What is the best book about doing business in China?

“Managing the Dragon” by Jack Perkowski! There are three things that make a business book stand out for me among all the many very ordinary books that are published each month. The author needs to know what they are talking about, They need to have something new to say, and they need to be able to write it in an interesting way that I can relate to.

Perkowski manages to do all three in a book about business that reads like a combination between a personal biography and a travel guide. Throughout the book three themes are continuously repeated, if not always explicitly: Connectedness in relationships, Trust, and Perseverance. I imagine that these three values would also be strong contributors to Perkowski's self-identity.

Perkowski knows what he’s writing about. He went to China in 1991 after a successful career on Wall Street, and founded a automotive parts company currently selling over US$500m and 30% of that outside China. His book outlines how he came to make the connections in China that enabled him to start and build his business, and the various challenges he has faced since.

He has a number of new things to say. For example, many people talk about the challenge of enforcing Intellectual Property Rights, (IPR), in China. Local laws do little to protect IPR, and writers often draw negative conclusions about the Chinese character and society as a result. Perkowski, on the other hand, has a purely economic take on the situation. He talks about the sort of products that are regularly knocked off, the kinds of buyers they have, and the distribution systems. His take is that all of these do much more to explain what happens in China than any judgemental comments about Chinese morality. His own business success shows how he has accommodated and succeeded in the Chinese market without compromising his principles. And the something new? Products with the most proprietary content and highest-technology value are probably the best products to take to China and the easiest to protect. (You’ll have to read the book).

Other counter-intuitive concepts in the book?

• You don’t need a local partner in China, and you might even be better off without one.
• You don’t need to learn Mandarin
• The real reason for the Chinese cost of manufacturing, (it’s not lower labor costs)

Not every one of Perkowski’s plans came out well. He discusses how he went through Plan A to begin his company, (it failed), Plan B, (which also failed), and he eventually settled on Plan C, (the success). The story of his three different strategies and how he learned from his mistakes is a lesson in persistence and humility many leaders can learn from. He describes his journey in China as a marathon.

There is a lot of discussion in the book about baijiu, the local alcoholic drink without which no business dinner seems complete. Many of the stories are funny and entertaining in their own right, and would stand up to inclusion in any collection of witty travel writing. Perkowski also uses them as a platform to talk about the importance of mutual respect, being willing to share, acting kindly toward others and having a sense of humility. All of the various dinners and social drinking sessions seemed to build supportive relationships that furthered the business without being focused on the business.

Finally Perkowski makes two points in his book that are interesting and easy for me to relate to. Firstly, he debunks the popular notion that China is different because it relies on Guanxi, which can best be described as “a network of influence and supportive social relationships”. A lot of foreigners emphasize the extent to which this is important in China, likening it to nepotism or cronyism. In fact, most successful people in any culture rely on networks of influence and social support. Managing The Dragon describes how China is the same, rather than focusing on how it is different. Perkowski uses his own career story to illustrate how important it is to be socially intelligent, and how he has benefited from the support of others.

The other concept emphasized in the book to which I readily relate is the importance of trust. If employee and customer engagement means contributing time, talent and resources to the organization it is impossible to imagine engaging people without trust. The importance of trust is a central theme throughout Managing The Dragon. The book looks at both the benefits of positive trust, and how difficult business is in the absence of trust.

Of all the business books on China I have read, this is one of the few that looks at how doing business in China is much the same as doing principled business anywhere else. No fancy tricks or “gee whiz” formulas. And at the end of the day, Perkowski sounds like a good guy to share baijiu with.

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Postscript: After this review was written Jack Perkowski left Asimco. I'm not sure of the circumstances, and I'm not sure they are relevant. However, here's another review of Perkowski's views of doing business in China, this time from the China Law Blog at http://www.chinabusinesslawblog.com/2009/02/want-lasting-relationships-in-china.html Interestingly, the emphasis in the article is on one of the key themes in the book that I picked up on: the importance of trust.

The end of week four

Genevieve took this portrait of me this morning, exactly four weeks after my surgery. I'm sitting at my computer and finally catching up on all my work and correspondence.

Yesterday we met with my surgeon for the first time since my discharge from the hospital. I'm doing well, as was indicated when the nurses asked if I would like a wheelchair to get to the X-ray department. I haven't used a wheelchair since the second day after the operation, and even walked out of the hospital under my own steam on the day of my discharge.

So yesterday I had a lot of blood samples taken, looked at a lot of charts and figures, and spent a lot of time contemplating my recovery.

I got the go-ahead to start driving, and because I'm pretty flexible now and pain-free, I even got approval to begin some light running if I want. I still can't lift much until the bones knit, but I can get around OK, and I have much of my old stamina back. (My old stamina, as in before 2008 since I suspect that much of what I thought was old age and laziness last year was really the result of the poor heart circulation).

All things being equal, this will probably be the last entry here that specifically relates to how I'm recovering. I still have some insights that have come as a result of the experience, and I'll continue to put those here where I feel they can benefit others.

