The very first "Org Chart"

Daniel McCallum is often credited with having developed the first modern organizational chart.  McCallum took over operations of the New York and Erie Railroad in 1854, which at that time was one of the longest and most extensive railroad systems in the world with nearly 500 total miles of track.  Once he took charge, McCallum quickly discovered that railroad operations were very inefficient.  The problem wasn't necessarily about communication, as by this time the railroad operators had access to real-time data and information via telegraph.  The problem was one of coordination, or the lack thereof.

McCallum solved this coordination problem by developing the first modern organizational chart, which is shown below (it's easier to see the details of the structure in the online version here).

My first impression of this chart is how very different it is compared to the organization charts that we see today.  Rather than a pyramid-shape, we have a flowery diagram that looks more like a tree.  I might even go as far as saying that the overall structure of this chart reminds me a little of the Mandelbrot set (at least when you start to zoom in on the fractal geometry of the Mandelbrot set).  What's not readily appreciated, however, is the fact that McCallum deliberately placed the Board of Directors at the root and the executive leadership team at the trunk.  In other words, he turned the organizational structure (at least the traditional ones used today) upside down!  

As Caitlin Rosenthal, writing for The McKinsey Quarterly, described it, "Critically, McCallum gained control by giving up control, delegating authority to managers who could use information in real time."  McCallum knew that the amount of data generated by front-line operations was far too much for any one individual to be able to process.  Rather, he empowered his front-line managers with the necessary authority to make decisions in real-time.  The executive leadership team would in turn review system-wide metrics and hold front-line managers accountable to performing to their targets on those metrics.

It's clear that McCallum was well ahead of his time in using what we frequently call "Deference to Expertise" or "Pushing authority to information" (as opposed to pushing information to authority in the traditional top-down, pyramid, hierarchical structure of today's organizational charts).  It's amazing to me that it has taken us this long to grasp the significance of McCallum's original organization chart.

Artificial intelligence?

I grew up during the beginning of the digital age.  I remember when the first personal computers came out.  I was always fascinated by a computer game called ELIZA, an early natural language processing game in which the computer played the role of a psychotherapist and the user would ask for help with his or her problems of the day.  Here is an example of how a conversation might go:

Little did I know that ELIZA was one of the early forerunners of artificial intelligence.  I was reminded of ELIZA (or at least I felt like I was talking to it again) just the other day when I was calling my health insurance provider (name withheld to protect the innocent) in order to submit a recent claim.  My provider coverage changed slightly at the beginning of the calendar year, and I had a claim to submit for service that occurred during the second week of December.  In this particular case, I paid out of pocket with the expectation that I would submit a claim later.

The website and app (which I usually use for these kinds of transactions) weren't able to assist me, so I called the service line directly.  As is usually the case, I was talking to an artificially intelligent virtual assistant.  The conversation went something like this (the first several questions were to verify my identity, which I am leaving out for obvious reasons):

Virtual Assistant: How can I help you today?

Me: I need to submit a claim.

Virtual Assistant: Okay.  You need to submit a claim.  Is that correct?

Me: Yes.

Virtual Assistant: What was the date of your service?

Me: December 6, 2024.

Virtual Assistant: Did you say "December 6, 2024"?

Me: Yes.

Virtual Assistant: One moment please.  I'm sorry, there is not a claim for that service.

Me: Correct.  That is why I need to submit the claim.

Virtual Assistant: I'm sorry.  I didn't get that.  How can I help you today?

Me: I need to submit a new claim.

Virtual Assistant: Okay.  You need to submit a claim.  Is that correct?

Me: Yes.

Virtual Assistant: What was the date of your service?

Me: December 6, 2024.

Virtual Assistant: Did you say "December 6, 2024"?

Me: Yes.

Virtual Assistant: One moment please.  I'm sorry, there is not a claim for that service.

Me: Can I speak to customer service?

Virtual Assistant: I can help you.  Would you like me to repeat the menu?

Me: Hang up.

Now, I realize that my issues weren't necessarily straightforward.  However, there was no easy way to request to speak with a living, breathing human being who would know how to help me.  I ended up going through a member of our HR team to help me submit my claim.  

I know that artificial intelligence has come a very long way since ELIZA, and I know that my health insurance provider's virtual assistant wasn't a true representation of what artificial intelligence can really do.  However, my experience did raise a few questions in my mind that inspired me to do a little research.  I read about something known as the Winograd schema challenge, a test of artificial intelligence developed by Hector Levesque in 2011 (and named after fellow computer scientist Terry Winograd), supposedly to improve upon the classic Turing test, which was originally developed by the computer scientist Alan Turing to test whether a computer could exhibit intelligent behavior equivalent to a human.   These tests are essentially questions that computers are terrible at answering, and here is a great example:

A large ball crashed through a table because it was made of steel.  What was made of steel?

