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5.0 étoiles sur 5
Berkshire Hathaway after Buffett? It will continue to be "an institution that transcends the man and will be his legacy.", Oct. 22 2014
In his brilliant Introduction to the Second Edition of The Essays of Warren Buffett: Lessons for Corporate America, Lawrence Cunningham observes, "The CEOs of Berkshire's various operating companies enjoy a unique position in corporate America. They are given a simple set of commands: to run their business as if (1) they are its sole owner, (2) it is the only asset they hold, and (3) they can never sell or merge it for a hundred years." With regard to investment thinking, "one must guard against what Buffett calls the `institutional imperative.' It is a pervasive force in which institutional dynamics produce resistance to change, absorption of available corporate funds, and reflexive approval of suboptimal CEO strategies by subordinates. Contrary to what is often taught in business and law schools, this powerful force often interferes with rational business decision-making. The ultimate result of the institutional imperative is a follow-the-pack mentality producing industry imitators, rather than industry leaders -- what Buffett calls a lemming-like approach to business."
Consider these observations as you now share Cunningham's thoughts about Buffett's successor, suggesting that the most important trait as chief executive officer "is a knowledgeable commitment to Berkshire culture, including permanence, autonomy, and acquisitiveness. Therefore, the best candidates are insiders, those now managing Berkshire subsidiaries, as Berkshire's succession plan contemplates. Among these candidates, especially promising are individuals with strengths like lengthy service history at Berkshire; proficiency leading its largest, most sprawling operations; and experience running subsidiaries bearing most of the specific traits that constitute Berkshire culture. Experience leading a large public company would also be a plus." Now you understand why I included the brief excerpt from The Essays of Warren Buffett. A succession plan has been in place, updated in 2006. Its purpose is to secure the company's permanence. "By installing exceptional managers in a variety of roles historically handled by a single person, succession is calculated to succeed."
These are among the dozens of passages of greatest interest and value to me, also listed to suggest the scope of Cunningham’s coverage:
o Warren Buffett: Acquisition approach and practice (10-11 and 213-214)
o Charlie Munger: Organizational leadership and structure for diversity (Pages 12-15, 19-20, and 111-112)
o BH culture (37-38 & 197-198)
o Ben Bridge (82-84)
o Organizational autonomy and business principles (84-8, 111-118 and 185-190)
o BH leadership succession (92-94, 194-201, 208-210, and 232)
o BH acquisitions (125-136 & 170-171)
o Sustainable business model and value creation (137-149)
o Phil Graham and Graham Holdings (179-180)
o BH durability (218-220)
Although for obvious reasons, Warren Buffett ad Berkshire Hathaway are widely viewed as synonymous, Cunningham points out that BH is structurally complete and highly decentralized. "The parent owns at least fifty significant direct operating subsidiaries; these direct subsidiaries in turn own an aggregate of at least 225 subsidiaries, divisions, or branches. The later group in turn owns a total of at least another two hundred business units. These, in yet another turn, own sixty-five units, and another twelve are owned by that lot. In total, the Berkshire family includes at least 425 operating subsidiaries, along with seventy-five divisions, twenty-five branches, and twenty-five units."
Cunningham acknowledges, indeed admires Buffett's defining characteristics: his "folksy demeanor, Midwest sensibilities, negotiating techniques, and writing style are inimitable...As a new guard leads the evolution of Berkshire beyond Buffett, they will set its course and the company will never be the same. Yet the core values that define it have proven to offer unique sustaining value. It is hard to imagine Berkshire without Buffett. But it seems wiser to believe in Berkshire beyond Buffett, an institution that transcends the man and will be his legacy."
It took a Great Man to envision, assemble, assimilate, and meanwhile lead the members of this "family" and now, thanks to him, there will be a number of great men and women to ensure that the family remains healthy and prosperous.
As for Lawrence Cunningham, another brilliant achievement among several. Bravo!
5.0 étoiles sur 5
How and why the success of a human community with a foundation of conscious capitalism cannot be contained, Oct. 22 2014
In this book, written with Paul Keegan and Casey Shilling, Kip Tindell shares the most valuable lessons he has learned from several separate but (to some extent) interdependent journeys. His own, of course, as co-founder, chairman, and CEO of The Container Store, a process during which he has achieved personal growth and professional development. However, there are also the journey of the company from its founding in 1978 until its debut as a public company last year (November 1, 2013) as well as the shared adventures with co-founder Garrett Boone, Tindell's family (especially wife Sharon), associates (especially Melissa Reiff, president and COO), and allies such as John Mackey, co-founder and CEO of Whole Foods Market.
Throughout his lively and eloquent narrative, Tindell cites several reasons for the company's exceptional success (e.g. on average, 20% growth each year it has been in business). They include "passion, commitment, and conscious capitalism" to which the book's subtitle refers but there are two others of at least equal performance: hiring policies and employee-centrism that have established and sustain a truly unique culture.
