Red light, yellow light, green light, GO!

A few years ago, the Neonatal Intensive Care Unit (NICU) at my former hospital came up with what I thought was a brilliant initiative focused on nursing staff wellbeing.  Basically, at the end of every shift, each nurse would place a colored ball (red, yellow, or green) into a jar by the main desk.  The red-colored ball indicated that the shift was very stressful, while the green-colored ball indicated that the shift was not stressful at all (the yellow-colored ball signaled that the shift was somewhere in the middle of those two extremes).  The unit leadership collected and counted all of the colored balls to get an idea of how stressful the shift had been for the unit as a whole, which they then used to retrospectively look at other key factors, such as the unit census (total number of patients), acuity (how critically ill all of the patients were during that shift), and staffing levels (how many nurses were working that shift, how many patients each nurse had been assigned, etc).  

Admittedly, the system that the NICU leadership had created provided a good retrospective view of the shift, but it could not have been used to adjust staffing levels or increase the number of manager check-ins and leadership rounds during that actual shift.  I filed away the NICU's initiative as something to consider for the future, but to be honest, the retrospective nature of the system of colored balls limited its widespread application to other inpatient units.  

I was reminded of this same NICU initiative after recently coming across a blog post about using a similar system during leadership check-ins (see Chad Dickerson's blog post, "The magic of the personal check-in: Red, yellow, green").  Here, meeting participants kick off every meeting (whether a 1:1 meeting or group meeting) by stating at the outset how they are feeling at that particular moment.  As Dickerson writes, "Red means you are having trouble focusing, you're extremely distracted, and/or you're feeling distressed.  Green means you are feeling good, focused, relaxed, and ready for any discussion.  Yellow is somewhere in between."

Dickerson explains why this simple "trick" works so well, stating, "The reason that the red/yellow/green exercise is so powerful is that it can quickly create a space of psychological safety that helps teams do better work.  It's also quick and simple.  You don't need to hire expensive consultants or take personality tests or get a special certification."

Participants don't have to explain why they are feeling Red, Yellow, or Green.  Rather, just by stating how they are doing at a particular moment in time creates a sense of authenticity, vulnerability, and humility, which in turn helps build psychological safety and engenders mutual trust.  There is perhaps no better way to build trust within a group or team than by individual members being vulnerable and honest.  

Incidentally, Dickerson references a Harvard Business Review article ("How One Hospital Improved Patient Safety in 10 Minutes a Day").  The article was written by Roel van der Heijde and Dirk Deichmann and presents a very similar initiative developed by leaders at Rotterdam Eye Hospital.  Prior to the start of every shift, team members would "huddle" together and rate his or her own mood as red, orange, or green.  The team leader then asks if there is anything that the team needs to know to work more effectively together that shift.  Lastly, the team leader assigns two staff members to each draw a card.  One card has a safety-related quiz (e.g. "What are the five steps in hand hygiene?"), while the other card asks the person to observe something during the shift and share his or her findings during the next day's team huddle.  Of particular interest, Rotterdam Eye Hospital claims that this routine has resulted in an improved safety culture, improved patient safety performance, and increased staff engagement and wellbeing!

What I particularly like about all of these similar initiatives is that they are so simple and easy to use.  As Dickerson suggests, they do not require specialized certification or training and can be easily implemented.  Incidentally, I am feeling particularly "green" today!  Now it's time to go!

For nearly a quarter of a century, nursing is the most trusted profession!

Gallup released the results of their annual Honesty and Ethics of Professions survey earlier this month, and once again nursing ranked as the most trusted profession in America.  The nursing profession has now held the top spot for the last quarter century!  Nurses have ranked number one every year since being added to the survey in 1999, with the sole exception of 2001, when firefighters ranked first (and nurses ranked second) following the 9/11 terrorist attacks.  Military veterans, who were added for the first time in this year's survey, ranked second, while medical doctors and pharmacists also received high marks.  In contrast, telemarketers (5%), members of Congress (7%) and car salespeople (7%) remain the lowest-rated professions for honesty and ethics.

Notably, while the nursing profession continues to be the most trusted profession in America, their latest rating is near the 73% low for the profession and 14 percentage points shy of their record high in 2020 during the COVID-19 pandemic.  Similarly, the rankings of the other two professions that rank just behind nursing (medical doctors and pharmacists) have also fallen by 20 and 18 points, respectively, since peaking during the pandemic and remain below pre-pandemic ratings.  

