New York City sprang from the confluence of accident and intent. Running between Sandy Hook Point and Long Island lies the passage that Henry Hudson followed to a sheltered harbor. The harbor was made from the ancient work of geology and water. Out of this, Manhattan emerged unplanned but driven by the irrepressible pressures of commerce and hope. Dreams and ambitions coalesced with the good fortune of a protected harbor and favorable trade winds.
This good fortune was further aided by the Erie Canal. Once connected to Lake Erie, the canal married intent with the luck of great lakes fed by navigable rivers. This swelled the flow of commerce. Again, good fortune mixed with resolve. A similar mixture fueled the growth of all great cities.
Best-selling management books have settled into a familiar formula that ignores the luck factor: Identify a set of high-performing organizations (often based on thin evidence), distill the characteristics they share (usually with significant literary license) and offer a set of surefire pathways that lead to glory (typically without any attempt to determine sustainability). And no one ever seems to ask, "What's happened to Fannie Mae, Kroger, Gillette, IBM or GM? Are they still great? And how long were they great anyway? Long enough to deserve emulation?"
The Man in Control Myth
Of all the inventions of popular management thought, the most insidious may be the "man in control." The plot of the story is familiar. Through brilliance and discipline, the man in control directs his organization into the future. But often his success has been inherited. Frequently, it reflects the collective effort of many in the shadows. And invariably it involves a good measure of luck. No management theory ever built a city. And no man in control ever crafted a trade route, launched a stock market or designed an Internet.
Unfortunately, the man in control remains the dominant stereotype for effective leadership. Whether through dictate or influence, the man in control bends the organization and the future to his plan. And the man in control actually may think he is in control. In many cases, this delusion is reinforced by ego. Surrounded by many who whisper in his ear, "Things are good and you made them so," what such men lack is a whisper in the other ear that says, "You have been lucky. This, too, will pass."
Advantage is rarely made purely of luck. Nor purely of will. It emerges from the confluence of circumstances and resolve. Good fortune often masquerades as intent. Ego and delusion can blind organizations to the influence of luck.
Napoleon is said to have asked new officers, "Are you lucky?" before handing them command. For Napoleon and others, it might have been "better to be lucky than good." But as Waterloo amply demonstrated, it is far better to be both lucky and good. Napoleon was apparently unlucky enough to have the flu the night before the battle. Throughout his life, George Armstrong Custer regarded himself as the beneficiary of a consistent good fortune that he often described as "Custer luck." This luck also had its limits.
When enterprises recognize good luck, it's because they've faced the consequences of bad luck. It is good to be lucky. Better to be lucky and know it. And even better to know that good luck rarely travels alone. Good fortune and bad fortune are two sides of the same coin.
Complexity Limits Control
There is a difference between seeking control and thinking you are in control. No one wants to be a passenger on an airliner with an out-of-control pilot. Control is a desirable thing, after all, particularly when considered in light of the alternatives. But a leader's zone of control is limited by complexity, which is characterized by uncertainty and resistance. Complexity strips away the pretense of control. The more complex the environment, the narrower the zone of control.
By definition, control requires knowledge of the future or at least a high degree of confidence about the likely shape of the future. But, increasingly, complexity sucks the predictability out of the environment. Metaphors about perfect storms and continuous whitewater don't quite tell the story; even storms and whitewater have an overall flow. A truly complex environment may not. What benefits an organization most in such environments is not the delusion of control but humility translated into readiness.
In complex environments, often the more you seek control, the less likely you are to get it; the more you surrender control, the more likely you are to regain your ability to steer. Things often push back when shoved. And a little push can cascade into a torrent of unintended consequences.
Smart leaders know when to reduce their zone of control and become flexible at the interface with turbulence. When organizations seek to be agile, they are expressing a desire to be able to shift as conditions shift. Young sailors are sometimes taught to feel the wind by sailing their boats while blindfolded and without a rudder. They learn to steer by shifting their weight as the wind shifts. And this requires the ability to feel the wind on their cheeks.
Too often, the man in control is insulated and isolated from where his organization's true value is generated. Leaders who aren't close to the real work of their enterprise or the dynamics of its environment rarely develop the ability to adjust to shifting conditions at a rate that reflects the speed of change. When people talk of entrepreneurs, they often describe their ability to move quickly, opportunistically and efficiently. These are people who can feel the wind on their faces. There is a presumption that entrepreneurial organizations inevitably must give way to bureaucracies, and entrepreneurs to the man in control. It is a presumption too untested.
Knowing What to Control
Agile organizations recognize luck when they see it. They also realize that in a complex environment, things often will self-organize if you let them and that the role of leaders in such situations is to provide something to self-organize around. It is important to define what's most important — those things the organization is relentlessly resolved about being and becoming. These are things to keep protected in a zone of control. Such things are described when leaders articulate the principles beyond compromise that constitute an organization's "way."
