What's in a name?

I like to listen to ESPN radio during my commute.  Just the other day, I listened to a conversation about two NFL players with the exact same name.  Apparently, during the 2023 NFL Draft, the Las Vegas Raiders selected Alabama defensive tackle Bryant Young with the 70th overall pick in the draft.  Young would finish the 2023 season with just four tackles (he only played six games) and was later waived by the Raiders.  He is currently playing for the Philadelphia Eagles practice squad (i.e. he is not on any NFL active roster).  His pick - at least at this point in the draft - surprised a lot of the experts.

The Los Angeles Rams selected another Bryant Young - this one from the University of Tennessee - with the 77th pick in the same 2023 draft.  The Bryant Young for the Rams is a linebacker and had an outstanding rookie season.  More importantly, he is still playing meaningful snaps for the Rams during this year's playoffs (he had 33 tackles and 7.5 quarterback sacks during the regular season).

The conversation I heard questioned whether the Raiders made a mistake and selected the wrong Bryant Young.  They say hindsight is 20/20, and the current body of work strongly says that the Raiders would have been better off picking the other Bryant Young.  But in this particular case, the talk show radio hosts were suggesting that the Raiders actually screwed up the names and meant to pick the Bryant Young from Tennessee all along!  I can't imagine that is true.  There's no proof that it really happened that way.  However, if hospitals spend so much time focusing on making sure that they have the right patient (see the report "Patient Identification Errors" which was released by the Agency for Healthcare Quality and Research), perhaps NFL teams should follow suit?  Just a thought...

Three-dimensional Leadership

I bet you can tell that I've been reading a lot of different leadership theories and models lately!  I introduced the Vroom-Yetton-Jago Model and the Blake Mouton Grid in two recent posts (see "Vroom Vroom" and "The Blake Mouton Grid").  I also mentioned another leadership model, developed by William James Reddin called the 3D Theory.  Reddin expanded upon the Blake Mouton Grid (as well as other models) in his 1983 PhD thesis, Managerial Effectiveness and Style: Individual or Situation. 

Reddin first developed a 2 dimensional model of leadership that is conceptually indistinct from the Blake Mouton Grid.  First, he developed a 2x2 grid with task orientation on the x-axis and relationship orientation on the y-axis (essentially, concern for results versus concern for people, as in the Blake Mouton Grid).  Based on where a leader falls on this grid (see the "standard" portion of the graphic below), Reddin developed four basic leadership types:

Related (High Relationship-orientation, Low Task-orientation): A "related" leader focuses on collaboration and team-based cooperation.  They provide a lot of autonomy, rather than directing or dictating their teams.  They are less hierarchical and less authoritative in their approach to leading teams.  These leaders would fall into the Country Club Management quadrant of the Blake Mouton Grid.

Integrated (High Relationship-orientation, High Task-orientation): An "integrated" leader builds a strong team capable of high-performance by providing the right balance between autonomy and "deference to expertise" on the one hand, and accountability on the other.  These leaders maximize the team's potential to perform at a high level.  These leaders would fall into the Team Management quadrant of the Blake Mouton Grid.

Dedicated (High Task-orientation, Low Relationship-orientation): A "dedicated" leader focuses on producing excellent results and achieving the goals of the organization.  While this is laudable, they often do so at the expense of developing the individuals on their team.  They do not provide a lot of autonomy, and they use a more authoritative or autocratic approach.  These leaders would fall into the Produce or Perish Management quadrant of the Blake Mouton Grid.

Separated (Low Task-orientation, Low Relationship-orientation): A "separated" leader focuses on correcting deviations from the norm.  They develop standard policies and procedures to follow, but they do not necessarily enforce them, nor do they take an active role in directing or commanding their teams.  These leaders would fall into the Impoverished Management quadrant of the Blake Mouton Grid.

What separates Reddin's 3D model from the Blake Mouton Grid is that he added a third dimension that he called "effectiveness", hence the 3D Model nomenclature.  The 3D Model incorporates concepts from situational or contingent leadership theory  He defined a leader's effectiveness as the appropriateness of their leadership style in any given situation (and argued that this should be the main focus of a leader's efforts to improve their leadership).  As you can see in the graphic below, the upper right and lower left matrices has the same 2x2 grid (task orientation versus relationship orientation), but now the upper right matrix depicts an appropriate style of leadership for a particular situation, while the lower left matrix depicts and inappropriate style of leadership for a particular situation.  As a result, we now have eight new leadership styles to explain.  The appropriate styles are Developer, Executive, Benevolent Autocrat, and Bureaucrat, while the inappropriate styles are Missionary, Compromiser, Autocrat, and Deserter.

Developer (Appropriate, Related): The "Developer" leadership style focuses on developing relationships through collaboration and cooperation.  Again, they provide a lot of autonomy, rather than directing or dictating their teams.  They are less hierarchical and less authoritative in their approach to leading teams.  In general, while they focus less on producing results (Low Task-orientation), because they apply this particular leadership style at the appropriate time, they are reasonably successful (i.e. effective) at achieving the goals of the organization.

Executive (Appropriate, Integrated): The "Executive" leadership style focuses on developing relationships and achieving results.  They effectively adapt their leadership style to the specific needs of the situation at hand by building strong teams capable of high-performance by providing autonomy with the right level of accountability.  

Benevolent Autocrat (Appropriate, Dedicated): The "Benevolent Autocrat" focuses on producing excellent results and achieving the goals of the organization.  They do not provide a lot of autonomy, and they use a more authoritative or autocratic approach.  However, because the specific situation demands this kind of approach, they are generally effective. 

Bureaucrat (Appropriate, Separated): The "Bureaucrat" focuses on correcting deviations from the norm.  They develop standard policies and procedures to follow, but they do not necessarily enforce them, nor do they take an active role in directing or commanding their teams.  However, because their teams are relatively experienced and motivated to begin with, the teams are able to produce good results.

Missionary (Inappropriate, Related): The "Missionary" is basically an ineffective "Developer", because the needs of a specific situation require a different kind of approach.  For example, the teams that they lead may be inexperienced or lack motivation such that they require a more authoritative leadership approach.

Compromiser (Inappropriate, Integrated): The "Compromiser" is an ineffective "Executive" who can't balance the needs of the team (relationship-orientation) with the need to produce results (task-orientation).  Instead, they make compromises that often result in poor results or even poor team morale.

