Military vs. Medicine: How Human Skills Contribute to Optimal Performance

Podcast Transcript

Adrienne Boissy: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast, exploring empathy in patient experience. I'm your host, Adrienne Boissy, chief experience officer here at the Cleveland Clinic in Cleveland, Ohio. Broadcasting from the Patient Experience Empathy and Innovation Summit, our 10th anniversary at the Cleveland Convention Center.

I'm very pleased to have one of my favorite people here, Geoff Colvin. Welcome to Studies in Empathy.

Geoff Colvin: Thank you, Adrienne very much.

Adrienne Boissy: I have about five pages of your accomplishments here, so I'm going to try to summarize them. Just to introduce you to the audience. You're an award winning journalist for Fortune and CBS radio. You're senior editor at large for Fortune magazine. You're a compelling keynote speaker as we just heard and versatile moderator and as a speaker, you've engaged all over the globe, really thousands of audiences.

You're the author of Humans Are Underrated: What High Achievers Know That Brilliant Machines Never Will. And the book Talent Is Overrated: What Really Separates World-Class Performers from Everybody Else. There's more, but I'll stop there.

Geoff Colvin: Thanks.

Adrienne Boissy: Anything I missed?

Geoff Colvin: No, you got all the high points for sure.

Adrienne Boissy: While you and I had the pleasure of having a real life conversation a couple years ago when you were working on Humans Are Underrated. Talk to me a little bit about that book and what inspired you to write it?

Geoff Colvin: Well, what inspired me to write the book originally actually was this experience I had, which I describe in the book where I had to compete against Watson in a round of jeopardy, not on TV, thank goodness, but at a big conference where IBM was participating. And so I and another hapless person had to compete against Watson. And I got some things right and Watson got some things wrong, but overall it was just a complete wipe out. I mean, I was completely shellacked by Watson in this game and I realized that this is just the latest example of technology doing stuff you never would have thought possible. Because Watson had to hear the... We didn't have Alex drew back that we had somebody else ask it, but the Watson had to hear these questions. Just the way I did, had to understand them.

Watson was not connected to the Internet. People are surprised by this. It was a free standing thing. It just had whatever was inside it to work with. Same as me. And yet it was no contest. It was a real a shellacking. And so I thought, well okay, it's only going to get better and faster and I'm not, I don't get twice as good.

Adrienne Boissy: You underestimaate yourself.

Geoff Colvin: But the computer gets better. I mean the technology gets better by a factor of two every two years. Right. We humans don't do that. And so I thought, okay, this is going to go on as far as the eye can see, what will people do in a world where technology does more and more stuff better than we do? Not just faster and cheaper, faster and cheaper and better than we do. And so that's what set me to going down this path. What are the high value human skills going to be? Because they're sure not going to be what they used to be.

Adrienne Boissy: And it's interesting. I remember, although you were asking me about research perhaps for the book. We wound up in a conversation around this experience I had had of trying to have difficult conversations with patients who thought they had one disease and I had to tell them they didn't have it. And you found that fascinating. And I'm curious sort of what do you recall from that first conversation that we had?

Geoff Colvin: Yeah, it was fascinating because just as you say you-

Adrienne Boissy: Not that I'm fascinating but just that story was fascinating.

Geoff Colvin: No, no, but yes you are, but the story you were telling, I mean, it was something I'd never heard of and never would have imagined that you were having to tell someone they didn't have the disease they thought, you would suppose would be the best day of their life.

Right. And it wasn't, I mean you expressed, you explained this, they had the opposite reaction. They didn't want to believe it. And when you said this hadn't happened just once in your experience. It happened regularly. And I thought, well, okay, this is really strange and how can I understand this? And then you explaining what you learned-

Adrienne Boissy: That's right.

Geoff Colvin: ... About how to interact with these people behaving in this way that would seem to make no logical sense, but it made emotional sense and that's what we had to understand.