Seven of the 21 occupations surveyed in the annual poll, conducted December 1-15, 2025, reached new low points or tied their previous lows (these include, most notably, nursing, accountants, advertising practitioners, bankers, members of Congress, building contractors, and car salespeople).  A core group of professions has been tracked consistently over the past four decades, including 11 that have been measured annually since 1999. The average positive rating across these 11 professions is now 29%, the lowest historically by one percentage point.

Gallup concluded with the comment, "Although nurses and other healthcare professionals remain among the most trusted, their ratings, along with those of many other professions, have declined from pandemic-era highs, leaving overall ethics ratings across many occupations at or near historic lows."

Pure Magic and the Hardest Song in the World to Sing

If you've ever been to a Chicago Blackhawks game, you would not have been so surprised to hear Jim Cornelison's singing of our national anthem at the Chicago Bears - Los Angeles Rams Division Play-off game this past Sunday night.  I've seen headlines such as, "Bears' national anthem singer sends NFL fans into frenzy with performance before playoff game" and "NFL fans go wild for 'best national anthem of all time' before Rams-Bears playoff game".  It was an amazing performance.  It's not often that you see so many NFL players singing the national anthem before a game, but Cornelison's rendition was so inspiring that fans and players both joined in to sing.

Cornelison is a regular at Chicago sporting events. He’s been the Bears’ national anthem singer since 2010. He has been singing the national anthem before every Chicago Blackhawks home game since 2008.  Cornelison has even sung "Back Home Again in Indiana" (one of my favorites) before the Indianapolis 500 since 2017.

It was a great moment for Chicago, even though the Bears' magical season finally came to an end with a disappointing loss to the Rams.  I was truly reminded of another magical moment - when legendary recording artist Whitney Houston sang the national anthem before Super Bowl XXV on January 27, 1991, just 10 days after the start of the Persian Gulf War (codenamed Operation Desert Storm).  Houston's performance is considered one of the greatest renditions of the U.S. national anthem of all time.

As I shared in a post from December, 2019 (which I will repeat, in part, here today), the "Star Spangled Banner" is notoriously difficult to sing.  The humorist Richard Armour once quipped:

In an attempt to take Baltimore, the British attacked Fort McHenry, which protected the harbor. Bombs were soon bursting in air, rockets were glaring, and all in all it was a moment of great historical interest. During the bombardment, a young lawyer named Francis Off Key [sic] wrote "The Star-Spangled Banner", and when, by the dawn's early light, the British heard it sung, they fled in terror.

Not everyone has Cornelison's operatic voice or Whitney Houston's five octave vocal range - not even close!  As a matter of record, there are several well-known disastrous performances of the national anthem (for example, see Billboard's top 10 worst performances of all time, as of 2024, here).  Both professional and amateur singers struggle with the song's vocal range and have been known to forget the lyrics.     

Take a look at this video of a woman who starts to sing the national anthem before an NHL hockey game.  She appears to forget the words, abruptly stops and turns around to go back and grab a lyric sheet, and returns a few seconds later.  While walking back onto the ice, she slips and falls, as the audience cheers and jeers in the background.  Now ask yourself, what would you have done if you had been there?  Would you have jeered or even booed at the woman?  Admittedly, I can totally see myself reacting in that fashion in a similar circumstance.  And I am not proud to admit that.

Now, check out this video of a similar circumstance.  In this case, a young singer was invited to sing the national anthem before an NBA basketball game between the Portland Trailblazers and Oklahoma City Thunder on April 25, 2003.  The singer was a 13 year-old 8th grade student who had been selected by the fans in a promotional contest.  As luck would have it, she woke up that morning with a case of the flu and felt awful as she walked out in front of 20,000 plus fans. 

The young girl started singing, but when she got to the phrase, "What so proudly we hailed," she stumbled over the words.  She stopped - complete mind block.  She started looking around for her father for help.  At first, the audience tried to encourage her to continue, but the longer her uncomfortable pause lasted, some of the cheers turn to jeers.  Suddenly, one of the Oklahoma City assistant coaches, Hall of Fame basketball player Maurice "Mo" Cheeks, walks up behind the girl, put his arm around her, and started singing with her.  He coached her through the next few words of the song (and if you pay close attention to the video, he actually gets some of the words wrong too!).  The audience's jeers and boos turn to cheers, as they collectively finish the song together.  The girl would go on to say, “It was like a guardian angel had come and put his arm around my shoulder and helped me get through one of the most difficult experiences I've ever had."

Which situation would you rather be in when you make a mistake - having people make fun of you or celebrate your failure, like the first video, or have someone support you and coach you through the difficult times, like in the second?  Now, ask yourself my earlier question again.  The next time you see someone struggle, will you be like the hockey fans in the first video or like Coach Cheeks in the second?

