Leaders as students: The team that developed #Venue

The launch of GE’s new Venue™ Ultrasound is now public knowledge.  It’s a remarkable new device built by a team of remarkable people.  There’s plenty online and plenty more coming for those curious about the how GE hopes to contribute to the challenge of caring for the critical patient through the Venue platform.  But this short essay is about leaders as students.  I believe that this dynamic is at the core of what makes Venue special.

The journey began a few years ago as I was out for a Saturday morning run.  It occurred to me at the time that for most of my time in medical ultrasound, innovation was about another micron of image resolution and another claim of uncommonly easy-to-use human interface.  We have focused for so long on the inputs to the care-giving process.  What would happen if we were focused on the patient encounter itself?  Instead of making a simple, fast, and precise (SFP) ultrasound system, what if we worked toward a SFP patient encounter?  After time, this refocus on the patient encounter came to be known internally by our team as SFP2.0. 

Maybe because I was out running, shortness-of-breath (dyspnea) came to me as a target problem and we pursued this until a care-giver said to me, “Paul, no one dies of shortness of breath.”  Of course, in absolute terms, this is an exaggeration, but the point was made, and we set about studying… well studying emergency and critical are medicine.  We did not create a class of engineers-cum-physicians, but we dug in.  Eventually we settled on medical shock as the target for this idea of SFP2.0.  As we learned, SFP2.0 became “The Shock Toolkit.”

Our study took three forms:

First, we elevated our clinical team to the staff level.  We have a terrific Clinical Insights team that helps to set strategy for me and the rest of our leadership.  They’re all current or former clinicians.  We added a few outside advisers to the mix.  Interestingly, one thing that we learned is that to make a difference in point of care ultrasound, we had to unlearn what we knew about traditional ultrasound.  That’s an interesting story for another essay.

Next, we studied.  I bet all of the leadership team and many of the rest each read about 70 peer-reviewed papers.  Some more.  In the end, there were twelve papers that formed the core of our thinking about medical shock.  You can find a video discussion of those papers here.  These became our touchstone and they are still the touchstone today.

At the same time, we became students of machine learning.  We hired a few experts, but largely, we went to school to learn with our existing team.  Some of the key problems of shock need solutions that are more nuanced than human-derived learning can do on its own and we found that this new world of computer-assisted algorithm development was really an accelerator for us.  To be honest, we’re only barely scratching the surface here.

Third, we strongly adopted the ideas described in Eric Ries’ book, The Lean Start-up… Specifically the ideas of minimally viable products and testing leaps of faith.  I’ve lost track of how many low fidelity prototypes we tested, but I know that there were hundreds of simulated use tests and nuanced changes in design before we got to the current implementation.  In every case, we found that we learned more from an observational experiment than we did from a survey question.  “Let’s use this to simulate a central line placement.”  The we would watch to see what people did observed where the prototype made it easy or not. 

It was so hard to keep the disciple of observing.  We were often tempted to try to sell our ideas.  Instead we learned to let the best ideas sell themselves, learning the art of humble acceptance of observed behaviors as more valuable than our opinions.  We were not perfect in this, and we’re still learning to be humble students, but we know it’s good for us when we do so.

I’m beginning to believe that the early enthusiasm for Venue is the result of this posture of a student.   Time will tell if it endures beyond the honeymoon.  But I love the idea that curiosity and disciplined study might be keys to innovation and leadership.  My sights are on where to point the team and the platform next.  For sure, we’ll continue to invest in deepening our understanding of medical shock and making these first tools even more robust.  Venue is a really terrific system, it’s not a perfect one, and that leaves lots of room for next steps.

But even as we deepen our study of shock, I have my head up looking around for where next to apply a team and a platform that has scholarship at its core.  Maybe trauma, or the monster we call sepsis, or a hundred other ideas we’re bouncing around.

Where would you lead at team like this?  Which clinical challenge sparks your enthusiasm?

Tolerance Atrophes

My good friend called me a few weeks ago.  He had just watched many people come together to grieve with a family who just lost the man who was friend, father, son, and husband.  Grateful as he was that our community responds well, he missed the fact that the community knew little of his own pain. Specifically, he mentioned to me the ways I had missed an opportunity to enter into his pain with him... ways I could have cared for him and didn't.

He was not complaining.  He was just sharing with me his ache.  It was an ache I suspected, even asked about, but really never really shared with him.  Yeah, I did the drive-by How are you, friend?  I even managed the occasional Really, brother, how are you.  I accepted the strong and predictable response from a male friend, and didn't press further.  And he still ached.

