Review ("Connect with Empathy, But Lead With Compassion").  As they point out in their article, the words sympathy, empathy, and compassion are often used interchangeably, but that is not quite right.  Using a classic 2x2 chart with "Understanding of the other's experience" on the x-axis and "Willingness to support" on the y-axis, they explain the difference between these words and why we need to understand that they are different:


  















Looking at the lower left-hand side of the graph, we see that when we experience pity for someone, we feel sorry for them without necessarily fully understanding what they are going through or being willing to help them.  When we experience sympathy, we are a little more willing to help and perhaps understand someone's experience better.  As we move diagonally up and to the right on the graph, we move towards empathy, where we may share the lived experience of the other person (literally taking on the emotions that they are feeling) and be even more willing to help them.  Finally, rather than just sharing the person's emotions (empathy), compassion is when we take a step away and actually move to help that person.  As Hougaard, Carter, and Afton write, "Compassion is an intention versus an emotion."

If you are still confused on the difference between empathy and compassion, perhaps a quote from Paul Polman, the former CEO of Unilever will help, "If I led with empathy, I would never be able to make a single decision.  Why? Because with empathy, I mirror the emotions of others, which makes it impossible to consider the greater good."

Empathy is a necessary step towards being compassionate.  Unfortunately, when we stop at empathy, we may not always make the right decisions that can help someone who is in distress.  When we are showing compassion, it's almost as if we are stepping outside ourselves and taking a broader view of the individual's circumstances, which allows us to better assess the situation, make better decisions, and actually act to positively address the situation.

The psychologist Paul Bloom talks about a study from the mid-1990's in his book, Against Empathy: The Case for Rational Compassion by C. Daniel Batson and colleagues, "Immorality from empathy-induced altruism: When compassion and justice conflict".  Study participants were told that they were going to work for a charity (entirely fictitious) called "The Quality Life Foundation" which provided funds to help improve the lives of terminally ill children (sort of like the real Make-A-Wish Foundation).  After listening to an interview with a 10 year-old child named Sheri Summers (again, fictitious), participants were given the opportunity to move Sheri up on the priority list, although this would mean that another child, perhaps one more deserving than Sheri, would not receive the funds.  Half of the participants were told to be objective, while the other half were told "try and imagine how the child who is interviewed feels about what has happened and how it has affected this child's life" (a prompt designed to elicit empathy).  Nearly three-fourths of the subjects who read the empathy prompt moved the fictitious patient Sheri up on the list (compared to just one-third in the group who were told to remain objective)!

Compassion then, is being able to take a broader view in order to actually help serve the greater good.  As Paul Bloom writes in his book, "I want to make a case for the value of conscious, deliberative reasoning in everyday life, arguing that we should strive to use our heads rather than our hearts."  Compassionate leaders use their heads and their hearts.

Hougaard, Carter, and Afton go on to suggest five key strategies for compassionate leadership:

1. Take a mental and emotional step away - As the study mentioned above by Batson and colleagues suggests, we can often make the wrong decisions when we are too empathetic.  We can avoid falling into this "empathy trap" by stepping out of the emotional space to get a clear perspective of the situation so that we can make a decision with our head, not our heart.

2. Ask what they need - Asking the simple question, "What do you need?" is sometimes all it takes to help someone.

3. Remember the power of non-action - Remember that in many situations, people don't need you to solve their problems, but rather just listen and care.  

4. Coach the person so they can find their own solution - As Hougaard, Carter, and Afton write, "Leadership is not about solving problems for people.  It is about growing and developing people, so they are empowered to solve their own problems."

5. Practice self-care - Show self-compassion by taking care of yourself!  It's hard for leaders to be compassionate when they are struggling themselves.

We could all use a little more compassion and kindness in the world.  Long ago, the Greek philosopher Plato wrote, "Be kind, for everyone you meet is fighting a harder battle."  The Chinese philosopher Confucius wrote, "Wisdom, compassion, and courage are the three universally recognized moral qualities of man."  And more recently, Albert Schweitzer suggested that "the purpose of human life is to serve, and to show compassion and the will to help others."

Friday, April 22, 2022

Dostadning

My wife and I have been living in two different places for the past two years (it's a really long story and has a lot to do with the COVID-19 pandemic).  We moved to a new city about 2 years ago and decided to rent a condominium close to my work.  We kept our old house during this time and drove back and forth at least once a month.  We recently sold our house, and we are close to completing our transition to our new home and city.  It's an exciting time, even if a little bittersweet.

We've been packing up a lot of the furniture and personal belongings that didn't make the move to our new city.  Surprisingly, we still have a lot of things in our old house.  We've made several trips back and forth to our local Goodwill , and we've thrown a lot of old things out (thank you 1-800-Got-Junk? and our local trash company).  Notably, had we moved two years ago, I do not think we would have thrown as many things out or donated as many items to Goodwill.  I suspect that, in the interest of time, we would have just moved everything.

I made a comment to a co-worker that perhaps Marie Kondo could learn from our experience!  We told ourselves that, "If we haven't touched it for at least two years, it's probably time to donate or pitch it."  One of our daughters told us, "When in doubt, throw it out!"  My colleague at work told me, "You are just doing a Swedish death cleaning - it's called dostadning."  I am always curious to learn new things, so I searched for the word dostadning on the Internet.