I also have to say, thinking and writing about things has benefited me enormously, particularly in so far as it has helped me get a sense of humility and the role of good fortune in my recovery.

Everyone has been wonderful and positive, and if I haven't said it directly, (which I hope I have often enough), then at least you know I have been continuously thankful and pleasantly surprised by just how supportive everyone has been.

Sincerely,

David

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"Implementing ITIL Change and Release Management", by Larry Klosterboer

Larry Klosterboer, author of "Implementing ITIL Change and Release Management" has written the comprehensive overview of managing ITIL based change strategies for IT Operations Managers and Directors.

So why is a psychologist reviewing an IT change management book?

For starters, many of my clients are IT and information systems specialists. Most are going through pain, change and challenges related to keeping up with the rapidly shifting demands of their customers, the adoption of new technology, and of course, the economy.

What makes this book different is it specifically speaks to the change and release methodologies you need to manage these three technology pressures. In particular, this book focuses on issues of Content, (Structure, Strategy, Process, Product) and Roadmap, (Project management, Governance, Implementation, Contingencies). This is both its strength and weakness.

In a recent interview Klosterboer offered these critical words of advice from his book:

5 must-dos

• Engage the organization-- implementing change and release management cannot be done in a corner.
• Establish strong policies so process documents never need to be interpreted on the fly.
• Use tools to automate the process rather than defining a process which fits the tools.
• Train each person for the role they will fill rather than creating generic process training.
• Build reports that people will use.

5 don'ts

• Don't forget to gather and agree on solid requirements before moving on to implementation.
• Don't believe implementation of a tool is the hardest part.
• Don't think you can implement release management without appropriate staffing.
• Don't underestimate the importance of a definitive media library.
• Don't settle for a general, high-level process that nobody really follows.

It’s the very first of these, engaging the organization, that is truly critical, and often overlooked or given not enough attention. Engaging people means getting them to devote their time, talent and trust to supporting your goals.

It's also true that the book deals largely with the Organization level of analysis. To be truly comprehensive change managers need to have a strategy to deal with the Group and Individual dynamics that get stirred up by organizational change.

The various chapters in this book work through the content and roadmap you need to lay out for your organization to get on top of change and release management, using the ITIL structures, but don't provide much detail on how to engage the staff and customers. Add in expertise on the People issues, (Mindsets, Reactions, Engagement, Acceptance, Commitment) or supplement it from elsewhere and the book would be perfect.

The Self-Identity Exercise

How you view yourself, and how others view you, has a major impact on how effective you are.

We know from extensive research that if you identify with a group that gives you a sense of meaning, purpose and belonging, it's likely that your positive self-image will spill over into your ability to interact positively with the world. In other words, if you feel you are part of a group or community that is generally successful, you are more likely to be generally successful yourself.

There is also a very obvious corollary of this. It is usually called the “halo effect”. If other people identify you with a positive and successful group, they are more likely to think of you the same way. Not only that, but as a result they are more likely to present you with opportunities, forgive you for minor mistakes and recognize you for your achievements.

Exercise:

Pick three aspects of your self-identify that have the most power to describe you to others and yourself.

It is likely the most powerful self-identities will be the ones that most differentiate you from other people. For example, being an American in America is unlikely to be a powerful differentiator. On the other hand, being an American might be a powerful descriptor of yourself if you move to the Middle East. Similarly, being a good parent is unlikely to be a powerful and distinguishing self-identity, although it might be if you have made some significant sacrifice to be a parent and it has changed your life as a result.

Here are three of my most significant self-identities, along with a few words that describe each one for me:

Psychologist: A person with evidence based expertise in how people behave.

Australian: A bit of rebel, open-minded, friendly, believes in a “fair go for all”.

Marathoner: Self-disciplined, determined to finish, able to achieve over the long-haul.

What three groups do you most identify with?

Review:

What do you do to live up to the ideals of the groups you identify with? How do you communicate to others that this is who you are? What happens when what you aspire to do comes in conflict with the demands of your life?

For Advanced Discussion:

Ask three to five of your closest friends, colleagues and associates to do the same exercise thinking of you. Do they come up with the same three ways of looking at you? What are the differences? Explain your three self-identities to them and note how they react.

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End of week three

This is me exactly three weeks after my operation. I’m still at home, but I’ve started seeing a few clients and getting back into my regular routine. I still can’t drive, but that will come soon.

Last week at my second physiotherapy session I lifted my arms over my head for the first time: painful but worth it. I can’t lift anything heavier than a gallon of milk, but I can put on my own shirt and tie, lift my books and generally get around the house. I still have to sleep entirely on my back, but I can get into and out of bed easily enough, and make myself comfortable in most chairs around the house.

Everything is relative.

I have been very lucky, both in the friends and clients who have been so supportive, and in the good healthcare outcomes that are putting me on the road to a great recovery.

A lot depends on whether you focus on how good things are, and work at the few things that are not going so well, or whether you focus on how bad things are and spend all your time looking for something to feel good about. I try to do the former.

