Leadership lessons from the COVID-19 pandemic was the topic of a podcast discussion between Intermountain CEO Marc Harrison, MD, and General Stan McChrystal, retired four-star general and founder of the McChrystal Group, an international consulting and leadership development firm.
Marc Harrison: So let's go ahead and jump right in. My belief is we are facing a defining moment for our generation. I think navigating this COVID crisis is going to require strong and decisive leadership in the face of uncertainty. Not an easy proposition. We're starting to see some real volume and we're starting to see some real acuity and it's scary for our caregivers as well as for the patients who are going through these situations. And we're well trained, we're well equipped, we're ready to rock and roll, but we also are already running into times where we're imperfect.
And I think some folks can roll with that. And other folks, they take that as a sign that the sky is going to fall because we have one moment of imperfection. I assume this happens in real life, in the battlefield, all the time. As hard as you train I assume that Mr. Murphy comes to visit you every once in a while. What do you do about that as a leader, Stan?
Stan McChrystal: Yeah. I started to think Murphy was my twin brother. We used to train up for combat, do all these things, prepare our equipment, write a great plan, rehearse the plan, go out and the plan never worked. I never once went on an operation when a plan unfolded like we wanted it to. Now we might win, we might do very well, but the enemy gets a vote and then there's all the other factors that come in. So I think what we can do with our teams is first tell people we must prepare. We must get ourselves ready. That's the responsible thing to do. But we must understand that we as individuals are going to make mistakes. We as organizations are going to make mistakes. And while that's not something we seek to do or we don't say it's okay, in reality, it's life. And so we learn to live with that.
Where it gets really hard is where it gets personal. Where you're responsible as a caregiver for a patient or a team has a patient. And more than anything in the world, they want to get a great outcome and they don't. Because as you know by experience, you don't always get the outcome that you want.
Marc Harrison: Hard as you try, yeah.
Stan McChrystal: And there's that temptation to feel guilty and we never can completely walk away from that. What we have to do is we have to understand that when something like that happens, what matters is not what's in the past, what matters is what's in front of us. It's the next patient. It's the next family we deal with. It's the next thing we do. And so people have got to get a mindset that says, "I can't change anything in the past. I can learn from it, but I can't change it. So I'm not going to agonize over it. I'm going to turn forward and think about what's in front of us."
Marc Harrison: I really, really like that. We talk a lot at Intermountain about leaning into things, failing fast, failing forward, learning, being continuously learning environment and then having the humility to say when we have done less than a perfect job, own that and then move on. I think one of the things that I noticed that's really tough, particularly in genuinely stressful environments is, and maybe you're different than I am, Stan, but I don't think you probably are, because most human beings do this.
We revert to our least good self when we're really highly stressed. And for me, I know that my least good self can be hyper-focused, can be very directive, can revert to command and control too rapidly, et cetera. Hopefully we get better and better at that. What kind of counsel do you give to your leaders, particularly the developing leaders about developing self-awareness around what their least good self might look like and how to avoid that?
Stan McChrystal: Yeah, I think Marc, we're very much alike. I get impatient. I’ll snap at people and it doesn't mean that I'm right when I snap at them. I'm not giving them the right answer. What I would say is one of the first things to understand is when you are under stress, they probably are also. The same situation that's created stress on you is probably doing it to them. So in reality, in just the moment when they need calm — when they need mature direction — I have a tendency to be at my worst. And so the way I try to think about this is when those kinds of things happen, I try to step back a little from it and this is one of the keys of being the leader and not doing everything yourself.
I find that if there's a task with 20 things to be done and I give the team 10 of them to do and I say I'm going to do these 10 myself, I get more stressed and I’m less effective. If I give 20 to the team and I step back and I'm going to lead the team, I'm going to be responsible for the outcome, but I'm not going to be doing a lot of the specific tasks myself. I actually keep my emotions more in check. I'm much more able to sort of step back and say, let's see the big picture and I do better. Now, there are some things that only you can do as the CEO. There's some things that only I can do, but I find if I reduce those to those which truly are unique to my position, then I do a much better job.
Marc Harrison: Well, I think that's the Holy grail. I wish I could do that 50 percent of the time. I'll keep working on it. I think it's sort of interesting that this all hinges on communication really. Because even if something's crystal clear in your mind, right? If other people don't know it, it doesn't do you any good. So in the face of a super busy, stressful, dangerous at times operational rhythm, how do you make sure you prioritize communications so that you can get people on the same page as much as possible?
Stan McChrystal: Yeah, I think first and foremost understand that as the leader, most of what we do is communication. We have a few decisions we make. We have some guidance that we formulate judgments that we provide and then the rest of it is communicating it so the team can do it effectively. Informally, quite often what I'll do is I'll give somebody something and then I won't just walk away. I'll say, "Wait a minute. Talk me through that. Tell me what you just got."