Autocrat (Inappropriate, Dedicated): The "Autocrat" is ineffective because they do not provide a lot of autonomy and utilize an authoritative approach when perhaps a more democratic approach is required.

Deserter (Inappropriate, Separated): The "Deserter" is disengaged to the point that the team becomes disengaged and unmotivated to produce the results that the organization requires.

Similar to the Blake Mouton Grid, Reddin's 3D model can be used as a self-assessment tool for leaders to improve how they lead and manage their teams.  If a leader finds that he or she is not producing the kind of results that are required by the organization, he or she should modify their leadership approach to match the specific needs of the situation or context, thereby moving up the graph towards an appropriate style of leadership.

The Blake Mouton Grid

As I mentioned in a recent post on situational or contingent leadership ("Vroom Vroom"), Robert Blake and Jane Mouton developed their well-known managerial grid model (also known as the Blake Mouton Grid) in the late 1960's.  During their work to improve effective leadership at Exxon, they noted that leadership and management behavior worked primarily along two axes (i.e., concern for production and concern for people) and moved along a continuum.  Using a 2x2 grid, they described five different leadership approaches based upon where they fell along this two-axis continuum.  

Importantly, rather than describing different styles or approaches that a leader can use at different times in his or her career, the Blake Mouton Grid is meant to be used as a self-assessment tool by which organizations can identify a leader's style or approach (and hopefully grow and improve as a leader).

Each dimension is scored on a scale from one (lowest) to nine (highest), based again on whether a leader is more concerned with the individuals on his or her team or the results that the team is trying to achieve.  Based on these scores, there are five different management approaches that describe a given leader:

Impoverished Management (Low Results/Low People): These types of leaders do not care for their team's motivation or morale.  They don't create an environment where their teams can be effective and generate positive results for the organization.  Leaders who fall into this category are not likely to be successful and may even be counterproductive, toxic, or harmful to the organization.  Teams that work for leaders with an Impoverished Management style will generally have low engagement, low motivation, low performance, and low retention.

Produce-or-Perish Management (High Results/Low People): These types of leaders generally adopt a more authoritarian, hierarchical, and autocratic style of leadership (but that is not necessarily always the case).  They focus primarily on the bottom line results, and the needs of the workforce are always secondary to productivity.  These leaders both follow and apply strict rules and policies, reward overperformance, and punish poor performance.  Again, teams that work for leaders with a Produce-or-Perish Management style will generally have low retention (see my posts "People don't leave organizations, they leave bad bosses" and "Fix the environment, not the people...").  

Country Club Management (High People/Low Results): These types of leaders focus excessively on the team's motivation, engagement, morale, and happiness.  While that is certainly not the wrong approach, these leaders do so at the expense of performance and efficiency.  These leaders are more laissez-faire in their approach, often to the point that their teams can lack focus and direction.  While this approach may work for a team with significant experience, motivation, and track record of good performance, less experienced or motivated teams will suffer.

Team Management (High Production/High People): These types of leaders are often great leaders, in that they have teams that perform at a high level and yet remain engaged, motivated, and generally happy.  These leaders create an environment of psychological safety, such that teams feel respected, valued, and committed to achieving the goals of the organization.  

Middle-of-the-Road Management (Medium Results/Medium People): These types of leaders take the proverbial "middle of the road" approach by balancing the needs of the workforce with driving performance.  However, this is not always successful, and most leaders that fall into this category will slip into one of the other quadrants (except Team Management, of course).  

While I personally think it's hard to classify leaders purely just on the two axes of people and production, the Blake Mouton Grid does have some merit, even if it was developed more than 50 years ago.  Our thinking about leadership has certainly changed since Blake and Mouton first developed their model.  Regardless, assessing your own leadership is always a worthwhile exercise.  The recommended approach would be to:

1. List the situations where you performed as a leader.  

2. Place yourself in the Blake Mouton Grid for each situation.  

If you find yourself falling into one particular category, think about how you can move into the Team Management category.  There are likely to be some situations where the Country Club Management or even the Produce-or-Perish Management style is the preferred approach.  As always, the context of a particular situation is important, and there is no one approach that fits every situation.  However, in general, the Team Management approach is likely to be the best approach for the majority of situations that a leader may encounter.

"Success is not the key to happiness..."

After reading Arthur Brooks' recent book Build the Life You Want: The Art and Science of Getting Happier, which he co-wrote with Oprah Winfrey (see my post "Are you happy?"), I started taking his edX online course "Managing Happiness".  So far, it's a great recap of his book and essays, but I am definitely enjoying it and finding it worthwhile.  During the first module, Brooks mentions how much inspiration he has found following His Holiness The Dalai Lama and his book, The Art of Happiness: A Handbook for Living.  It sounds like a book that I should check-out for sure.  

Brooks also mentions a great quote by Albert Schweitzer, who said, "Success is not the key to happiness.  Happiness is the key to success.  If you love what you are doing, you will be successful."  Unfortunately, too often the last sentence gets cited without the first two sentences.  For example, Mark Twain reportedly said, "Find a job you enjoy doing, and you will never have to work a day in your life."  It's unfortunate, because I've not found it to be 100% true.  I absolutely love what I do, but there are always days when my work feels like, well, work.  The most important part of Schweitzer's quote is the sentence that says that just because you are successful doesn't mean that you will be happy.  However, if you are not happy, no amount of personal achievements will make your life a successful one.

I recently read an editorial in Crain's Chicago Business from the December 16, 2024 issue by Michael Fassnacht, currently the Chief Growth Officer at Clayco in Chicago, "The right mindset can put you on the path to success".  In the editorial, Fassnacht offers three essential insights that he has learned over time and which he feels are crucial for those entering the workforce to understand and appreciate.  

1. You won't change a corporation.  I can't even begin to count how many times that I have written the words "Change is hard" in this blog.  What Fassnacht is really saying here though is that changing a culture within an organization is difficult (not impossible, just really, really hard).  He writes, "Every organization has a unique origin story, intrinsic values, ingrained behavioral patterns, and spoken and unspoken norms.  These elements, combined with organizational muscle memory and other factors, create inherent resistance to change."  It's hard enough for CEO's and other members of the executive leadership team to create meaningful change, let alone someone just starting out in an organization.  Change can (and occasionally does) occur from the bottom up, but that kind of change will require effort, time, and allies.  No one can do it alone.