In an unrelated turn of events, I happen to have good friends whose marriage is in a tough place.  I have entered in to their pain, but not with any real competence.  Good will?  You bet.  Good skill?  No.

I've started to ponder how I got to this place where I have good will without good skill when it comes to caring for people I love.  These are people whose best interests I want to promote.  These are people with whom I have lived a long time and I sort of have the insight and the right to be involved when it matters.  I don't think I'm unusual.

Here's another observation:  In both of the tough situations I've mentioned, those I care for have not been really good at receiving care either.

Why is this?

Here's my hypothesis:  I suspect that as our society elevates privacy and tolerance to the position of ultimate values, we put up barriers to caring.  We are at a point of where the cultural norm is to stay out until invited in.  Caring is a muscle that has atrophied for lack of exercise.

We have locked the doors on the exercise room of care.  Here are a two examples:  In the surgical waiting room, my daughter is a number on an electronic board because HIPAA rules are protecting her privacy.  My good friend cannot just drop by to care for us as a result.  When a colleague is dismissed at work we replace clarity with "Pursuing opportunities outside of the business."  We are left with nothing to explain the absence.  Rumors fill the void.

I suppose we use the euphemisms as a way to protect the honor of the injured, but I wonder if we're really protecting much.  And if we're not protecting much, have we erected an un-needed barrier to care?  Have we essentially put a cast on our caring muscles so long that they've atrophied?

Abuse of Power

A coworker stood in the doorway of my office musing about a wide variety of things.  She mentioned her interest in reading on the topic of the use and abuse of power in the workplace.  I was in the midst of exercising my power (not over her) as the manager of my group.  The question caused me to stop and think.

It strikes me that there are two ways to abuse power:  The stereotype is the capricious, ego-centric, unreasonable, fist-pounding leader who exercises power like a sit-com manager.  The other abuse of power is the failure to use legitimate authority when it is needed.  If child neglect is child abuse, then leadership neglect is power abuse.

The former is obvious and stereotypical.  So for the moment, let's consider why we may fail to exercise legitimate authority:

1. We don't know what to do.
2. We are afraid of the conflict
3. We want to protect the vulnerable (a variant of #2)

Option 1 seems easy enough to fix... go get help or advice or, in the case of the truly unsolvable problem, at least take first steps to understand what you're facing.

But for Options 2 and 3, the question seems to bring up moral dilemmas... Do I fire this person for non-performance even though she's the sole wage earner in her family?  Do I redefine this person's assignment to align to the business needs even though this puts him outside of his circle of expertise?  

But we need to see that the failure to address legitimate leadership needs with clarity, though apparently kind or considerate nearly always ends with delayed and amplified anger, frustration, or misunderstanding.  I am learning that clear conversations, even if they're difficult to have, are always better to have early and often.  The anticipation of the difficulty of a conversation seems always ti be greater than the actual difficulty.

Clarity does not require unkindess, but leadership fuzziness is always unkind.

Creation Posture

A fully footnoted version of this essay can be found here.

Creation Posture A call to the Church to get itself into position for Kingdom impact.

November 2014

Table of Contents

The core idea.

Posture

Posture puts you in position to respond

Posture communicates

Posture and safety

Created to be Creative.

Create

Value

Creation and Posture

Playing Out of Position

Ignorance:

Lack of Practice and Bad Practice

Practicing Our Preferences

Fear

Permission

Transition

God & Company

Building the Company

The Finders – Community Connectors

The Minders – Coaches for the People of Your Church

The Grinders – Consultants Deployed for the Kingdom

The Company

Scope of Engagements

Getting Started

Other Options

Concluding Thoughts

The freedom of creative constraints

The Freedom of Constraints.

On the face of it, one would not think that constraints are liberating.  Handcuffs do not set you free.  But in leadership, they can be.   Here are a few examples

Time:  When a meeting is limited to 15 minutes, we seem to get it all done and the normal 1-hour time slot is liberated to do other things that matter.  There is something magic about saying, let’s be direct enough to accomplish this fully in constrained time. 

Cost:  When we ask our development team to build a new system for 10% less cost, they work on it.  But if we ask for 50% cost out, they completely rethink what they have to do and new opportunities in design emerge.  What is exciting is how many new ideas beyond the cost out have emerged as a part of the experience.