The word dostadning apparently comes from two Swedish words - "do" meaning "death" and "stadning" meaning "cleaning."  As it turns out, my colleague was right, the word literally means "death cleaning."  There's even a book by Margareta Magnusson called, The Gentle Art of Swedish Death Cleaning: How to Free Yourself and Your Family from a Lifetime of Clutter.  The concept here is that you should declutter your life now, so that your family won't have to do it after you die (it's a little morbid, I realize, but the concept still makes a lot of sense to me).

Here's the thing, though.  Dostadning doesn't have to be just about decluttering the things at home.  We can and should metaphorically declutter the things we have accumulated in our professional lives too.  Every so often, we should take a good, hard look at the things that we do that keep us busy.  Are we spending our time and energy on activities that are going to make us better as individuals or that help us to achieve our goals?  If not, it's time to stop.  We should remove all the junk and the clutter, and focus our attention on the things that are important to us.

As Marie Kondo herself said, "From the moment you start tidying, you will be compelled to reset your life. As a result, your life will start to change."  She was referring to tidying up your house, but I think she meant that we should tidy up our lives too.  Dostadning.

Wednesday, April 20, 2022

Go ahead and wear that Barry Manilow shirt!

My wife and I attended a wedding a few months ago.  The wedding was a three hour drive away from us, so we left on Friday evening after work.  Neither one of us packed ahead of time, so we each threw some clothes in a bag and left home in order to beat the rush hour traffic.  Unfortunately, I brought one of my dress shirts with French cuffs and forgot the cuff links.  I had to wear the shirt, so I just went without cuff links.  My wife kept telling me that no one would notice, but I wasn't so sure.  Rather than risk being caught, I simply told my sister-in-law who was sitting next to me what had happened.  She just shrugged it off.

I didn't know it at the time, but I was experiencing what cognitive psychologists call the "spotlight effect".  The "spotlight effect" is that tendency that we apparently all have to overestimate how much people notice things about us.  It's as if we had a spotlight shining on us to highlight all of our personal flaws for everyone in the world to see.  The "spotlight effect" was first described by Thomas Gilovich, Victoria Husted Medvec, and Kenneth Savitsky in a study published in the Journal of Personality and Social Psychology.  These investigators found that college undergraduate students significantly overestimated how many of their classmates would notice that they were wearing an embarassing T-shirt to class (in this case, the T-shirt was a Barry Manilow shirt!).  It wasn't even close!  

Apparently we are so self-absorbed that we believe that we are the center of the universe.  Okay, it's probably not quite that extreme, but you get the picture.  We falsely believe that we stand out in the eyes of others, both in a positive sense ("Wow, look at the dude, he is so cool!") and negative sense ("Wow, look at the dude, he is such a nerd!").  The evidence tells us that this is simply false - unless we are wearing a clown outfit in the middle of a crowd, people aren't likely to notice anything different about us.  

So next time you are having a "bad hair day" or have a spot of coffee on your shirt, don't worry about it.  Chances are that people aren't going to notice.  As Adam Grant recently said on Twitter, "The people you are trying to impress are probably busy trying to impress someone else."  Go ahead and wear that Barry Manilow shirt - proudly!

Monday, April 18, 2022

Michael Scott's 10 rules for business

I never really watched the television show, The Office, when it was on regular television, but since the pandemic I've become absolutely addicted to it.  As I stated in two previous posts (see "Is Michael Scott a bad boss?" and "Leader...ship"), my wife and I binge-watched the show on Netflix all the way from start to finish.  I've found that both the cable television networks Comedy Central and
Freeform broadcast reruns of the show on an almost nightly basis, so I end up wasting a lot of free time watching old reruns of the show.  I've yet to go to The Office Experience here in Chicago, but it is definitely on my "To Do" list (assuming that I can get tickets - it's been sold-out for a while).

A few nights ago (I told you that I watch the show a lot), I watched episode 4 of the second season ("The Fire"), where Michael Scott, the Regional Manager of Dunder Mifflin Scranton tries to provide mentorship to the temporary employee, Ryan Howard, by giving him his "Ten Rules of Business" (all while everyone in the building evacuates due to a fire that Ryan accidentally started by the way).  I thought they were pretty good.  I realize you can probably just look them up on the Internet, but I decided to list them here and give my own interpretation instead.

Rule #1: You need to play to win, but you also have to win to play.

I like the first half of this rule a lot.  I think the key issue here is that in order to be successful (and you can define success however you want), you have to be willing to take risks.  You have to to start somewhere.  One of my mentors once told me, "You will never get the research grants that you don't apply for, so go ahead and apply."  An ancient proverb says that the journey of 1,000 miles begins with a single step, and that is absolutely true.  You will never complete a journey that you don't begin.  So take that first step.  Put yourself out there, and go for it.

The second half of the rule is a little more nuanced, and in order to fully appreciate its meaning, you are going to have to take a close look at it.  The individuals who are winning in the game of life are the ones who persevere through the tough times and find a way to win.  These individuals see obstacles, not as barriers, but as ways to move forward.  As the ancient Stoic philosopher and Roman emperor Marcus Aurelius said, "The impediment to action advances action. What stands in the way becomes the way."

Rule #2: Adapt, React, Readapt, Apt.