How was that achieved? Here's Tindell's response: "This first Foundation Principle [i.e. 1 Great Person = 3 Good People] is our hiring and payroll philosophy: One great person is equal to three good people. We really believe that. . We're trying to get the very best people we can, in the stores, in the office, and in our distribution center. No one is overqualified...We absolutely want our people to be the best. We love and are compassionate to everybody, but we want excellence. I think life is too short not to try to do anything and everything with excellence."
When I came upon that passage, I was reminded of Ben Bradlee's comment that, when he became executive editor of The Washington Post in 1968, he decided that its motto would be inspired by the standard one of his grade school teachers set for each of her students: "Our best today; better tomorrow." The Post's motto? "Put out the best, most honest newspaper you can today and put out a better one tomorrow." During Bradlee's tenure, members of his staff were awarded 17 Pulitzer Prizes.
These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Tindell's coverage:
o The Seven Foundation Principles (Pages 18-27)
o Product selection and customer experience (Pages 50-52)
o Container Store concept development (59-69 and 239-240)
o Garrett Boone (64-73)
o Hiring policies and procedures (73-84)
o Sharon Tindell (92-98)
o Competition (108-110)
o Rapid growth and hiring standards (125-130)
o Foundation Principles and Conscious Capitalism (135-137)
o Communication IS leadership (138-146)
o Purchase of elfa systems (151-158)
o Pricing policies and standards (161-166)
o Importance of mutual trust (185-187)
o Majority share sale (191-210)
o Rob Holmes (203-208)
o Staff meetings and the air of excitement (220-223)
o Whole Foods Market (228-229)
A liquid assumes the shape of its container. At the risk of injecting a metaphor with steroids, I suggest that members of a workforce assume the shape of the given enterprise, for better or worse, in terms of its vision, its core values, its foundation principles, its traditions, and its people-centrism.
It is no coincidence that The Container Store and a few other companies annually ranked among the most highly admired and best to work for are also annually ranked among those that are most profitable and have the greatest cap value. If not a coincidence, what? With Paul Keegan and Casey Shilling, Kip Tindell provides a brilliant explanation in this book. Bravo!
| by Atul Gawande|
|Prix : CDN$ 20.65||
5.0 étoiles sur 5
Invaluable insights that reveal and affirm the importance of the quality of death, Oct. 22 2014
It is impossible to calculate the number of lives that have been saved by a visionary pragmatist, Atul Gawande, M.D., and his passionate advocacy of using checklists to reduce (if not eliminate) mistakes during healthcare provision. For years, mechanics as well as pilots and their navigators have spent hours prior to each flight to ensure that there will be no problems with the given aircraft. Why not healthcare professionals? As they will readily concede, a hospital probably is the unhealthiest place to be when already ill.
"We have just two reasons that we may fail. The first is ignorance - we may err because science has given us only a partial understanding of the world and how it works. There are skyscrapers we do not yet know how to build, snowstorms we cannot predict, heart attacks we still haven't learned how to stop. The second type of failure the philosophers call ineptitude - because in these instances the knowledge exists, yet we fail to apply it correctly. This is the skyscraper that is built wrong and collapses, the snowstorm whose signs the meteorologist just plain missed, the stab wound from a weapon the doctors forgot to ask about. For nearly all of history, people's lives have been governed primarily by ignorance."
With regard to healthcare provision, he adds, "At least 30 percent of patients with stroke receive incomplete or inappropriate care from their doctors, as do 45 percent of patients with asthma and 60 percent of patients with pneumonia. Getting the steps right is proving brutally hard, even if you know them." Hence the importance of using checklists to improving the quality of care...and the quality of life.
I urge those who have not as yet read his book, The Checklist Manifesto, to do so as soon as possible.
There is almost universal agreement on what the meaning of the phrase "quality of Life" means but that is hardly true with regard to the meaning of the phrase "quality of death." Perhaps the strongest disagreements and most heated exchanges involve those who support or oppose assisted death, counterpart and polar opposite of assisted living.
I agree with Sarah Nelson's observations that, "Through interviews with doctors, stories from and about health care providers (such as the woman who pioneered the notion of "assisted living" for the elderly)--and eventually, by way of the story of his own father's dying, Gawande examines the cracks in the system of health care to the aged (i.e. 97 percent of medical students take no course in geriatrics) and to the seriously ill who might have different needs and expectations than the ones family members predict. (One striking example: the terminally ill former professor who told his daughter that "quality of life" for him meant the ongoing ability to enjoy chocolate ice cream and watch football on TV. If medical treatments might remove those pleasures, well, then, he wasn't sure he would submit to such treatments.) Doctors don't listen, Gawande suggests--or, more accurately, they don't know what to listen for."
Presumably an increasingly greater number of healthcare administrators are compiling a checklist of the checklists that are needed, identifying also those best-qualified to compile them so that the meaning of "assisted dying" is extended to include making every effort possible to ensure a quality of death that takes into full account what will respond effectively to the emotional and psychological as well as physical needs of patients. That is what they deserve and that is what their loved ones should expect of those to whom their loved ones' care has been entrusted.