Connections, Connections, Connections

During my recent hospitalization I made many connections with the nurses, technicians, physicians and support staff on my ward. Hospital rooms are a bit like Times Square or in my home town, Flinders Street Railway Station: many people constantly coming and going whose purpose and motivations you don't understand.

A concept I discuss with my students and clients is Peter Singer’s “circle of ethics”. Drawing on a long history Singer talks about how most of us start with a fairly narrow circle of care: the people whose interests we try to assist and whose positive outcomes we support. It begins with parents and family, extends to neighbors and play-mates at school, and over time comes to include “first a class, then a nation, then a coalition of nations, then all humanity.” As the circle of care expands, so too does the circle of influence. Once we begin to care about suffering in other countries, we start to find ways to positively influence overseas welfare. Our circle of care runs a little ahead of our circle of influence, and directs where we spend our time and emotional energy.

In the hospital I made a point of introducing myself to everyone who came into my room. When Genevieve was allowed to stay with me I introduced both of us, and I made a point of trying to remember everyone’s names so I could greet them again when they came back. This is just part of my nature, but I imagine it’s also something I have learned to do because I am positively rewarded for it. The staff made little allowances for us, and generally made our stay as pleasant as possible. We were pulled into their “circle of care” because we had created a personal connection with each other.

As an example, it seemed like every six hours or so someone would come to change my IV site, take a blood sample or do something else that involved tubes and poking me with sharp needles. One day, two gentlemen came in together and I went through the usual introductions: “Hello, I’m David, and this is my wife Genevieve.” Almost anyone will then tell you who they are by name, and these two introduced themselves and told me they were the new phlebotomist and his trainee. We made a little small talk, and I was interested to hear how the trainee's job was going because my Little Brother from the BigBrotherBigSister scheme has just started working as a trainee at the Red Cross.

So then the time came to stick me. “Ah,” I said. “And which of you will be drawing my blood today?”

Now you have to remember that my arms already have two IV lines in them, and they are blue and bruised all over from the many blood draws I already have. A trainee will be hard pressed to find a spare vein, and will find it even more difficult than usual to take the blood sample painlessly.

“Well…I guess I can do your draw today” said the trainer, and the trainee handed over his needles.

Connecting with people draws you into their circle of care, and if they have the ability to influence your well-being it makes people positively inclined to go out of their way for you. It’s why waiting staff introduce themselves to you at your table, and why it pays to get to know your auto mechanic. Done with sincerity and genuine care it expands the circle of people around you who will put out their hand to help you.

The Three Principles Exercise

Three principles govern your success as an ethical leader who gets things done:

• Treat everyone with integrity
• Align activities to deliver what matters most
• Engage stakeholders to commit their time, talent and trust






Exercise:

Divide your activities each month or week into three groups:

1. Treating people with integrity: All the things you do specifically to communicate the core purpose of yourself and your organization, set your values and demonstrate your principles in action. This is how you shape Why things are done by you and your organization.

2. Alignment: All the things you do to set and support business goals that focus on what matters most; your activities to drive results, and actions you take to cascade accountabilities to all levels. This is how you shape What is to be done in your organization.

3. Engagement: All the things you do to encourage people to commit their time, talent and trust; the things you do to provide recognition, build morale and encourage effort. This is how you shape How things are done in your organization.

Review:

Do the review at a high enough level that you start to see themes in your activities. Don't be too concerned if you assign some of the activities to more than one of the principles.

What can you learn from how you spend your time? Given your Strategic level, what things are you doing that don’t contribute to the three principles? What things do you need to do more of and less of?

For Advanced Discussion:

Compare how you spent last week/month/year with how you plan to spend next week/month/year. What are the differences? When are you most successful? What are the barriers that prevent your time being spent the way you plan?

Download a version to print or share here.

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Recovery is a marathon

I’m up and about, and yesterday I even met with a client as I slowly resumed my normal work pattern. Not such a good idea.

I think that if you wanted to make a broad generalization about people you could say that they are either temperamentally suited to be sprinters or marathoners. The sprinter types see challenges and obstacles as something to be tackled right here, right now. They throw their all at a situation, and depending on talent, motivation and opportunity, they either succeed or fail, right here, right now.

Marathoners are a little different. Today wasn’t such a good day for me. Just as a hill looks different at mile six, or sixteen or twenty-six, a few simple tasks today completely tuckered me out. I hadn’t realized how much being out and about had taken out of me. I slept in front of the TV for three hours yesterday, and this morning I was still sleeping on the sofa at 11am.

However, I don’t succeed or fail based on how I feel today. Recovery is about keeping your eye on the finishing line and keeping on being the best you can. I want to give my clients my full attention when I'm with them, and I want to be on top of my game. Recovery is a marathon, and sometimes you have to slow down to go fast. I’m taking it easy for a couple of days and then I’ll try again…and I’m going to make that finish line faster than you might expect.

How fast is trust?