The question would be easy for a human to answer (the ball crashed through the table because the ball was made of steel), but apparently artificial intelligence would have difficulty answering the question.  I guess we need to add one more question to the Winograd schema challenge - "What was the date of your service?"  I am reminded of an essay that Nicholas Carr wrote on October 5, 2012 entitled "The ennui of the intelligent machine" (I can't find it online, but it included in his book, Utopia is Creepy, a collection of his essays, articles, and blog posts).  Carr was writing about neural networks and how Google was using artificial intelligence for some of its speech recognition and image recognition tasks.  He quoted one of Google's engineers, Jeff Dean, who said, "We are seeing better than human-level performance in some visual tasks" (specifically identifying house numbers on satellite images for Google's Street View application) and how Dean thought that the real Turing test has less to do with what we think of intelligence and perhaps more to a computer's inability to experience boredom.  As you can imagine, some of these tasks are fairly mundane.  

Dean went on to say, "It's probably that the task is not very exciting, and a computer never gets tired."  Carr added that it takes real intelligence to get bored.  He added, "Forget the Turing Test.  We'll know that computers are really smart when computers start getting bored.  If you assign a computer an overwhelmingly tedious task like spotting house numbers in video images, and then you come back a couple of hours later to find the computer checking its Facebook feed or surfing porn, you'll know that artificial intelligence has truly arrived."

What is clear is that artificial intelligence is most definitely here to change how we work and how we live.  As I talked about in a recent post (see "Six tests (plus one challenge) for physicians and health care leaders..."), artificial intelligence will be integral to just about every facet of health care in the future.  Health care leaders (and physicians) will need to embrace it or be left behind.

"Why the past 10 years of American life have been uniquely stupid..."

 One of the books that has consistently appeared on several lists of the "Best Books of 2024" is The Anxious Generation by Jonathan Haidt.  My wife purchased the book upon the recommendation of one of her teacher colleagues, so I am looking forward to reading it after she's done.  Jonathan Haidt is a social psychologist at New York University's Stern School of Business.  He has written a number of books and articles on the psychology of morality and moral emotions, particularly as it relates to our lives in society today.  By happenstance, I recently came across an essay that he wrote in the spring of 2022 for The Atlantic, "Why the past 10 years of American life have been uniquely stupid" (he ominously added, "It's not just a phase").  If you have a few spare minutes of time, it's definitely worth investing some time in reading it.

Haidt begins his essay with the biblical story of the Tower of Babel, which appears in the Book of Genesis of the Hebrew Bible and Christian Old Testament.  If you aren't familiar with the story, the descendants of Noah built the city of Babel in the land of Shinar (Lower Mesopotamia).  The people were united and all spoke a common language.  They built a tower "with its top in the heavens" (see the 1563 painting "The Tower of Babel" by Pieter Bruegel the Elder below), more or less, because they could.  God was offended by the hubris of the people of Babel and said, "Look, they are one people, and they have all one language; and this is only the beginning of what they will do; nothing that they propose to do will now be impossible for them.  Come, let us go down, and confuse their language there, so that they will not understand one another's speech."

The people of Babel could no longer understand each other, so the tower was never finished.  It's never stated explicitly that God destroyed the tower, even though several popular renditions of the story state it this way.  

Haidt explains his analogy and writes, "The story of Babel is the best metaphor I have found for what happened to America in the 2010s, and for the fractured country we now inhabit.  Something went terribly wrong, very suddenly.  We are disoriented, unable to speak the same language or recognize the same truth.  We are cut off from one another and from the past."

It's not just that we are highly polarized as an American society, but rather that our society has become so fragmented.  Haidt writes, "It's a metaphor for what is happening not only between red and blue, but within the left and within the right, as well as within universities, companies, professional associations, museums, and even families."  We have somehow lost the ability for mutual discourse.  

The American political scientist Robert Putnam suggested as early as 2000 (see Bowling Alone: The Collapse and Revival of American Community) that Americans have stopped participating in the kinds of community activities that used to bring us all together.  He made the simple observation that Americans used to bowl in leagues, but now we don't.  Our sense of community - the sense of togetherness - deteriorated along with our drop in participation in different social and community organizations (sports teams, such as bowling or softball leagues; church groups; civic organizations such as the Knights of Columbus, the Kiwanis, or the Freemasons; labor unions; parent-teacher organizations; volunteer organizations, such as the Boy Scouts and the Girl Scouts; and many more).  