Adrienne Boissy: That's right. And I had felt so strongly in my younger career that telling the truth was so important and maintaining integrity and you should do that as soon as possible. And that was a part of my job as a doctor was to get the diagnosis right and be honest about it. And then when I did do that, I have the reaction of people complaining about me.

Geoff Colvin: Well, right.

Adrienne Boissy: Felt really unfortunate.

Geoff Colvin: Yeah. Wouldn't you think you give them the best news you could give them and they're unhappy about it and I remember also that you said there are some doctors who don't do it the way you did. They would let the person persist in thinking that they had the disease, but it was just in a minor form or a weak form or in remission somehow or something like that, which wasn't honest.

Adrienne Boissy: That's right.

Geoff Colvin: So is that the right thing to do or not? That is the big question.

Adrienne Boissy: Yeah, well we wound up writing a paper about it called A Touch of MS: Therapeutic Mislabeling and that mislabeling at times can in fact be validating and therapeutic for the patient who believes and who has wrapped some of their identity in a diagnosis. And what I didn't appreciate then was just that you can rip out so many other things, right. Part of their identity when that diagnosis goes away. So it was a very humbling experience. And your support of me quite honestly in that conversation was actually quite helpful. You were empathic and curious and I just knew after that conversation that you were going to be a friend for lifetime.

Geoff Colvin: Thank you very much. I remember it very well also and it astounded me, I was truly and remain truly fascinated and interested in how one, how you would handle that. So it was a really, really affecting.

Adrienne Boissy: I have a funny feeling that curiosity has served you well in your career.

Geoff Colvin: It has. I am extremely curious. And what could be better?

Adrienne Boissy: Well, were you always like that or where did that come from?

Geoff Colvin: Well, that's a really fundamental question, is a very deep question. Where did it come from? Because-

Adrienne Boissy: Are you interviewing me or am I interviewing you?

Geoff Colvin: I don't know, but who cares? But it is one of those issues which actually comes up a lot in the discussion of human abilities and skills. What are you born with and what are you not born with? Right. And so was I curious because I was born that way? I actually don't think so. My own guess is is that, that's probably not something that is innate or not. It was probably nurtured by my parents. The older I get, the more I appreciate the parents I had, I think they're the world's greatest parents, but I think that they probably nurtured that in me. The teachers I had and so forth they were all essential in that I was lucky.

Adrienne Boissy: Well, it strikes me that curiosity might be really pertinent to our conversation today. I mean, you wrote a book saying humans are underrated. What really machines won't know. I wonder if they'll ever know curiosity.

Geoff Colvin: It's a great question. Will they? I hesitate ever to say that there's something machines will never be able to do because they get twice as good every two years. I mean we truly can't easily imagine what it's going to mean. So what is curiosity? Well, it's probably hearing something, realizing that it connects somehow to something you already knew or already wondered about and then wanting to figure out-

Adrienne Boissy: More.

Geoff Colvin: ... More. So could a computer do that? Oh, sure. It's not inconceivable. It's unlikely. I'd never even of that question until this moment, but sure. It's conceivable.

Adrienne Boissy: Talk to me about what you learned from the military as you were doing some of your research.

Geoff Colvin: One of the great surprises in the research was finding that the US military is a deep, deep believer in the importance of human skills and has gone all in on training these skills.

And it turns out this is something they discovered when they went into Iraq and Afghanistan 15 or more years ago. That mission success didn't depend much on traditional military operations though they happen. Those were important for sure. But a lot of the time, mission success was determined by how the leader of a unit behaved in a village with the village elders, with shop people, Imams, children and so forth. Because a misunderstanding, a cultural confusion about what a gesture means, what a term means, how someone behaves, if that goes wrong, the consequences could be literally deadly. And so in fact I then spoke to generals about this. I spoke to a former Secretary of Defense about this and what they said was, look, in military conflicts in today's world, the military part of it is generally over pretty fast. We don't have battles that go on for days and weeks or months like they used to like they did in World War II.

