Book Report: The Spirit Catches You and You Fall Down

Anne Fadiman’s book The Spirit Catches You and You Fall Down, chronicles the care and treatment of a Hmong child with epilepsy who is living in the United States.

At every turn, there are clashes of culture, understanding, language, norms, and even understanding of what “health” might mean. No one is right and everyone is right. No one is wrong and everyone is wrong.

Lia Lee was born in the United States. Her parents were refugees from Laos and settled in a small county in California. She was diagnosed with severe epilepsy. Her doctors and family all wanted the best for her, but they each defined “best” differently. The story is a compelling one where you will find yourself rooting for Lia and sympathizing with all of the other players in the story.

This book brings up questions of identity and cultural values. As I read it, I couldn’t help but wonder what I would have done if I was one of the players in the story. How have I , inadvertently disrespected the cultural norms of another person or group? This should be a must-read for anyone working with diverse populations or for someone working in a culture other than their own. This book never suggests that we will be perfect interpreters of other cultures, but the underlying message is one of effort. Health care providers should put in an effort to understand the lived experience of their patients and should understand their understanding of disease.

For those of you who have read the book–an update from the New York Times is here.

Book Report: Drive: The Surprising Truth about What Motivates Us

Instinctually, many of us may think that motivation at work is driven by money. Or maybe power. Or, in the case of some of us (ah hem) the mission of the organization for which we are working.

Daniel Pink, a smarty-pants lawyer-turned-motivation-researcher has spent four decades researching the idea of motivation. In his book, Drive: The Surprising Truth About What Motivates Us, he shares his findings about motivation which boils down to three main factors:

  • The ability to direct our own lives, which he calls “autonomy”
  • The ability, freedom, and space to learn and create new things, which he calls “purpose”
  • The ability to do better by ourselves and our world, which he calls “mastery”

So, what does this mean for you and the teams you manage? Mainly, I think it means making space for you and your teams to engage in your work in those three ways. How can you help your team members to build their autonomy, purpose, and mastery?

This book, and the third factor in the list above, inspired me to integrate one super simple practice into my every-day management style. When I delegate tasks or make an ask of my team, I gave them a compelling “why” that is linked to the bigger picture of our work–why what we were doing was going to make the world better.

Now, let’s say that I was asking my team to do something mundane, like, say submit their milage report. How in the world would I be able to link that to saving the world? I admit that at the start of my practice, I had difficulty linking tasks like this to our mission. With practice, I became a pro. So, for this example, I would tell my team that by submitting their milage reports we could assure our donors and funders that we were responsible stewards of their donation, that we actually were doing consistent and meaningful work in the community, and that our timely report submission was a sign of our respect for them.

Pink fights against theories that folks are motivated “extrinsically” with  short-term incentive plans and pay-for-performance schemes and the traditional carrot-stick motivation and punishment.  Pink writes that those extrinsic motivators “can deliver a short-term boost — just as a jolt of caffeine can keep you cranking for a few more hours. But the effect wears off — and, worse, can reduce a person’s longer-term motivation to continue the project.” That reduction in long-term motivation is partially due to the waining intrinsic motivation BECAUSE OF the extrinsic motivator–it is a vicious cycle once extrinsic motivators are introduced.

I found two of Pink’s illustrative examples particularly compelling. Swedish blood banks decided to change things up and pay people to donate blood. They anticipated that their blood bank would be filled to the brim. In fact, they saw blood donations plummet. Why? Well, you may have guessed…turns out we are motivated to donate blood out of the goodness of our hearts and not for literal blood money. The good Swedes are motivated intrinsically, not extrinsically. The second example that I found compelling was about Encarta. Remember Encarta? It was a pet project of Microsoft’s Bill Gates. It was a 1990’s CD-based encyclopedia that Microsoft paid big bucks to develop. Microsoft eventually threw in the towel and admitted defeat. While Microsoft never publicly stated it, it was presumed that their defeat was at the hands of Wikipedia–an online encyclopedia with content that is generated for free by people like you and me out of a desire to share knowledge. Those who contribute to Wikipedia are those who are motivated, again, intrinsically and not with the traditional carrot.

This book is most applicable to those who are managing people and teams. However, I think it is also tremendously useful to teachers and parents as they consider how to build motivation in children. I also find it particularly useful to consider as I develop trainings that are meant to change behaviors over the long term.

With this new knowledge, that we can and should build intrinsic motivation of our teams, I pose the question: How do you help to promote building purpose, mastery, and autonomy in your teams?

You can read the book, which I highly recommend. But, if you only have 18 minutes and 36 seconds, here is his TED Talk that describes some of the highlights of his theories.

Book Report: Getting Things Done

Book reports–I’ll read it so you don’t have to.
 
One of the constant challenges that managers face is in balancing it all–taking time to be deliberate, creative, strategic, and visionary all while driving work forward.
 
