The only person who likes change is a wet baby!

The high-reliability expert, former founding partner of Healthcare Performance Improvement (HPI), and current partner at Press Ganey Associates, Craig Clapper recently wrote in his book  Zero Harm, "Improvement by the yard is hard; improvement by the inch is a cinch." In other words, any improvement initiative - really, any major organizational change initiative - should start with small tests of change, focusing on small, pilot groups before spreading to the broader organization.  "Big Bang" types of change initiatives that touch virtually every part of the organization at the same time are rarely, if ever successful.  Data analyzed by the consulting firm, McKinsey, suggests, in fact, that only 30% of change initiatives succeed.  

One of the most important aspects of leadership is change management, and change management is something that leaders continue to struggle with in every industry, including health care.  All health care organizations need to change in order to survive in this rapidly evolving environment in which we all currently live and work.  Given the need for change, why is it so difficult for organizations to do so?

As the old saying goes (reportedly first stated by Mark Twain), "The only person who likes change is a wet baby."  The question is why?  Why are we so resistant to change?  The best-selling authors, Chip and Dan Heath provide two possible answers in their book, Decisive: How to Make Better Choices in Life and Work.  The first answer is something called the mere exposure effect.  Basically, this well-known psychological effect states that individuals develop a preference for things that are familiar to them (the effect is also called the familiarity principle).  

Here's a great study ("Field Extension of the Frequency-Affect Findings") that explains the mere exposure effect, which was originally described by the psychologist, Robert Zajonc in the early 1960's.  College students would enter their classroom every day to find strange words written on the blackboard (the study was performed by Rick Crandall in the 1970's, long before the use of smartboards of course) - words like, SARICIK, RAJECKI, KADIRGA, NANSOMA, and ZAJONC.  Different words would appear every day without any explanation from the professor teaching the class.  On certain days, the same words in different combinations would appear.  After about 9 weeks of this very peculiar exercise (at least for the college students), the students completed a survey with a list of 14 foreign words on it - five of these 14 words had appeared on the blackboard.  The survey asked the students to rate how they liked each word.  Crandall found that the most-liked words were the ones that had appeared most frequently on the blackboard.  In other words, as the Heath brothers write, "Familiarity doesn't breed contempt, then, but more like contentment."  Similar studies have been performed with a variety of objects, words, symbols, etc - they consistently show that mere exposure to these objects, words, and symbols created strong preferences for them.  We like things that are familiar to us!

The second answer to the question "Why is change so hard?' provided by the Heath brothers is something known as loss aversion, which was best described by Amos Tversky and Daniel Kahneman.  This well-known principle states that individuals prefer to avoid loss, even at the expense acquiring equivalent gains.  Some studies would even suggest that losses are twice as powerful as gains in this regard.  In other words, we hate to lose!  As an example, imagine playing a game based upon a flip of a quarter.  If the coin flip turns up "heads", you will win $100.  If the coin flip turns up "tails", you will have to pay me $50.  Would you play?  It's a standard quarter, so no tricks are involved here.  You have a 50/50 shot at winning $100 or losing $50.  Most studies suggest that we would prefer not to risk losing $50 and just not play.

In another frequently cited study ("Experimental tests of the Endowment effect and the Coase Theorem") on loss aversion (it's actually a related concept, known as the Endowment effect), half of the students in a college class are awarded a free coffee mug with the university's logo emblazoned on the side.  The students who didn't receive a coffee mug were asked how much they would be willing to pay to buy one.  The average amount they were willing to pay turned out to be $2.87.  Okay, fair enough - that seems like a pretty good deal (actually, it's a great deal, just walk into your friendly neighborhood college bookstore and see how much these things really cost!).  Conversely, the students who had the coffee mugs were asked what price they would be willing to sell the mug (remember - the mugs were a free gift).  The average selling price turned out to be $7.12!  When it comes to coffee mugs, the selling price is nearly two and half times as high as the price that most of the students were willing to pay.  Call it whatever you want, we are just not willing to part with something that we possess.  