2. Your well-being is up to you.  Here is where I think Schweitzer's quote (the first two sentences at least) resonate with me the most.  Rather than focusing on being successful, professionals that are just starting out should focus on being happy.  Fassnacht writes, "The pursuit of professional success should not come at the expense of emotional well-being.  Relentlessly chasing status can lead to unproductive stress and self-doubt, undermining your emotional health."  He goes on to say that "While dedication and excellence in work are admirable, it's crucial to ensure that personal happiness and emotional health remain independent of the corporate environment...this emotional independence is critical to achieving balance, happiness, and ultimately, greater success."

3.  Don't let a job keep you up at night.  As one of my senior residents told me when I was a third-year medical student, "The longer you stay...the longer you stay."  Fassnacht claims (and I agree with him) that no job is worth losing sleep over due to stress.  He goes on to say that he has followed one simple rule throughout his 25 year career, "If my job causes me to lose sleep for more than five consecutive nights, it's time to seriously consider leaving."

I hope to share additional insights from Arthur Brooks in future posts.  For now though, I will end with a key insight from His Holiness The Dalai Lama (one in which Brooks returns to again and again in his writings and in his course): "Happiness is determined more by one's state of mind than by external events."

Six tests (plus one challenge) for physicians and health care leaders...

Drs. Thomas Lee (Chief Medical Officer at Press Gainey) and Toby Cosgrove (a world-renown heart surgeon who served as the President and Chief Executive Officer at the Cleveland Clinic from 2004-2017) have written two articles that I think are important reads for physicians and health care leaders.  Both articles were published in NEJM Catalyst.  The first, "Six Tests for Physicians and Their Leaders for the Decade Ahead" was written in 2020, but the themes continue to be relevant today.  The second ("Health Care Leadership in the AI Era: A Seventh Test for the Decade Ahead") just came out in December, 2024, in which Drs. Lee and Cosgrove added a seventh "test" to the original list.   

They start the first article with a rather ominous (but honest) statement: "For physicians and their leaders, the recent past has been difficult, and the decade ahead will be even more challenging."  I completely agree with their assessment.  I've mentioned in several posts recently that we live in a VUCA/BANI world.  Health care as an industry - and medicine as a profession - have certainly been challenged with the COVID-19 pandemic, but it's also important to recognize that we didn't necessarily enter the pandemic on stable footing either.  The U.S. health care system continues to cost significantly more compared to our peers, yet we don't compare favorably to these same countries on health-related outcomes.  Even before the pandemic, hospital systems were dealing with staff shortages, supply chain issues, and medication shortages.  These problems have continued, and in some cases, have worsened since the pandemic.  Finally, it's been over two decades since the Institute of Medicine published To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, we still have significant opportunities to improve both the quality and safety of care (see the report in Health Affairs entitled "Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety" for further discussion).

At the same time, there has been significant scientific progress that have made possible a number of advances in therapeutics, technology, and surgical procedures, whereas diseases that used to be fatal are no longer so.  As Drs. Lee and Cosgrove call out, the doubling time (the time it takes to double in quantity) of medical knowledge has decreased from 50 years in 1950 to 3.5 years in 2010 to less than 3 months in 2020.  It's becoming more difficult for physicians to keep up with this overwhelming body of evidence, which could be one reason that patients receive only half of the care that they should receive, based upon the available evidence (as highlighted in Crossing the Quality Chasm).  The overwhelming abundance of information is potentially one of the drivers for the move to artificial intelligence, which is the subject of their second NEJM Catalyst article.

Just as important, the physician workforce has been changing even prior to the COVID-19 pandemic, but the changes have continued to accelerate since the pandemic.  As Drs. Lee and Cosgrove mention, older physicians are being replaced (or will soon be replaced) by a newer generation of physicians who are younger, more tech savvy, and increasingly female.  This new generation is also more likely to work in teams (a positive trend), and they are more likely to be employed by hospitals or health systems.  Gone are the days when physicians owned their practices and were active members of the medical staffs of multiple hospitals.

Drs. Lee and Cosgrove list six tests (in order of ascending difficulty) for physicians and health care leaders that, if successful in meeting, will likely define what is defined as effective health care leadership in the next decade:

1. Really Putting Patients First - The first test is likely not very controversial.  Patients have been and should continue to remain the top priority for health care organizations in the coming decade.  Research shows that when quality (as defined by the patient) is better, both physician morale and organizational business success improves.

2. Building Super-Teams - Medicine has become a team sport.  Chronic, complex medical conditions require a team-based approach in order to achieve the best outcomes.  Press Ganey patient satisfaction surveys consistently show that coordination of care between physician teams, between physicians and nurses, and across the continuum of care (inpatient, outpatient, peri-operative) is what patients value most.  As Drs. Lee and Cosgrove write, health care needs "to create the medical equivalent of the Navy SEALS; that is, a group of committed, high-performing individuals who understand and value the importance of working as a team to accomplish the mission at hand."

3. Plunging into Competition - Drs. Lee and Cosgrove write, "Physicians should give their complete attention to taking care of their patients, and the best way to ensure that this remains possible is to encourage their organizations to plunge into competition, not deflect it.  The reason is that the marketplace must control costs and ensure quality, and if competition cannot accomplish those goals, regulation of some kind will be invoked."

4. Taking on Costs - Health care costs have gotten out of hand.  Rather than avoiding it, physicians should embrace cost reduction.  As Drs. Lee and Cosgrove mention, "The risks are high that external parties (e.g., government) will take action to cut spending if health care itself is unable to take on this problem."

5. Embracing Innovation - The kind of innovation that is needed to tackle some of health care's most challenging problems will require creativity, courage, and patience.  

6. Grasping Leadership - We need physicians to take the lead on solving all of the challenges and problems that exist in health care today.  Leadership can be taught, but it takes more than reading articles and books (and blog posts!).  Organizations need to invest in leadership development programs for their physicians.

Drs. Lee and Cosgrove added a seventh test in the second article, which appeared more recently.  They write, "Artificial Intelligence (AI) is moving quickly into virtually every aspect of health care that involves thinking, reacting, or communicating."  While they do not explicitly state the seventh test, they do suggest that "It remains essential that leaders have expertise in operational excellence and strategy, but now they must add management of 'breakthrough innovation' and leadership of the culture change necessary to take full advantage of AI."

I agree with most of the points made in these two articles.  These two thought leaders make some excellent points.  What do you see as the major challenges for physicians and health care leaders in the coming decade?