Manual:  In a recent meeting, I asked our team to think about what we’d have to do to make our next system user manual only 50 pages (the current one is 1400).  The ideas that emerged about user interaction and context-sensitive help are stunning.

Service: We have been working on how to reduce our variable costs by making the devices easier to serve.  But when we set the constraint such that the end-user with no tools and no special training had to be able to service the system, the whole design got simpler in almost every dimension.

10 words: The marketing guys are tired of my insistence that we rephrase key benefits in 10 words.  But the magic of this marketing haiku is that it drives clarity of thought and helps us to focus on what is truly important.  We are now much more clear because – in part – we are constrained to a short expression of the idea.

I am not the first to think about this.  Barry Schwartz has written about the paralysis of choice (link here).  His thesis is that when we have too many choices we are more paralyzed, less happy, and less satisfied.  If you read the commentary on the web site, you will see lots of debate about Schwartz’s approach.  Most of the comments focus on what makes a good constraint and who gets to choose.  Since I’m the leader, I get to choose, but I have noticed that some constraints are helpful and some are just painful.  I have been trying to sort out what the difference between good and bad constraints might be. 

Though this is still an emerging set of ideas, here is a set of guidelines I’m finding to be helpful:

Helpful, liberating constraints vs Unhelpful dominating constraints:

·      Helpful constraints are purpose-driven,
Unhelpful constraints are fear-driven

·      Helpful constraints are about what,
Unhelpful constraints are about how

·      Helpful constraints encourage complete rethinking,
Unhelpful constraints are incremental.

·      Helpful constraints are derived from possibility or opportunity,
Unhelpful constraints are derived from compliance or obligation

·      Helpful constraints require domain experience,
Unhelpful constraints are arbitrary or out of context

·      Helpful constraints are expressed as “What would we have to do in order to…?” 
Unhelpful constraints are expressed as “We need to…”

These all have one thing in common:  They give our teams permission to explore without the precondition that they commit.  The phrasing of the last item in the chart above states this most clearly.  “What would it take,” releases the team from the anxiety of their history and experience.  Instead of discounting potential solutions based on the last attempt or tribal wisdom, it allows them to explore what could be.  It turns cautious managers into possibility thinkers.

“What would it take to reduce approval time for a major program from five weeks to five days?”  I asked that question recently and I learned that we had to settle a few key vision questions, get a global team in the same place to debate remaining issues, and ensure some facilitation.  Then it was my choice about whether to allocate the resources.   We did it.  We unlocked the “it takes five weeks” mentality by setting a creative constraint of five days.  As the team explored what it would take, they were not committing to five days, but they provided the solution nevertheless.

 

Not a magic wand:  This concept of constraints is not a magic wand.  My team is currently struggling with a battery quality and supply chain issue.  I cannot just ask, “What would it take to solve this problem in 3 days?”  Though I have to admit that it is tempting!  Some problems take real technical expertise in the traditional sense.

I have also found that this is not a “just do it” magic wand.  The problem with just do it is that it forces a commitment more than it opens the opportunity to explore.  Recently we had a small team struggling between two Product Management options we really didn’t like.  In one case we would have a better long-term solution and in the other we would meet a short-term market need, but the two options were mutually exclusive.  In this case, the magic words were “We need another idea, let’s take the weekend to think about it.”  Sure enough, this opened up the freedom to rephrase the problem outside of the pressure of a just-do-it meeting.   This is an example of removing a constraint rather than imposing one.

So far, this is still more art than science, but I’m finding that there is great freedom in carefully crafted constraints.

Uniqueness

Whether mankind is really that different from other creatures on the planet is a debate as common as a late night conversation.  Apparently the DNA of humans and dung beetles are 90% similar.  There seem to be ways for apes, whales, and Golden Retrievers to communicate.  And with the benefit of retrospect, one can trace a family tree from the earliest hominids to modern man on a poster in a sixth grade science fair.

But the common arguments focus on our construction, bill of materials, and certain skills... the hardware, if you can bear the metaphor.  But the software -- essentially what happens on that hardware -- seems to have some unique characteristics in humans.  Specifically, it appears that to be human means you are creative, and you make promises.  And as I hope to explain below, if only humans can make promises, only humans can make commitments to the actions required to secure the well-being of another... in more common terms, only human beings can love.  And finally, if humans are uniquely creative, then only humans can discern a sense of purpose.  It is this combination of creativity, promise, love, and purpose that then are the fuel for our sense of what ought to be.  I believe it is why one ponders can reasonably ponder whether humans are the only truly moral creatures.

