Ben White

Management by Values

01.16.24 // Miscellany

Steve Jobs, as collected in Make Something Great:

There’s a lot of management techniques. I’m sure you study a lot of management techniques. When I was younger, it was management by objective. It’s all a crock. They’re all after-the-fact management techniques: “You’ve failed, and I know that because we are going out of business tomorrow.” All after the fact. “You’ve ruined this department; all the good people have left. So now I’m firing you.” “You’ve accomplished none of your objectives.” It doesn’t work.

And a really smart guy I met a long time ago who used to teach at Disney University—Walt Disney recruited him to run Disney University, actually—he told me about his point of view, which I’ve remembered to this day. He called it management by values. What that means is you find people that want the same things you want, and then just get the hell out of their way.

The way I describe it is, let’s say we’re all going to take a trip together. The first thing is to figure out where we all want to go. The worst thing is if we all decide we want to go to different places. You can never manage it. [Pointing] You want to go to New Orleans. You want to go somewhere else. I want to go to San Francisco. You want to go to San Diego.

It doesn’t work. Right?

But if we all want to go to San Diego, that’s the key. Then we can argue about how to get there. [Pointing] You think it’s better to walk. You think it’s better to take a plane. You think it’s better to take a train. We’ll figure that [part] out. Because if I say, “I want to take a train to San Diego,” and somebody goes, “That’s really stupid! It will take three days! We can fly and be there in an hour,” I’ll go, “Oh. OK.” Because, actually, I want to go to San Diego. So if I can get there in an hour [flying], I’ll ditch my idea about the train.

That’s what management by values is. It’s finding people with passion that want to go to San Diego—who want to go to the same place you want to go to! Right? That’s the key.

When I think about culture as it pertains to medicine, and how large institutions falter, academic departments implode, and even smaller groups struggle, I think so much of it boils down to this:

There is no management technique to consistently make a group of people want to go to the same place after the fact.

Many management techniques and leadership styles can spoil a great enterprise, but perhaps none can craft one from an unformed mass of individuals, especially not the model of the business suit directing an army of practitioners.

C.S. Lewis (of Narnia fame) on peer learning:

It often happens that two schoolboys can solve difficulties in their work for one another better than the master can. The fellow-pupil can help more than the master because he knows less. The difficulty we want him to explain is one he has recently met. The expert met it so long ago he has forgotten.

I’ve always been a big proponent of peer teaching and peer mentoring in medicine. I also often wonder if I’m getting worse at teaching the basics as I get older.

// 01.15.24

2023 Word of the Year

01.10.24 // Miscellany

The American Dialect Society chose their 2023 word of the year: enshittification.

From its coiner, Cory Doctorow:

Here is how platforms die: first, they are good to their users; then they abuse their users to make things better for their business customers; finally, they abuse those business customers to claw back all the value for themselves. Then, they die. I call this enshittification.

Think every social social media company, Google, Amazon, etc.

I first discovered Cory Doctorow eons ago via his unique science fiction novel set in Disneyland, Down and Out in the Magic Kingdom (which he somewhat famously simultaneously traditionally published commercially and also released for free in 2003 under a Creative Commons license, and which has been available for free ever since).

In unrelated news, Doctorow had a nice linkpost and summary of private equity and hospices last year.

From “How to Do Great Work” by Paul Graham:

Schools also give you a misleading impression of what work is like. In school they tell you what the problems are, and they’re almost always soluble using no more than you’ve been taught so far. In real life you have to figure out what the problems are, and you often don’t know if they’re soluble at all.

Schools sometimes also give students the misleading impression that learning is not fun for its own sake and that writing should be boring.

// 01.04.24

From “The Bitter Lesson” by Rich Sutton:

In speech recognition, there was an early competition, sponsored by DARPA, in the 1970s. Entrants included a host of special methods that took advantage of human knowledge—knowledge of words, of phonemes, of the human vocal tract, etc. On the other side were newer methods that were more statistical in nature and did much more computation, based on hidden Markov models (HMMs). Again, the statistical methods won out over the human-knowledge-based methods. This led to a major change in all of natural language processing, gradually over decades, where statistics and computation came to dominate the field. The recent rise of deep learning in speech recognition is the most recent step in this consistent direction. Deep learning methods rely even less on human knowledge, and use even more computation, together with learning on huge training sets, to produce dramatically better speech recognition systems. As in the games, researchers always tried to make systems that worked the way the researchers thought their own minds worked—they tried to put that knowledge in their systems—but it proved ultimately counterproductive, and a colossal waste of researcher’s time, when, through Moore’s law, massive computation became available and a means was found to put it to good use.