Again, it is impossible to calculate the number of people who will benefit from what Atul Gawande recommends in his latest book. Having lived as long as I have, and given my own experience during the last days of family members and friends, I think those of us who cared for them did our best to make them comfortable, to manage their pain (if that's really possible), and to treat them with proper respect. Only by reading this book did I realize, however, what more -- and less -- could have been done, with greater sensitivity.
The review of Being Mortal by "Helping Hands" in The Economist concludes, "Many people fear that a doctor who does not try everything possible has abandoned his patients, and they will die earlier as a result. Surprisingly, however, the try-everything approach appears not even to offer a longer life. Multiple studies have shown that patients entering hospice care, which usually means abandoning attempts at a cure, live at least as long as those receiving traditional care. A startling study in 2010 found that patients with advanced lung cancer who saw a specialist in palliative care as well as receiving the usual oncological treatment stopped chemotherapy sooner, entered a hospice earlier, suffered less--and lived 25% longer than comparable patients who received only the standard care. 'If end-of-life discussions were an experimental drug, the FDA [an American regulatory body] would approve it,' says Dr Gawande. In life, as in all stories, he writes, 'endings matter.'"
Anyone who questions that should ask those now close to end-of-life.
5.0 étoiles sur 5
“To strive, to seek, to find, and not to yield.” Tennyson’s Ulysses, Oct. 20 2014
Most people are caught up in what James O'Toole so aptly characterizes as "the ideology of comfort and the tyranny of custom." That is why, when someone comes up with a breakthrough insight, most people think it is crazy and ignore it. Some of them ridicule it. Then, if the idea seems to gain traction, they do all they can to oppose it. When Galileo supported Copernicus' assertion that the sun (not the earth) was the center of the universe, for example, he was brought before the Spanish Inquisition. Had he not recanted, he would have been executed. More recently, many people thought Henry Ford was crazy when he began to pay his workers a dollar an hour in wages.
In Linda Rottenberg's thoughtful and thought-provoking book, she discusses a number of people who illustrate "the power of zigging when everyone else zags," whose ideas were (at least initially) called "crazy" and ridiculed. What she shares is based on what she learned from working with more than a thousand entrepreneurs over the years. She classifies them within four category types: gazelles (agile and fast-moving with high-impact), skunks ("operating within large organizations "who go out of their way to stink up the joint"), dolphins (visionary contrarians in the non-profit world), and butterflies (sole proprietors or small-business owners with small-scale impact). This book is her attempt "to beak down a process that often seems overwhelming into a series of achievable steps. It's my shot at answering the question: Since everybody has to take risks these days, how do you know that you're taking smart risks?"
In his latest book, Entrepreneurial StrengthsFinder, written with Sangeeta Bharadwaj Badal, Jim Clifton observes, "Innovation is essential, and we need it. But the real magic starts with entrepreneurs - with people who are born with the rare gift to build successful businesses. Years ago, Thomas Edison observed, "Vision without execution is hallucination." Clifton obviously agrees. "An innovation has no value until an ambitious entrepreneur builds a business model around it and turns it into a product or service that customers will buy. If you can't turn an innovative idea into something that creates a customer, it's worthless."
I agree that such an initiative is "worthless" in terms of its commercial value. However, many so-called "failures" In experimentation or prototyping can be of substantial value in terms of what can be learned from them. Creating more and better jobs will depend on wide and deep support of entrepreneurism in both the public and private sectors.
Here's my take on what I think Rottenberg and Clifton seem to share in common in terms of their perspectives on entrepreneurship:
1. The better the idea, the greater the resistance to it. (See Tennyson quote.)
2. Small-scale, low-risk experimentation and refinement are essential and must be continuous.
3. Combine tenacity with patience while keeping the faith.
4. Keep the dream alive but focus on the process of collaboration.
5. If an idea is DOA, bury it and come up with a better one.
6. Several ideas are good and a few are (potentially) great.
7. Many ideas initially make little (if any) sense.
8. IDEO uses brainstorming of as many ideas as possible to generate a few to prototype.
9. Conventional wisdom is not necessarily wrong but, more often than not, it may be inappropriate to the given need.
10. The most successful entrepreneurs are results-driven, customer-centric visionaries with an insatiable curiosity to understand what works, what doesn't, and why. They thrive on challenges and delight in building value for everyone involved in the given enterprise.
These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Rottenberg's coverage:
o Susan Senglemann (Pages 22-25 & 202-203)
o Thomas Edison (30-32)
o Richard Branson (43-44)
o Friends and Family: In business and on test-driving ideas (49-53, 116-120, and 163-164)
o Edgar Bronfman, Jr. (65-66)
o Entrepreneurial personalities (89-109)
o Jeff Bezos and Amazon (126-127, 157-158, and 208-209)
o Agility (136-141)
o Mentors (157-177)
o Purpose-driven workplace (181-203)
o Culture Club (190-194)
o Get Going (206-212)
o Go Big (212-216)
o Go Home (216-221)
As indicated earlier, Rottenberg has much of value to say about four different species of entrepreneur. The one with which most successful entrepreneurs will be identified is the "gazelle." (Ray Kroc, Ted Turner, Mary Kay Ash, Herb Kelleher, Jeff Bezos, Richard Branson, Reed Hastings, and Sophia Amoruso immediately come to my mind). The term refers to the classic entrepreneur of myth and reality, someone who starts a new business venture (or a new way of doing business) and aims for it to explode into a white-hot phenomenon such as Home Depot, Facebook, Jenny Craig, Netflix, Under Armour, and Instagram.