You don't have to be an NBA Hall of Famer to be a leader.  At times, leadership is defined as being directive but calm under pressure.  At other times, leadership requires patience and humility.  There are going to be times in your leadership career when everything seems to click - those times will seem like pure magic.  There are also going to be times when things don't go very well.  How you react to both instances will define you as a leader.  How you react will make all the difference in the world.

"But if you keep your nose down in life and keep working, anything is possible..."

Congratulations to the Indiana University Hoosiers for winning their first EVER National Championship in college football last night!  They finished a perfect 16-0 season by beating a very tough Miami Hurricanes football team.  The Hoosiers won by beating traditional football powerhouses Ohio State (in the Big Ten championship game), Alabama, Oregon, and Miami.  

What is so unbelievable is that Indiana University has been for many years known as a basketball school (as Wall Street Journal reporter Jason Gay wrote today, "This was a basketball school that played football as a way to get to the basketball season"), winning the NCAA National Championship in 1940, 1953, 1976, 1981, and 1987.  The football program has been the proverbial doormat, losing 715 games in their history, the second most in FBS history and just one game less than Northwestern University.  IU Head Coach Curt Cignetti came to IU just two years ago, following the firing of then Head Coach Tom Allen.  Coach Cignetti inherited a team that had finished 3-9 in Coach Allen's final year.  Shortly after his hiring, he was asked how he was selling his vision for the program to potential recruits and transfers.  He replied, "I win. Google me." 

The Hoosiers finished Cignetti's first season in 2024 ranked number 10 overall with an 11–2 record, but their season ended with a loss to Notre Dame in the first round of the 2024–25 College Football Playoff (CFP).  They would not be denied in Cignetti's second season, finishing the Big Ten season with an undefeated record before defeating the defending national champions Ohio State Buckeyes to enter the CFP as the number one ranked team in the country (their first ever number one ranking).  Along the way, quarterback Fernando Mendoza would win the Heisman Trophy, the first in Indiana University's history.

Coach Cignetti is famously stoic on the sidelines and during post-game interviews.  Not this time.  During post-game interviews with ESPN sideline report Molly McGrath, Cignetti said, "Let me tell you, we won the national championship at Indiana University, it can be done.  I’m so happy for our fans. Words can’t describe it."

McGrath asked what he was feeling at that moment.  Cignetti replied, "What’s this moment like for me?  Back when I was waxing the staff table at IUP, Thanksgiving weekend and school was shut down for the playoffs, did I ever think something like this was possible? Probably not. But if you keep your nose down in life and keep working, anything is possible."

Amazing performance by an amazing football team.  Just to put it all in perspective, the last time a college football team won the national championship and finished an undefeated 16-0 was 1894, when Yale's football team did it.  Cignetti called his team's season "probably one of the greatest sports stories of all time," before ending, "but it's all because of these guys and the staff."  Congratulations to the Indiana University Hoosiers, National Champions!

In Honor of Dr. Martin Luther King, Jr

Today we celebrate Dr. Martin Luther King, Jr Day.  President Ronald Reagan signed a bill in 1983 marking the third Monday of every January as Martin Luther King, Jr. Day, the first national holiday honoring an African American.  I was looking back on some of my past posts celebrating Dr. King (for example, one of my first posts in 2017, "Remembering Dr. King" or "Silence is Betrayal" the next year).  I've posted about some of his well-known speeches (see "I have a dream" or "Tell them about the dream, Martin").  I've posted about a trip my wife and I made to the National Underground Railroad Freedom Center in Cincinnati, Ohio (see "The Three Dimensions of a Complete Life").  One of my favorite posts, however, was "What would Dr. King say today?" in 2021, which I wish to re-post today.  Here is the post from 2021:

Dr. Martin Luther King, Jr was born on January 15, 1929.  Today, we officially celebrate his birthday and honor his legacy.  Given all of the events and changes of the past year, I can only wonder what Dr. King would say about the state of our world today.  

I believe he would say something about how polarized our country has become and tie that fact back to the state of race relations that existed during his lifetime (and which unfortunately haven't changed all that much), using "The Other America" speech that he gave at Stanford University on April 14, 1967 (see also one of my old posts, "The Other America" from last Spring).  His words then are eerily poignant in light of recent events in the past couple of weeks, "What I'm trying to get across is that our nation has constantly taken a positive step forward on the question of racial justice and racial equality. But over and over again at the same time, it made certain backward steps. And this has been the persistence of the so called white backlash."  