I often ask my clients and presentation audiences “How fast is trust?” The answers are usually the opposite of what the evidence says, and their own experience would indicate. We have been brought up to think that trust is slow. We are told it takes a long time to build up trust, and people often think that once established trust takes a long time to erode. Something happened to me last week that emphasized again the answer is the opposite of what you might think…

Last week we went to a production at our local Guthrie Theater. It was “Two Gentleman of Verona”, and it’s the kind of play that you want to talk about for a while afterwards. We were all primed for some light refreshments when we left the theater. Across the road from the theater exit is Spoonriver, a nice little restaurant run by one of the Twin Cities better known restaurateurs. So here’s the first lesson about trust. Once lost, it takes a long time to regain. I think this person’s restaurants are overpriced for what you get, and there’s not a lot to choose from on the menu. I haven’t been back in a very long time after a previous bad experience.

On this night there was a sandwich-board type sign out the front that advertised “After Theater Menu: Appetizers and Desserts”. That sounded ideal, so contrary to my previous experience I was prepared to try again. This is typical of how trust works. It’s fast. We typically decide whether or not to trust someone or something very quickly, and the research shows that this is true whether we are making hiring decisions or deciding on a new brand of soap powder. Change a couple of variables and we are generally prepared to review the situation.

[Note: This is true of most people. While some people are generally “trust averse” they are just as likely to make that decision not to trust quickly. The speed of most people’s trust decisions is fast regardless of whether they are typically trusting or not.]

It’s cold in Minneapolis at this time of year, so entering a restaurant entails a lot of work. You stand about waiting for your table, and then spend five minutes taking off all the various layers of coats, hats and gloves you needed outside to remain warm. This explains why we didn’t leave when we were told the kitchen was closed once we were seated. No apology…just an offer of a drinks menu. Shortly after we saw staff standing in the kitchen doorway eating. To be fair, the food might have been leftovers or reheated, but letting staff eat in view of paying customers who had been denied food didn’t look good. The people next to us complained, and were just told again “the kitchen is closed”.

We finished our one drink and left. On the way out we saw…the sandwich board with the “After Theater Menu” still on the sidewalk. So, they were quick to gain my trust, and just as quick to lose it. It's a lesson for every business and every executive: you can gain trust quickly with the right approach, but you will lose it just as quickly if you let people down. And now it’s been lost, how long do you think it will be before I go to Spoonriver again?

Self identity and effectiveness

This is me two weeks exactly after my surgery. You can tell from the beard...I'm not planning to keep it but it's been growing since the operation. It gives me a Ernest Hemingway look that goes with the fact I have been doing a lot of writing and reflecting lately.

Two things happened today that made me think again about how my recovery process has progressed. Firstly, I received my monthly copy of the Journal of Applied Psychology today. This month's special edition is on social identity and well-being. (I'm an applied psychologist...that means I did six years full time university study after my undergraduate business degree, and my focus is psychology applied to real world issues. In my case my expertise is psychology applied to business, ethics and organizations. The International Association of Applied Psychologists is the world's oldest professional psychology association.)

Secondly, someone I don't know was reading this blog and commented "...I did find it interesting. He sure is a type A. I could not agree with him more on how his outlook affects how he recovered!!!"

I don't think of myself as a type A, or super competitive, or very driven. I've had feedback before that I come across this way, but, like most people I just think I'm "normal". However, I know that how you identify yourself makes a huge difference to your effectiveness when faced with stresses and challenges.

You've possibly heard the saying "whether you think you can or think you can't, you're always right". A lot of people mistake "positive outlook" for some kind of new-age ability to affect the world around you because of how you think. It's much more complicated than that. My IAAP journal featured articles that show that if you identify with a group that gives you a sense of meaning, purpose and belonging, it's likely that your positive self-image will spill over into your ability to handle challenges, particularly health related challenges.

Type A outlook? Sort of, but not quite.

You can see in the picture that I'm wearing my last marathon finisher's t-shirt. Today was my first day of physiotherapy, and I wore it to the physio session. I wasn't trying to be smart, but I think of myself as a marathoner. I identify with that determination to finish, stamina, and positive mental attitude. I didn't think about why I wore it today until I came home, read my email comments and opened my journal. Yep...that's one of the ways that I identify myself, and that attitude carries over into my ability to deal with this surgery and everything else in my life.

Social and self identity are extremely important. How you see yourself is reflected in how others treat you, and plays a key role in determining the mental resources you can muster. I once coached a Finance Director who felt that every day on the job was a fraud...another day he got by until people found out he wasn't very good. The thing is he really was good, running financial operations for a multi-billion dollar operation spread across dozens of countries, but with that attitude he could never muster the self-confidence to be a really effective leader in his organization.

It's better to find a more effective self-identity...like great parent, generous parishioner, faithful friend or whatever. All of us have complex self identities, part of mine is being a marathoner.

How do you identify your self?