Marc Harrison: I really like what you just said there. I think that piece is, and this is super difficult, it's impossible to learn when you're on transmit. You can only learn when you're on receive. And balancing the transmission of commander's intent, which I think those of us who are effective, we get pretty good at that with the appreciative inquiry associated with being on receive. That's a fine balance and the higher the pressure of the situation, the less likely one is to take that pause in order to go on to go on receive.
I heard Oprah get interviewed. I was at a lunch that she was at and she told a really funny story about herself that I really respected. She shared that she was slated to go spend a week with Desmond Tutu and she said to her boyfriend, "What am I possibly going to talk to him about for a week?" And her boyfriend said, "You might try listening." How great that she told that story about herself, right? Very humble. Can you talk a little bit about how you balance transmit and receive so that you have the most effective team talks?
Stan McChrystal: Yeah, I think the first thing is, listening is the ultimate sign of respect. And so if you go to someone that works for you that's more junior and you say, "What do you think?" And then you can hold off your desire to talk long enough to truly listen to him, it's extraordinary how they respond because it’s a sign, “I care what you actually have to input here.” And then if you listen of course you get extraordinary insights into what's happening. I also think there are times you should structure conversations such that you don't muddy the water too early.
One of the traditions in military commanders meetings, they call them counselors of war. What they always do is they get the commander and subordinate commanders in, and they postulate a question and then they start with a junior person and they go in reverse order. They go in reverse order because they know as soon as a junior person hears from a senior person, it affects what they're going to say. So they go all the way to the commander that way. And if the commander's got the right self-control, it's extraordinary how much they'll take in during that period.
Marc Harrison: That's terrific. So let me ask you a question. It strikes me that you can't have too many good people in your foxhole right now. And we've got tons of leaders who are, I almost think of them as structural leaders. They've climbed the ranks, they've gone from being a frontline person to now a senior person. I'm seeing some extraordinary stuff that gives me unbelievable hope of folks who are not necessarily formal leaders, but they're stepping up, they're leaning in, they're making sacrifice. They're fully engaged in every possible way. I imagine you've seen a lot of that in your career as well. Can you talk to me and to my leaders about how we foster that informal leadership as well?
Stan McChrystal: Yeah. That’s the most fulfilling part of all of this. You've got certain leaders you've been with a long time, they grow up, they do very well and you feel really good about it, but there's other leaders who in a moment suddenly appear and they do things that are pretty amazing and you just step back and go, "Well, I didn't see that coming."
Marc Harrison: Right.
Stan McChrystal: I think the key there is to create an atmosphere that celebrates that. First you have to create the opportunity to do that because if everybody is tightly corseted by prescriptive directives or proscriptive directives, if they don't have much ability to make decisions or use initiative, you won't get much initiative. But if you look at people and say, "Okay, I'm loosening the rules on what you can't do and I'm not going to tell you how to do it, but I want you to produce that outcome." People will do amazing things. When I took over JSOC in 2003, what I found was we had developed this series of rules all put in with good intentions that gave us an excuse for failing. We're not doing things.
Marc Harrison: Interesting.
Stan McChrystal: You had to have belt suspenders, backup belt, backup suspenders for everything you did. And I took all that away and I said, "I want you to use your best judgment. Don't be cavalier with the lives of our soldiers, but now get things done and I'm going to support you." In a highly dangerous environment, I was able to do that. In the medical world, sometimes you got to put a few more rules in there, but I think if you give people a little more flexibility but also look at them and say, "I'm counting on your judgment and initiative," they will do extraordinary things. There'll be mistakes, but there won't be more mistakes than you make if you centrally try to do it.
Marc Harrison: Well, let me ask you a little bit more about that. Although less extreme on the front lines of the COVID-19 epidemic, but not that much less extreme. We have caregivers who are putting themselves in harm's way, for real. Can you talk a little bit about how you counsel your soldiers and leaders around the balance between self-care and care for others — both of which are very important? Mission driven people want to serve a higher purpose, but — and not to put too fine a point on it — but if they're injured or killed, they can't help other people. Can you give me some guidance please?
Stan McChrystal: You will have the same challenge that we had. It wasn't getting people to take personal risk because they feel mission driven. They feel responsible to do that. What I had to tell people was, it’s actually really important that you not get hurt. It's really important that you not be killed because you are so valuable to us. There will be the occasional moment on the battlefield where sacrificing your own life is the right thing to do, but that’s very rare.
As a caregiver, I would say that we need to give care to as many people as possible as well as we can, but we need to preserve our ability to give care to the entire population, to all the people. So you have to keep, as you work on one patient or in one situation, you have to be thinking about the next patient and the patient after that. My guess is your workforce will have to be constantly reminded to take care of themselves, not just protecting themselves with gear from the coronavirus, but from exhaustion, from emotional burnout, from those things that affect you — the sense of guilt or things back at home that are so bad that you can't do your job as well. So I would say that the desire to go nonstop until you drop is not what's going to work for an extended challenge like this.