In this same speech, Dr. King goes on further to talk about civil unrest and civil disobedience:

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

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

I would imagine that Dr. King would have a comment or two on the state of our health care system, especially in light of the racial and ethnic disparities that have persisted since his lifetime and are perhaps even worse now with the COVID-19 pandemic.  Back on March 25, 1966 in a Chicago press conference following the annual meeting of the Medical Committee for Human Rights, he said "Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.”  

And, rather than just talking about the problems we are experiencing today, Dr. King would offer a message of hope for the future, giving us a roadmap on how to move forward, just as he did in his famous, "Letter from Birmingham Jail".  He would likely tell us that we needed to do more, each and every one of us, both individually and collectively, to fight for social justice: "...all too many others have been more cautious than courageous and have remained silent behind the anesthetizing security of stained-glass windows."  

I think Dr. King would also tell us that in order to bend the long arc of the moral universe towards justice, we would need to go deeper to understand these issues, perhaps deeper than we are comfortable with: "Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection."

I would love to have that conversation with Dr. King.  I think he would have a lot to teach me.  Today, I think that the best way that we can honor his legacy and his memory is to go back and read some of his speeches and truly begin to live by his words.  We have a long way to go still, but “Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred.”  Let us move forward.  “Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice.”  “Now is the time to make justice a reality for all of God’s children.”  “Now is the time to lift our nation from the quicksands of racial injustice to the solid rock of brotherhood.”

"Don't send me a customer satisfaction survey in the middle of the night!!!"

One of the real advantages (among many others, of course) of being a pediatric critical care physician is that I can literally fall asleep anywhere.  There were many nights when I was on an overnight call when I took advantage of a few minutes here and there to catch a few winks.  I am also a fairly light sleeper as a result of those many night calls.  I think I was trained to hear my pager go off in the middle of the night.  Later in my career, I became accustomed to "hear" text messages in the middle of the night.  

So recently, I heard that familiar text message "ping" in the middle of the night.  I checked my phone, which I always keep on my night stand, and quickly saw that it was around 1:30 AM.  I thought to myself, "Oh, no!  This can't be good."  When I opened up the text message, I saw the following:

We want to hear your feedback.  Click this link to start a short survey.

I had scheduled a follow-up appointment with my primary care physician earlier in the day on My Chart (which was very convenient by the way - if your hospital doesn't allow direct online scheduling, you should re-think your access strategy!).  I had received a survey link earlier in the day, but I saved the text in order to respond to it later.  I guess because I ignored the first text message, the system felt that I needed a reminder...IN THE MIDDLE OF THE NIGHT!!!

I know customer feedback is important!  Unfortunately, we have been inundated so frequently with customer satisfaction surveys that it is starting to feel intrusive!  For example, my wife and I recently traveled over the winter holidays.  We received a customer experience survey from the airline, the hotel, and the rental car company.  Given my current role and position (and the fact that health care is a service industry too), I generally respond to almost every survey I receive.  I know that most organizations leverage their customer service data in order to make improvements in the service that they deliver.  It's important, even if it is getting a little too excessive.  At least we are past the comment that I used to receive (way too much), "Please rate me high on "Recommend" because my bonus depends upon it."  

Customer experience data is critically important.  However, given the sophistication in technology today, there is absolutely zero reason that anyone should receive a customer satisfaction survey in the middle of the night!  The first thing that I did when I arrived at work the next morning was to check in with our patient/family experience team to make sure that we had something in place to prevent survey links getting sent out in the middle of the night...

Deaths by horse kick...

A couple of years ago, I came across an editorial in the journal Anaesthesia that caught my attention - "Deaths by horsekick in the Prussian army - and other 'Never Events' in large organisations".  The editoral was written by Jaideep Pandit, who at the time was a Consultant Anaesthetist and Professor in the Nuffield Department of Anaesthetics at Oxford University Hospitals NHS Trust in England.  Dr. Pandit stated, "It was arguably the Prussian military that first recognised the notion of a 'never event' when it became concerned (in peacetime) about the number of its officers killed by horsekick in the cavalry."

The term Never Event was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF) to describe "particularly shocking" cases of medical error that should never occur in hospitals today.  Examples include, but are not limited to, surgeries performed on the wrong patient, surgeries performed on the wrong site (e.g. left versus right), an unintended retained foreign object in a patient after surgery, or the wrong procedure performed on a patient.  These medical errors should be largely preventable if a hospital follows existing national guidance and/or national safety recommendations on how an event can be prevented.  