The battle part is usually over pretty quick. What's important is what comes after and getting people to accept what has happened. And that is all about as a former secretary of defense, Ash Carter said to me, it's all about having people at the front lines with human skills. And so they completely revamped [inaudible 00:11:05] in California, 1000 square miles of Mojave desert that they have.

It used to be used for rehearsing tank battles with the Soviets because that was considered to be the key skill that the military needed. They got rid of all that. They built these simulated villages, Iraq and Afghany. Put in people who were native speakers of the appropriate languages and created these huge high fidelity simulations. And they would put service members through those simulations to teach them the human skills that they would need when they were over deployed.

And a number of them have come back and said that training was critical to our success and some of them have said that the training in human skills that they got there literally saved their life when they were deployed. It's quite astounding. And it's not just the army at Ford or when the army does it a couple of other places. The Marines do it at Twentynine Palms in California. The military has actually become very skilled at training these skills, which is important because some people think they can't be trained.

Right.

Adrienne Boissy: That's right.

Geoff Colvin: Some people think that you got it or you don't. It's not true.

Adrienne Boissy: And evidence would support you in that statement is simply not true.

Geoff Colvin: Well, and Adrienne, look what you've done at Cleveland Clinic is astounding in the way of training these skills. It's real pioneering work. And I wrote about it a lot in the book.

Adrienne Boissy: Thank you for that.

Geoff Colvin: Yeah.

Adrienne Boissy: So when you were researching the military, did you see other examples of them amplifying empathy? So I heard a story once from a neuro surgical chief resident who had spent time in the military saying she wished that healthcare operated like the military because in the military, every six months they had an mandatory emotional debrief with the soldiers. And I thought that's fascinating, right? Because those spaces to talk about how your work impacts you and the weight of it are at times few and far between in healthcare.

But the fact that there was some carve out spaces within military practice, I thought it was fascinating.

Geoff Colvin: It is fascinating and very unexpected to most people, right? They can't imagine that, this is not how they pictured the military. And the parallels are interesting with healthcare because you think if there are two fields of endeavor in the world where the stakes are highest, it's the military and it's healthcare, right? Literally life and death, the stakes are as high as they can be and the point being they have a lot to learn from each other and the military has been very disciplined about doing this kind of thing.

Years ago, and I write about this also because it's fascinating, the army adopted something they call the after action review after every exercise or in war, after every battle. Everybody involved gets together in a room. Everybody takes their headgear off, which symbolically is supposed to remove rank, right? Nobody if they take all their headgear off, the rank is gone in the room and then they have a discussion about what went well and what didn't go well.

And when that was adopted, I mean it just sounds like an obvious common sense thing. Right? When that was adopted, there were four star generals who were adamantly opposed, adamantly opposed. They said it would destroy discipline, that it would expose the errors of the leaders to the enlisted men and that this would just be the end of the army and instead it transformed the army. And the generals have told me this, those who went through it, it has transformed the army. It's similar in other endeavors, meaning people think it sounds like a great idea, but they're also terrified of it. And it can happen in healthcare. And in fact, I know you know better than I do that that kind of attitude does persist.

Adrienne Boissy: Well, what a great equalizer though. I mean we just heard a great conversation with Christine Porath about civility in medicine and civility in the workplace. And we were talking about how important it is to give feedback, but when there's this power differential it's going to be really hard to have an honest conversation around the table.

Geoff Colvin: Yup. You're seeing right to the heart of it. And so when that began, as you can imagine, the lower level soldiers at first just wouldn't say anything critical of their officers. And finally it had to be ordered. Okay. So that an officer-

Adrienne Boissy: Come on.

Geoff Colvin: ... Would say to him, okay, and it got to be, give me three up and three down. That means tell me three things that went well and three things that did not go well and it's an order, well then they had to do it. But once they had done it that way for a while, everybody got to realize that in fact this was enormously valuable, that they were now performing much, much better. And pretty soon it wasn't necessary to order them anymore. But to any old timer from the military to see a sergeant stand up and tell the lieutenant who was in charge of the operation that he screwed up in a certain way. And the sergeant had to do such and such to save him. That was unthinkable, unthinkable. But it became okay.