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"What Would Google Do?" by Jeff Jarvis

“What Would Google Do?” is a provocative title because Jarvis knows Google is unlikely to do many, if any, of the things he writes about. Things like run a bank, build cars or get involved in hospitals and insurance. What he tries to do is get at the essence of what has made Google successful, and use that to hypothesize how Google’s terms of engagement could be applied to other industries. Interesting…

When I was an economics student I learned there were only four engines of prosperity and wealth:

1. Arbitrage: The classic buy low/sell high, either across time, across space or between different buyers’ perceptions of value.
2. Compound growth: Reinvesting your winnings, no matter how modest, and letting exponential growth provide you with a healthy return.
3. Leverage: Borrowing to maximize the returns compared to the capital invested.
4. Value Enhancement: Addling labor, capital or marketing to a product to improve its value in the market place. What most of us do by going to work and laboring for wages and salaries.

Jarvis says that in the new market place all that has changed. Google has made “free” into a business model, and encouraged us to make money by “getting out of the way”.

In reality, what Google has done is removed one of the most significant barriers to a free market: getting perfect or near-perfect knowledge to consumers at near zero cost. In the old economy one of the reasons people made a lot of money in the four ways above was because they had access to knowledge at a cost most couldn’t attain. They knew where to invest, where to leverage, how to add value and where the best price differentials were. Google changes all that. Google commodifies everything and enables everyone equal access to all parts of the market at the lowest visible cost.

The book is in two parts. First, Jarvis sets out new business realities in a world where instantaneous knowledge is near perfect and near free. Second, Jarvis looks at specific industries and speculates on what they would look like if they were run in a way that takes most advantage of the new business realities.

Here are a couple of examples. “Atoms are a drag” and so in the new world businesses should try to be as virtual as possible. Avoid buildings, trucks and stock in your business…manufacture just in time to meet consumer demands, and distribute using existing infrastructure that you access at the lowest possible cost. This is the model Amazon uses for selling and distributing books and many other goods, and it works. “Answers are instantaneous” so your consumer responsiveness better be lightening fast. “Everything is searchable” so you had better be transparent, honest and capable of recovering from your mistakes.

One of the most significant areas of analysis in the book is the section on ethics. The message seems to be that when everything you do is searchable and visible to all you better be good. Although the approach is very pragmatic and utilitarian it nevertheless encourages all business people to be honest, open, collaborative and self-regulating. Not a bad admonishment for businesses everywhere.

I like this book largely because of the second half. It’s interesting to look at how Jarvis envisions Google running retail: responsive, collaborative, and virtual. In Jarvis world restaurants would aggregate all the information available about who orders what with what, and use it to offer you specials, discounts and wine/food pairings based on your tastes and the tastes of the people you emulate. Airlines get out of the business of “moving atoms” and get into being a social marketplace where people can exchange travel options. Car companies collaborate with consumers to produce vehicles people really want, (a purple electric SUV with DVDs, a child’s high chair and no stereo perhaps).

Jarvis personal style is a little irritating. I learned too much about how much he earns, how successful his meetings are at Davos and what it’s like to run an internet community of his devoted fans. Still, the book has many valuable insights into doing business in a modern economy. It’s worth it just for the great chapters on “If Google ruled the world”.

An ethical suggestion for the bailout package

Here's a suggestion for the government's upcoming economic bailout package. It won't require special appropriation beyond what congress has already approved; it won't set up bad precedents for the future; and it will encourage the right kind of economic behavior.

Get ethical!

Alex Brigham is the Executive Director of the Ethisphere Institute, a research, rating and media organization designed to develop, drive and reinforce profitable ethical business practices, www.ethisphere.com. In a recent article, (http://foxforum.blogs.foxnews.com/2009/02/08/brigham_obama/), he pointed to the waste in government spending that comes from poorly supervised government contracts that go to people with political connections and lobbying ability rather than those with the best economic outcomes for the public. He estimates that more than 50% of government contractors can't show compliance with even the most basic ethics requirements of the government's contracting laws. If the waste is only 10% of this 50% it still comes to more than $18 billion.

That's a lot of money.

However, it's already the case that companies actively engaged in federal procurement and contracting, particularly those who receive contract awards in excess of $5 million, have to develop and maintain compliance plans, business ethics training, and related internal controls under rules that amend Parts 2, 3 and 52 of the Federal Acquisition Regulations (FAR).

Every organization actively engaged in federal contracting! So the 50% who can't point to their interal controls are out of compliance and shouldn't be receiving federal contracts.

How about if some of the economic bailout money went into investigation and compliance programs. It probably wouldn't cost $18 billion, and with the improved efficiency and ethical compliance it would probably end up being cost neutral if not revenue positive. Even if it wasn't, it would be a positive step toward getting organizations to what they are supposed to be doing anyway.

That would be a good use of the money, and probably one of the better bailout measures.

Of course, if you want to be ahead of the game, you could make sure you have your ethics and compliance program in place, (including your code of conduct, internally publicized reporting hotline, internal control system that prevents violations of law, periodic reviews, and procedure for self-disclosing of violations). I'm sure you can find a consultant who could help you with that.