The book Getting Things Done offers lots of tricks and tools that can help do just what the author promises.  Frankly, I found the paper-based system to be outdated in this digital world; I am far too often on-the-go, rarely work at the same desk, and don’t own a filing cabinet all of which are requirements for his paper-based system.  However, I have some great take-aways from this book that DO work for me in our digital world.
So, this post is, essentially, a Cliff Notes series of suggestions that work for me, and hopefully, will work for you!
 

First up, the weekly review: In a weekly review, you, essentially, clean up the week that just ended and plan for the week to come. I especially like this approach as I find it helps me to transition more easily into the weekend and sets me up for success for the following week.  I find that my weekends are much more enjoyable and relaxing when I know that I have tied up loose ends from my workweek. This article offers a fantastic list of what you can include in your weekly review. Fans of Marie Kondo and Gretchen Rubin will appreciate how the process also includes a cleaning up of one’s physical work space, too. I typically look back at my calendar to see what meetings I was in and make sure that I have either completed the tasks that were assigned to me during the meeting or do any follow up that may need to happen such as asking for meeting notes, scheduling the next meeting, and so on. I also look to the week ahead and make sure that I have either provided or requested agendas for all of the meetings on my calendar. Great tip–if there is not an agenda consider carefully if it is worth your time! 

As a minimum, on Fridays, I try to use at least thirty minutes to review my calendar for the upcoming week, prioritize my to-do list, and use the Getting Things Done trigger list to help spark my memory of things that may be in the back of my mind or loops that may need to be closed. I don’t have a perfect system but this helps to make sure that I stay on top of my activities. Plus, I find that by using the Trigger List that I end up clearing my mind of all of these little things that I’d subconsciously been keeping track of.  I would love to hear your suggestions about how you optimize your time and make sure that we honor our commitments.  

 
What tricks have you learned and developed over the course of your career?
What works best for you?
Let’s hear from you in the comments so that we can all benefit from your practices! 
 
Do you have a team member who could use some help in getting and staying organized? Perhaps this review could do the trick!

Picture a Leader. Is She a Woman?

Check out Nancy Pelosi. Even a glance will show you that she is the only woman at the table (and one of 2, it seems, in the room).

The New York Times wrote an article entitled Picture a Leader. Is She a Woman?

The author shares findings from an organizational behavior professor from the UK. She asked executives to draw a picture of a leader. Invariably, they drew pictures of men.

The researchers took the research further to investigate how “holding unconscious assumptions about gender affect[s] people’s abilities to recognize emerging leadership”.

“What they found, in a study posted by the Academy of Management Journal, seems to confirm what many women have long suspected: getting noticed as a leader in the workplace is more difficult for women than for men.”

This drew my attention because I have led a similar activity in a leadership training. Except, I do not ask participants to draw A leader, I ask them to draw a picture of a leader who has inspired and motivated them. While I cannot say with perfect accuracy how often women or men were drawn, I can 100% tell you that the participants have drawn women far more often than men. I have done this training now with hundreds of participants from six countries. The results never vary. Men and women alike draw women more often than not.

Maybe this exercise will be more balanced as women and men see more examples of women in leadership roles. We are still, in 2020, seeing a lot of “firsts” for women in leadership roles and women being rewarded and recognized for their contributions.

For goodness sake, we saw the first all-women space walk in 2019!

We also saw the second woman ever to win the Nobel Prize in economics! In 2019.

If I were to dive deeper, I’d posit that, true, sure, maybe it is harder to be recognized as a leader as a woman. But once you ARE a leader, you are more likely to be seen as a GREAT one. An inspiring, motivating leader.

What do you think? Once women are leaders, are they more likely to inspire greatness?

What it Takes to be a Good Leader

I’d like to share some  ideas about what it takes to be a good leader.

Take a listen to this talk by Roselinde Torres.

She distills the best qualities of leaders into three elements:
1. The ability to see changes that may be on the horizon and prepare for them
2. Networking skills that bring various perspectives to the work
3. The willingness to take some risks and abandon practices that may have been successful in the past but no longer serve the team

The reflection questions below may give you insight into your own practices and habits (and maybe encourage a change or two!):

  • What are your skill levels as they pertain to those three qualities?
  • Take a moment to think about, as she suggests, how you spend your time–do you allow yourself the opportunities to develop in these three ways?
  • Are you cultivating your team to be leaders?

What do you think about her distillation of leadership qualities? I would add skills around trusting and transparent communication to her very valuable list. To me, trusting and transparent communication is critical to giving and receiving feedback and to ensuring that your team is helping you to see what is on the horizon.

Have you considered watching TED talks like this one with your own teams? I have always appreciated leaders and managers who ensure that I keep learning and developing. Plus, they are short enough to fit into team meetings or over a lunch break. How do you help to foster growth and development in your team and in yourself?