"The Three Dimensions of a Complete Life"

I always like to celebrate Martin Luther King, Jr Day by learning something about Dr. King.  For example, one year, my wife and I went to an exhibit on Dr. King at the National Underground Railroad Freedom Center in Cincinnati.  Sometimes, I simply celebrate his life by reading one of his speeches or sermons.  To that end, I recently read a sermon that Dr. Martin Luther King, Jr delivered in Philadelphia on December 11, 1960, at least according to the Martin Luther King, Jr Research and Education Institute at Stanford University.  Apparently Dr. King used this particular theme in several sermons and speeches as early as 1954 (for example, he delivered a sermon in Chicago on April 9, 1967 with the same theme and title).  It's called "The Three Dimensions of a Complete Life", and I thought that the themes that Dr. King discussed were important for leaders today.

Dr. King began his sermon with a reference to John of Patmos, a Christian prophet who is believed to have lived in the late first century and is believed to be the author of the Book of Revelation.  John was exiled to the Greek island of Patmos for his beliefs during the reign of the Roman Emperor Domitian.  John had a vision (several, actually) of the New Jerusalem descending out of heaven and described as being equal on all sides.  John writes (Revelation Chapter 21), "The city was laid out like a square, as long as it was wide. He measured the city with the rod and found it to be 12,000 stadia [that is, about 1,400 miles or 2,200 kilometers) in length, and as wide and high as it is long."  In other words, this new city, the ideal city if you will, was perfectly balanced and complete on all sides.    

Dr King used this analogy to define a complete life as one that is similarly equal in all three dimensions: "Life at its best and life as it should be is three-dimensional; it's complete on all sides...there are three dimensions of any complete life...length, breadth, and height." 

He goes on to define each of these three dimensions, "The length of life, as we shall use it here, is not its longevity, its duration, not how long it lasts, but the push of a life forward to achieve its personal ends and ambitions.  It is the inward concern for one's own welfare.  The breadth of a life is the outward concern for the welfare of others.  The height of a life is the upward reach for God...These three must work together; they must be concatenated in an individual life if that life is to be complete, for the complete life is the three-dimensional life."

The key point here, in my opinion, is that we should strive for balance in all three dimensions of our personal lives.  In most cases, balance in our personal lives should translate to relative balance and harmony in our professional ones too.  Thomas Merton, a writer (perhaps most famous for his book, The Seven Storey Mountain) and theologian, said, "Happiness is not a measure of intensity but of balance, order, rhythm, and harmony."  

The French mathematician Henri Poincaré knew a thing or two about how difficult it was to find balance and harmony, particularly when there were three different things involved.  Poincaré lived between the late 19th century and early 20th century and first worked on the so-called "Three Body Problem", which laid the foundations for chaos theory.  The  "Three Body Problem" is a famous problem in mathematics and physics that involves predicting the motion of three celestial objects (stars, moons, planets) interacting with each other by gravity. Each body influences the others, causing their orbits to change in unpredictable ways.  Compared to a two-body problem, where the motion of objects under gravity is predictable and relatively straightforward to calculate, the three-body problem does not have a general, exact solution.  Poincaré said of balance, "It is the harmony of the diverse parts, their symmetry, their happy balance; in a word it is all that introduces order, all that gives unity, that permits us to see clearly and to comprehend at once both the ensemble and the details."

The first dimension is length, which reflects our inward concern for our own wellbeing.  Before we can love others, we first have to love ourselves.  Dr. King mentioned a book by the Jewish rabbi, Joshua Liebman, that makes this exact point, entitled Peace of Mind.  Liebman writes, "The quest for unwearied inner peace is constant and universal.  Probe deeply into the teachings of Buddha, Maimonides, or a Kempis, and you will discover that they base their diverse doctrines on the foundations of a large spiritual serenity. Analyze the prayers of troubled, overborne mankind of all creeds, in every age—and their petitions come down to the irreducible common denominators of daily bread and inward peace."  

We find that "unwearied inner peace" when we learn to love ourselves.  And we can only learn to love ourselves when we can accept who and what we are in this world.  Dr. King said, "The principle of self-acceptance is a basic principle in life."  After learning to love ourselves and accept who we are, we have to discover for ourselves what we are called to do in this life.  And whatever that is, we must do our best to be as good as we can be.  Abraham Lincoln is often credited with saying, "Whatever you are, be a good one."  Dr. King references a short poem by Douglas Malloch called "Be the Best of Whatever You Are":

If you can't be a pine on the top of the hill,

Be a scrub in the valley — but be

The best little scrub by the side of the rill;

Be a bush if you can't be a tree.

If you can't be a bush be a bit of the grass,

And some highway happier make;

If you can't be a muskie then just be a bass —

But the liveliest bass in the lake!

We can't all be captains, we've got to be crew,

There's something for all of us here,

There's big work to do, and there's lesser to do,

And the task you must do is the near.

If you can't be a highway then just be a trail,

If you can't be the sun be a star;

It isn't by size that you win or you fail —

Be the best of whatever you are!

The second dimension is breadth, which reflects our outward love for others.  Unfortunately, far too many individuals in this world stop with the length of life.  Dr. King said, "There is nothing more tragic in life to find an individual bogged down in the length of life, devoid of the breadth...unless an individual can rise above the narrow confines of his individualistic actions to the broader concerns of all humanity, he hasn't even started living."  

Dr. King then talks about the Parable of the Good Samaritan from the Gospel of Luke, which is the story of a traveler (a Jewish man) who is robbed on the 20 mile stretch of road between Jerusalem and Jericho (see my post, "If I do not stop to help this man...").  The robbers left the man to die on the side of the road.  Several individuals (including a priest and a Levite) soon walked by, but no one stopped to help the man.  They just crossed to the other side of the road and kept walking.  Finally, a Samaritan (the Jews and Samaritans were bitter enemies apparently) stopped and helped the man, taking him to safety and paying someone to continue to care for him while he recovered from his injuries.  Dr. King suggests that the priest and the Levite probably asked themselves, "If I stop to help this man, what will happen to me?"  The Samaritan asked a different question, "If I do not stop to help this man, what will happen to him?"  Too many people in our society today ask the former question, when they should be asking the latter one.

While it starts with us, it can't end with us.  Just as we, as individuals, have to lover others, our communities, cities, and nations must do so as well.  Dr. King said something that I don't hear enough these days, "Every nation must be concerned about every other nation.  No nation can live in isolation today.  We live in a world that is geographically one now.  We have the job of making it spiritually one...all life is interrelated.  Somehow, we are tied in a single garment of destiny, caught in an inescapable network of mutuality, where what affects one directly affects all indirectly."