I must say that I'm not the first to have thought these things.  Apparently Frederich Nietzsche, in his work on the Genealogy of Morals, stumbled into the same question of making promises.  He argued that to survive, humans need to be able to forget, but that unlike cattle, they do remember and make commitments.  I liked the way Sunny Auyang's explained this in her book, Mind in Everyday Life and Cognitive Science:  

Nietzsche (1874) observed that it is possible to live and live happily without memory, like grazing cattle blissfully oblivious of the past or future, but to live without forgetfulness is as impossible as to live without sleep.  The strength of forgetfulness makes more remarkable the genealogy of morals, which culminates in the autonomous and responsible individual with the right to make promises.  Only animals with logos can promise.  A promise is a choice made in the present.  It implies not merely the the passive inability to forget an utterance, but the active memory that must hold through all the vicissitudes between the initial "I will" and its final discharge   Our full-blown mental capacity manifests itself in the will to remember, the confidence to promise, and the assurance to foresee one's own ability to stick to his freely given words.  As Nietzsche (1887:II.1) wrote: "To breed an animal with the right to make promise -- is not this the paradoxical task that nature has set itself in the case of man?  Is it not the real problem regarding man?"

To paraphrase Timothy Keller, in his book,  The Meaning of Marriage, consider this:  To stand at the altar and make the wedding vows is not simply to say, "I love you today and I'm willing to say that in front of my mother-in-law and a few hundred others."  Rather it is to intentionally promise to love regardless of circumstances.  It is something I will do in the future.  It is a promise that includes the calculus of intent (I will) and capability (I can) and desire (I want to).  But interestingly, at least in traditional marriage, I will and I can have a future tense orientation, and I want to is in a present tense.  It is to say, I want to now, and I will in the future regardless of whether I want to then.  That is the nature of a promise and it appears that only humans can do this.

Stuart Briscoe, has often repeated this definition of love.  "To love is to be preoccupied with the well-being of another regardless of their position or response."  This definition eliminates a sentimental love that is blind to reality because it is aware of the other's position and response.  Though it is not in the definition itself, the implication is that we make promises, perhaps implicitly, to act in a way that benefits another.  Note that it is not reciprocal... I will regardless of whether you.  What makes it compelling is its unconditional nature and how starkly it stands in contrast with a simple conditioned response that will behave lovingly when it is suitable.  Love intends.  Furthermore, it intends to be durable.

From the concept of promise, let's move to creativity:

Andy Crouch's book, Culture Making: Recovering our Creative Calling, makes roughly this argument:  If you look at the apes, they've been eating bananas for millenia in the same way:  peel of the skin, swallow the insides.  But mankind has developed thousands of alternative banana-eating approaches from Bananas Foster to peanut butter and banana sandwiches.  (My analogy, not Crouch's.) Crouch suggests this, if in the beginning God created, and if God created mankind in his own image (Gen 1:26), then mankind was created to be creative.  (By the way, this is not the main point of Crouch's book.  His main point is really that we can have either a posture of creativity in a way that is consistent with our creation, or we can have a posture of critique in a way that is consistent with our cultures, and he urges us to the former.)

Leslie Newbigin, former Bishop of the Church of South India (and contemporary of CS Lewis) in his book, Foolishness to the Greeks: Gospel and Western Culture, argues that modern constructions of how things work miss the point of why they work.  He uses the analogy of a speaker at a podium.  With all of the mechanics and software of modern technology, one could build a machine that could reproduce the motions of the tongue, lips, lungs and vocal chords and nearly reproduce the actions of the speaker.  But the purpose of the speech would still be a mystery.  To understand the actions of mankind requires that one understand his purposes.  Viktor Frankl, in his writing, Man's Search for Meaning, recounts his time caring for others as a Nazi prisoner. He observed that man can endure hardships of every kind -- deprivation of food, sleep, rest, relationship -- but once a person loses purpose or hope, they will die within 48 hours.  The awareness of purpose, and its cousin hope is an essential element of what it means to be human.

Of course, for Christians, of which I am one, the catalog of the last half dozen paragraphs, resonates like a kind of modern echo of the texts of the Old and New Testaments.  God is portrayed as a covenant maker (promise), creator (creativity), agape-er (love), and the ultimate source of purpose.  It is not my intent to write an argument for the veracity of the scriptures; others have done a more complete job here than I will. Rather, I argue that these scriptural descriptions of God -- promise, other-focused love, creativity, and purpose -- are the building blocks of the uniqueness of humankind.  One can observe them objectively, describe them metaphorically, experience them personally, and connect them historically and theologically.  But it is impossible to reproduce them outside of mankind.