The Story of Us

Since the 2016 Presidential elections, I’ve been reading more and more of the work of Marshall Ganz (and wish that I had an earlier introduction to his body of work!).

Ganz worked for United Farm Workers for sixteen years before becoming a trainer and organizer for political campaigns, unions, and nonprofits. He is largely credited for the success of the Obama grassroots campaign. 

Why am I writing about him now? 

Well, let me draw your attention to this article: Leading Change: Leadership, Organization, and Social-Movements and in particular, the section on telling stories. I try to help health care workers see themselves as agents of change. In trainings, I aim to include elements that work to build motivation and build a sense of unity between health care workers and their community and patients.

Whenever I am working to develop a curriculum or health care worker training, I like to ask three simple questions:

  • What should the participants know?
  • What should the participants be able to do?
  • How should the participants to feel about whatever they are doing/learning?

This is, of course, a re-visioning of the standard “know-do-understand” model of curriculum development. There are times when we need to ensure that health care workers are not perpetuating stereotypes or messaging treatment options in ways that may be alienating to patients.  By helping to frame the story of health care, we can also help to ensure that patients receive the best possible care.

How do you incorporate storytelling into your work?

Surprising Habits of Original Thinkers

I’ve often witnessed an amazing power in collaboration around brainstorming and great ideas; it is amazing when it happens and has led to some of the best work in which I’ve participated.  At times, though, managers will need to nudge their teams along when it comes to brainstorming. We’ve all been in a position where we don’t want to be the one to share the dumb idea or to be the one to suggest something that has been tried before.

This talk by Adam Grant about the Surprising Habits of Original Thinkers and the accompanying discussion guide may help you to appreciate how your team may process their ideas, come up with creative ideas, and communicate about those ideas.

In global health, we strive to be innovative and come up with creative approaches to solving complex health issues.  It is a task with significant weight–truly lives are on the line.

Might you be up for leading your team in a discussion about creativity and original thinking?  Hopefully we can help to support the creativity of our teams and help to grow comfort in thinking about the same old problems in new sorts of ways.

PS: The Lean In website has lots of great resources that you can use. I am a fan of the discussion guides that can be used to guide our teams through difficult conversations or to help set team norms.

 

Everyday Leadership

This week, I have been thinking a lot about the role of a manger and how complex it can be between driving a project or program forward, supporting our teams, helping our teams grow and develop, and strategizing about the future.

At times, our own growth and development can get lost in the mix. For me, I have had a wonderfully fulfilling time focusing on my career. My development has certainly not made it to the top of my to-do list. So, today, in some ways, I am letting us all off the hook.  There are many moments where we can seize the moment to be a good leader without planning or forethought. There are leadership moments at every turn.

Take a few minutes to watch this Everyday Leadership talk by Drew Dudley where he describes the everyday leadership as “lollipop moments”.

His call to action for us today is…”that we need to get over our fear of how extraordinarily powerful we can be in each other’s lives. We need to get over it so we can move beyond it, and our little brothers and sisters and one day our kids — or our kids right now — can watch and start to value the impact we can have on each other’s lives, more than money and power and titles and influence. We need to redefine leadership as being about lollipop moments –how many of them we create, how many we acknowledge, how many of them we pay forward and how many we say thank you for. Because we’ve made leadership about changing the world, and there is no world. There’s only six billion understandings of it.

Let’s start our day by thinking about someone who has made an impact in our lives—who should you acknowledge and thank today? How are you going to pay forward the impact that person had on you?  How can you make your team feel like they have an “everyday leadership” role on your team and in our work?

Enjoy the everyday leadership in your day!


Want to watch this with your team? Awesome!

Here are some discussion questions that might help to spark a conversation!

  1. What is a lollipop moment?
  2. What does Drew Dudley mean when he says, “As long as we make leadership something bigger than us, as long as we keep leadership something beyond us, as long as we make it about changing the world, we give ourselves an excuse not to expect it every day from ourselves and from each other”?
  3. How can lollipop moments can change our understanding of leadership?
  4. Who has shaped you are in a positive way? What specific things has that person done to help you?
  5. What are some big moments or milestones in your career? Who were important in making those moments happen?
  6.  Who helped you reach those accomplishments?
  7. Who is someone you never thanked for something they did for you?
  8. How can we have more lollipop moments as a team?

Book Report: With Charity for All: The Terrible Truth of Charitable Failure

Ken Stern, a former CEO of NPR, chronicles ways in which non-profits are financial nightmares…from overpaying CEOs, to failing to deliver on programatic promises, and finagling suspect non-profit tax breaks.