Resistance to change - also known as the status quo bias - is not easy to overcome.  We are dead-set in our ways, because we like familiarity (mere exposure effect) and we hate to lose (loss aversion) things that we are comfortable with (i.e. the way we've always done things).  I would like to finish, as I frequently do (my apologies) with two final quotes:

"Sometimes the most difficult act of leadership is not fighting the enemy; it's telling yourself and your friends that it is time to change." --- Bill Gates

"When you improve a little each day, eventually big things occur...Don't look for the quick, big improvement.  Seek the small improvement one day at a time.  That's the only way it happens - and when it happens, it lasts." --- John Wooden

Leadership is about managing change.  And the best way to manage change is to start with small improvements.  "Improving by an inch is a cinch."

What does the musical Hamilton have to do with procrastination?

Our youngest daughter and I watched the musical Hamilton on Disney+ over the weekend.  The movie was released at the beginning of the month, but it's actually edited together from three performances by the original Broadway cast in June 2016.  Regardless, we still enjoyed it - in my opinion, the musical lived up to all of its hype.  The main protagonist of the musical is our nation's first Secretary of the Treasury, Alexander Hamilton.  The muscial is in fact based upon the 2004 biography written by Ron Chernow.  The main antagonist is Aaron Burr, one of our nation's so-called "Founding Fathers" who served as our 3rd Vice President (during Thomas Jefferson's first term as President of the United States), who famously shot and killed Alexander Hamilton during a duel (sorry - I should have warned you about the Spoiler!).

Aaron Burr once said, "Never do today what you can do tomorrow.  Something may occur to make you regret your premature action."  Perhaps he was thinking about dueling?  I am not certain of the context of this quote, but it's quite clear that Burr is advocating for procrastination here!

We are all - okay, at least most of us - really good at procrastination.  I am sorry to confess that I recently finished a work assignment that was due by the end of today.  The work was originally assigned at the end of May, so I had more than 2 months to complete it.  What did I do?  I absolutely waited until the last possible minute to finish the work.  I will even admit to you that I didn't even start working on the assignment until this past week!

Why do we procrastinate so much?  Do we really agree with the philosophy of a man famous for killing the man who was played by Lin-Manuel Miranda?  Or is it that we work better with a deadline?

Before you answer, I would like to tell you about a 20th century British naval historian named Cyril Parkinson.  During his long career, Parkinson wrote over 60 books, but his most famous was the best-seller Parkinson's Law, which he wrote in 1957.  The book describes what has come to be called, "Parksinson's Law," which states simply, "Work expands to fill the time available for its completion."  If you are interested, you don't have to read his book - check out a very brief article that he wrote for The Economist magazine in 1955 (see link here).  According to Parkinson's Law, we spend a good portion of our lives wasting time!

Just think about it - how much time do we spend mindlessly daydreaming, playing games like "Candy Crush" on our smart phones, or checking the lastest cat videos on social media?  Trust me - I am NOT criticizing, I waste a lot of time too!  Case in point - I waited until the last possible minute to finish up an assignment.

We have become experts at putting off until tomorrow what we should be doing today!  Parkinson was simply the one who actually described it in terms of a fundamental law of human nature.  The U.S. military, arguably one of the most well-run organizations around, is no stranger to Parkinson's Law.  Consider that the unofficial slogan for the U.S. military is "Hurry Up and Wait".  

Now, how do we avoid succumbing to our procrastinator tendencies?  At least one article recommends creating artificial constraints for ourselves by setting up deadlines!  Deadlines give us a goal to achieve - they give us a finite point in time that our work has to be complete.  It's the same thing if you always set your alarm clock 5 or 10 minutes ahead of time, giving you the impression that it is later than you think (i.e. a deadline to get moving!).  It's pure genius when you think about it.