You can send me an email by clicking here, or you can share a comment for others to see by clicking on the word "comments" below

How trust helped me through

I’m writing this in the second week after my open-heart surgery. I’m home and feeling well, and getting ready for my first physiotherapy sessions. I am reflecting on my experience and the notes I took and I have decided to start with the big one: Trust. Trust is the basis of all human interactions. That’s a huge statement, and one I repeat frequently with my clients and in my presentations. Trust helped pull me though my recent surgery.

I shopped around for my surgeon. I called on my network and checked out a few of the different places and people who could do my operation. When I sat with my surgeon for the first time it was Genevieve and I having a three-way discussion about my options and prognosis.

What would have happened if we hadn’t trusted each other? Without trust it’s difficult to have a relationship of mutual and positive outcomes. If you don’t have trust you’d better at least have, in declining order of effectiveness:

1. Respect
2. Compelling Mutual Goal/Context
3. Continual and Intense Communication
4. Power and Competition
5. The ability to “live with it”

Sound familiar? Many patients complain they don’t understand their surgery, or they feel powerless to get what they want. Eventually, many patients have to “live with it”, feeling pushed around by their medical staff and not a part of the process.

I wanted to trust my surgeon, and just as importantly, I wanted my surgeon and my medical team to trust me. What is trust? Here’s how I define trust as an outcome of four different aspects of the relationship:

• Capable: Can do what you say
• Reliable: Will do what you say
• Open: Will say what you do
• Principled: Will do what you should

When it comes to trust, like a crop, you reap what you sow. So of course, we asked many questions such as how many of these procedures the surgeon had done before, what the success rate was, what the options were and so on. One question in particular stood out for me. I wasn’t afraid of much with regard to the operation, but I did have a morbid dread of being one of those patients who “wake up” under anesthesia and experience the pain of the operation without being able to do anything about it. The surgeon’s response? “Yes, that would be terrible, and it does happen. That’s why we do X, Y and Z to minimize the chance of it happening during your operation.”

I liked that. He was clearly competent and didn’t try to sugar coat the risks for me. He empathized with my fears. He outlined what might happen, and the steps taken to minimize the risk. He was principled…he was open and frank with me and I trusted him as a result. But how did I come across to him?

Trust is a two way street. By doing my homework before our meeting I hoped he would see I was competent and reliable as well. I was open about what I knew I could do post-surgery, and what I felt was beyond me…and in our discussions I believe I came across as principled: someone who would do the right thing when needed.

And as it turned out, I believe my surgeon’s trust in me helped my recovery just as much as my trust in him. Certainly, when it came to my peace of mind it was much easier to be relaxed and focused believing I was in the best hands. When the medical team discussed my pain medications and my options for getting up and moving around they let me try to move forward at my own pace. They trusted that even if I wasn’t as pain medicated as many patients, and was trying to get up and walking quickly compared to others, I would be open with them about my limits and take responsibility for the outcomes. They let me try walking on the first day, and I was able to gently push myself to getting out of the ward on the fourth day post-op.

Our mutual trust worked well for both of us, and set the basis for our interactions together.

Doubt, Starring Meryl Streep and Philip Seymour Hoffman

A few minutes into this movie I wanted to dislike it intensely. It seemed that we were being set up from the beginning to view the priest played by Hoffman as someone who was having inappropriate relationships with the boys in this 1960’s Bronx Catholic school. My reaction was based on the fact that we could see what was going on so clearly, yet the staff of the school seemed oblivious. It would have been too easy to make a movie that attacks the Catholic church, or uses a “ripped from the headlines” approach to engage the audience. However, not long into the movie it takes a turn, and the doubts and ambiguity of the situation start to be spelled out for the audience. This is a clever film, and one with significant lessons for how people try to do well in difficult circumstances, and what organizations need to do to address wrong-doing.

[Warning: Plot spoilers follow]

Streep plays Sister Aloysius, an old-fashioned nun and stern principal of the school. She distrusts Father Flynn, a laugh-out-loud jolly priest with a compassionate view of what it takes to help children grow and provide love and support in a poor working class neighborhood. Sister Aloysius distrusts his use of ball point pens, (we can almost hear her mutter “tools of the devil”), and in turn Father Flynn says “the dragon is hungry” when seeing the principal call another luckless student to her office for discipline.

The drama in the movie revolves around the school’s first African-American student and his relationship with Father Flynn. Is the priest just solicitous and compassionate, or is there something inappropriate in their relationship? Sister James thinks she sees something when the pupil is called to a private meeting with the Father, and she suspects she smells alcohol on the boy’s breath after. The boy’s mother just wants to enable her son to graduate, go to a good high school, and avoid a beating from his father who suspects him of having an “unusual nature”. Sister Aloysius goes on a crusade to get Flynn to confess, Flynn provides extremely plausible explanations of everything that happens.

The film’s ending leaves what actually happened unresolved. We don’t know for sure whether there was any wrongdoing. Indeed, we don’t know if Sister Aloysius’ distress and doubt at the end is at the role played by the church hierarchy, or directed at her own role in removing a potentially innocent priest from his calling to teach, or even a wider doubt in her faith that such things could happen at all.