[…]

We want AI agents that can discover like we can, not which contain what we have discovered. Building in our discoveries only makes it harder to see how the discovering process can be done.

// 01.03.24

Paying Attention to Attention

12.13.23 // Miscellany

From “Burned Out on Burn Out” by  Sanj Katyal MD:

As we get older, time seems to fly faster and faster.

And it’s not just a hackneyed expression (it’s that too, of course), but studies really show that we experience time differently as we age. One argument is that we feel time as a fraction of our conscious experience. 5 minutes for my 4-year-old daughter is a much bigger percentage of her life than it is of mine, which is smaller still than for my father in his 70s. Others have argued we experience time as a matter of novelty. When we’re young, everything is novel, and so each day is filled with new things that demand our attention. Less so our more repetitive adult days filled with commutes and office jobs.

Our ability to pay attention to our time is the main thing that has changed.

When we were young, everything was new and captivated our attention. We were fully present as we learned about ourselves and the world around us. As we got older, however, we settled into comfortable routines and mental models of life. The simple wonders of each moment were no longer enough to hold our attention. Play was replaced by work, close conversations with friends were replaced by quick texts and each day started to feel the same. There was not much new to learn or experience in our daily routines so we began looking forward to the weekend, our next vacation or even retirement. This only served to speed up time even more. Many of us are bored with our lives. We seek adventure and new experiences, even if only found on our phones. We can do better.

The problem, whatever the explanation, is that we don’t want time to fly. We don’t want the days to flow into weeks to months to years in a wave of sameness punctuated by rare major events, some of which will inevitably involve hospitals and funerals. Without attending to the day-to-day moments (i.e. the boring stuff), we find ourselves looking forward to the end of the workday or pining for the weekend when we can binge on sleep or entertainment. That boredom and frustration can make us paradoxically want time to speed up for a big fraction of our days just to get to the good stuff.

One truism is that if you do what you love you’ll never work a day in your life. I think this is backward for most people, who don’t magically love things that provide a steady paycheck.

The more achievable goal, especially for someone who finds themselves working a job that doesn’t exactly organically spark joy is to love what you do.

Dr. Katyal argues the solution is to cultivate attention and novelty:

The solution to boredom and routine is to cultivate attention, constraints and novelty about everything we do.

If we can really pay attention to what we are doing (and we do this by imposing some constraints that force us to focus), we can find new things about the task, different ways to do things, and notice something we never noticed before.

This provides novelty which in turn infuses a sense of wonder/fun into our lives.

Playing catch again with my son? How can I throw the ball even harder or ask different questions to have a deeper conversation while catching?

Reading another 100 cases today? Can I identify a subtle finding that explains the patient’s symptoms? Can I read the imaging study like it was my mom’s scan? Can I be thankful that I am able to read a complicated CT and think back to my training when things like this seemed so hard?

Sometimes I think about this reframing: the thing isn’t boring, you’re boring. Boredom isn’t something forced on you, it’s a frame of mind you choose when your lizard brain isn’t being stimulated.

So, maybe, the solution: be less boring.

Private Equity & Piracy Metaphors

11.17.23 // Finance, Miscellany

Time horizons, incentives, and moral hazard: a very enjoyable easy-listening zoomed-out discussion of the Private Equity industry on the Freakonomics podcast.

If you find the discussion of healthcare and PE on this site and others to be too tedious and haven’t learned more about this very large and very important industry, this is a great well-produced episode.

It includes an interview with Brendan Ballou, author of Plunder: Private Equity’s Plan to Pillage America.

(Which is not to be confused with These Are the Plunderers: How Private Equity Runs—and Wrecks—America by the Pulitzer Prize­­­–winning Gretchen Morgenson…there’s a theme here.)

From the short essay, “Energy Makes Time,” by Mandy Brown:

But there’s something else I want to suggest here, and it’s to stop thinking about time entirely. Or, at least, to stop thinking about time as something consistent. We all know that time can be stretchy or compressed—we’ve experienced hours that plodded along interminably and those that whisked by in a few breaths. We’ve had days in which we got so much done we surprised ourselves and days where we got into a staring contest with the to-do list and the to-do list didn’t blink. And we’ve also had days that left us puddled on the floor and days that left us pumped up, practically leaping out of our chairs. What differentiates these experiences isn’t the number of hours in the day but the energy we get from the work. Energy makes time.

The what is sometimes even more important than the how much.

// 09.04.23