The accidental death of a cavalry officer in the army from getting kicked by a horse was clearly a serious incident that could lower morale or adversely impact operational readiness.  Army cavalry officers required a lot of training, and experienced officers were not easy to replace.  Rather than blaming the victim for being too careless or the horse for being too vicious, the Polish mathematician Ladislaus Bortkiewicz conducted his own analysis, studying the death rates over a 20-year period (1875-1894).  In his book, Das Gesetz der kleinen Zahlen (in English: The Law of Small Numbers), Bortkiewicz noted that the data followed a Poisson distribution:

Classically, a Poisson distribution is a discrete probability distribution (similar, but different than the well-known Gaussian or normal distribution) that expresses the probability of a given number of events occurring in a fixed interval of time if these events occur with a known constant mean rate and independently of the time since the last event.  The Poisson distribution describes rare and more or less random events.  Bortkiewicz concluded that because deaths by horsekicks in the Prussian army cavalry followed a Poisson distribution, they could be assumed to have arisen completely by chance and not as a result of specific intent or design.  In other words, because they occurred purely by chance, they were largely not preventable.

Dr. Pandit's editorial was written in response to an article that appeared in that same issue of the journal Anaesthesia by I.K. Moppett and S.H. Moppett, "Surgical caseload and the risk of Never Events in England".  Moppett and Moppett surveyed all of the English acute hospitals in the National Health Service to determine the number of surgical Never Events and surgical caseload volumes for 2011-2014.  They noted that the number of Never Events followed a Poisson distribution.  

Moppett and Moppett also reviewed other hospital-wide safety metrics, such as the standardized mortality ratio (SMR).  The SMR is a ratio between observed deaths and expected deaths (based on patient acuity), so the SMR should ideally always be below zero (observed deaths less than expected deaths) and never above zero (observed deaths greater than expected deaths).  There was no association between the number of Never Events and the hospital-wide standardized mortality ratio.

Moppett and Moppett concluded, "The data support the hypothesis that Never Events should be viewed as rare, random events...The risk of serious harm from surgical Never Events in England is very low but not zero...Never Events are important, but as they are rare, apparently random events they are the wrong metric to gauge safety within the operating theatre."

By their very definition, Never Events are rare (thankfully).  Even if they do follow a Poisson distribution, that doesn't mean that they occur purely by chance.  Moppett and Moppett also wrote that "in some respects, our findings are no surprise - other things being equal, larger organisations should have more Never Events."  I don't think that is necessarily a true statement.  

So, what do we know?  First, at an individual patient level, a Never Event is likely to have a significantly adverse impact on both outcome and experience.  Second, at the hospital level, a Never Event may not negatively impact the standardized mortality ratio (which is an imperfect and arguably suspect marker of hospital quality in and of itself), but that doesn't mean that it should not be taken seriously.  Third, based on my own personal experience, these kinds of events are exceedingly rare.  However, when they do occur, it's usually because some best practice was not followed.

I've often stated that so-called High Reliability Organizations implement best practices in order to (1) decrease the chance that an error occurs and (2) minimize the impact of an error if it does occur.  What has worked for HROs can also work for hospitals.  Never Events should occur exactly as often as the name states - NEVER.  

"The Buck Stops Here"

About eight years ago, while still living in Cincinnati, I joined a book club that read one biography of each of the U.S. Presidents, in chronological order.  The book club was sponsored by the Cincinnati Mercantile Library (if you ever get a chance to visit, it's well worth spending a couple of hours there).  After moving to Chicago, I continued, at least for a while, because the in-person book club meetings moved to virtual meetings due to the shelter-in-place restrictions during the COVID-19 pandemic.  Unfortunately, once the meetings moved back in-person, I had to stop attending.  The book club eventually finished, as they ran out of U.S. Presidents.  However, I am still trying to catch up!  I am currently on Harry Truman, who served as the 33rd U.S. President.

If you know anything about President Truman, you probably know that he used to keep a sign on his desk that said, "The Buck Stops Here!"  What you may not know (I definitely didn't know) was that the phrase, the buck stops here derives from the slang expression pass the buck, which means passing the responsibility on to someone else. The latter expression is said to have originated with the game of poker, in which a marker or counter was used to indicate the person whose turn it was to deal. Apparently in the early frontier days, a knife was used (perhaps a "buck" knife?).  If the player did not wish to deal he could pass the responsibility by passing the buck, as the counter came to be called, to the next player to deal.

President Truman referred to the desk sign in public statements at least a few times during his administration.  For example, in an address at the National War College on December 19, 1952, President Truman said, "You know, it's easy for the Monday morning quarterback to say what the coach should have done, after the game is over. But when the decision is up before you -- and on my desk I have a motto which says The Buck Stops Here - the decision has to be made."  And later, in his farewell address to the American people in January 1953, President Truman said, "The President - whoever he is - has to decide.  He can't pass the buck to anybody. No one else can do the deciding for him. That's his job."