Both Haidt and Putnam (in an update and revision of his book in 2020) blame the rise of social media and the Internet.  Recall that social media was supposed to bring us closer together as a society.  Facebook CEO Mark Zuckerberg said, "Facebook was not originally created to be a company. It was built to accomplish a social mission - to make the world more open and connected."  That mission was accomplished, but arguably, social media has pushed us further apart more than it has brought us together.

Haidt writes, "Social scientists have identified at least three major forces that collectively bind together successful democracies: social capital (extensive social networks with high levels of trust), strong institutions, and shared stories.  Social media has weakened all three."

Facebook used to provide users with a timeline of content generated by their friends and connections, with the most recent posts at the top and the oldest ones at the bottom.  That changed in 2009, when Facebook added the ability to "like" posts with the simple click of a button (Twitter introduced the "Retweet" feature which was soon copied by Facebook with the "share" button).  Shortly after that, Facebook's software engineers developed algorithms that would bring each user the content that they would most likely "like" or "share".  As a result, users would see only content that they most likely agreed with, and as a result, our society became more and more polarized into different factions.  One of the engineers at Twitter who had worked on the "Retweet" feature later regretted his contribution, comparing it to handing a four year-old a loaded weapon.

Controversial posts tend to get retweeted, shared, or liked.  So it is the controversial or inflammatory content that tends to go viral.  Social media encouraged dishonesty and "mob rule" dynamics.  We have created a vicious cycle that has created more polarization, more factions, and more mistrust due to the spread of misinformation.  Founding Father James Madison wrote in Federalist No. 10 on our tendency to form factions and the dangers to democracy that can result from that tendency - specifically, we become "much more disposed to vex and oppress each other than to cooperate for the common good."

Former CIA analyst Martin Gurri predicted the polarization of society in his 2014 book The Revolt of the Public and the Crisis of Authority in the New Millennium.  Social media and the internet have shattered the ties that bind us together as a society.  We have become, in his words, "highly fragmented" and "mutually hostile".  The mutual trust, belief in our institutions, and shared stories that are so essential for democracies to thrive are gone.

Much of what Haidt writes in his essay is consistent with what I have read this past year in a couple of books written by Nicholas Carr (and recommended in my 2025 Leadership Reverie Reading List).  I would recommend, again, in particular, The Shallows: What the Internet is Doing to Our Brains, The Big Switch: Rewiring the World, From Edison to Google, and his upcoming book, Superbloom: How Technologies of Connection Tear Us Apart.  And, I would recommend reading Haidt's essay.  I am looking forward to his book, The Anxious Generation.  Finally, I want to say that while it would be easy to blame all of society's problems on social media, that would just not be completely fair.  However, to say that social media doesn't share at least a major portion of the blame is simply naïve and untrue.  

I think it would be a mistake to do away with social media completely.  I do think there are some important lessons and caveats for leadership from the essays, articles, and books mentioned today, particularly Haidt's article in The Atlantic:

1. Social media has democratized the dissemination of information.  It's likely that truths and falsehoods about events happening within your organization will be "out there" in cyberspace before you and your leadership team has a chance to act.  As Dan Kramer posted on LinkedIn earlier last year, "The immediacy of social media demands quick and thoughtful responses to emerging situations. Transparency is no longer optional; it's a prerequisite for trust and credibility."

2. Build authentic connections on social media.  I used to accept almost every professional friend request on social media.  More recently, I've only accepted requests from individuals I either personally know or ones that I know that I will interact with at some point in my career.  

3. Build and foster meaningful relationships outside of work.  I think we need to start building new relationships outside of social media again (true, real, in-person connections).  We should get more involved and volunteer, so that we can build our community and networks outside of work.

4. Be wary about what you post.  Posts can be misconstrued and go viral quickly.  We should be careful and deliberate about how we use social media and craft clear, consistent, and culturally sensitive content.  Similarly, we should also be very careful about what we choose to "Like", "Share", or "Retweet".

Nicholas Carr wrote an article for The Boston Globe ("How Tech Created a Global Village - And Put Us At Each Other's Throats") and said, "If our assumption that communication brings people together were true, we should today be seeing a planetary outbreak of peace, love, and understanding."  The reality is, that we are not.  He goes on, "Free-flowing information makes personal and cultural differences more salient, turning people against one another instead of bringing them together. Familiarity breeds contempt is one of the gloomiest of proverbs. It is also, the evidence indicates, one of the truest."