Marc Harrison: And it's a long campaign I think Stan.
Stan McChrystal: And you can't just tell them, "Take care of yourself." That's not enough. That's kind of a bumper sticker. I think you've got to make it not only okay for them to do that, you've got to say, "I am requiring you to do that because I need you long-term. You have to be in the fourth quarter."
Marc Harrison: So let's, if this isn't too personal, I'd love to hear a little bit more about how you've learned to take care of yourself. My worst day ever as a pediatric ICU attending was an evening I sequentially and unsuccessfully tried to resuscitate four sisters who died in a house fire. I'll never forget those four little bodies lined up in the emergency department. Really tough. But you also have to get up and go to work the next day. And over the years I've tried to come up with my approaches to taking care of myself. I'd be curious to hear from you about how you stay grounded and balanced and a good granddad and a good friend and a good colleague in the face of some of the very tough things that you've seen or done over the course of your career.
Stan McChrystal: Yeah. First off, I wouldn't claim I'm as good at it as I’d like to be, but I'll tell you what I've done. I'll start with a quick story. When I was a Colonel, I was commanding the 75th Ranger Regiment, this elite 2,000 person light infantry unit, and I had to have shoulder surgery. I did a parachute drop, I tore my rotator cuff and I had to have surgery for it. And I was several weeks in a sling. And when my regimental surgeon was leaving the organization, as I did with all my senior leaders, I had him in for a final counseling session. As part of that, I would ask them to criticize me, tell me something that I need to do better. And I've got an ego like anybody else, so usually people throw a softball to that question.
Marc Harrison: Did he ask your wife?
Stan McChrystal: But this surgeon who is a great guy, he said, "Sir, when you injured your shoulder," I started running again while I still had the sling on and I thought, I'm a hero. I'm a stoic hero. And he said, "When you injured your shoulder, you pushed yourself really hard. You went out and did PT when you didn't have to and you probably shouldn't have." And I took that as really a compliment. I said, "Oh, I'll correct that," but really I'm patting myself on the back when he says it. I'm a hero. And he goes, "No, no, no, no, you don't get it." And I said, "Whoa, what are you talking about?" He says, "You just made it not okay for every other Ranger who gets hurt to recover."
Marc Harrison: Wow.
Stan McChrystal: And I go, "Whoa."
Marc Harrison: That's a big deal.
Stan McChrystal: Yeah. He says, "You screwed 2,000 other Rangers." And I said, "Okay, now we're serious." This gets to taking care of yourself. You know, there's kind of a hero thing about leadership that heroes are all — my dad taught me this years ago — heroes are always tired because they work harder than everybody else and they don't eat right and they're so selfless that other people have got to hand them a piece of bread to keep them alive because they're heroes. And he goes, "That's not what you need in truly effective leaders. What you need in truly effective leaders who people who are in it for the long haul, there for the fourth quarters, are not so tired that they can't pay attention. Not so tired that they can't give to other people and they make it okay for other people to take care of themselves.”
Stan McChrystal: So the leader has got to sort of overtly go home at the right time. The leader has kind of overtly got to get enough sleep. So that was sort of the motivation. And so that the period of time when I'm available, I'm better than if I don't do those things. And so I do those. I also need a certain amount of time by myself. I'm very introverted by nature. On the psychological test, I peg it. So for me to relax is not to go get in a group of people and yak for a while. That's exhausting. I've got to go read. I like to sit in a chair, I've got a place in my house here, and for maybe just an hour or so, just sort of decompress down. That's it. And even when we're at war, I did that every night because that's what was required for me to sort of get my emotional activity down to a stable level.
I would imagine doing surgery, like you, going in and out of that at some point there's got to be a way where you find to sort of get back to recharge your psyche as well as your body. Is that?
Marc Harrison: Well it actually sounds like we were separated at birth. My wife, who I adore and puts up with me now for over 30 years, she said she's tired of going to bed at 9:30 at night. And you know, the alarm goes off at 4:00 in the morning. I train every day. And I think I'm an introvert who likes people. I really genuinely like people, but my bucket gets refilled with a run in the mountains or that sort of thing. So I think we're probably pretty similar. I think it's important for the people who follow us to realize what works for Stan or what works for Marc doesn't have to work for them. They just need to figure out what works for them.
I like what you say about giving people permission, and maybe even expectation, that they care for themselves. So those are actually the questions I have for you. Is there anything I can do for you, sir?
Stan McChrystal: I've got a question for you.
Marc Harrison: Okay.
Stan McChrystal: Okay. And we talked about this, I mean, since you've been in this job, you're battling your own health issue.
Marc Harrison: Yep.