So there you have it - in less than three degrees of separation, I have forged an everlasting connection between the musical, Hamilton and procrastination!  It's just a short step from there to Parkinson's Law and the use of artificial time constraints - deadlines - to get you back on task!

"Vontae Mack No Matter What"

I miss sports.  There are certainly more important things in life, and I fully realize that a lot of us are struggling right now.  Some of us are even fighting for our lives.  I still miss sports though.  We can learn so much from sports, whether we are watching them or playing them ourselves.  It was the actor, Robert Redford, who once said, "Sports are a wonderful metaphor for life."  I wholeheartedly agree.

We can often find some of the best sporting metaphors for life in movies.  A few years ago, while flying across country, I watched an in-flight movie called Draft Day.  The movie was about a guy named Sonny Weaver, Jr (played by the actor Kevin Costner, who may be the king of sports movies), who happened to be the General Manager of the National Football League's Cleveland Browns.  The movie takes place on one day, the 2014 NFL Draft.  The Cleveland Browns have the 7th pick in the draft, and as in real life, the Browns aren't very good.  Another team, the Seattle Seahawks, hold the first overall draft pick, and the General Manager for the Seahawks offers to trade the pick to the Browns.  Sonny gives away the team's first-round draft pick for the next three years, but on the surface it seems worth it.  There is a once-in-a-lifetime quarterback prospect (think the next Tom Brady) that everyone - the fans, the team's owner, and the the team's new head coach are very excited about drafting.

Sonny seems to have made a great trade.  Earlier that morning, he had written down a name on a Post-It note.  You are led to believe, all through the movie, that Sonny wrote down the player he was going to draft on the Post-It note.  Which player's name did he write down though?  There's an All-American linebacker from Ohio State that Sonny seems really keen on drafting.  There's also a really good running back whose father played for the Browns and really wants his son to play for the Browns too.

Sonny has his doubts about the quarterback prospect.  Slowly, the facts start to come out - this guy is not a team player.  Along comes Draft Day and who does Sonny pick?  The linebacker from Ohio State, Vontae Mack.  Everyone is incredibly angry - the team owner can't believe it and is ready to fire Sonny on the spot.  But something miraculous happens (it's the movies after all) - teams that are picking below the Browns suddenly get spooked.  What does Sonny know that made him not pick the quarterback?

Recall that the Seahawks still have the seventh pick.  Sonny convinces a rookie general manager for the Jacksonville Jaguars to give up the sixth pick in exchange for the Browns' second-round draft picks for the next three years.  By doing so, Sonny has mortgaged the Browns' future.  Here's where the movie gets interesting.  Sonny calls up the Seahawks General Manager and tells him, "I'm taking Callahan" (the highly touted quarterback).  He convinces the General Manager to trade up for the sixth pick, getting the Browns' original first-round draft choices back plus an All-Pro punt returner.  The Seahawks take the quarterback, and with the seventh pick, the Browns choose the running back with the Cleveland Browns heritage.  ESPN sportscaster Chris Berman, in a cameo role, summarized Sonny's Draft Day as follows:

"General manager Sonny Weaver, Jr. took one pick in the first round, the number seven pick. He sprinkled it with fairy dust, wished upon a star, and somehow, he turned it into not one, not two, but three potentially impactful players for his team next year. One pick!"

Incredible!  In the end, the only thing he gave up were the Browns' second-round picks for the next three years.  Later, towards the end of the movie, you get to find out just what Sonny wrote on his Post-It note - "Vontae Mack No Matter What."

Sonny Weaver, Jr knew exactly what he wanted.  At all costs, get the Ohio State linebacker, Vontae Mack.  No matter what.

What's the metaphor for life outside sports?  Stick to your primary objective.  Whether you are in a difficult negotiation or making a critical decision, remember your core values and focus on your primary objective.  At the end of the day, nothing else really matters.  Sonny knew he wanted the linebacker, and he was ready to risk everything, including his career, on making sure that he was able to get the player he wanted.