Dr. King references a famous poem ("No Man Is an Island") by the English poet John Donne: "No man is an island, entire of itself; Every man is a piece of the continent, a part of the main...Any man's death diminishes me, because I am involved in mankind.  Therefore never send to know for whom the bell tolls; it tolls for thee."  Only by discovering how we are all connected can we master the breadth of life.

The third and final dimension is height, which reflects the upward reach towards a higher power.  Our quest for inner peace and our love for others cannot be complete, unless we are grounded in some sort of religious faith or bounded by a set of moral and ethical principles that help guide us through this life.  Remember that Dr. King was delivering a sermon at church (and that he was a Baptist minister), so he emphasizes the importance of the Christian faith and the Christian God.  In my opinion, the height dimension doesn't have to be either the Christian God or any religious faith.  I go back to the Alcoholics Anonymous concept of a "Higher Power" in the Twelve Steps.  The "Higher Power" doesn't have to represent a particular religion or spiritual tradition, nor does it even have to represent a spiritual deity - it could represent non-spiritual things such as the twelve-step program itself.  It simply represents a power greater than ourselves.  All of us, need a perfect ideal to strive for.  

So there you have it.  The measure of each and every one of us is revealed in the three dimensions of length, breadth, and height.  Balance in our personal and professional lives requires us to focus on loving ourselves (length), loving others (breadth), and striving towards the ultimate perfection, our higher power.

A whale of a tale...

A tagline for an article that recently appeared in Crain's Chicago Business caught my attention: "Is Hershey the white whale for Oreo-maker Mondelez?"  The article mentions that the Chicago-based snack maker, Mondelez (the company that makes Chips Ahoy cookies, Oreo cookies, and Ritz crackers, among several other well-known snack items) is exploring an acquisition of Pennsylvania-based Hershey.  Hershey is what is known in business circles as a "white whale" due to the potential for Mondelez to significantly increase market share and revenue.  A "white whale" is a potential customer, client, or business acquisition that is particularly difficult to win over or to persuade to make a purchase.  The term comes from the classic book, Moby-Dick by Herman Melville.  

I just recently finished reading Moby-Dick for the third time.  While it's one of his most famous novels, it's neither my personal favorite nor even one of his best, at least in my opinion.  I've read a number of Melville's books over the years, and I don't really know how or why I have read Moby-Dick on three different occasions.  The book is considered the prototypical "Great American Novel" (whatever that means), so I first read it during my senior year in high school.  I even had to write a research thesis on all of the symbolism that Melville used in the novel.  I think I read it a second time, some time either during college or shortly after, because I couldn't remember any of the symbolism or why it was considered a "Great American Novel".  I started reading it a third time, after reading Why Read Moby-Dick? by Nathaniel Philbrick (one of my favorite authors right now).  Philbrick called Moby-Dick "the greatest American novel ever written" and claims to have read the book at least 12 times during his lifetime.  Notably, Melville is said to have based his story of the white whale on the true story of the Nantucket whaling ship Essex, which was attacked and sunk by a sperm whale on November 20, 1820.  Philbrick too was inspired by the story and wrote about it in his book, In the Heart of the Sea, which was later made into a movie of the same name directed by Ron Howard and starring Chris Hemsworth, Cillian Murphy, and Brendan Gleason.  

I have to admit.  The book was still a tough read, even on the third go-round.  Part of the reason is that Melville added several chapters on a variety of subjects that were tangentially related to the main plot of the story.  For example, there are chapters on the classification of the different species of whales and cetology, the science of whales (at least what was known about whales at the time).  There are entire chapters dedicated to what life was like aboard a whaler in the 19th century in incredibly minute detail.  While I can appreciate the rationale for including all of these so-called digressive chapters, they add significantly to the overall length and complexity of the book.

Moby-Dick is certainly not alone when it comes to books that incorporate large portions of seemingly irrelevant text that doesn't seem to contribute to the plot of the story.  Many epic novels are structured in this way.  While not necessarily a classic, William Goldman's book The Princess Bride (made into a movie by the same name in 1987) is presented as an abridgement of a longer work by a fictional author, S. Morgenstern (the actual title of the novel is The Princess Bride: S. Morgenstern's Classic Tale of True Love and High Adventure).  Goldman uses the fictional frame story that his own grandfather read him the book aloud when he was a child.  When he found the book later in life, he hated it because there were so many digressive chapters on the history of Guilder and Florin (the two countries featured in the book), the hereditary family tree of Prince Humperdinck, and various commentaries of the politics of the age.  Goldman then "re-wrote" the book and removed all of the "boring parts".  One can only wonder if Moby-Dick would benefit from a similar abridgement!

So, what did I learn from reading Moby-Dick a third time?  First, the novel reinforced what I already knew, that whales are both highly intelligent and fascinating creatures (for example, did you know that whales sleep with half of their brain at a time?).  Second, if you skipped all of the digressive chapters, the story is really enjoyable (dare I say "a whale of a tale"?).  Third, just because something is a classic doesn't mean that everyone has to like it.  Moby-Dick is not for everyone, and you shouldn't read it just to say that you have done so.  Last, and perhaps most importantly, is a lesson I thankfully learned a long time ago that is often lost on high school English teachers and college literature professors.  Unless we have solid evidence that the author used a particular word, sentence, or passage as symbolism, we shouldn't necessarily take someone else's interpretation of that same word, sentence, or passage as gospel.  What really matters is what you as the individual reader gets out of the word, sentence or passage.  Nothing else should matter.  

Personally, I see the novel as a cautionary tale for what happens when an individual becomes too obsessed with something - in this case, Captain Ahab's unhealthy obsession, bordering on madness, for the white whale known as Moby-Dick.  As Starbuck says to Ahab, trying desperately one last time to give up his monomaniacal pursuit of the whale, "Moby-Dick seeks thee not.  It is thou, thou, that madly seeks him."  One can only wonder how things will turn out between Mondelez and Hershey...