Here is a great example of a typical improvisation by Michael Scott (he calls it an "improversation") - he literally makes things up on the fly.  However, I find again that there is a lot more truth in this rule than even Michael Scott probably intended.  I am reminded of the OODA loop developed by U.S. Air Force Colonel John Boyd (Observe-Orient-Decide-Act) or the PDCA cycle (also known as the Shewhart Cycle, Plan-Do-Check-Act, which is more commonly known as a PDSA cycle for Plan-Do-Study-Act).  

I'm not sure what "Apt" means here in this context (and neither did Michael Scott I suspect).  I suspect he meant to say "Act" here.  Regardless, what is important is the sequence of actions that help leaders make decisions and react to situations, no matter how complex or unexpected.  

Rule #3: In business, image is everything.

Michael Scott was referring to the Canon television commercials ("Image is Everything") from the late 1980's featuring U.S. tennis star Andre Agassi.  Once again, Michael Scott nailed it with this one.  Image, i.e. how an individual or an organization is portrayed and perceived by the public, matters a lot more than you think.  Respect, trust, and loyalty are earned with difficulty.  Unfortunately, they are also very easy to lose.  

Rule #4: Safety first, i.e., don't burn the building down.

Remember that during this specific episode, everyone had to evacuate the building due to a fire.  At the end of the episode, we learn that the fire was started by a piece of bread in the toaster (and apparently Ryan was the one who had accidentally started the fire by trying to make a piece of toast).  Again, there is more here than meets the eye.  I interpret this rule as "Take care of yourself" and "Don't burn out."  There is a strong association in health care between employee engagement, wellbeing, and safety and patient outcomes.  As the saying goes, "Put on your own oxygen mask first."

Well, that's it.  If you're paying attention closely, I said that I was going to tell you "Michael Scott's Ten Rules of Business."  If there are indeed ten rules, he never told anyone on the show.  I suspect that he was making these up on the spot all along, but then you have to remember that this show was a situation-comedy.  Regardless, even his four rules have a lot to tell us.  We would all do well to keep them in mind, both in our personal and professional lives.

Thursday, April 14, 2022

Holes

Several years ago (it seems like forever), our family spent just over a year in Augusta, Georgia.  I remember we moved into our brand new home (the builder had just finished it a week or so before we moved) right around the first of July, and the builder had decided to plant grass seed in the backyard rather than sodding it.  If you've ever spent time in Georgia, you know that the summers are very hot.  Grass doesn't grow too well in that heat, so our backyard stayed dry, dusty dirt for most of the summer.  My wife and I still joke about the time that our kids refused to "go out and play" because (1) it was too hot and (2) the backyard looked like the movie Holes!   

The 2003 movie Holes was based on a book of the same name by the author Louis Sachar.  The movie (and book) is about a wrongfully accused and convicted adolescent named Stanley Yelnats, who is sent to a juvenile correctional facility in the middle of dry lake bed in Texas.  The prisoners spend their days digging holes in the dry desert lake bed in order to "build character."  The warden is really making them dig holes to find a lost treasure.  The book won both the 1998 U.S. National Book Award for Young People's Literature and the 1999 Newbery Medal, and the movie was very popular with an all-star cast, including Sigourney Weaver, Jon Voight, Patricia Arquette, Tim Blake Nelson, and Shia LaBeouf in his movie debut.  I won't spoil things by giving away the plot, except to say that thankfully I could not find any evidence that the highly venomous yellow spotted lizards truly exist!  Watch the movie - or better yet, read the book!

If you do watch the movie, you'll see very quickly that digging holes really seemed pointless to the prisoners.  It reminded me of the old chain gangs that pounded large rocks with sledgehammers in order to make smaller rocks ("Let's make work!").  Meaningless tasks are not very motivating - what's the point of doing a good job if the job means nothing at all?  I wrote about the meaning of work in a post earlier this month (see "The Search for Meaning"), specifically focusing on a study by the psychologist Dan Ariely which found that recognition and monetary awards can certainly motivate employees to improve their performance and/or productivity (even in an otherwise meaningless task).  However, the more compelling finding was that the study showed that attaching a "meaning" to the work also significantly improves performance and productivity!

I wanted to talk about a couple of other studies that I found when researching this topic.  Most of the investigators in this field believe that there are two kinds of motivationIntrinsic motivation involves performing a task or job for its personal reward or fulfillment, which can be as simple as the satisfaction we get from doing a job well.  In contrast, extrinsic motivation involves performing a task or job in order to receive an external reward (e.g., payment) or to avoid punishment (e.g., getting fired for not doing your job).  Importantly, the external reward doesn't have to be monetary in nature.  

Michael Kosfeld and Susanne Neckermann showed that even providing a largely symbolic award to workers (similar to an "Employee of the Month" recognition or plaque) improved productivity.  Undergraduate students were recruited to enter information into a database (a very monotonous task) without any direct supervision (so they could easily distract themselves by surfing the Internet or scrolling through their social media accounts).  Students were randomized to a recognition group or control group.  Students in the recognition group were told that the top performer would be personally recognized at the end of their work session.  These students increased their productivity (number of database entries) by 12% on average compared to the control group.