We will never know whether Sonny made the right decision - the movie ends at the end of the first night of the draft.  I think you will learn, however, that when you stick to your primary objective and remember your core values, every decision that you make will be the right one for you, at least in the long-term.

It's been several days since my last post.  As I mentioned before, I took a brief hiatus from social media and blogging.  I used the time away to think about my core values, as well as my primary objective.  It was a good exercise, and now I am ready to return to writing.  It's good to be back.  

A brief hiatus

I have been taking a break from posting on my blog site - my last post was on Father's Day on June 21st.  For the past few years (actually, since August, 2016), I have been more or less posting about twice a week.  I have tried to post something on every Sunday and Wednesday.  Some weeks, I have posted more than twice, while other weeks I have only posted once. 

I have always enjoyed writing.  As my career has evolved over the last several years, I have found fewer opportunities to write, and this leadership blog has filled some of that void for me.  I have truly enjoyed it.  While I do not journal, my blog post has at least provided me a moment to reflect, learn, and grow.  I have shared my thoughts and lessons that I have learned with others, which I sincerely hope has been worthwhile.

There were a number of reasons why I chose to take a break.  For one, it just seemed like the right time to do so.  We have all experienced a lot of changes over the course of the past few months.  Change can be exhausting.  And when you are pushing your limits, some times it is best to take a break.

I also recently learned an important lesson - perhaps one that I should have already known.  I used to give a lecture every year to our residents and fellows entitled, "Professionalism in the Age of Social Media."  I used to tell our residents and fellows to always keep your professional social media lives separate from your personal ones (for example, try having two Facebook accounts, one for your professional, job-related social media activities and one for your personal ones).  I have always used both my Twitter and LinkedIn accounts to post updates to my blog.  While my Twitter account has no specific mention of where I am working, my LinkedIn account certainly does.  Recently, someone pointed out to me that some of my blog posts have represented my personal opinions and may not accurately reflect the opinons of my employer.  While I am confident that I have never posted anything controversial or counter to the opinions of most of the individuals who I am fortunate to work with on a daily basis, I also recognize that in these times, it is difficult to remain entirely apolitical.

So, I will follow my own advice, and in the future, I will no longer post updates to my blog using my LinkedIn account.  Let me assure you that I did not get into trouble with anyone at work.  However, it is clear to me that, at least when it comes to social media, I have not been following my own advice.  So, for all of my previous posts and for all the ones that I will post in the future (and yes, I will start posting again soon), let me state once and for all that the opinions and views expressed in all of my posts, past, present, and future, are my own opinions and views and do not necessarily reflect the official policy or position of any organization or institution that I have been affiliated with in the past, present, or future.  They are my own  They belong to me.  And I am proud of them.

Fatherly Wisdom

A few years ago, I wrote down some of the leadership lessons that I have learned from my father (see Fatherly Leadership).  This year, in honor of Father's Day, I'd like to add to that list some of the leadership lessons that I have learned while being a father as well.

1. Silly (and corny) dad jokes are a thing. 

There's nothing like a corny dad joke to get a laugh at just the right time, even if it is just a sympathy laugh ("Oh, Dad...").  The fact that all four of adult children still laugh at my silly dad jokes tells me one thing - a child's love is unconditional and forever.  And that is one of the greatest gifts of being a father.  We should all repay that unconditional love right back to our children.

2.  No matter what you think of the next generation, they won't let you down.

I can't tell you how many times that I have heard an older adult tell someone from the next generation on down, "When I was your age..." (fill in the blank - it's usually something like "we had to walk to school through ankle-deep snow, up hill both ways" or something like that).  I've said it myself.  It's easy for older adults from Generation X to look at Millennials or Generation Z, shake their heads, and question whether the future is in good hands or not.  Preceding generations said the same thing about us!  I look at our children and have nothing but hope for the future.  I know we are in good hands.  I am proud of the individuals that each of our children have become.  They have never let me down, and I don't think their generation will ever let us down.