Succeeding by Succession

The Pittsburgh Steelers are always listed among the all-time great National Football League (NFL) franchises.  The team was founded in 1933, making it the 7th oldest team in the NFL and the oldest team in the American Football Conference.  They are tied with the New England Patriots for the most Super Bowl titles at six, and they have played a total of eight Super Bowl games (tied with the Denver Broncos, San Francisco 49ers, and the Dallas Cowboys for the second most number of appearances in the Super Bowl).  They have played in (16 times) and hosted (11 times) more conference championship games than any other team in the NFL.  Since 1969, they have had three head coaches (Hall of Fame Coach Chuck Noll from 1969-1991, Hall of Fame Coach Bill Cowher from 1992-2006, and current Coach Mike Tomlin from 2006 to present), which is absolutely amazing!  

Coach Tomlin is likely to be inducted into the Hall of Fame by the time he is done.  During his tenure, the Steelers have played in two Super Bowls (winning Super Bowl XLIII in 2008 and losing to the Green Bay Packers in Super Bowl XLV in 2010).  Coach Tomlin has an overall record of 183-107-2 as head coach (including an 8-11 record in the playoffs), and he has NEVER had a losing season.  

And yet, after the Steelers were defeated by the Baltimore Ravens in the Wild Card Round of this year's playoffs (ending their season with five straight losses), all the pundits are asking if it's time for both Tomlin and the Steelers to mutually part ways!  At least one sports journalist keeps mentioning that the Steelers haven't won a playoff game since Barack Obama was President!

Upon a closer look, Coach Tomlin has done an amazing job getting the most out of his players.  He's not had a good quarterback, arguably the most important position on the team, since Ben Roethlisberger retired at the end of the 2021 NFL season (Roethlisberger won't be eligible for the Hall of Fame until 2027).  The Steelers had 18 seasons with Roethlisberger as their quarterback, and since his retirement, they've gone through a string of less than stellar quarterbacks, including Kenny Pickett, Mitchell Trubisky, Mason Rudolph, Justin Fields, and Russell Wilson.  

There are two pathways to getting what is called a "franchise quarterback" (one who will win championships) - the NFL Draft and free agency.  The only legitimate way to secure a "franchise quarterback" via the NFL Draft is to get incredibly lucky at picking up a great quarterback that nobody thought would be great in the later rounds (think about Tom Brady who was selected 199th by the Patriots in the 2000 NFL Draft and more recently, Brock Purdy, who was drafted with the last pick by the 49ers in the 2022 NFL Draft) or pick someone at the top of the first round.  The only way to get a pick at the top of the round is to either "trade up" or have a really bad season.  You're never going to be picking at the top of the first round of the NFL Draft with a Coach Tomlin at the helm.  He's just too good at what he does.

All of this could perhaps have been avoided, if the Steelers had drafted a quarterback while Ben Roethlisberger was still playing.  Think about how the Green Bay Packers have done it - they drafted future Hall of Fame quarterback Aaron Rogers while Hall of Fame quarterback Brett Favre was still playing, and they drafted their current starting quarterback, Jordan Love, while Rogers was still playing.  In other words, the Steelers should have had a better succession plan.

Enough about sports.  What's important here is to recognize the importance of developing a succession plan.  It is the job of every leader to develop an orderly succession plan with multiple potential candidates to replace them at some point in the future.  It is the job of every organization to make sure that they have a succession plan for every executive position within the organization.  Unfortunately, the available research suggests that most organizations are like the Pittsburgh Steelers - they don't do succession planning well and so are ill-prepared for the departure of a key leader (see "The High Cost of Poor Succession Planning" and "Succession Planning: What the Research Says" in Harvard Business Review).  If you or your organization choose to learn anything from the Steelers, choose this - don't get caught without a solid succession plan for your key leaders!  Succeed by succession!

Raitis tammikuu

The U.S. Surgeon General, Dr. Vivek Murthy (Dr. Murthy is the 19th and 21st Surgeon General, serving under Presidents Obama, Trump, and Biden) recently released an advisory declaring that there is no safe level of alcohol consumption.  The advisory called out in particular the risks associated with several types of cancer, especially breast cancer in women and cancers of the digestive tract in both men and women.  The advisory states, "The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day."  The advisory further provides a number of recommendations to minimize the health risks associated with alcohol consumption, most notably the addition of a health warning label on all alcohol-containing beverages to now include cancer risk (similar to the warnings placed on all tobacco products a number of years ago).

Given the push to limit alcohol consumption, I thought it would be a good time to talk about "Dry January", a challenge to avoid all alcohol consumption for the entire month of January.  While the formal notion of "Dry January" first began with a campaign launched in 2014 by a charity in the United Kingdom known as Alcohol Change UK (notably "Dry January" is a registered trademark with Alcohol Change UK), the history of abstaining from alcohol during the first month of the year goes back much longer.  The government of Finland created "Raitis tammikuu" (literally meaning "Sober January") as part of a war effort to save money in 1942!  However, the campaign launched in the UK certainly did the most to popularize the challenge.  At least 175,000 people signed up to participate in "Dry January" on the Alcohol Change UK website in 2023, and 15% of adults in the U.S. (that's 260 million people) also pledged to abstain from alcohol during the month of January.

Last year, Alcohol Change UK reported that 88% of individuals who participated in the challenge saved money, 71% had better sleep and more energy, and 58% lost weight.  While most people believe that they will revert back to their old drinking habits at the completion of the challenge, there is some evidence to suggest that the making this small lifestyle change, even if only for a month, will have significant health benefits and an impact on healthy habits for several months afterwards.  

There are a number of websites with recommendations on how to be successful with the "Dry January" challenge.  For example, Harvard Medical School provides a list of recommendations ("Thinking of trying Dry January? Steps for success") on its health blog.  In addition, Alcohol Change UK created an app to assist with the challenge (see the link here).  The National Institute on Alcohol Abuse and Alcoholism says, "Remember, if you feel better when you are not drinking, or when you decrease your drinking, then your body is telling you something. Listen to your body."  All of these websites also provide a list of signs and symptoms for alcohol withdrawal syndrome, which can be serious - the Harvard Medical School blog post says, "If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help."

The Surgeon General's report states loudly and clearly that all types of alcohol, including wine, can increase the risk of cancer.  One of the questions we had was about the purported benefits of drinking a glass of red wine - the so-called French Paradox, based on an observation that the people of France lower rates of coronary heart disease (CHD), including deaths, despite a high intake of dietary cholesterol and saturated fat.  Back in the 1980's and 1990's, we heard that at least some experts suggested that consumption (in small amounts) of red wine could reduce the risk of CHD.  Red wine contains an anti-oxidant known as resveratrol, a compound believed to have anti-hypertensive effects and potential protective properties because of the ways it relaxes blood vessels.  Unfortunately, if that was the explanation, an individual would have to consume about 500 to 2,700 liters of red wine, or 800 kilograms of red grapes, or 2,900 kilograms of dark chocolate — massive amounts that would not be considered healthy, or even possible - in order to get the 1 gram per day of resveratrol that some research suggests would result in such health benefits! 