Adrienne Boissy: So I was in a recent conversation where there was a review of a safety event at one of our hospitals and we call those root cause analysis and probably very similar to after action review. And it's everybody sitting around the table, right. Everyone who's involved, spiritual care, nurses, doctors, executives, coming together to talk about what went wrong and not for the point of blaming although people sometimes do bear that responsibility quite heavily.
And what was beautiful was, although we identified several reasons for the root cause, there was this beautiful moment where one of the nurses said I messed up, I put the wrong tag on the wrong place and I own that. That's no one else's responsibility. That was mine. That's my piece of it. And the shame you just saw come over her was tremendous. And it wasn't shame from the group it was internally placed.

Geoff Colvin: Was internal, right.

Adrienne Boissy: And we took a minute in the session to say we want everybody around the table to raise their hand if you've ever made a mistake and everybody around the table raised their hand. And keep your hand up if you've ever felt embarrassed or shame or, and she just burst into tears. And I can imagine as those leaders sat and heard feedback or heard their own pieces of their responsibility in that after action review, that is also a beautiful opportunity to be empathic to them. Right. I'm curious if the military goes that far, but when we're talking about mistakes, there is a natural opportunity to empathize with those that may have made them.

Geoff Colvin: Right. And so to think of stories that have been told to me about this experience in the military. Yeah, sure. A sergeant gets up criticizes the actions of an officer who said then, "Gosh, thank you for doing that." And the sergeant says, "Don't mention it." And it's like that kind of exchange was unimaginable. But once you've had it, everyone now can feel solidarity as it were. They are on the same team from that point on.

Adrienne Boissy: Right. Almost a safety in opening that up.

Geoff Colvin: Precisely. But your experience, as you describe it, is a great example because it depended crucially on that one nurse.

Adrienne Boissy: Yeah.

Geoff Colvin: If that hadn't happened, there would have been a completely different atmosphere in the meeting. It wouldn't have been nearly as successful as it was. It's a breakthrough.

Adrienne Boissy: Well, it's interesting, the layers of it, right? And those opportunities where we're debriefing, there's a layer of identifying the root cause, but maybe there's another layer to it that we can create a safer environment for all, an emotionally safe environment and really heal a little bit in those settings because I think these failures, if that's what we're going to call them, weigh on all of us.

Geoff Colvin: Yeah. They do.

Adrienne Boissy: More heavily than perhaps we recognize. Let's talk about teams for a second. It has to do a little bit with the military as well. So we all read the Team of Teams book recently.

Geoff Colvin: Oh yeah. Stan McChrystal's book.

Adrienne Boissy: And something that really resonated with me. A very concrete action that they describe in that book, if you're familiar with it, was this idea that the navy seals were so different from the marines, were so different from the army rangers that they sent one member of the team to go spend a few months with another team because they found that naturally there wasn't this coming together, there wasn't this connectedness. What have you learned about teams?

Geoff Colvin: What makes them effective is first of all, an ability just to be sensitive to one another. It's really interesting what makes effective teams. The research shows, for example, that the IQ of the smartest person on the team does nothing for the effectiveness of the team. Average IQ does a little, the most important factor is the social sensitivity of the team members, their ability to read one another. And a corollary of that is that in the most effective teams, nobody dominates. And man, that is tough to achieve in a lot of cultures because typically there is a team leader and that person often will take it upon him or herself to lead the team, to lead the meetings. And we've all been in that situation where people are afraid to speak up because you don't know whether the leader of the team agrees with what you're about to say.

And this a dysfunctional team, nothing very helpful gets done. So when the best ones, nobody dominates, everybody speaks up and everybody has a good sense of what the others are thinking or feeling. In other words, sometimes you can tell that somebody wants to speak up but they're not, so you get them to do that. And as you discussed the ideas, sitting around a table, everybody is saying things, "Mm-hmm or hmm. Or really, hmm." And the researchers have actually measured all those little sounds that people made.