These same investigators followed up with a study comparing monetary and recognition incentives (as a source of extrinsic motivation) in the presence or absence of meaning. Here, "meaningful work" was defined as a task or job that is recognized by others and/or has some point or purpose.  They again recruited students to enter information into a database.  Students in the "high meaning" group were told that the information was vital to the successful completion of a research project, while students in the "low meaning" group were told that the information that they entered was likely never going to be used.  Students were also randomized to either a monetary incentive (payment for the number of database entries) or recognition incentive (a symbolic recognition similar to the study above).

"Meaning" significantly improved productivity (similar to the results of the study mentioned in my post "The Search for Meaning").  Both monetary and recognition incentives also improved productivity.  Monetary incentives improved productivity regardless of "meaning", while the recognition incentive only increased productivity when "meaning" was low.  In other words, recognition provides meaning to an otherwise meaningless task.

Studies performed as early as the 1950's have shown that giving external rewards for jobs or tasks that are intrinsically motivating can actually decrease the level of intrinsic motivation.  This particular effect has been called the "overjustification" or "crowding out" effect.  Two additional studies by Dan Ariely and his colleagues adds another layer of complexity to this argument.  Ariely suggests that there is a third form of motivation, called image motivation (also called signaling motivation), which is the drive to complete a task in order to improve people's perceptions of us.   For example, we are more likely to give to a charity if we gain the approval from others by doing so (the "lumpers" among us would argue that this is just another form of extrinsic motivation).  

Ariely conducted an experiment in which undergraduate students worked at a seemingly meaningless task for a charitable cause.  Monetary incentives for the work increased job performance only when they were given in private.  If it was visible to the public that the students were being paid for their activities, monetary incentives no longer had an effect on performance, i.e. there was evidence of a "crowding out effect."  Ariely talks about similar findings from a study by Richard Titmuss in the 1970's that showed that blood donations dropped when individuals starting getting paid to donate blood.  People want to be seen by others that they are doing good for the sake of doing good and not because they are being paid for it.  

There's one last wrinkle to this discussion.  Ariely and his colleague James Heyman suggested that there are two types of markets at play - a monetary market and a social market (see "Effort for Payment: A Tale of Two Markets").  When people are working with a monetary market framework, increasing the monetary (or even nonmonetary) incentives will result in an increase in job performance and/or productivity.  In contrast, when people are working within a social market framework, the degree of effort that individuals employ is based upon their altruism.  Monetary incentives in this case will result in the "crowding out effect" described above.

Imagine that you are getting ready to move your apartment.  You ask your friends for help.  Do you pay them?  If so, do you pay them back with money or do you give them dinner and a few beers?  The results from Heyman and Ariely's study suggest that if you do offer to pay your friends back, you will shift them from a social market framework to a monetary one.  As such, their willingness to help (as well as their effort) will increase with the amount of money and/or gifts you promise to give them in return for their help.  They also found that sometimes, your friends would exert a greater effort in the absence of a promise to pay them than if you offered to pay them for a trivial amount.

Clearly, humans are complicated creatures!  Collectively, all of these studies suggest that the warden in the movie Holes would have increased the prisoner's effort and motvation by:

1. Providing them with simple recognition at the end of the day (perhaps giving an award for the prisoner who dug their hole the fastest during the day)
2. Giving them meaning or a reason to dig (not to "build character"), perhaps by telling them they were digging for a buried treasure (though that's complicated too)

There are lessons here for leaders and managers too.  Leadership is all about motivating your team to perform at their best.  Leaders and managers would do well to understand the nuances between intrinsic, extrinsic, and image motivation!

Monday, April 11, 2022

"Never lose infinite hope..."

Dr. Martin Luther King, Jr said, "We must accept finite disappointment, but never lose infinite hope."  Hope is an incredibly powerful thing.  Desmond Tutu said that "hope is being able to see that there is light despite all of the darkness."  It's what keeps us going on.  We are resilient, as long as we have hope.  The Russian author, Fyodor Dostoevsky wrote, "To live without hope is to cease to live."

A study came out a few years ago linking a decrease in the average life expectancy of Americans due to what the investigators called "deaths of despair".  The dramatic increase in mortality from suicide, drug overdose, and alcoholism can be traced indirectly to a loss of hope.  Studies have linked greater hope with better physical and mental health outcomes, health-related behaviors, emotional well-being, social relationships, and overall life satisfaction!  

Dr. Carley Riley, one of my former colleagues at Cincinnati Children's recently published a very interesting study ("Trends and Variation in the Gap Between Current and Anticipated Life Satisfaction in the United States, 2008-2020") that is highly pertinent to this discussion.  Riley and her team leveraged a large set of data collected almost daily beginning in 2008, the Gallup National Health and Well-Being Index, to develop a measure of hope among individuals living in the United States.  The database included over 2.7 million respondents from 2008 to 2020, representing approximately 3/4 of the entire U.S. population.  Two specific questions were utilized:

Please imagine a ladder with steps numbered from 0 at the bottom to 10 at the top.  The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.  (1) On which step of the ladder would you say you personally feel you stand at this time? (2) On which step do you think you will stand about 5 years from now?

The first question measured current life satisfaction (CLS), while the second question measured anticipated life satisfaction (ALS).  A population's hope was therefore defined as the mean ALS minus the mean CLS (i.e., anticipated life satisfaction higher than current life satisfaction).  From 2008 through 2019 (i.e. right before the start of the COVID-19 pandemic), overall hope across the U.S. remained largely unchanged.  Even though CLS significantly decreased from 2019 to 2020 (likely due to the pandemic), ALS remained unchanged.  In other words, the individuals responding to the survey by and large maintained a sense of hope for the future, even in spite of everything going on in the world at that time.