The French Paradox is still widely debated.  However, if we are going to pay attention to epidemiological studies linking wine consumption with lower risks of CHD, we also have to pay attention to the more rigorous studies linking alcohol consumption with an increased risk of cancer.  The bottom line is that alcoholic beverages, even wine, should be limited to at most one drink per day (and the Surgeon General's report suggests that we should even limit our consumption further than that amount).  Novelist and wine aficionada Boris Fishman discusses some of the benefits to wine consumption (albeit limited) in New York Times editorial released in response to the Surgeon General's advisory.  My wife and I enjoy drinking the typical "glass of wine with dinner", but we decided to jump on the bandwagon and take the "Dry January" challenge this year.  Balancing all of the potential benefits and potential risks, I suspect my wife and I will go back to drinking our wine again after the month of January.  But for now, we will push on and abstain for the rest of the month.

Vroom Vroom!

I've always strongly believed in the concept of situational leadership, which is the idea that there is not one universal leadership style that works for every situation.  Rather, effective leaders adapt their style to the context of the particular situation (see my posts "What style of leadership works best? It depends upon the problem at hand...", "Connecting the dots...", "Tame the chaos", and "The place where we feel we belong" for more on this topic).  It is a well-accepted truism that when it comes to leadership, a one-size fits all approach just doesn't work.

While situational leadership as a theory/model was originally described by Paul Hersey and Ken Blanchard in the 1970's while working on their classic textbook Management of Organizational Behavior, the concept of adapting your leadership style to the specific needs of the situation has certainly been described by other management and organizational behavior experts.  For example, contingency theory, developed in the 1950's is very similar to situational leadership theory and emphasizes that there is no one best way to organize and lead a team, group, or corporation or make decisions.  Rather, the best approach is contingent (dependent) upon the specific needs of the situation. 

Robert Blake and Jane Mouton  developed their managerial grid model (also known as the Blake Mouton Grid) in the late 1960's (more on that model in an upcoming post).  William James Reddin developed the 3D Theory (also a subject for a future post), which he first outlined in his 1983 PhD thesis, Managerial Effectiveness and Style: Individual or Situation.  Reddin stated, "Any managerial style has a situation to it, and many situations inappropriate to it..." 

More recently, Daniel Goleman described six different leadership styles in his article, "Leadership That Gets Results" that was published in the March/April 2000 issue of the Harvard Business Review.  These six leadership styles included coercive leadership, authoritative leadership, pacesetting leadership, affiliative leadership, democratic leadership, and coaching leadership.  Importantly, Goleman concluded that "being a great leader means recognizing that different circumstances may call for different approaches." 

In today's post, I want to discuss the Vroom-Yetton-Jago Model which was first developed in 1973 by Victor Vroom and Phillip Yetton, with later contributions by Arthur Jago in the late 1980's.  Again, the underlying assumption of this model is that there is no single universal approach to leadership, and the optimal leadership approach is determined by the specific context or situation at hand.  Vroom and his colleagues described a number of different leadership styles, ranging from autocratic (the leader makes decisions on his or her own) to collaborative (the leader reaches consensus with the other members of his or her team).  They developed a series of yes/no questions - seven in total - that would help a leader navigate through a complex decision tree, which would determine the leadership approach that would work best in a particular situation:

1. Is the quality of the decision important?

2. Is team commitment to the decision important?

3. Do you have enough information to make the decision on your own?

4. Is the problem well-structured?

5. If you made the decision yourself, would the team support it?

6. Does the team share organizational goals?

7. Is conflict amongst the team over the decision likely?

Here is the decision tree that Vroom and his colleagues developed:

Here were the five different leadership styles that Vroom and his colleagues proposed:

Autocratic Type 1 (A1): The leader makes his/her own decisions using information that is readily available at the time.  This style is completely autocratic.

Autocratic Type 2 (A2): The leader collects required information from followers, then makes a decision alone.  The problem or decision may not be fed back to the followers, and their involvement is simply to pass along and provide information to the leader.

Consultative Type 1 (C1): The leader seeks ideas and suggestions on how to solve a problem from followers individually, but still makes a decision alone.  The leader's decision may or may not be influenced by the followers' input.

Consultative Type 2 (C2): The leader meets with the followers as a group and seeks their collective input, but still makes a decision alone.  The leader's decision may or may not be influenced by the followers' input, but at least the followers have an opportunity to express their opinions and share their ideas with the group.

Group-based Type 2 (G2): The leader meets with the followers as a group and seeks their collective input.  The leader accepts any decision by the group and does not try to force his or her idea on the group.  The ultimate decision is made by consensus.

I suspect that no one in their right mind would actually go through the exercise of answering all seven questions as they work through the decision tree, particularly when a decision needs to be made quickly.  That's not the point here though.  While there are certainly advantages and disadvantages to using this model, I think the key point is that there is likely to be a situation or decision that lends itself very well to a specific leadership approach, even what Vroom and his colleagues call an autocratic approach.  The seven questions can provide leaders with a rough idea of which style fits which particular situation the best.

I think William Reddin and Daniel Goleman perhaps said it best.  Reddin said, "Any managerial style has a situation to it, and many situations inappropriate to it..." Goleman added, "Being a great leader means recognizing that different circumstances may call for different approaches." Incidentally, rumor has it that Victor Vroom once had a boat that he named "A1".  In other words, he was the captain of his boat and on his boat, he called the shots!

Resolutions

Today, January 10th, is unofficially known as "Quitter's Day" - yes, it really is a thing!  "Quitter's Day" typically occurs on the second Friday after New Year's Day and is the day when most people have decided to quit on their resolutions for the new year.  Apparently the tradition of setting New Year's resolutions started during ancient times, though the concept of a "Quitter's Day" is much more recent.  According to research conducted by Strava in 2019, around 80% of individuals on their platform had abandoned their resolutions by the second week of January.  More recent research suggests that the vast majority of individuals give up on their resolution within a month.