As I reflect more, what President Truman really is talking about is personal accountability.  Personal accountability means taking ownership of your actions, choices, and their outcomes - good or bad -  without blaming others or making excuses.  When leaders hold themselves accountable, they are in a much better position to hold their teams accountable.  And a team in which all the members hold each other accountable is a team in which everyone one another to do their job and to do what's right.

I remember talking about a concept that we used in my patient safety work called 200% accountability - referring to the fact that I am responsible for holding myself accountable as well as the other members of the team.  Peter Pronovost, a critical care physician, author, speaker, and patient safety expert who currently serves as the Chief Quality and Transformation Officer at University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine recently wrote an article for Becker's Hospital Review on accountability, "The beautiful power of accountability".  Dr. Pronovost often visits hospitals and says that one of the first question he asks is, "What do you think of when you hear the word accountability?"  Most individuals respond with a certain level of discomfort, because when they think of accountability, they think of punishment, discipline, blame, or being called out for doing something wrong.

Dr. Pronovost says that accountability shouldn't be something that we fear.  He writes, "True accountability is not punishment - it is a beautiful and noble idea."  

He explains further, "It means keeping promises, showing up with integrity and being trustworthy with one another. It’s the foundation of reliability, belonging and growth...When we reclaim accountability as noble, it becomes a source of pride, not pressure; learning, not blame. It transforms compliance into commitment and responsibility into connection. When accountability is weaponized, people hide. When it’s grounded in love and trust, people shine."

He goes on to write that accountability isn't about control, it's about commitment.  Accountability is not about fear, but rather trust.  It's not about compliance, but rather accountability is about connection.  He writes, "When accountability and love walk hand in hand, teams flourish — and organizations thrive.  That is the beautiful power of accountability."

Accountability is a beautiful and noble concept.  And when you consider something beautiful and noble, why wouldn't you want to have more of it?

Leadership Reverie Top Ten Posts from 2025

It's been just over 10 years since I started the Leadership Reverie blog.  I posted for the very first time (see the link below) on January 2, 2016.  It's hard to believe that it's been 10 years.  I just published my 1,263th blog post earlier this week, and I am quickly approaching over 1 million views on the blog site.  I've accomplished everything that I had originally hoped to accomplish with my blog, and it's been a lot of fun.  I am looking forward to posting more in the coming year.  

As I have done almost every year since first creating my blog, I thought I would list the Top Ten Most Viewed Leadership Reverie Blog Posts from the past year.  Here they are (in order, as of January 1, 2026):

1.  "Never stop fighting until the fight is done!" April 25, 2025

2.  "The importance of nothing” May 15, 2025

3.  The third place no more? April 3, 2025

4.  The very first "Org Chart" February 5, 2025

5.  The Blake Mouton Grid January 26, 2025

6.  Hope is not a strategy...or is it? February 27, 2025

7.  "The Three Dimensions of a Complete Life" January 20, 2025

8.  Vroom Vroom! January 12, 2025

9.  "Success is not the key to happiness..." January 24, 2025

10. "The truth about connection" June 24, 2025

Here are the Top Ten Most Viewed Leadership Reverie Blog Posts from All-time (again, as of January 1, 2026):

1.  "Amateurs talk strategy.  Professionals talk logistics." May 8, 2020

2.  "What you permit, you promote..." February 15, 2021

3.  "Hatred corrodes the container it's carried in..." December 30, 2018

4.  "Vontae Mack No Matter What" July 22, 2020

5.  Two sisters and an orange... February 27, 2019

6.  "The legs feed the wolf..." September 13, 2017

7.  "Do we need a National Women Physician's Day?" February 3, 2018

8.  "Those who honor me, I will honor" May 24, 2017

9.  "First blog post!" January 2, 2016

10. Napoleon's Corporal October 22, 2017

Happy reading and thank you for sticking with me all of these years!

2026 Leadership Reverie Reading List

Once again I am putting together a reading list for 2026!  Just like last year's list (see "2025 Leadership Reverie Reading List"), I included five books that I have read and highly recommend, as well as five books that I am planning on reading.  As I look over last year's list, I did pretty well.  The only two books that I didn't get to finish were Collapse by Jared Diamond and Sapiens by Yuval Noah Harari.  Hopefully I will finish both this coming new year!  