The United States Conference of Catholic Bishops gives the movie a favorable review, (http://www.usccb.org/movies/d/doubt.shtml), despite the fact that it deals with themes of child abuse and sexual misconduct within the Catholic Church. I think it is because the film deals sympathetically with the dilemma of the school, the staff and the Catholic Church, a dilemma faced equally often today by contemporary businesses and organizations.

Since at least 1970, social researchers such as Latane & Darley, (http://answers.yahoo.com/question/?qid=20070430084944AAby7D0), have recognized five stages of helping behavior.

1. You must notice an event
2. You must interpret the event as requiring help
3. You must assume personal responsibility
4. You must decide what action is required
5. You must act

The film illustrates that this is not as obvious as it seems. It would have been easy for Sisters Aloysius and James to ignore the warning signs of potential misconduct, and equally easy for them to accept Father Flynn’s explanations as showing no intervention or help was necessary. Similarly, had not Sister Aloysius taken personal responsibility for dealing with the situation and saving the boy the movie illustrates that the church and the schools in this era had no infrastructure set up to deal with child abuse. While Sister Aloysius works through her options it is clear there is no one easy way to deal with a potentially inappropriate relationship in the school and the church. Her actions end up including direct confrontation, (trying to get Father Flynn to confess), and deception, (pretending she has spoken to a nun from the Father’s previous school who has spilled the beans on his past). Sister Aloysius is a model of the Latane and Darley theory, but also a sad illustration that a reinforcing social infrastructure is needed to enable helping behavior to be successful.

What can contemporary organizations do to enable helping behavior to succeed?

Organizations can “inoculate” themselves against bad behavior by systematically and sequentially addressing Awareness, Desire, Knowledge, Abilities and Reinforcement. Using the movie Doubt as an illustration, here’s how a successful implementation might look.

Awareness: What is right and what is wrong needs to carefully explained so everyone is aware of the difference. Meeting with the priest to discuss pastoral matters is right. Calling boys for private meetings with Father Flynn when the purpose is unspecified and setting is hidden is probably wrong. Providing respect and support is right, providing hugs and giving individual gifts, (as Father Flynn does), is probably wrong. One of the major traps Father Flynn and many organizations fall into is that it is not enough not to do wrong, you have to be seen to not do wrong. Even if Father Flynn’s behavior had been acceptable the private and secretive nature of the relationship provided enough of an opportunity that something inappropriate could be happen. As such, Flynn’s behavior was wrong and his actions should have been subject to “the cleansing light of open air”.

Desire: There needs to be a shared understanding and desire of what the right behavior will do, and how the future can be better. Sister Aloysius and Father Flynn have very different views of what is right for the boys in the school. The principal is a disciplinarian who favors mirrored glass to enhance the ability of the teachers to have “eyes in the back of their heads” and hands out repetitious tables and word drills for disciplinary infractions. The priest believes the boys respond to positive modeling, (“look at my clean nails” he says), and offers opportunities for sport and positive interaction as well as delivering his traditional sermons from the pulpit. An organization needs to create a vision of what can come from positive change, and engage everyone in working constructively toward the common goal. Such collaboration lessens the possibility of in-fighting and reduces the opportunity for bad or deviant behavior to exist or worsen.

Knowledge: Had Sisters James and Aloysius been able to understand from the beginning the purpose of what had been happening between the priest and the boy there would have been less room for ambiguity. The priest was secretive, exerting his authority in the face of legitimate enquiries and attempting to intimidate the principal with a sermon on intolerance. One of the surest guards against bad behavior is public knowledge. The less that is secretive in an organization, the less opportunity there is for bad behavior to go unnoticed.

Ability: Sister Aloysius doesn’t know what her abilities are to act against the appearance of wrongdoing from Father Flynn. Had the school or church wanted to ensure such things did not happen there needed to be system of enquiry or “whistle blowing” that empowered anyone with suspicions. The system need not be punitive. It should have given Sister Aloysius the ability to have her doubts heard without adverse consequences. It should have enabled self-learning in the school and church as organizations. The school could have let Father Flynn continue in place, but changed its rules on private meetings with the boys or the giving of personal favors. One of the saddest outcomes of the movie is that you suspect that if Father Flynn were guilty, the church had simply moved him to another parish where he could transgress again unless there were another equally powerful sister to stand up to him.

Reinforcement: This is the crux of the final scene in the film. Sister Aloysius is not positively rewarded for what she has done. Rather, she is left out of the church’s decision to relocate Father Flynn, and left to deal with her own doubts over her actions. She is comforted by Sister James, but not by the church and its hierarchy. We wonder as an audience whether it was worth it for her. There is a whole sub-plot in which the boy’s mother wants no part of confronting the priest, and it seems that she is alone and unrecognized. Would she do the same again? Father Flynn moves on, neither reprimanded nor enlightened as to his role. Indeed, we are told his new position is a promotion. Organizations need to set up positive reinforcement for people who do the right thing, especially when it involves speaking up against authority or disclosing unpleasant truths.