The word resolution when used in this particular context is defined as a firm decision to do or not do something.  Most people that I know come up with at least one resolution for the New Year, either committing to doing more of something or less of something.  Most resolutions involve exercise, dieting and weight loss, or trying to break some bad habit.  There are numerous articles on how not to break your New Year's resolution (here's a great one on Medium), so I am not going to add anything new here in today's post.  To be 100% honest, I don't make a resolution every new year.  Rather, I come up with my own personal list of annual goals.

I've found that setting personal and professional goals for myself is a much more fruitful exercise than coming up with a resolution that I will likely fail on anyway.  To be clear, the great thing about a New Year's resolution is that it is usually simple, clear, concise, and focused.  Some experts would argue that setting 5-10 personal and professional goals is too many, but it works for me.

This year I tried to focus on goals that would help my mind, my body, and my spirit.  I focused on intellectual, physical, and spiritual growth and development.  Three of my goals are physical in nature (and yes, one involves weight loss), four are intellectual in nature and involve new priorities for learning, and three are spiritual in nature and relate to developing new friendships and improving the ones that I already have.  

I try to use the SMART goal framework.  For example, all of my goals are all time-bound, in that they are things that I want to accomplish by the end of the year.  I've found that when it comes to goal-setting, it's a marathon and not a sprint.  I suspect that part of the reason why individuals give up on their resolutions is because they try to do everything all at once in the first few weeks of the new year.  It's also important to push yourself a little, so all of my goals are what we would call "stretch goals".  Importantly, however, I don't set the bar so high that it's almost impossible to reach.  For example, I did NOT set a goal to run next year's Chicago Marathon in under three hours!

Only time will tell if I achieve my personal goals.  However, I feel pretty good about them.  I'm not necessarily trying to completely re-invent myself, which is why I think a lot of people give up on their New Year's resolution.  For those of you who find yourself abandoning your one resolution for the year on Quitter's Day (or even later in the month), try setting annual goals instead! 

"Health care workforce challenges persist..."

I hate to start off a new year with bad news, but the NEJM Catalyst just released a new Insights Report "Health Care Workforce Challenges Persist as a Legacy of COVID-19".  It's a good read, as well as a sobering one.  The Insights team surveyed 691 members of the NEJM Catalyst Insights Council, which is a group of physicians, clinical leaders, and health care executives working in health care organizations in 292 different countries around the world.  These senior leaders reported that the top two challenges that their organizations will face in the new year are (1) staffing shortages and (2) clinical burnout.  

Just over half (53%) of the senior leaders surveyed reported that staffing shortages have actually worsened since the COVID-19 pandemic, which is not a reassuring trend.  Frederick P. Cerise, MD, MPH, currently President and Chief Executive Officer at Parkland Health & Hospital System in Dallas, Texas, said, "Our staffing challenges are dramatically different from the height of the pandemic to now.  It's no longer the desperation of filling shifts.  But pressure is still there."

Recruiting physicians and other clinicians remains a significant concern, with 83% of senior leaders reporting that recruiting physicians and nurses is difficult, very difficult, or extremely difficult.  Recruiting challenges have, in fact, worsened since the last Insights Council survey in November, 2022.  These challenges are particularly impacting pediatric subspecialties, as fewer medical students are choosing pediatric residency training programs.  Similarly, fewer anesthesiology, radiology, and surgical residents are choosing pediatric subspecialty fellowship programs.

Retention is almost as difficult as recruitment, and again these challenges have increased since the November, 2022 survey.  Part of the issue here is the ongoing crisis of clinician burnout.  Nearly half of the respondents reported experiencing signs of burnout related to work-related stress.  

Finally, 45% of Insights Council members reported that trust in leadership/hospital administration has worsened in the last 2 years.  Dr. Cerise said, "The erosion of trust was going on before the pandemic, and almost half of respondents say it worsened in the past 2 years."  Staff shortages and burnout certainly contribute to the lack of trust, but so too have ongoing financial challenges with the consequent need to emphasize productivity, the lack of autonomy that many clinicians perceive, and ongoing administrative hassles that clinicians encounter every day as they try to provide the best care for their patients.

The results of the NEJM Catalyst Insights survey probably shouldn't surprise too many of leaders in health care.  I hope you agree that the findings are important.  What is clear is that we have an obligation to work hard to address some of the findings in this survey, at least those that are under our direct control. 

Do coaches matter?

The NFL regular season officially ended yesterday, which means that today is what has become unofficially known as "Black Monday".  I recently posted about "Black Monday" (see "Black Monday is coming soon...") and focused particularly on the situation with the New England Patriots and their now former head coach, Jerod Mayo.  At least at the time of this writing, five NFL teams have cut ties with their head coaches.  Jerod Mayo was one of those coaches who lost his job, and there will likely be more to come, if not today then later in the week.  

There's at least some evidence to suggest that better coaches and managers help sports team perform at their best, at least when it comes to wins and losses.  For example, one study using data collected from the NFL, NHL, NBA, MLB, and college football and basketball suggested that coaching explains somewhere between 20-30 percent of the variation in a team's success.  So, I guess it makes sense for some of the low-performing teams to move on and try to change coaches.  But let's also be realistic - it's not easy to lead any sports team or organization through a turn-around situation, nor is the new coach, manager, or leader always successful.

At least one of the arguments is that the best coaches get the most production and performance out of each individual player on the team.  Is that true though?  Does better coaching lead to better individual performance?  If you were a professional athlete, would you take a small pay-cut to go play for a legendary head coach or manager? 

Interestingly enough, Lawrence Kahn published a study several years ago that looked at individual players performed under successful managers.  Kahn used a manager's salary as a measure of "manager quality", which makes some intuitive sense, as the more successful a manager is in terms of wins and losses, the higher he is likely to be paid.  Kahn found that (1) higher quality managers lead to higher team winning percentages and (2) players tend to perform better, relative to their prior years of performance, under better managers.  Kahn wrote that "when a high-quality new manager takes over a team, the average starting player's performance relative to his lifetime statistics (accumulated under other managers) is greater than when a low-quality manager takes over the team."  

I will be the first to admit that what happens in the sporting world doesn't always transfer over to the non-sports world.  However, I do think that the best leaders often get the most out of their teams.  As John Quincy Adams once said, "If your actions inspire others to dream more, learn more, do more and become more, you are a leader."  At the end of the day, regardless of the organizational context (sports, military, politics, business, health care), it pays to invest in hiring and developing great leaders.