Here is the official 2026 Leadership Reverie Reading List:

Unreliable: Bias, Fraud, and the Reproducibility Crisis in Biomedical Research by Csaba Szabo

I checked this book out at our library because (1) the topic sounded interesting and (2) Dr. Szabo actually worked in the Division of Critical Care Medicine at Cincinnati Children's Hospital Medical Center right before I started my fellowship there.  Dr. Szabo discusses what he thinks is a major problem in biomedical research (and I agree) - researchers who publish questionable or incomplete data (probably very common according to Dr. Szabo and others) or even outright fraudulent data (more common than perhaps realized).  

The Lords of Discipline by Pat Conroy

I saw the 1983 movie based on Conroy's novel when I was still in high school.  The book (and movie) explores the topics of loyalty, honor, racism, and courage in a story partially based on Conroy's own experiences at a military academy.  The movie was fantastic, and I've always wanted to read the novel.  Here's my chance!

The Speed of Trust: The One Thing that Changes Everything by Stephen M.R. Covey

I posted about this great book earlier this year (see my post, "Change happens at the speed of trust...").  It's probably one of the best books that I read in 2025.  Given the importance of trust (and the unfortunately widespread lack of trust in society today), I think this is one of those books that should be read by every leader.

The Book of Hope: A Survival Guide for Trying Times by Jane Goodall

The English scientist Jane Goodall died on October 1st this past year after an incredible career studying chimpanzees in Tanzania.  I read (and thoroughly enjoyed) Frans de Waal's book Chimpanzee Politics a few years ago, which appeared on my 2022 Leadership Reverie Reading List, so I know that the animal world has a lot to tell us about group dynamics, group politics, and leadership.  I am hoping (no pun intended) that Goodall's book will tell me a lot about hope.

Abundance by Ezra Klein and Derek Thompson

It seems like this book appeared on a number of "Reading Lists" in the past year, including President Barack Obama's 2025 Summer Reads and Bill Gates' 2025 Holiday Book List.  I attended an event here in Chicago in which Ezra Klein and Derek Thompson were promoting the book, and one of the benefits was a "free" copy of the book (we had to pay for a ticket to the event).  I would have gladly paid for the book.  Klein and Thompson argue that many of America’s biggest problems—such as unaffordable housing, stagnant infrastructure, delays in clean-energy rollouts, and slow scientific progress—aren’t due to lack of resources or innovation, but to self-imposed scarcity. They claim that the U.S. has the wealth, talent, and technologies it needs, but decades of well-intentioned rules, bureaucratic hurdles, and political gridlock have created barriers that slow or block progress. What once protected communities or the environment has become a system that often prevents building and improving what society needs.  It's definitely a different take on what our country needs to do to address some of its biggest problems.

The Explorer's Gene: Why We Seek Big Challenges, New Flavors, and the Blank Spots on the Map by Alex Hutchinson

Someone once asked the legendary British mountaineer George Mallory why he wanted to climb Mount Everest, which at the time had never been done before.  His simple answer, "Because it's there" has become famous and became the subject of a New York Times article published on March 18, 1923.  Mallory went on to explain, "Everest is the highest mountain in the world, and no man has reached its summit. Its existence is a challenge. The answer is instinctive, a part, I suppose, of man’s desire to conquer the universe."  Mallory never made it to the summit and would die during his attempt to climb the world's highest mountain.  The author Alex Hutchinson may have found a better answer to the question, which is why I am looking forward to reading his book this year.

The Circle by Dave Eggers

I recently watched the 2017 film "The Circle", starring Tom Hanks, Emma Watson, and John Boyega.  While the movie was enjoyable, the book was so much better.  If you've ever worried about how powerful and ubiquitous technology companies like Google, Amazon, Facebook, and Apple have become in today's society, then this book is definitely going to worry you even more!  It's fiction, but it comes fairly close to describing at least one potential scenario.  I couldn't put the book down.

The Art of Happiness: A Handbook for Living by The Dalai Lama

We could all do with more happiness in our lives.  I read Build the Life You Want: The Art and Science of Getting Happier by Arthur Brooks and Oprah Winfrey last year and really enjoyed it.  Since that time, I've wanted to read The Art of Happiness and The Book of Joy by the Dalai Lama (the latter was co-written with Desmond Tutu).