When the investigators drilled down further at county-level data (survey responses were geographically linked to zip codes), they found that the difference between ALS and CLS declined in 1 out of every 7 counties (and both declined in 1 out of 11 counties) even before the pandemic.  So, the sense of hope and optimism for the future was not uniform across the country.  These results are consistent with other studies that show that hopelessness clusters at the neighborhood level.

It's encouraging that Americans overall remain optimistic about the future, at least through 2020.  A lot of things have happened since the end of 2020 though, so it will be interesting to see whether this trend holds in future surveys.  Moreover, as Dr. Riley and her team suggest, this rather interesting study doesn't necessarily tell us how to address the loss of hope that has occurred in certain areas of the country that seem particularly prone to these "deaths of despair."

Saturday, April 9, 2022

The Oak and the Reeds

There's a famous story (from Aesop's Fables) called The Oak and the Reeds that I've been thinking about a lot lately.  The two main characters in the story are a giant oak tree and some reeds growing near a stream.  The story goes something like this:

A proud oak tree stood with its branches lifted proudly up towards the sky, while the humble reeds stood below at the river's edge crouched low in the wind.  The proud oak tree called out, "The slightest breeze that ruffles the surface of the water makes you bow your heads, while I stand upright and firm before the howling tempest."

"Do not worry about us," replied the Reeds. "The winds do not harm us. We bow before them and so we do not break. You, in all your pride and strength, have so far resisted their blows. But the end is coming."

Just then, a gale force wind rushed out from the north.  The reeds bent low and did not break, while the mighty oak tree was uprooted from the ground.  The lesson - "Better to yield when it is folly to resist, than to resist stubbornly and be destroyed."

The "bend but don't break" mentality of the reeds is a perfect illustration of what we know as resilience.  While variably defined, resilience generally means the ability to adapt or rebound from adversity, i.e. to bend without breaking.  One of the five core principles of so-called High Reliability Organizations (HROs) is a commitment to resilience.  In a recent post ("Murphy's Law, the U.S. Navy SEALS, and High Reliability Organizations") I presented the argument that most, if not all, HROs are characterized by a sixth core principle, "comfort with uncertainty and chaos."  If you think about it, one of the reasons that individuals (and organizations) are comfortable with uncertainty and chaos is the fact that they are resilient!

With this in mind, I recently found an article from the International Journal of Emergency Mental Health entitled the "Seven characteristics of highly resilient people: Insights from Navy SEALs to the 'Greatest Generation'".  The article is co-authored by a former Navy SEAL who later became a psychologist, an expert in organizational development, and an expert in the psychology of disasters and is based upon over 100 years of collective experience and research in the study of resilience.  Notably, these same three individuals later co-authored a book based upon their research, Stronger: Develop the Resilience You Need to Succeed.  They distilled the concept of resilience down to seven characteristics:

1. PrĂ©sence d’esprit (a French phrase translated literally to "presence of mind"), which they describe as calm, innovative, non-dogmatic thinking (also described as "thinking out of the box"), especially during times of stress.  Individuals who exhibit this characteristic generally believe that a solution can always be found to any problem.

2. Decisive action, which I have described before (see "The seven deadly sins of leadership") as the ability to make a decision in the absence of "perfect information" and summarized by the old proverb, "He who hesitates is lost" ("Buridan's ass").  Individuals are reluctant to make decisions when they are afraid of making a mistake or failing, which is why psychological safety is so important.  The important corollary to "decisive action" is taking responsibility for one's actions.

3. Tenacity, which they describe with the popular "light bulb" story about Thomas Edison ("I didn't fail 1,000 times, I just found 1,000 ways how not to build a light bulb."), as well as the story about Abraham Lincoln's long series of repeated failures before he became President of the United States.

4. Interpersonal connectedness and support, which they claim is "the single most powerful predictor of human resilience."  They mention the community of Roseto, Pennsylvania, a community whose citizens seemed to be resistant to heart disease despite having all of the classic risk factors (hypertension, high cholesterol, obesity, smoking, etc.  The so-called "Roseto effect" was featured prominently in a book by the physician Stewart Wolf (who first described it), The Roseto Story: An Anatomy of Health and by the popular author, Malcom Gladwell in his book, Outliers.  Apparently, the citizens of Roseto were Italian immigrants who maintained the strong family-oriented social structure (multiple generations of a family lived in the same household), cohesiveness, and traditional family values brought over from Italy.  This strong sense of family and community was felt to account for the lower rates of heart disease compared to surrounding communities.  Importantly, as the community became more "Americanized" (less social cohesion, breakdown of family-oriented social structure, etc), the differences in heart disease disappeared!

5. Integrity, which they defined as "doing what is right" and "considering not only what is good for you, but what is good for others as well."  They mention Mahatma Gandhi's seven things that will destroy society ("the seven social sins"): wealth without work, pleasure without conscience, knowledge without character, religion without sacrifice, politics without principle, science without humanity, and business without ethics.  

6. Self-discipline and self-control, which they define as the ability to control impulses, to delay gratification, and to engage in a healthy lifestyle.  