The term "gazelle" was coined by the economist David Birch. His identification of gazelle companies followed from his 1979 report titled "The Job Generation Process" (MIT Program on Neighborhood and Regional Change), wherein he identified small companies as the biggest creators of new jobs in the economy. In 1994, however, Birch revised his thesis, isolating job-creating companies he called "gazelles." Characterized less by size than by rapid expansion, Birch defined the species as enterprises whose sales doubled every four years. By his estimates, these firms, roughly 4% of all U.S. companies, were responsible for 70% of all new jobs. The gazelles beat out the elephants (like Walmart) and the mice (corner barbershops). When you hear politicians say, "Small businesses create most of the new jobs," they're really talking about young and growing firms. They are talking about gazelles.
Unsurprisingly, gazelles are rare creatures. A 2008 study by Zoltan Acs, director of the Center for Entrepreneurship and Public Policy at George Mason University, found that a mere 2% to 3% of all companies were high-impact firms. Elephants and mice cut jobs, and the deeper they slice the higher unemployment rises. But when it comes to job creation, they are almost irrelevant.
I commend Linda Rottenberg on the abundance of invaluable information, insights, and counsel that she provides. For aspiring entrepreneurs as well as for others whose business initiatives need a turbocharger, this may well prove to be the most important book they ever read.
5.0 étoiles sur 5
How and why "simple, fast, cheap, smart, lean, and important experiments can supercharge any serious innovation process", Oct. 15 2014
As I began to read Michael Schrage's latest book, I was again reminded of a passage in Paul Schoemaker's latest book, Brilliant Mistakes: "The key question companies need to address is not `[begin italics] Should [end italics] we make mistakes?' but rather [begin italics] Which [end italics] mistakes should we make in order to test our deeply held assumptions?'" This is precisely what Anjali Sastry and Kara Penn have in mind when introducing, in Fail Better, what they characterize as a better approach to innovation: designing smart mistakes, learn from them, and thereby achieve greater success and do so sooner.
Peter Sims has much of value to say about this strategy in Little Bets: How Breakthrough Ideas Emerge from Small Discoveries. As he explains, "At the core of this experimental approach, little bets are concrete actions taken to discover, test, and develop ideas that are achievable and affordable. They begin as creative possibilities that get iterated and refined over time, and they are particularly valuable when trying to navigate amid uncertainty, create something new, or attend to open-ended problems."
In Serious Play (1999), Schrage introduces several core concepts that he develops in much greater depth in this, his latest book. The 5x5 X(experimental)-team approach is a rapid innovation methodology emphasizing lightweight, high-impact experimentation, as follows: "Give a diverse team of 5 people no more than 5 days to come up with a portfolio of 5 business experiments that cost no more than $5,000 (each) and take no longer than 5 weeks to run." Schrage adds, "that the 5x5 seeks an 80/20/20 vision. That is, what hypothesis could we test -- what experiments could we run -- that generate 80 percent of the useful information that we need to make a decision in 20 percent of the time, and with but 20 percent of the resources that we ordinarily use to do so?" Schrage thoroughly explains the theory and practice of this method in the book. Yogi Berra once observed, "In theory there is no difference between theory and practice. In practice there is." Presumably Schrage agrees.
These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Schrage's coverage:
o The Business Experiment: A fast, inexpensive, and informative test of a business hypothesis (Pages 10 & 12)
o Implementation and prototypes (24-33)
o Experimentation and innovation (36-38 & 85-87)
o Warren Buffett (49-56)
o Resistance to business experiments (67-687, 85-88, & 178-179)
o Blockbuster (77-85)
o Julian Simon (89-92)
o 5x5 X-team approach (95-138)
o Business experiments (141-153)
o Charles Kettering (146-148)
o Business hypotheses (177-185)
o David Kelley (210-211)
o Decision theory (213-216)
I commend Schrage on his innovative use of (boxed) mini-commentaries, inserted throughout his narrative that include "The 5x5" (Page 5), "Formulating the Hypothesis" (11), "Moving from Hypothesis to Experiment" (12-13), "A Prototype Is a Hypothesis" (30-32), "Scott Cook, Founder and Chairman of Intuit, on Experimentation" (57-58), and "Q&A: The Experimenter [Gary Loveman]" (205-206). This material complements rather than supplements the information, insights, and counsel he provides elsewhere in the narrative. The same can be said of passages that examine experiments by real people in real-world situations, experiments that produced mixed results to be sure but demonstrate the truth of Thomas Edison's claim, "I have not failed. I've just found 10,000 ways that won't work." The companies that have --or should have -- followed the 5x5 X-team approach include (in alpha order) Amazon, Apple, Blockbuster, Delco, Facebook, GE, General Motors, Google, NCR, P&G, Tesco, Toyota, and Walmart.