3.  Pride is forever.

As I look back over the years, some of the best moments as a father were sharing in the triumphs and successes of our children.  I vividly remember the day that each of them rode a bike for the first time without training wheels just as clearly as I remember the times that they graduated from pre-school, middle school, high school, and college.  But I also remember, with just as much pride and joy, how they each handled the failures and disappointments that came along the way as well.  Failure is a part of life - we can either dwell on our failures or move on and learn from them.  They used their failures as a learning moment, and they never let failure stop them from moving forward.  In a sense, I've learned and grown just as much from sharing in our children's experiences with success and failure as they have learned.

4.  Never stop learning.

As it turns out, you can teach an old dog new tricks.  Our children have taught me that there's no time like the present to learn something new.  As I've watched them all deal with the COVID-19 pandemic, each of them have started doing something new that they did not do before.  They've taken up new hobbies or re-invigorated old ones.  You are never too old to learn something new.  Never stop learning.

5. Being a father is the best job I've ever had.

I am so thankful and lucky to be a father to these four adults.  Their words and actions continue to amaze and inspire me, and more importantly, they remind me that being a father is the best job that I've ever had.

Thank you to our four children - I am lucky to be your father.  And to my own father, you were the first man I ever met and the greatest man that I have ever known.  Thank you for being my Dad and showing me the way.

Happy Father's Day to all!

Boris the Spider

I have a pet spider.  Well, technically "he" (I have no idea whether he is a male or female spider) lives right outside my window.  He's been there the past 2 weeks or so, and we've come to share a bond together, as he is there when I go to bed at night and again when I wake up every morning.  I've named him Boris - after The Who song of course!

I have to give credit to Boris - he's been through an awful lot the past couple of weeks.  First off, he went through a lot just to get to be outside my window (I am currently living on the 57th floor in a studio apartment).  So, he clearly has the endurance to climb what must be like, to him, at least a bazillion miles or so.

Boris also had to fight off at least one intruder spider.  Within a few days after he finished spinning his web, he had an unwelcome house guest.  At one point, there were two spiders on the same web.  I don't know what exactly happened with the second spider, but now there is only just Boris (RIP intruder spider). 

Finally, if you've ever spent time near the lakefront in Chicago, you will understand some of the challenges that Boris has had to face.  Since he arrived on my window, we've had a couple of major thunderstorms, one hail storm, and several days with really high winds!  Boris has had to completely re-spin his web several times over the course of these past 2 weeks.  There have been times, when I have looked out my window first thing in the morning only to see Boris gone and his web all twisted and frayed.  By the time I come back to my apartment in the evening, he's back with a brand new web!

I know what you are probably thinking - "He's lost it!"  Not at all.  I am telling you all about Boris, because I am incredibly impressed by his resilience.  We hear a lot about resilience these days - even before the COVID-19 pandemic.  For example, interventions focusing on resilience are frequently offered as solutions to professional burn-out.  Angela Duckworth has talked about resilience in a very popular TED talk and best-selling book called Grit: The Power of Passion and Perseverance.

Resilience, at least in this context, is defined as the capacity to recover quickly from difficulties.  I like the alternative definition better - the ability of an object or substance to spring back into shape; elasticity.  Resilient individuals, and spiders, have that knack to easily (at least it seems that way) to bounce back and "spring back into shape."

I have found, in virtually every case, that resilient individuals maintain a positive attitude, even in the face of adversity.  Viktor Frankl, Holocaust survivor, psychiatrist, and author of Man's Search for Meaning had this to say about resilience, "Everything can be taken from man but one thing: the last of the human freedoms - to choose one's attitude in any given set of circumstances, to choose one's way."