7. Active optimism, which they define as "the tendency to take the most positive or hopeful view" and "expecting the best outcomes."  They emphasize the difference between passive optimism ("hoping things will turn out well") versus active optimism ("acting in a manner to increase the likelihood that things will turn out well").  

Always remember that "the oak fought the wind and was broken, while the reeds bent when they had to and survived."  What is true for individuals is also true for organizations.  There is an old Japanese proverb that I think perfectly summarizes the concept of resilience, and I will end this post with it here, "Fall seven times, rise eight."

Thursday, April 7, 2022

Tit for tat

Several years ago, our family took a trip to Bali, Indonesia.  Bali is an amazing place to visit, but I wouldn't recommend going there if you are afraid of monkeys (apparently this is even more true since the COVID-19 pandemic)!  I've posted about our scary trip through the Ubud Monkey Forest in a post last year ("Dart-throwing Monkeys").  

We visited a lot of Hindu temples during our trip.  A lot of monkeys seemed to congregate around these temples, perhaps because the tourists were also congregating there!  The monkeys would often confront an unsuspecting tourist (usually one taking a picture and not paying attention to the monkeys) and use the opportunity to steal a hat, sunglasses, cameras, or anything else that they could get their hands on.  They would then run off and sit just out of reach of the tourist.  They would only give the item back in exchange for food.  You can't say that these monkeys were unintelligent!

I am sure the monkey didn't realize it was using what is called, at least in game theory, a "tit for tat" strategy.  Several years ago, Robert Axelrod, a political scientist from the University of Michigan, held a tournament to determine the optimal strategy for the Prisoner's Dilemma, one of the classic problems in game theory (first described by Merrill Flood and Melvin Dresher at the RAND Corporation in 1950).  More on Axelrod's experiment below, but first let me explain the Prisoner's Dilemma game.  

While there are a number different variations to this game, the basic set-up is the same.  Two criminals have been arrested and are now being held prisoner in separate jail cells.  The police don't have enough evidence to convict them on the principal charge, but they do have enough evidence to convict them on a lesser charge.  The police offer each prisoner a bargain - betray the other (testify against the other prisoner - this has also been called "defect" in the literature) and go free or remain silent (this has also been called "cooperate" in the literature) and serve the 1 year prison sentence on the lesser charge.  As outlined above, the possible outcomes to the game are as follows:
  • A and B each betray the other - each of them serve two years in prison
  • A betrays B, but B remains silent - A is set free and B serves three years in prison
  • A remains silent, B betrays A - A serves three years in prison and B is set free
  • A and B both remain silent - each of them serve only one year in prison
As you can see, the best option for both prisoners is to remain silent (i.e. "cooperate" with each other) and spend only 1 year in prison.  Remember though that the prisoners are acting independently.  How can they trust each other not to betray each other?  If only one betrays the other, he or she goes free (and the other goes to prison for three years).  However, if both of them betray each other, they go to prison for two years.  Since two years of prison is better than three years, they end up betraying each other rather than taking the risk of staying silent (which would have been the better option, hence, the dilemma).

Axelrod set up his tournament so that games would be repeated multiple times. Over 20 individuals (all experts in game theory) submitted a strategy for an online Prisoner's Dilemma tournament.  Each of the strategies was paired off with the others to see which strategy was the most effective.  Surprisingly, a very simple strategy known as "tit for tat" was the most effective strategy in the tournament.  The "tit for tat" strategy is one of simple reciprocity in which the player cooperates on the first move and then does whatever the other player did in the previous move in all subsequent moves.  An example of a sequence of player using the "tit for tat" strategy is shown below (note that Player One is using the "tit for tat" strategy):

Player One                    Player Two
Cooperate                        Defect
Defect                              Cooperate
Cooperate                        Defect
Defect                              Cooperate
Cooperate                        Cooperate
Cooperate                        Cooperate

Axelrod conducted a second tournament with more subjects, including individuals who weren't experts in game theory.  Again, the "tit for tat" strategy was the most effective strategy played.  Axelrod subsequently published the results of his findings in the journal Science in a paper entitled "The Evolution of Cooperation".  He later expanded upon this paper in a book with the same title, which describes how cooperation can emerge in a variety of contexts (his theory has subsequently become a very important theory in evolutionary biology, as well as game theory).

As it turns out, cooperation is a widespread phenomenon in nature.  For example, one member of a meerkat colony usually performs sentry duty.  When the sentry sees a predator (a jackal, for example), the sentry makes a very loud and distinctive cry, which acts as a warning signal to the rest of the meerkat colony that danger is close.  Think about it for a second.  By crying out loudly, the sentry is drawing attention to itself, which increases the risk of being attacked by the predator and eaten.  However, this selfless act alerts (and likely saves) the rest of the colony.  The sentry is using a version of the "tit for tat" strategy - the sentry understands that it may be with the colony the next time that another member of the colony is performing sentry duties (reciprocity and mutual cooperation).

Cooperation is the preferred (some would say dominant) strategy in nature.  We can learn a lot from the animal kingdom!  I hope to return to this discussion in future posts, as the topic on the evolution of cooperation is absolutely fascinating and quite instructive.

Tuesday, April 5, 2022

"The soul becomes dyed with the color of its thoughts..."

