CONCLUSION

UNLEASHING OURSELVES

In 1993, my wife, Mary Carole, and I moved to Bangor, Maine, to work at a small regional medical center. I had finished my residency, and before I started my fellowship training, we thought we’d slow down our careers for a year and take some time for ourselves. We each planned to work half-time, Mary Carole as a general pediatrician and I as head of the center’s small pediatric ICU. I wound up working constantly that year and absolutely loved it. Although I had only two months of experience in an ICU previously, I now had the opportunity to run one myself and lead a team of caregivers.

It wasn’t long before I felt the full weight and responsibility of leadership. One day, paramedics brought in a 16-year-old patient with meningitis who was gravely ill with septic shock. It’s a bad sign when patients tell you that they think they’re dying. But that’s exactly what this patient muttered to us before losing consciousness. Our job was to stabilize him enough so that we could airlift him to Boston Children’s Hospital for more specialized care.

We didn’t normally get patients this sick in this ICU. My small team—composed of a respiratory therapist, a pharmacist, and a couple of nurses—was terrified. With very little hands-on ICU training, I was terrified, too. My pulse quickened as they wheeled the patient in—if we screwed this up, this child would die. Fortunately, I managed to stay calm and be there for my team. Standing at the head of this patient’s bed with my team standing around me, I took a deep breath to center myself and gave a short pep talk. “Look,” I said, “we’re a really good team. We know how to do this. Let’s take care of one another, and let’s take care of this patient. If we do, I think it’s going to go really well.”

These words weren’t especially profound or poetic, but they galvanized all of us to do our best. By acknowledging the fear that we all were feeling and by offering reassurance, I was able to provide emotional relief to my team at a critical moment. They were now reinforced in their belief that they were up to the challenge of saving this patient’s life. In asking them to take care of one another, I was setting an important ground rule: we would surmount the obstacles in our path by pulling together and operating as a unified, cohesive team.

We quickly intubated this patient, inserted arterial and central venous lines on our first try, and started him on a medication to support his blood pressure. Thankfully, his condition stabilized. As it turned out, we couldn’t fly him out right away—a storm had rolled in, and the weather was too rough. I wound up staying at his bedside for almost 72 hours until the helicopter finally arrived. The patient went on to make a full recovery. His family was so grateful that they sent me a signed poster to express their thanks. Today, it hangs in my home as one of my most treasured keepsakes.

I’ve described how my cancer diagnoses have lent urgency to my efforts to unleash others, but it was in Maine that I first came to regard the pursuit of progress as my life’s purpose. Operating under extreme pressure, I galvanized a team to tackle a seemingly impossible challenge, and it left me feeling both humbled and exhilarated. I wanted to spend my career leading people through adverse circumstances, creating conditions that allowed them to question their own assumptions about their existing mental and physical limits and surpass them. I wanted to unleash people to make a difference in the world, whether it was saving a sick child’s life, creating a new business, taking an accomplished organization to new heights, revolutionizing the reigning business models in healthcare, or even building a more equitable and compassionate society.

As I’ve argued in this book, all of us have it in us to drive progress. We can think bigger, adopting innovative business models that add more value for all stakeholders. Implementing those models aggressively and at scale, we can unleash our workforces to make the world better—more equitable, safer, more prosperous, more compassionate. We can take our established, successful organizations and improve on them, so that they not only endure but stand as models for others to emulate.

Unleashing possibility starts with embracing the foundational principles of empathy and openness to those in outsider positions. We can’t achieve meaningful change unless we first learn to see the world with new eyes. Understanding viscerally the needs of those whom we serve can fire up our collective passion to drive change, while bringing outsider perspectives to bear can help us to dislodge parts of conventional thinking that might be holding us back.

We also must become more brutally honest with ourselves about how our organizations perform, putting structures and systems in place that foster introspection and enhance our organizations’ capacity to transform themselves. Fine-tuning our strategies, we can unleash others by innovating our offerings, collaborating with competitors, pursuing “good” growth, and looking upstream to address the root causes of social and health problems. Finally, we can rally our workforces behind change by taking public stands on behalf of our purpose and values and by reaching pragmatically across political lines.

So much of this challenging work boils down to navigating a perennial tension between imagination and fear. On the one hand, leaders can unleash others by expanding their sense of what’s possible. Questioning conventional wisdom, we can evoke a desirable future and empower others to take risks in pursuit of it. On the other hand, we must manage the fears that innovating and risk-taking naturally trigger. We must emphasize that it’s OK at times to throw out established rules and guidelines to put our mission first. We must affirm that it’s acceptable to make mistakes and that our failures fuel our growth. We must set an example by taking risks ourselves and occasionally falling on our faces. Ultimately, we must create contexts in which it becomes safe to take the initiative and try something new.

When we do the sustained and difficult work of unleashing others, we position established organizations to reach new heights of performance and social impact. Workforces become more engaged and inspired. Consumers (or in our case, patients) are better served. Ultimately, the organization creates more economic and social value. And as leaders, we walk away with the deep personal satisfaction that comes with having delivered positive change on a large scale.

The task of unleashing others might well feel daunting. In this regard, I have one final story to share. During the summer of 1987, I had just finished my first year of medical school and was taking it easy (in relative terms), working in a lab in Vermont and training like crazy for the Cape Cod Endurance Triathlon, my first full Ironman distance race. I had raced triathlons over the past five years, but this one was a whole different beast. To complete an Ironman, I’d have to swim 2.4 miles, bike 112 miles, and run 26.2 miles. I had never ridden a bike for more than 100 miles at a time, nor had I run more than 20 miles. I planned to run the race the following autumn in Cape Cod, and I knew it would be tough.

Each day that summer, I pushed myself as hard as I absolutely could. By the time autumn came and I was back in school, I thought I was ready. But when race day came around, I suddenly felt overcome by fear and doubt. Standing at the starting line, waiting for the gun to go off, I thought to myself, “What have I gotten myself into? Am I in too far? Will I fail? Why am I doing this?”

The gun went off, and guess what? I didn’t turn around and go home. I pushed forward, shifting my thinking to remove some of the pressure. “You’ve done the work,” I told myself, “now let’s see what happens. If worse comes to worst, you’ll fail. And if you do, you’ll just try again.” I kept going, one mile at a time, and let the momentum carry me. I wound up finishing and thoroughly enjoying the experience. I also found that I came out mentally stronger. Now that I had completed an Ironman, I wondered what other seemingly impossible challenges I might take on, both athletically and in my career.

Before we can unleash others to grasp possibility, we must first unleash ourselves. We must fire up our own imaginations and manage our own fears. In this instance, I had a dream of finishing a triathlon. More recently, I had a dream of transforming a storied healthcare system. What’s your ambition as a leader? How might you best be of service to others?

After reflecting on such questions, you must bring yourself to take that difficult first step. Don’t perseverate. Just do it. Let the momentum carry you. You might fail, but if so, don’t worry. You can pick yourself up and try again. And the failure will teach you something.

Once you take a risk and do succeed, I suspect you’ll feel both humbled and emboldened, as I did, to take on still more challenges. You’ll believe that other people, too, can do incredible things and that you can help them get there. Over time, driving progress will become an indelible part of who you are. You’ll still feel fearful, but you’ll realize that sticking with the status quo just isn’t good enough, and that with enough diligence you really do have it in you to do more. You’ll experience setbacks, as I did with my cancer diagnoses, but you’ll keep pushing forward, working harder than ever and enjoying every minute. In the end, you’ll make meaningful change happen— for your community, your people, and yourself.

I wish all this for you—and good health, too.