John Kotter once suggested that the most difficult challenge to change initiatives is to change how people think about change. The same can be said about innovation and experimentation, as Schrage suggests in the book's final chapter, "Experimenting with Experimentation." He quotes Kevin Kelly: "Anybody who works in science knows that they're constantly finding new things that they don't know. It increases their ignorance...while science is certainly increasing knowledge, it's actually increasing our ignorance even faster. So you could say that the chief effect of science is the expansion of ignorance." You could also say, at least I do, that rather than increasing ignorance, science increases our knowledge of what we don't know. Some of the worst decisions people make are based on insufficient or inaccurate information. Hence the critical importance of testing all assumptions and premises. Paradoxically, the most innovative and creative thinking requires the multiple disciplines of the scientific method.
Here's George Schrage's response to Kelly's comments: "Substitute business for science and opportunity for ignorance, and Kelly's tongue-in-check observation explains why the ongoing revolution in experimentation defines the innovation future. There's never been a better time for innovating with experiments or experimenting with innovation."
Obviously the "Whack-a-mole" approach to innovation makes no sense nor does a concentration of massive resources on one major experiment. Breakthroughs are few and far between lots of small, low-risk, prudent, and numerous experiments.
Invoking a set of horticulture metaphors, here's my take on Michael Schrage's approach: innovation requires careful planting of seedlings (i.e. ideas, possibilities, hypotheses) in properly prepared soil. Cultivate them and protect them for a while, then nourish those that begin to indicate promising growth. A few will. Perhaps combine a few of the others and keep an eye on them. Eventually, hopefully, there will a few robust results.
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How and why Google continues to attract and retain so many "smart creatives", Oct. 15 2014
Before Eric Schmidt and Jonathan Rosenberg, with Alan Eagle, explain how Google works, Google cofounder and CEO, Larry Page, shares his thoughts about why it works in the unique ways it does: "Over time I've learned, surprisingly, that it's tremendously hard to get teams to be super ambitious. It turns out most people haven't been educated in this kind of moonshot thinking. They tend to assume that things are impossible, rather than starting from real-world physics and figuring out what's actually possible. It's why we put so much energy into hiring independent thinkers at Google, and setting big goals. Because if you hire the right people and have big enough dreams, you'll usually get there. And even if you fail, you'll probably learn something important."
Schmidt and Rosenberg devote an entire chapter, "Talent -- Hiring Is the Most Important Thing You Do" (Pages 95-141). They believe that hiring is the most important area of what Google does and explain how and why. Of special interest to them are people they characterize as "creative smarts," those who are a "firehose" of new ideas that are genuinely new. "She is always questioning, never satisfied with the status quo, seeing problems to solve everywhere and thinking that she is just the right person to solve them. She can be overbearing."
These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Schmidt and Rosenberg's coverage:
o Keep them crowded, and, Work, eat, and live together (Pages 34-38)
o Organize the company around the people whose impact is highest (47-48)
o Don't be evil (64-65)
o Bet on technical insights, not market research (69-74)
o Optimize for growth (78-81)
o Don't follow competition (90-91)
NOTE: Long ago, I realized that an organization's #1 competitor tomorrow is what it does and how it does it today.
o The herd effect (99-100)
o Hire learning animals (102-105)
o Expand the aperture (108-112)
o Interviewing is the most important skill (113-118)
o Decide with data (151-153)
o Make fewer decisions (158-160)
o Meet every day (160-161)
o Horseback law: quickly identify the main legal issues (165-167)
o It must be safe to tell the truth (180-182)
o Repetition doesn't spoil the prayer (184-187)
o Innovation is something new that is "radically useful" (205-206)
o Think big/bigger (216-220)
o Ideas can come from anywhere and anyone (231-233)
o Ask the hardest questions (249-254)
Readers will appreciate the boxed mini-commentaries that provide supplementary information, insights, and counsel such as "Eric's Notes for a Strategy Meeting" (Pages 92-93), "Google's Hiring Dos and Don'ts" (132-133), "Career -- Choose the F-16" (133-141), "The World's Best Athletes and You Don't?" (170-171), and "Jonathan's Favorite 20 Percent Project" (230-231). It's true: Google has become a huge, immensely complicated global organization with vast resources. However, it needs to be said that many (if not most) of Schmidt and Rosenberg's insights will be of interest and value to leaders in almost any organization, whatever its size and nature may be.
The Google culture is one in which personal growth and professional growth are most likely to thrive but it must also be said that competition becomes more ferocious each day between and among the workforce as well as within each of its members who are driven to learn and understand more, then do what they do better and faster with fewer resources.