Island of the Lost: An Extraordinary Story of Survival at the Edge of the World by Joan Druett

I've mentioned this book a couple of times in posts over the years (see in particular my post "A tale of two leaders" from February 26, 2020).  Druett tells the story of two shipwrecks that miraculously occurred at about the same time and in the same remote location.  The story takes place in a group of islands in the South Pacific (nearly 300 miles south of New Zealand), known as the Auckland Islands around the time of the U.S. Civil War.  The shipwreck of the schooner Grafton and its crew of five men occurred on January 3, 1864, while the shipwreck of the much larger (1100 tons) sailing ship, Invercauld and its crew of 25 men occurred on May 11, 1864.  The two ships wrecked at opposite ends of the island, the two crews never interacted (and really had no idea that they were both on the same island).  The way that the two captains and their crews handled this series of rather unfortunate events couldn't have been more different.  As Florence Williams writes in her New York Times book review, "Their divergent experiences provide a riveting study of the extremes of human nature and the effects of good (and bad) leadership."

Life After Power: Seven Presidents and Their Search for Purpose Beyond the White House by Jared Cohen

I have Jared Cohen's previous book Accidental Presidents sitting on my shelf waiting to be read.  I should probably read that one before I move to his most recent book.  Both books have been very well received and highly recommended.  

"The Gate of the Year"

Happy New Year!  Another year is in the books!  I wanted to share a post from New Year's Day 2017.  That post was also called "The Gate of the Year" and referred to a poem by the British poet Minnie Louise Haskins.  As I look back on that day, we were going through a lot of major milestones and changes as a family.  What's evident to me now is that 2026 will be a time for change as well.  Change is constant.  Time continues to move quickly.  This year will be no different from the past one in that regard.  The message I delivered in 2017 is a good reminder, to me at least, that change is okay.  A new year brings new change, and change is good.  Change means that we are growing into someone new and better.

Here is the post from 2017:

It is really hard for me to believe that 2016 is over and that we are already in the year 2017.  My oldest daughter last week asked each of us at the dinner table what was the best part of the past year.  As we looked back, a lot happened for us this past year.  My wife and I celebrated our 25th wedding anniversary.  We bought a new house, sold our old house, and moved (in that order).  There were several family trips, several college tours, and several visits with friends and family.  All things considered, it was a pretty good year for our family, even if it was a difficult year for our country (indeed, our world).

I have always been fascinated by the New Year's holiday.  The start of a new year is a chance to reset, refresh, re-focus, and re-energize.  The start of a new year is an opportunity to look back on what was accomplished in the past 12 months, as well as what was not accomplished.  The start of a new year is a time to set goals for the next 12 months.  With this in mind, there are a few goals that I set last year that I attained, as well as a few that I failed to reach.  One of my goals was to start a blog - check!  Although I slacked off after a good start last January, I think I ended up the year with a good finish.  Writing is something I enjoy, and this blog has been a great chance for me to practice my writing skills and reflect on things that I have heard and learned.  

I have read a lot of articles, blog posts, and editorials in the past couple of days looking forward to the end of what many would say has been a bad year.  We - all of us around the world - have been through a lot this last year, and some would argue that our best days are behind us now.  Quite the contrary, I look forward to the next year with faith in humanity, a hope for peace, and a love for one another.  There is no doubt that we have our differences, but I firmly believe that the bonds that we share are stronger than our differences.  There is more that unites us than separates us.  We have more reasons to be optimistic than pessimistic.  

Today at Mass, our priest read a passage from a speech by King George VI.  The year was 1939, and England was on the brink of defeat.  England had declared war on Nazi Germany in September, shortly after Germany had invaded Poland.  It was tradition for the King to address the British Empire at the start of a New Year.  As immortalized in the 2011 movie, "The King's Speech", King George VI hated public speaking - indeed, it terrified him.  He had dealt with a speech impediment for his entire life, and he was naturally shy, introverted, and reserved.  In fact, he had reluctantly become King only when his older brother David had abdicated the throne.  He delivered a speech by radio on Christmas Eve from the royal country home at Sandringham:

A new year is at hand. We cannot tell what it will bring. If it brings peace, how thankful we shall all be. If it brings us continued struggle we shall remain undaunted.

He then read a passage from a poem that his daughter, Princess Elizabeth (now the Queen of England), had given him.  The poem is called "The Gate of the Year" or "God Knows" and was written by the British poet, Minnie Louise Haskins.  

And I said to the man who stood at the gate of the year:
“Give me a light that I may tread safely into the unknown.”

And he replied:
“Go out into the darkness and put your hand into the Hand of God.
That shall be to you better than light and safer than a known way.”

So I went forth, and finding the Hand of God, trod gladly into the night.
And He led me towards the hills and the breaking of day in the lone East.

The speech united the nation in a common cause.  The speech inspired a nation to continue the struggle for freedom.  As our priest said today, let us too, at the start of the new year, 2017, put our hand into the Hand of God and find our way.