Stan McChrystal: You don't see that coming. You're leading a huge, very successful healthcare institution, but now the whole healthcare system in the United States has thrown this curve ball of a pandemic. Just when you've got Intermountain kind of going the direction you want it to. Now we've got this thing that sort of upends all health systems or at least threatens to, and you're in charge. And so you've got a lot of curve balls. How do you keep your eye on all of them? How do you make sure that one doesn't hit you in the head?
Marc Harrison: Well, every once in a while one does hit you in the head, but then you've got to dust yourself off. It's funny because at dinner last night, Mary Carole reminded me that about a month or a month and a half ago that I said I was "Just a little bit bored," and I think I may have jinxed us Stan. Don't tell anyone. Before I answer the rest of your question, no one would wish for what's happening right now. Economic dislocation, terrible health problems. But what a privilege to have an opportunity to lead at this time. For people who want to serve other people, I think this is a defining moment for us to learn a lot about ourselves and to do some real good for lots and lots of other folks.
Marc Harrison: This is my second go around with cancer. I had bladder cancer when I was in my 40s, and now I've got multiple myeloma. I had a bone marrow transplant back on November 8. Recovered well from that, but I still need ongoing therapy. I've been straightforward. This is a chronic disease that I hope will go on for a really long time. And probably something that you dealt with in your military career, and I don't want to sound more philosophical than I actually am, there's nothing I can do about yesterday, tomorrow's not promised, how am I going to live today? And I wish I could say I was better at that than I am, but I'm getting pretty good at it. And I think without being naive or losing peripheral vision, as we talked about, I think it is possible to live in the moment with super clear priorities. How did I treat the people around me? Am I accomplishing my mission? When the people who follow me watch me, am I walking the walk or am I not? Is it okay for them to see me suffer at times? I think it actually is because I'm a human being.
I think anybody who tells you that cancer or anything like this is a blessing is full of it. But you can make good things come out of bad things, and that's what I'm trying to do. One of the things I tell people is you don't get to choose your path, but you get to choose how you walk it. And so I'm just going to walk it the best I can.
Stan McChrystal: I think you're doing an amazing job. I want to raise one final point. It's really for you and for the entire team, and it's something I've been thinking a lot about lately. When we were in the Balkans, I watched what happened when a society fragmented and went at each other's throats. And then in Iraq. When we arrived in Iraq, the Sunni and Shia, they were two different parts of society but they were inter-married, they lived together. They weren't at each other's throats. But by 2006 they were killing each other. They were living in these small tribal like enclaves. And it was horrific.
I think that when a pressure comes on a society like a pandemic and an economic shock, there's a chance that it will be a big unifying event. We'll all link arms, we'll become closer and we'll work through it together. There's also a chance we won't. There's a chance that we will fragment. We’ll go first to our families and then to whatever little groups we identify with and there's a great potential for losing social cohesion even in a country as stable as the United States. We've already got income inequality, we've got still racism, we've got political polarization. All of those things are fissures which exist and I think what we could find is these pressures are almost like fracking and could cause us to break.
Interestingly enough, I think the healthcare system over the next few months, maybe the next 18 months, is going to be one of the big unifying forces. In the South during the civil rights movement it was the Southern Baptist church, the African American Baptist church. It was the glue where people came together and they met and they were common cause. Although we didn't plan it, I think maybe in the next few months, it maybe the healthcare workers. It may be that they'll be the fabric that we admire in execution and we need to keep us all connected against a common enemy. I think the example that you’re setting, and I know your team is going to set, is going to be one of those things that helps keep us together. And if we all sort of remember just how important that is, the physical wellbeing of Americans is key, but that psychological cohesion I think is essential.
Marc Harrison: I think that's really wise. We happen to be pretty blessed to live in a society here where people really do take care of each other as well as themselves, very responsible. There are plans here in the Valley on the Wasatch Front to make millions of masks for people for across the world, not just for the United States.
Stan McChrystal: Great.
Marc Harrison: The number of people who are coming forward, asking can they watch another person's kids so that person can go to work. We have some plans in place for our caregivers to be able to hand out food to other folks to make sure that their colleagues actually have enough to eat. We're going to be real intentional about this. I guarantee we'll fall short in a lot of places. It's not enough to just heal the body, we need to come out of this whole as human beings and as a society at the same time. So we'll try and live up to that and I'll take that as a to do.
Stan McChrystal: Wow. I think you're already doing it, but thanks for all you're doing, Marc.
Marc Harrison: Thanks Stan. I appreciate this. I've so looked forward to this conversation. You're a person who I admire greatly, and I know you've been told this a million times, but thank you for your leadership and service, sir.
Stan McChrystal: Well, I turn that right back to you. Thank you.
Marc Harrison: Thank you. Bye. Bye now Stan.
Stan McChrystal: Thank you.