In fact, the argument that mankind is more than just an incremental evolutionary step away from other creatures may be the best we can do when our tools are those of a biologist.  But the demonstrated nature of humans is dramatically distinct in its foundation.  To explore the distinction can be an adventure.  To ignore it is willful deception.

Leadership Lessons from the Laboratory of Life

Recent months have put me in some of the most difficult and most rewarding leadership laboratories.  Here are some of the lessons I'm learning:

You cannot reason a person out of a decision they did not reason themselves into
I already knew that in the absence of full information, people will fill the gap with the worst possible scenario. What I have been surprised to learn is that even with all available the facts, some people will have their own narrative about motivation or causality or conspiracy.  Re-presenting the facts doesn't seem to help these folks to share my point of view.  I have to learn to get to the source of their narrative whether or not it aligns with facts on the ground.  Logic will not replace anger, injury, or shame, even when they may not be sensible. Anger requires reconciliation; injury requires pardon, shame requires release.  None require another litany of the truth until the mind and heart are tuned to the ideas more than the injury.

Leaders of integrity have to watch their reflexes
I work hard to be a man of integrity.  Really hard.  So when my integrity is called into question, I will defend it.  Generally, my reflex is to disclose what I know in order that others will see how reasonable I have been and how careful and transparent I am willing to be.  But in one moment recently, I came to see how my transparency could unnecessarily destroy another (Rom 14, would be a good scriptural touchstone here.)  I realized that some observers equate integrity with transparency.  I had to learn that I do not worship at the altar of my integrity.  I am careful to nurture integrity, but it is secondary to other things.  So I chose at times to be silent, when speaking would reveal my logic, skill, and transparency.  It cost me the respect of some who I want to respect me.  But that silence protected people and institutions I care about.

Necessary pain, unnecessary pain, and wasted pain
My colleagues and I have spoken a lot about the necessary pain that comes with change and transition.  We have talked about the times when the approach to change caused pain that was not necessary, and for that we need to find a place to repent and improve our skill.  But I was struck by the words of a colleague who encouraged us not to waste any pain.  The concept of wasted pain... that which teaches us nothing except for the intensity of injury... strikes me as one of the most important.  I want to learn as I lead and I will use that pain to improve.

Lead when you're tired
There are times when leadership just has to happen.  At times it's not when it's convenient.  So sometimes one has to lead in the midst of exhaustion, or inconvenience.  But we should never seek to lead out of exhaustion, and we should seek reasonable alternatives to delay or re-balance.  My urgency to find clarity or reconciliation or a solution sometimes led me to act faster than I needed to.  I could have waited until I was more clear-headed.

Leadership is a technical skill
If someone fixes your computer network issue, you're grateful.  If they properly adjust the sound system so that you can hear the speaker well, we commend the sound tech.  If the brochure is engaging and beautiful, we recommend the graphic designer.  But outside of big corporations, if the leader brings his expertise, many suspect manipulation or complain about becoming overly corporate or over managed.  Why is it that we presume good intent for the pianist, the podiatrist, party planner, and photographer, but we proceed with caution when we meet a skilled executive leader practicing her craft?

You are not your title
People may be mad at me for what I do.  That is different from being mad at me for who I am.  I have learned the difference.  Those who are mad may not see the difference.  It does not always matter that they do.

Organizations take on the personalities of their leaders.
Enough said.   We must manage our tone if we want to manage our teams.

About every 5 years, I realize I'm an idiot.
Someone shared with me the idea that About every five years I realize that 5 years ago I was an idiot.  There are so many things I might have done differently in the last 3 years.  Given the skill I had and the information I had I did the best I had.  I now have new skill and new information and I can do better.  Rather than mourning my idiocy, I learn to celebrate my maturing.  I still have to go back and apologize, of course. But at least I can apologize out of an informed mind and a wiser heart.

Sometimes apology isn't enough.
Yeah, sometimes saying "I'm sorry" is not enough for the injured.  But for some, repentance is not enough either...  Reciprocal injury is what they want.  That may be just, but it is not right.

Don't let the rice burn while your recording your thoughts.  
There's nothing to be learned from burning the rice.