"We see the new breed, day in and day out, and marvel at their confidence and smarts. They tell us what's up and what's going to happen, and when it comes to deciding what to do next, they tell us as often as we tell them. Such is our fate, surrounded by up-and-coming smart creatives." Eric Schmidt and Jonathan Rosenberg, with Alan Eagle, realize that for every "rock star" they encounter in their work each day, there are dozens (perhaps hundreds) of others now hard at work on preparations to knock Google from its perch. Out there, somewhere, there is a brave business leader who has gathered a small dedicated team of smart creatives. "Maybe she has a copy of our book, and is using our ideas to help her create a company that will eventually render Google irrelevant. Preposterous, right? Except that, given that no business wins forever, it is inevitable. Some would find this chilling. We find it inspiring."
So will many of those who read this book.
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How and why group practices can provide much better - and much less expensive -- healthcare, Oct. 11 2014
There are valuable business (i.e. leadership and management) lessons to be learned from the information, insights, and counsel provided by Toby Cosgrove, M.D. and CEO of the Cleveland Clinic. These are among the questions he addresses: "How can the performance of an entity as large and complex as a hospital be improved, given that there are so many different professionals coming together to get the job done? How can doctors, nurses, technicians, and other support staff improve, for instance, the care that lung transplant patients receive so that they recover more quickly and stay in intensive care for fewer days? How can the many teams within a hospital uniformly sterilize surgical instruments so that patients sustain fewer serious infections? How can teams of professionals -- each with different training and perspectives -- improve their care of women during labor and delivery to minimize the number of risky procedures (for example, cesarean sections) that these women undergo?"
One of the keys to the effectiveness of healthcare provision at the Cleveland Clinic is the group practice model, one that was essentially born and continuously improved at the Mayo Clinic (co-founded by William and Charles Mayo in Rochester, Minnesota, in 1889) and the Cleveland Clinic (co-founded by George Crile Sr., Frank Bunts, William Lower, and John Phillips) in 1921. During the First World War, Dr. Crile and his colleagues set up military hospitals not far from the front. "They were impressed by the military approach to medicine, which was so different from the private practice model that dominated civilian medicine. Military medicine was collective." More to the point, it was collaborative and collegial. "Everyone shared the same mission, and all were focused on the patient and making the patient better." That, in essence, soon became the "Cleveland Clinic Way."
Cosgrove has much of value to say about eight trends that will define the future of medicine. In fact, they will probably define the future, period. He explains WHY or HOW
1. Group practices will provide better -- and cheaper -- healthcare
2. Collaborative medicine is more effective
3. Big Data will be harnessed to improve the quality of healthcare as well as lower costs
4. Cooperative practices can be the wellspring of innovation
5. Empathy is crucial to better patient outcomes
6. Wellness of both mind and body depends on healthcare, not sickcare
7. How healthcare is best provided in different settings for greater comfort and value
8. How tailor-made healthcare treats a person rather than a disease
Directly or indirectly, these trends will sustain patient-driven healthcare with its focus on the quality of patient experience. These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Cosgrove's coverage:
o Origins of the Group Practice Model and the Cleveland Clinic (Pages 4-6)
o The Power of Collaboration (29-30)
o The Teamwork Incubator (31-34)
o Working Together in Institutes (38-44)
o The Wondrous New ace of Medicine (50-52)
o Electronic Medical Records Offer Significant Advantages (57-61)
o Big Data Drive Medical Research and Improve Healthcare Outcomes (65-70)
o Improving Performance at All Levels (73-76)
o Innovation and Its Enemies (83-84)
o Innovation at the Margins (90-94)
o Bringing Innovation to Market (94-100)
o Navigating the Cultural Sea Change (112-116)
o Improving Caregiver-Patient Communication (120-123)
o Bad Habits Cost More Than Money (135-138)
o Changing Tines, Changing Care (155-157)
o Toward Better Integration (161-167)
o How Personalized Care Works (176-178)
Cosgrove provides a substantial value-added benefit: mini-commentaries that provide valuable supplementary information about the Cleveland Clinic way (in practice) within the context of the narrative. Their subjects: "Teams Tamer Seizures" (48-49), "Call Today for an Appointment Today" (124-125), and "A System Open to Anyone" (162-164).
When concluding this remarkable book, Cosgrove observes, "Healthcare professionals, policy makers, patients, and citizens together can lead the way to improved healthcare delivery in this country. I've written this book in the hope of creating a movement of individuals who realize what is at stake and what is possible and are committed to leading the way. Count yourself as a member of this movement. Speak out about healthcare. Break new ground. Make new connections. Be a pioneer." Years ago, Margaret Mead observed, "Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has." The Mayo Brothers and their associates did that 1889 and Dr. Crile and his colleagues did that in 1921. I agree with Toby Cosgrove: "Now it's our turn."