He posits that the non-profit machine keeps churning because donors do not do their homework. We donate to a charity when a friend is fundraising on Facebook. We buy the wrapping paper because out nephews are hawking it and don’t give a thought to the beneficiary. And, oh yes, I will gladly buy those Girl Scout cookies (I will gladly support girls empowerment with inclusion of LGBT kids!)!

He also writes about non-profits that have detriment effects–like D.A.R.E. Did you know that kids who went through a D.A.R.E. program are MORE likely to try drugs? There are even more organizations who can’t prove the effect of their work; maybe they have a positive effect, maybe not. In an ideal world, every non-profit will have a skilled monitoring and evaluation team working to ensure that programs are on track. Sometimes, for small organizations, that isn’t quite feasible. When I was a Peace Corps volunteer, I worked at a very small organization with just three of us working full time. We kept track of some key data and could certainly show an effect of some of our work. Could our M&E systems have been more robust? Sure–but that would have required another person on staff!

He makes the point that non-profits are often judged on their ratio of programmatic spending to overhead. Big overhead = bad. Oh, how I wish that donors would see a big picture. Non profit employees often earn less than for-profit counterparts and are still expected to have the same level of investment in terms of their education and professional development. The lowly non-profit workers are often strapped with debt, living with roommates until 35, and eating Ramen for far longer than anyone should. Interested in learning more about this aspect of the book and indulging in my tangent? Watch this great TED Talk by Dan Pallotta.

So, what are we to do?

Stern suggests greater government oversight, a requirement for non-profits to reapply for their government non-profit status, and for non-profits to invest more time and energy into measuring the results of their work. But, for donors, some of the onus is on us to dig deeper into organizations we wish to support–he urges us to look beyond HOW the money we donate is spent to the RESULTS of that spending. Certainly good advice! If you need some help deciding or don’t wish to do the research yourself, GiveWell.org is a great resource for reviewing charities you are considering.

I am also asked frequently what organizations I donate to– sometimes knowing someone in the industry is helpful. I have an eye on the budgets of the some of the places where I work and being in the field helps to know which organizations have an ethos that aligns with my own (like Partners in Health) and which ones do not (like World Vision). If my ethos and values align with yours, I’d be happy to chat!

Book Report: The Invisible Cure

I read The Invisible Cure, by Helen Epstein, at least ten years ago when I was on a particularly fevered quest to learn as much as I could about HIV. I was so impressed by her work that I later went to a talk that she gave about her work.

Epstein moved to Uganda in 1993 to work on an HIV vaccine. She worked across sectors, with politicians, activists, researchers, doctors, economists, and so on.

She challenged the prevailing orthodoxy and the struggled to understand how politics and greed can infect and corrupt even the most honorably motivated humanitarian projects. For me, I am always impressed by stories, like those told in The Invisible Cure, about the power and potential of grassroots community organizing as the most effective solution to community problems. She offers insight into the thoughts of the Ugandans with whom she is working:

“As a woman living with HIV,” says Beatrice Were of Uganda, “I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives.”

The story that is told is one that focuses on the Ugandan solution to the Ugandan Problem. The story takes place in the Bush era (so prepared to be fired up about major failings due to political ideologies!) and focuses on the successful reduction of new infections that stem from, Epstein argues, not the billions of dollars from the West, but from the “collective efficacy” of a “shared calamity,” where people helped each other and talked openly about sex, sexuality, and HIV. The reduction of HIV incidence in Uganda focuses on the “B” of the old ABC prevention methods (abstinence, be faithful, condomize). The “A” was problematic as a huge portion of infections were happening in marriages. The “C” was problematic because there simply were not enough condoms to go around at that time. So, Uganda focused on the “B”. President Yoweri Museveni called for “Zero Grazing” as a means of limiting the numbers of concurrent partners that Ugandans (and other groups, too) had. And it worked. Dramatically. Before there were millions in funding for HIV prevention.

In reflecting on the ten years that have lapsed since I read this book…all I can think is “thank goodness”! Thank goodness that we have more in our HIV toolkit than A, B and C. Thank goodness treatment is now much more widely available. Thank goodness we have gotten from a place of encouraging “Zero Grazing” as national policy to a place where we are aiming for 90% of those taking drugs to be virologically suppressed—an HIV prevention tactic I was longing for in the 90s and early 2000s.

Of course, the dark lessons, of the bumbling western influence into the affairs of other countries continues.  “Everyone seems to know what Africa needs, but sometimes I think our minds are not really on it,” she writes. “Most of us see only Africa’s contours, and we use them to map out problems of our own. Africa is a career move, an adventure, an experiment. It fades into an idea. We aren’t really looking.”

Those lessons around the neo-colonization that is funding, aid, and imperialism are still ever present. While times have changed, I still recommend this book for you public health junkies out there. It offers a compelling look back and lessons around the importance of community involvement, questioning what we think we know, and challenging the status quo.