Doubt is a powerful movie with great illustrative power. I will be using it with my clients to demonstrate a practical example of how well meaning people can’t always prevent bad behavior, and how organizations need to reinforce and support people doing the right thing.

A psychologist's experience of open heart surgery

So this is me six days after surgery: at home, out of pain and well on the road to a complete recovery and resumption of my healthy pre-op life.

I've done well, but more importantly, I had a network of really powerful relationships supporting me through all this. Let me take a quick moment to express my thanks to my beautiful wife Genevieve, her mother and my parents, the surgical and post-operative teams at Park Nicollet Cardiology, my friends, my clients and everyone who has been in touch and provided comfort and support.

My recovery has been really good. I know that because I saw others on my ward and heard the experiences recounted to me by the medical teams. This is the biggest thing that has ever happened to me...more life changing than I could have imagined originally. I took notes throughout, and with hind sight I can pull apart my experiences and explain them with the benefit of my training. I am going to put what I have learned into a series of posts here.

• The importance of trust
• Self-awareness
  
• Self-efficacy and the belief you can do well
• Emotional support
• Managing your emotional state
• Building relationships
• Appreciating others

The soft stuff is the hard stuff. Everything I knew and applied helped me come through this as strong and well as I did.

You can send me an email by clicking here, or you can share a comment for others to see by clicking on the word "comments" below.

Sincerely,

David

Getting strong again

This is me on the afternoon of the first day after surgery. I'm sitting up out of bed, I've asked for my book and some glasses, and I've put on my own "luxury" robe.

Why?

I can't speak highly enough about the surgical and post-operative teams. While I was in the hospital I saw my one job was to work at feeling as well as I could. I didn't emphasize "getting better" because that might be out of my hands, but I did know that I could be fully responsible for making the best of every opportunity I had to be as well as I could. It's a subtle difference but an important one.

Shortly after this photo was taken I went for my first "walk". Probably not really a walk. The ward I was on was in the shape of a cross, with a central nurses' station, and rooms coming off each of the arms. My best guess is that the arms were about twenty metres/twenty five yards long. On the first day I went from my room to the nurses' station, up one corridor and back...maybe sixty or seventy yards round trip. It took a good twenty minutes and left me totally exhausted.

I had a tag on my arm saying "fall risk" and a nurse on one side with Genevieve on the other.

On the second day I made the trip eight times...it took me eight hours.

By the third day every nurse or procedure technician coming in would say "oh, you're that marathon guy aren't you?". I was off pain medication for more than twenty-four hours, and off the blood pressure medication as well, which none of the nurses could believe. I had a slight set back in that I put on eight kilos/twenty pounds in water weight on Saturday, and needed to be stabilized again. On Sunday I was asking to go home. I was disappointed when they wouldn't let me out on Monday, although they removed all the drainage tubes, catheters and pacemaker wires. By then I was cruising the halls of the hospital taking walks every hour or so, and covering my floor and the public floors below.

They made the decision to let me go home before lunch on Tuesday.

For more click here.

You can send me an email by clicking here, or you can share a comment for others to see by clicking on the word "comments" below.

My operation

This is an illustration of the operation I had done, beginning with the incision made in my chest. Basically the surgeons needed to get access to my heart, and the way we chose to do it was by the frontal incision you see here. There is a neat scar from just below where my throat ends to just underneath my sternum. Once the chest is opened the sternum is cracked, (sawn?), and the ribs spread. The internal organs are moved around, and the heart is exposed for the operation.

I say "we" chose this because we had discussions with the surgeons before the operation about how it could be done. There is an alternative method that involves "keyhole" type surgery from the side. Post-operatively the results are much better as there is less trauma to the body. However, the surgical outcomes in terms of repair and complications may not be so good. We figured I was young and fit enough that I would prefer the better chance of a full repair and I'd fight my way through the recovery after.

I believe a major factor in my recovery is that I felt engaged and fully trusted the surgical team. I'll come back to this in a later post because this is a major learning for me and my clients in terms of self-efficacy. We do well because we believe we can do well, and there are clear paths to improving what we believe about our abilities.

The day before the major operation I had a angiograph...one of the procedures where they knock you out and put a catheter into your heart from the artery in your leg. Then they flood the heart with dye and check out the health of the blood vessels. Bingo! I have the heart of an ox, and despite the occassional beer, wine and plate of fish and chips everything was clean and healthy.


This is an illustration of the work done in the heart. It was cut open to reveal the mitral valve between the two left heart chambers. In my condition the valve wasn't closing properly, so if I understand correctly about 40% of each pump went back up the heart instead of into the body. This was causing my upper atrium to expand, and limiting the oxygen my muscles were getting.

The damage to the upper atrium isn't permanent, but would have become permanent if this had gone on.

After the repair I was moved to ICU where I was on ventilation and a heart pacemaker. For the next two days I had IV drips in my arms, two drainage tubes from my chest attached to a portable "suction" machine, and the electrical lines for the pacemaker still buried into my heart "just in case".

For more on my recovery click here.