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The Great Confusion: Perhaps the problem lies with the economic principles or the way they have been understood, Oct. 10 2014
As we now realize and as James Galbraith duly notes, "a good command of economic principles was not sufficient to foresee the Soviet collapse. And two decades later, we discovered that a good command of economic principles did not help foresee the world financial crisis either. Perhaps the problem lies with the economic principles or the way they have been understood. And that's the reason for this book. "
The title of this thoughtful and thought-provoking book refers to the economic impact of four factors: the rising costs of diminished resources, the now-evident futility of tradition/conventional military power, the labor-saving consequences of the digital revolution, and the breakdown of law and ethics in the financial sector. My take on Galbraith's overview on the last 50-60 years is that there has been a major paradigm shift in a sequence of stages, each of which redefined "normal": first, the decline of easy growth in the 1970s; then uneven and unsteady (if any) growth in the 1980s and 1990s; and then in the 2000s until 2008, the global economy has been "the best of times" for some countries, the "worst of times for others." Since 2008 until now, so-called experts have tried -- with limited success -- to explain the causes that have driven each phase of the shift. Galbraith views much of the on-going discourse as being either wrongheaded or insufficient. In this book, he responds, demonstrating a good command of economic principles while sharing his thoughts about what has happened and is happening now. His hope is that in doing so, he will help those who read his book to change or at least cope with the current "Great Crisis."
These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Galbraith's coverage:
o A Contest of One Note Narratives (Pages 11-17)
o Economic Growth (21-37)
o Ben Bernanke (60-63 and 208-209)
o The Pragmatic Practice of Bubble Detection (80-83)
o Nonlinear financial dynamics (87-92)
0 U.S. Military Power (113-128)
o Creative Destruction (134-138)
o Information revolution (137-147)
o Financial fraud and great financial crises (149-168)
o Forecasting failures (172-178 and 180-181)
o ARRA (177-180 and 185-186)
o Crackpot counterrevolution (189-205)
o The U.S. economy in comparison/contrast with others (211-223)
o European economy: perils and potentialities (225-235)
o What a high-growth economic strategy favors (241-253)
o The economics of Axel Leijonhufvud and Earlene Craver (262)
I am grateful to James Galbraith for the information, insights, and counsel he provides. Frankly, I need to re-read the book because, with regard to much of the material, I may have understood its meaning but probably not its significance. The economic challenges we continue to face are immensely complicated and defy simplistic explanations. However, unless and until we understand their nature and extent, we cannot respond effectively. At least for me, doubt and uncertainty will continue to be "normal."
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How and why innovation without successful entrepreneurship is "worthless", Oct. 10 2014
In my opinion, Jim Clifton is one of the most important and yet least appreciated business thinkers now discussing the global marketplace. Written with Sangeeta Bharadwaj Badal, his latest book makes an urgently needed distinction between inno0vation and entrepreneurial innovation. As he explains, "Innovation is essential, and we need it. But the real magic starts with entrepreneurs - with people who are born with the rare gift to build successful businesses. Years ago, Thomas Edison observed, "Vision without execution is hallucination." Clifton obviously agrees. "An innovation has no value until an ambitious entrepreneur builds a business model around it and turns it into a product or service that customers will buy. If you can't turn an innovative idea into something that creates a customer, it's worthless."
I agree that it is "worthless" in terms of its commercial value. However, many so-called "failures" in experimentation or prototyping can be of substantial value in terms of what can be learned from them.
With regard to leadership, consider these observations: "During my 40 years at Gallup, I've observed that when very talented leaders fail, it's often because their thinking failed them. Not their management or leadership skills, but their thinking about a core belief that they put at the center of all their strategies. Because they are so wrong about that core belief, every subsequent decision actually makes things worse, because every decision is tied to that belief. The more they manage and lead, the worse things get...Here's what leaders need to know: Jobs and GDP growth [begin italics] do not [end italics] follow innovation. Jobs and GDP [begin italics] do [end italics] predictably follow entrepreneurship. Put another way" Entrepreneurs create customers. And customers, in turn, create jobs and economic growth. Almost no leader knows this."
I share Clifton's concern about the nature and extent of impact (i.e., damage) about a core belief that drives the strategic decisions of many (most?) business leaders. I hope this book attracts wide and deep interest among those now in a position to get their companies -- and our nation -- back on track. "Because we have misdiagnosed the cause and effect of economic growth, we have misdiagnosed the cause and effect of job creation. To get back on track, we need to quit pinning everything on innovation, and we need to start focusing on the almighty entrepreneurs and business builders. And that means we have to find them."
Many who read this book may be curious to know (a) what the defining characteristics of a risk-taker are, and (b) whether or not they possess sufficient risk-taker talent. Jim Clifton devotes all of Part 3 to a rigorous and thorough examination of what he views as the "Ten Talents of Successful Entrepreneurs." Then, as a substantial value-added bonus, a packet is inserted at the end of this volume. It contains a unique access code to the "Entrepreneurial StrengthsFinder Assessment," all by itself worth at least ten times the cost of the book. This access code is valid for one use only. Do not buy a copy of this book if its packet has been opened.