If you've never watched the 1987 film The Princess Bride, you are missing out!  There's a scene in the movie when the character Prince Humperdinck (played by the actor Chris Sarandon) says, "I always think everything could be a trap - which is why I'm still alive."  That is certainly one way to view the world.  It's a bit pessimistic, but it seems to be a common viewpoint.  For example, how many times in your childhood did your parents tell you that the "world isn't fair" or that "the world is a dangerous place"?  With the former case in regards to Prince Humperdinck, the belief is that by always preparing for the worst, one is neither surprised or caught unprepared (which sounds a lot like the High Reliability Organization characteristic of "Preoccupation with failure" doesn't it?).  In the latter case, parents want to instill a sense of caution in their children.

The ancient Roman emperor and Stoic philosopher, Marcus Aurelius, wrote in his Meditations, "Your mind will be like its habitual thoughts; for the soul becomes dyed with the color of its thoughts."  I wonder then, if choosing to be pessimistic about our view of the world tends to be self-reinforcing?  As it turns out, a pessimism likely begets pessimism.  I came across an interesting study in the Journal of Positive Psychology, entitled "Parents think - incorrectly - that teaching their children that the world is a bad place is likely best for them".  

The study investigators first surveyed a group of parents to determine the beliefs about the world ("the world isn't fair" versus "the world is just", "the world is dangerous" versus "the world is safe", etc) that they instilled in their children.  The vast majority of patients surveyed thought that seeing the world as distinctly positive was not good parenting.  Rather, most tended to teach their children that the world was dangerous and unfair.  Consistent with Prince Humperdinck's statement above, most parents felt that the best way to prepare to children to successfully navigate life was to teach them that the world is a bad place.

The next part of the study was even more interesting.  The investigators leveraged six pre-existing surveys of individuals from 48 different job categories who answered a variety of questions about their job success and satisfaction, general and mental health, and overall satisfaction with life.  Their results were based on over 4,500 different survey subjects.  In general, a negative or pessimistic outlook on life ("the world isn't fair" or "the world is a dangerous place") strongly correlated with lower rates of job satisfaction and success, worse general and mental health, and lower satisfaction with life.  Those subjects with a pessimistic viewpoint had higher rates of depression, anxiety, and suicide when compared to their peers with a more optimistic view of the world.

These are powerful results!  As my wife would say, "It's the power of a positive attitude!"  "Happiness is the highest form of health."  So what should we do if someone intentionally tries to hurt our feelings?  After all, dealing with other people's bad behavior is one of the reasons why parents felt that telling their children that the world wasn't nice or fair was a good idea in the first place.  Again, the ancient Stoic philosophers can give us some suggestions.  Epictetus said, "If anyone tells you that a certain person speaks ill of you, do not make excuses about what is said of you but answer, "He was ignorant of my other faults, else he would not have mentioned these alone."  He goes on, "Any person capable of angering you becomes your master; he can anger you only when you permit yourself to be disturbed by him."  And finally, "another person will not do you harm unless you wish it; you will be harmed at just that time at which you take yourself to be harmed.”

Sunday, April 3, 2022

The Search for Meaning

If you aren't following the behavioral economist and author Dan Ariely, you are missing out!  A few years ago, I took one of his massive open online courses (MOOCs) and thoroughly enjoyed it.  He's written a number of books on his research, and he now has a feature ("Ask Ariely") in the weekend edition of the Wall Street Journal.  His research has covered topics as diverse as the use of behavioral economics for clinical management of heart failure to the use of default orders in clinical informatics to dishonesty and cheating (see my post on the Valjean effect).  He's even published a study to determine whether it is better to rip the bandage off quickly or slowly peel it off (as it turns out, most people preferred the slow approach).  

I've posted about Ariely's research in the past (see "Are trick-or-treaters honest?" and "The IKEA effect").  Today I wanted to talk about another interesting study that he published in the Journal of Economic Behavior & Organizations.  The titles of Ariely's papers are typically eye-catching, and this one was no different ("Man's search for meaning: The case of Legos").  He starts with a rather interesting quote from the famous economist, John Maynard Keynes

If human nature felt no...satisfaction (profit apart) in constructing a factory, a railway, a mine or a farm, there might not be much investment as a result of cold calculation...Enterprise only pretends to itself to be mainly motivated by the statement in its own prospectus.

In other words, identity (the sense of who we are as individuals), pride, and meaning (the "why" of what we do) are all left out of the standard economic models of labor supply and demand.  Recognizing that the "meaning" tied to our work is important, Ariely and his colleagues conducted a set of controlled laborastory experiments to determine the effect of "meaning" on labor supply.  In the first experiment, undergraduate students were randomly assigned to one of three conditions - Acknowledged, Ignored, or Shredded.  All three groups were told to find 10 instances of two consecutive letters ("s" in this case) on a sheet of paper.  Once they finished, they were given a new sheet of paper with the same instructions.  They were paid $0.55 for the first sheet, and with each subsequent sheet they were paid $0.05 less until they decided to stop.  

Subjects in the Acknowledged group were told to write their name at the top of each sheet of paper, and each sheet was collected and filed by the experimenter as each subject finished it.  When subjects in the Ignored group finished, each sheet was placed in a large stack of other sheets - the experimenter did not look at the sheet.  Finally, once subjects in the Shredded group handed in each sheet, the sheet was placed in a shredder without looking at it.  Notice that the subjects could cheat in either the Ignored or Shredded groups (the experimenter never looked at the sheet, the subjects didn't write their names on the top of each sheet, and any "evidence" of cheating was lost when the sheets were either filed in a large stack of other sheets or shredded).