Harvard Business School professor, Nancy Koehn recently authored a book called Forged in Crisis: The Making of Five Courageous Leaders (which is excellent, by the way), which provides a case study of crisis leadership.  I was struck by the fact that all five leaders had one thing in common - a positive attitude.  Dr. Koehn said, "Consider the freedom we each have, even in very difficult situations, to CHOOSE our own attitude.  This fundamental truth, as hidden as it often seems, is a source of empowerment and possibility.  It can fuel our survival and inner growth."

Is it really that simple?  I think so.  In my own experience, regardless of the situation, having a positive attitude makes it so much easier to deal even with the most difficult of challenges.  As my wife always says, "The power of a positive attitude!"  She is absolutely right.  Attitude makes all the difference in the world.

Boris keeps coming back.  Again, again, and again.  It would be easy for him to give up (after all, he's just a spider), but he doesn't.  Be resilient like Boris - have a positive attitude!

"To protect the whole line"

About a year or so, I wrote a post about the ancient Spartans.  According to Plutarch, mothers and wives of Spartan soldiers would tell their loved ones as they departed for battle, "Come back with your shield or on it".  As Steven Pressfield recently wrote, the Spartans would not punish a soldier who dropped his helmet or breastplate in battle, but if any soldier lost his shield, he would be put to death immediately.  Why the difference?  Plutarch tells it best, "Because helmet and breastplate are worn to protect the individual alone, but the shield is borne to protect the whole line."

Both ancient Greek and Roman soldiers fought in what is called a phalanx - each soldier would stand shoulder to shoulder such that his shield would overlap with the shield of the men next to him on either side.  Opponents would confront a single, powerful, impenetrable wall of armor as opposed to individual soldiers.  The enemy's only chance of beating the phalanx was to break the line at a single point - one failed shield would result in the loss of the entire army.  For this reason, Spartans placed so much emphasis on the importance of keeping one's shield - losing your shield was punishable by death.

I hope you know where I am going with this - we are seeing a similar strategy today during the COVID-19 pandemic.  As Pressfield asks in the article mentioned above, "Why are we asked to wear surgical or face masks in public, to practice social distancing, and to observe self-quarantining?"  His answer - "Because these practices are not for the individual alone but for the protection of the whole line."

Does wearing a surgical mask in public protect you from COVID-19?  Maybe just a little.  What's really important is that by wearing a mask, you are protecting everyone around you.  The available research suggests that wearing a simple face mask can block almost 99% of the number of virus particles that we emit from our mouths and nose!  So if everyone is wearing a mask, we are significantly reducing the transmission of COVID-19.  Universal masking works.  Social distancing works.  Self-quarantine works.

Two studies deserve mention here.  The first study looked at the number of cases of COVID-19 in counties that bordered both the state of Iowa and Illinois.  While Illinois issued a stay-at-home order, as well as universal masking in public, Iowa did not.  While the number of COVID-19 cases were similar in border counties prior to Illinois' stay-at-home order, there was a significantly higher number of cases in the Iowa counties afterwards.  In other words, social distancing and universal masking work!

The second study reported the number of employees at a single hospital in Belgium who tested positive for SARS-CoV-2 antibodies.  SARS-CoV-2 is the virus that causes COVID-19, so the only way to get antibodies to this particular virus is if you have been infected with it.  This hospital tested almost all 4,000 or so employees - only 6.4% of the staff tested positive for the SARS-CoV-2 antibody.  There were no differences in testing in workers who cared for COVID-19 patients and those who didn't, nor was there any difference in testing in workers who were exposed to colleagues with COVID-19 and those who weren't exposed.  As it turned out, most of the workers acquired the virus through exposures to infected family members at home.  Incidentally, this hospital had instituted both social distancing and universal masking.  Again, masking works!

It's not a political issue (or at least it shouldn't be).  Wearing a mask protects your friends, your colleagues, and everyone around you.  You don't wear a mask for yourself - you wear it for everyone else!  You wear the mask "to protect the whole line", just like the Spartans in ancient Greece.