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Since 1988, Jim Clifton has served as CEO of Gallup, a global leader in consulting, public opinion research, and analytics. Under his leadership, Gallup has expanded from a predominantly U.S.-based company to a worldwide organization with 30 offices in 20 countries and regions. He is the creator of The Gallup Path, a metric-based economic model that establishes the linkages among human nature in the workplace, customer engagement, and business outcomes. This model is used in performance management systems in more than 500 companies worldwide. His most recent innovation, the Gallup World Poll, is designed to give the world's 7 billion citizens a voice in virtually all key global issues.
Clifton is the author of The Coming Jobs War and coauthor of Entrepreneurial StrengthsFinder, as well as many articles on global leadership. His blog appears regularly in the Influencer section of LinkedIn and on Gallup.com's Chairman's Blog. He serves on several boards and is Chairman of the Thurgood Marshall College Fund. He has received honorary degrees from Jackson State, Medgar Evers, and Bellevue Universities.
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“You can’t escape failure”: How to use it to achieve great success that would not otherwise be possible, Oct. 10 2014
As I began to read this book, I was again reminded of a passage in Paul Schoemaker’s latest book, Brilliant Mistakes: "The key question companies need to address is not ‘[begin italics] Should [end italics] we make mistakes?' but rather [begin italics] Which [end italics] mistakes should we make in order to test our deeply held assumptions?'"
This is precisely what Anjali Sastry and Kara Penn have in mind when introducing what they characterize as the “Fail Better” approach: designing smart mistakes, learn from them, and thereby achieve greater success and do so sooner.
These are among the dozens of passages of special interest and value to me, also listed to suggest the scope of Sastry and Penn 's coverage:
o Failures, Small and Good, Big and Bad (Pages 16-18)
Note: Peter Sims has much of value to say about this strategy in Little Bets: How Breakthrough Ideas Emerge from Small Discoveries. As he explains, "At the core of this experimental approach, little bets are concrete actions taken to discover, test, and develop ideas that are achievable and affordable. They begin as creative possibilities that get iterated and refined over time, and they are particularly valuable when trying to navigate amid uncertainty, create something new, or attend to open-ended problems."
o It's Not You, It's the System Complexity (18-24)
o Projects Are the Crucible (27-30)
o The Fail Better Method (34-44)
o Taking Your First Steps to Implement the Method (50-53)
o Results-Driven: Link Action to Outcomes (63-81)
o Build Your Team (87-92)
o At-a-Glance Guidance for Launching Your Project (100-106)
Note: This is one of several "At-a-Glance Guidance" sections located throughout the narrative. Great for frequent review.
o The Power of Iteration (112-127)
o Embed the Learning (152-174)
Note: Derek Bok, former president of Harvard once observed, "If you think education is expensive, try ignorance."
o Implementation: Developing the Fail Better Mind-Set (199-221)
o The Only Benefit of Failing Is What You Learn (226-228)
o Designs for Learning: Calibrated Challenges (228-233)
o Skills for Extracting Feedback's Lessons (237-243)
o Concluding Thoughts: What BRAC Reveals About Failing Better (261-263)
o Build on the Lessons, Use the Method, and Initiate Larger-Scale Change (280-281)
I commend Sastry and Penn on their provision of nine "Real-World Inspiration" mini-case studies that focus on real people in real companies facing real-world challenges who demonstrate the power of the Fail Better Method. They include several companies wholly unfamiliar to me (e.g. WiPower and Pivots Software) and others that are prominent (e.g. Eli Lilly and IDEO). With all due respect to the importance of developing the Fail Better Mind-Set, responding effectively to challenges using the Fail Better Method must be a collaborative effort at all levels and in all areas of the given enterprise. Most change initiatives either fail or fall far short of original expectations and the reasons vary. However, as James O'Toole suggests in Leading Change, most of the resistance tends to be cultural in nature, the result of what he so aptly characterizes as "the ideology of comfort and tyranny of custom."
Sastry and Penn are well aware of all this, of course, and conclude their book by offering "some parting suggestions for putting the method into practice." I share their hope that those who read their book will then succeed in helping their organizations to remake work experiences by accelerating the personal growth and professional development of everyone involved. It certainly will not be easy. Indeed, it will be damn difficult. But it can be done because it already has been done by companies such as BRAC, an organization that over the course of four decades has achieved global change with limited resources."
Why not yours?
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Anjali Sastry is senior lecturer at MIT Sloan School of Management and lecturer in the Department of Global Health and Social Medicine at Harvard Medical School. Her research investigates global health delivery and management, applying systems thinking and practical, business-based approaches in low-resource settings. She has conducted numerous field studies and collaborative action projects in Africa and Asia and advises and teaches internationally.
Kara Penn is cofounder and principal consultant at Mission Spark, where she works on the front lines of practical management to implement new approaches in complex settings. She has led award-winning community collaboratives; designed, managed, and evaluated multiyear social change initiatives; and guided more than sixty NGOs, social enterprises, corporations, and foundations. Several prestigious fellowship programs, including Coro, Watson, and Forté, have recognized her leadership and community contributions.