Subjects completed an average of 9.03, 6.77, and 6.34 sheets and received a total of $3.01, $2.60, and $2.42 in the Acknowledged, Ignored, and Shredded conditions, respectively.  Notably, almost half of the subjects in the Acknowledged group were willing to work until their wage dropped all the way to zero!  Apparently, adding some degree of "meaning" to a rather inconsequential and otherwise meaningless task (by requiring each subject to write his or her name at the top of every sheet and having the experimenter examine it before filing it away).  

The next experiment was very similar.  Subjects (again, undergraduate students) were randomly assigned to one of two conditions, Meaningful versus Sisyphus (recall that Sisyphus was the Greek hero who was forever condemned to roll a rock up a steep hill every day).  Subjects were paid for assembling Bionicle Lego models (each consisting of 40 separate parts, which required about 10 minutes to assemble), again according to a declining wage schedule ($2.00 for the first model, $1.89 for the second, and declining by $0.11 to a minimum of $0.02 after the 20th model).  After building each model, subjects in the Meaningful group placed each assembled model on the desk in front of the experimenter, who would then hand over a new model.  Conversely, subjects in the Sisyphus group handed over their assembled model to the experimenter, who would then hand over a second model and then disassemble the model first.  Once the subject finished the second model, the experimenter would hand over the disassembled first model, and so on.  The subjects in the Meaningful group built significantly more models and received significantly more money than those in the Sisyphus group (average 10.6 models and $14.40 versus an average of 7.2 models and $11.52).  Again, the loss of "meaning" in the work decreased the subjects' willingness to keep going on to assemble more models.  

Ariely concludes that "meaning, at least in part, derives from the connection between work and some purpose, however insignificant or irrelevant that purpose may be to the worker's personal goals.  When that connection is severed, when there is no purpose, work becomes absurd, alienating, or even demeaning."  As it turns out, small effects of meaning in terms of recognition and purpose can translate into even larger effects on workers' motivation and productivity!  

Just look at how mountaineers are motivated to climb seemingly impossible mountains for the simple reason that "It is there" (see this great study by George Loewenstein "Because it it there: the challenge of mountaineering...for utility theory"). Conversely, taking away meaning can have an equally powerful impact, albeit in the opposite direction, on motivation and productivity.  For example, breaking up a large job (say, building a car) into several smaller steps (as on an assembly line) can actually take away the perceived meaning of the work, particularly if each worker doesn't see the final product of his or her efforts.

Ariely mentions one last implication that I found interesting.  He mentions that a number of studies have suggested that close supervision of workers may undermine intrinsic motivation and decrease worker productivity (see for example, "The hidden cost of control" by Armin Falk and Michael Kosfeld or "The transparency paradox" by Ethan Bernstein).  Ariely suggests that the way that workers are supervised may be particularly relevant.  If the "supervision" is perceived as interest in the worker (similar to what had occurred in the first experiment with the sheets of paper) - i.e. adding meaning to his or her work - may actually improve productivity without the negative side effects of control.

As concentration camp survivor, psychologist, and author Viktor Frankl writes in Man's Search for Meaning,  "Those who have a 'why' to live, can bear with almost any 'how'.”  Powerful words for sure.  He goes on to write further:

“Don't aim at success. The more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side effect of one's personal dedication to a cause greater than oneself or as the by-product of one's surrender to a person other than oneself. Happiness must happen, and the same holds for success: you have to let it happen by not caring about it. I want you to listen to what your conscience commands you to do and go on to carry it out to the best of your knowledge. Then you will live to see that in the long-run—in the long-run, I say!—success will follow you precisely because you had forgotten to think about it.”

Friday, April 1, 2022

It's April First!

A couple of years ago, the British Medical Journal published what I thought was a provocative clinical trial, "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial".  Individuals 18 years or older who were planning on jumping out of a perfectly good airplane were eligible to participate in the study.  Subjects were randomized to one of two groups - parachute (the experimental condition) and no parachute (the control).  Ninety-two individuals were approached, though only nineteen agreed to participate.  The outcome of interest was death or major trauma (defined by an Injury Severity Score greater than 15).  

Surprisingly, there were no significant differences in death or major injury between the two groups (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants versus mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001).  The study investigators concluded that parachute use did not reduce death or major trauma, though they recognized the limitations in their study design and suggested that the findings of their study may not be translated to the general population of skydiving enthusiasts.

Bravo to the editorial staff of the British Medical Journal for publishing such an important study, even though the results of this clinical trial were negative!  As you may have figured out by the title of the blog post, the study was a little farcical (although I do think they actually conducted the study). I do believe the authors were poking fun at the concept of evidence-based medicine suggesting that you don't always need clinical trial evidence for certain clinical interventions.  For example, one of my former attending physicians used to argue that there are no clinical trials suggesting that we should or should not monitor patients' blood pressure in the intensive care unit right before challenging us to think about managing a patient without measuring trends in important vital signs.  I won't jump into the pro/con debate on the merits of evidence-based medicine.  For now, I will just wish everyone a happy April Fool's Day!