If you can read them, the team actually can figure out very quickly which ideas they think are the good ones and which ones are not. Another element that good teams share is the team members go out into the world individually to meet people that wouldn't be involved in their business normally.

And they take what they learn from these unorthodox sources and then bring them back to the team and introduce them and everybody talks about them. And that introduces all this fresh material. It's a habit that characterizes the really good teams.

Adrienne Boissy: Well it reminds me then of what McChrystal did. Right?

Geoff Colvin: Yes. Exactly. Yes Exactly.

Adrienne Boissy: Saying you guys aren't communicating, these teams need to talk to each other in order for us to be successful. We probably could have prevented some of the things that happened had we been sharing data and been transparent about that. So now you go and get to know Bob over there and Joe is going to come over here so it won't be them, us, it'll be together. Right? The team.

Geoff Colvin: The team. And I mean that was a huge part of his success in getting those teams to work together because they would traditionally think of themselves as rivals after all. I mean, and that's very military culture that the other services are competitors and so forth. But yeah, getting them together had a tremendous effect. And again, they were talking to people they wouldn't normally talk to. That's a lot of the value. It was not the usual sources, right? Getting stuff that was truly fresh and new and bringing it back. It's not what most teams do, but it's what the best ones do.

Adrienne Boissy: That's right. And to reference, Google studied teams we heard and one of the things that struck me, which we haven't quite touched on yet, is the norms within the team. Right? So what I've seen some leaders come in to teams I've been on and set some behavioral norms like we're all going to be transparent. You're expected to speak up. And when that hasn't happened, it's as though the team can't figure out by what rules we're playing by. And when that's really clear, I expect you to speak up, that at least you know what the guard rails are.

Geoff Colvin: Yeah. It's a great relief to everybody to know what the norms are and to know that everybody else knows what they are because then you don't hesitate. Right?

Adrienne Boissy: That's our right. You're not unsure.

Geoff Colvin: You're not unsure.

Adrienne Boissy: I love it. So when you began years ago researching all of these books and in all the interviews you've had, I mean, what has surprised you in your career where you were like, wow, I've never seen that, I've never heard of that. What a beautiful example. What really blew your mind?

Geoff Colvin: A few things. We've talked a little about training these skills and they can be trained as you and I have discussed but there are in the outside world there are still people who are skeptical about it. Before I even wrote the Humans Are Underrated stuff. I was working on something else about that became the book called Talent is Overrated because it's all about how we can acquire skills that we never thought we could acquire. And I started by writing a large article about that in Fortune, and I had an experience such as I had never had before in many, many years of writing articles for Fortune, which was people I didn't know would write or come up to me at events and tell me the same thing. You know that article you wrote about the secret of great performance and how anybody can have it available to them?

I read that article to my kid. Well, I can tell you can write a lot of articles for Fortune and nobody will ever read them to their kids, right? But this one, lots of people did. And I was just bowled over by the effect that this had. And then frankly, by the effect of the book had, when that came out, people being told, based on evidence that the greatest performers were not born that way. They got that way. And it's available to all of us. It's not easy. I can't tell you that it's quick or easy, but it's available to all of us. And when we talk about these deep human skills, to think that those are available to all of us, even people who don't think they could ever be good like that, it's not true. You can be.

Adrienne Boissy: Do you know what that sounds like to me? I mean, certainly a skill that a machine may never have that humans have and you were able to provide on those platforms is hope.

Geoff Colvin: Yeah. Great point. Great point.

Adrienne Boissy: Thank you for providing all of us with a bit of hope.

Geoff Colvin: My pleasure.

Adrienne Boissy: I can't thank you enough for joining us.

Geoff Colvin: I really enjoyed it. Thanks for asking me.

Adrienne Boissy: This concludes Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcasts. Subscribe to Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcasts. Thank you for listening. Please join us again soon.