Many of health care's most successful organizations have institutionalized their way. This is true at the Mayo Clinic, the Cleveland Clinic and Johns Hopkins. Principles and vision become the beacons to which organizations can steer when the wind and waters whirl. Without such beacons, organizations can disintegrate into centerless mobs carried along, at least for a while, by the momentum of past accomplishments and good fortune.
The key to agility is to create an organization that can respond at the edges. Command-and-control models that depend on tall hierarchies have become dinosaurs. Things are moving too fast. There's no time for decisions to make their way up the hierarchy and back down again.
The rigid subordinate-superior concept is in deep trouble. Rigid things are like dry spaghetti. They tend to break when they are pushed. But limp things are like cooked spaghetti. They can't be pushed forward either. You need a balance of resolve and flexibility. Both rigid things and limp things can be pulled forward. And that's the role clear principles and vision serve. They help pull the organization through the storms of complexity and into the future.
There are many health care executives who believe the force of their will brought new buildings out of the ground and led to impressive growth in their revenue base when the real explanation more likely can be found in government largess, ready capital, technological breakthroughs and physician ambition.
Some executives will argue that even if the man in control isn't viable today, it was what worked in the past. After all, how did organizations achieve what they did if their control model didn't work?
I'd suggest they may never have been in control to begin with. In particular, they had little control over the most important component of their value-generating engine — physicians. Some might respond by saying, "Well, that's changing now as hospitals begin to employ the preponderance of the nation's physicians."I doubt it. Employment doesn't equal control. Indentureship went out of vogue as a business model more than a century ago. Any leader who's sought to undertake significant change knows how willful and contrary employees can be.
Lucky Confluences That Made Great Institutions
William Worrall Mayo was the father of Will and Charlie Mayo. He left England to become a country doctor in America, but a doctor who embodied an important difference. Unlike most of his physician contemporaries, he believed deeply in the power of combined effort.
As American railroads knitted an ever-tightening web, they often followed the rivers that had preceded them as paths of commerce. One of those railroads ran along a tributary of the Mississippi. It channeled a growing number of patients to the practice of W.W. Mayo in what might otherwise have remained an unremarkable Minnesota farm town. It was a lucky set of circumstances transformed by what became a shared resolve to make teamwork and a focus on the patient the only considerations. Later, a tornado nearly destroyed Rochester, Minn. This arbitrary disaster solidified the partnership between Mayo physicians and the nuns who helped carry them to greatness.
In 1958, F. Mason Sones, a pediatric cardiologist at the Cleveland Clinic, inadvertently injected dye into a patient's right coronary artery. From this accident, he realized that small amounts of contrast dye could be safely injected directly into coronary arteries. The discovery led Sones to pioneer cardiovascular angiography. It was an important catalyst for the Cleveland Clinic's rise to international renown.
Years later, a rural Argentine physician by the name of René Favaloro showed up uninvited in the office of Donald Effler, the Cleveland Clinic's head of cardiovascular surgery. Barely able to speak English, he pronounced his interest in becoming a heart doctor. Effler must have known luck when he saw it. Working with Sones, Effler and others at the clinic, Favaloro became the first physician to perform bypass surgery.
The clinic's founder, George Crile, had happened to meet Will Mayo when both were serving as physicians in World War I. Mayo's notion of a multispecialty group practice impressed Crile, as did his own experience in the field hospitals of Europe. From these associations came the central principle around which subsequent leaders of the Cleveland Clinic organized: Act as a unit.
Similar confluences of luck and intent made many of America's greatest health care institutions. In Houston, two powerhouses of ambition squared off. That Michael DeBakey and Denton Cooley should end up within walking distance of one another was not planned by a man in control. It was luck. And from this sprung the phenomenon of renowned heart programs at St. Luke's Episcopal Hospital and the Methodist Hospital.
Giving Physicians Room to Lead
There is an old piece of advice that many hospital administrators once ascribed to: "Paint the halls and stay out of the way." It was an honest and humble reflection of a central reality. Physician energy and ambition drove institutional progress. Smart administrators facilitated rather than presumed to control that ambition. And they recognized luck when it walked through the door.
More important than the Patient Protection and Affordable Care Act and all the noise surrounding it are the tectonic shifts, most already well under way, that the act may accelerate. Chief among these are the shifts from anecdote to data, from faith to outcomes, from isolation to collaboration, from good intentions to demonstrated value and from ego to reality. All of this was inevitable. It reflects the triumph of complex market dynamics more than social policy, political will or men in control. This is a good time to recognize luck. A good time to be good. A good time to be lucky and good. And a good time to be humble.
Dan Beckham is the president of The Beckham Company, a strategic consulting firm based in Bluffton, S.C. He is also a regular contributor to H&HN Daily.