If you’re unaware of Jamie Katuna, then you’re missing out on healthcare’s version of Hamilton. Her third video is intended to get everybody in motion, to try something, to experiment with what they can do, rather than waiting for a perfect answer. When you’ve spent the morning having Dave Snowden remind you that sometimes there is no perfect answer, it’s hard to justify walking away.

Surely, I said to myself, I know something that could be useful to her, and those like her. So I asked her what she might find useful.

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Jamie’s amazingly thoughtful response to my question “What skills or knowledge do you wish for?”

When I look back on the frustrations of my 20s, I wish that I had been enlightened enough to ask a question like that one. This question goes straight to my soul, and to the issues that matter most to me. I don’t know if I have a ‘right answer’, but I’ll give it my best shot.

Firstly, let’s address the elephant in the room: Some people really are evil. For some people, the only thing with any meaning at all is their personal wealth, and they squeeze everything they can find to get more of it.

However, in my conversations with senior people in big companies, I’ve found that the highest levels of most big companies are filled with very intelligent people who honestly and sincerely mean to do good things. A man who says “President Mandela said that he needed me to build a school. What choice did I have? We built a school, and we tried to make it a good one,” doesn’t fit well with our imagination of corporate leaders as villains.

But if they aren’t villains, then why do such horrible problems persist?

Why becoming a CEO is the worst

A change in perspective

When I was a senior programmer, I was routinely asked to solve difficult technical problems. In one such case, I worked on a really tough problem for a week before I understood it. Proudly armed with my new understanding, I went to my boss and told him about it, boiling a week of experience into a 5-minute lecture. He looked at me blankly and said, “I don’t understand, I need you to draw me a chart.”

I was greivously offended — I’d given him a perfectly sensible explanation of a really difficult problem, and if he was qualified to be my boss, then surely he could understand what I was saying? I’d boiled a week of experience down to five minutes, how could he possibly expect me to dumb it down any further?

Ten years later, I was managing a development team, a quality assurance team and a support team, spread across two countries (with a two-hour time difference). I had, among many other problems, a really difficult technical problem that needed solving; so I got my best senior programmer, and told him what the problem was.

A week later, in between meetings about 15 different problems, I managed to get 5 minutes to talk to my senior programmer. He explained the problem, and the solution that he’d found. He sounded confident, but my brain was overflowing, and I just couldn’t take it in. How could I help him to help me understand? Of course! “I don’t understand,” I said, “I need you to draw me a chart.”

The look of frustration and pain he gave me was so powerful that I immediately saw what I had done. It was then that I started to realise that the cultural barriers between layers in an organisation happen for reasons other than malice and stupidity.

Distillation of the worst

Elon Musk said something like, ‘As the CEO, you deal with a distillation of the worst problems in the company. Every problem that can be solved lower in the organisation gets solved lower in the organisation.’

If you’re a doctor, then the patient who is dying right in front of you is the worst problem that you’ll be expected to solve. If you’re a manager, then you have responsibility for that dead patient, and all the other dead patients, and the fact that one of your doctors wants to quit because they don’t want patients to die, and they can’t stand watching it happen.

As that manager, the doctor who is threatening to quit is a far more threatening problem than one dead patient — less doctors available to work means a lot more dead patients. Overworked and stressed, you’re unlikely to the combination of time, skill and emotional resources required to be very sympathetic — words you promised you’d never say (like “We all get over it, you’ll just have to do that yourself”) may fly out of your mouth. You then convince yourself that it’s true.

As the CEO? Everything turns into numbers (a vital skill for CEOs is to be able to understand what everything means in terms of time and money, the two vital substances that underlie everything else; CEOs believe they can achieve anything if you give them enough time and money, and they have good reasons to believe it). People will tell you that they can solve your problems for a price, and most of them will be wrong. People will tell you that you can’t possibly achieve things that you have already achieved, and you become deaf to their warnings.

And at every rung of the ladder, you compromise. You can’t save every patient. You can’t save every doctor. You can’t save every hospital. Every step up brings a new level of loss that you can’t prevent: either you accept certain losses as unavoidable, or you stop climbing the ladder, or you burn out, or you destroy yourself.

If you’re going to survive as you climb the ladder, you learn to savour the victories. I managed to save that patient. I managed to retain that doctor. I reduced costs, and that hospital stayed open. You might grieve the losses, or you might dissociate from them.

It’s just hard

Going from being a veteran programmer to a novice manager was painful. So was going from being a veteran manager to a novice salesman. I thought I knew what I was in for when I became a novice CEO, but ‘the real thing’ always finds ways to surprise us.

There are so many things you have to learn. In the process of learning to win the battles, it can be hard to remember what the war was about. It stops being a struggle to achieve lofty objectives, and it becomes a struggle simply to survive. “I’ll make the world a better place tomorrow, after I survive today,” you say to yourself.

Why being a CEO is the best

Eventually, with all transitions, you get over it. You find yourself able to hold on to a point in the ladder, and develop a sense of what’s going on. You no longer yearn for the days when you had the luxury of dealing with only one (or ten, or a hundred, or a thousand) problem at a time. You become able to see things in terms of abstract forces (like time and money), and details stop being horrible distractions.

You learn that it’s not actually your job to tell the company what to do. Your job is to help other people tell you what the company should be doing, and then to set the company to work on doing those things. You listen, you watch, and you avoid the issues where your power won’t make any difference.

People tell you about what’s going wrong, and demand that you fix it. The only way that they can imagine you would allow such a horrible problem to exist is if you didn’t know about it. In most cases, you’ve known about the problem for years. In most remaining cases, the problem that you’ve got is vastly preferable to the problem you used to have. You say “If you have ideas on how to fix it, I’m always happy to receive a proposal” and you pray that they believe you.

People come to you with proposals. Mostly, they are terrible, naive proposals that would never work in the real world, but that’s OK. You try to shoot down the proposal in such a way that they’ll come back with a better proposal next time.

You identify talent and you match it against problems that need to be solved. You put the best talent on the worst problems, and try to show them enough appreciation that they don’t interpret it as a punishment. You watch them screw up, and you try to make sure that they don’t do more damage than the company will survive.

You receive proposals that make sense, that have a good chance of delivering something important, and which you can actually afford to implement. You give those proposals the talent, time and money that you can afford to give them; almost always less than what the proposal deserves, but hopefully enough for it to deliver a positive result.

You identify someone or some group that is passionate about doing something important, and willing to work hard to achieve it. You decide that the cost to your authority from their political mistakes is worth the reward, and you support them openly. With a little luck, they follow enough of your advice to avoid disaster and to deliver something amazing and good. You give a speech where you say “These people did all this amazing work, and we should all be grateful.” You mean every word. When you get home, where nobody can see it, you congratulate yourself for making it possible for them to do all that amazing work.

There’s probably more to it than that. I am a novice CEO, and therefore (as CEOs go) young and naive. Hopefully, this picture of the boardroom is better than nothing.

Written by

Nick Argall is an organization engineer, structuring activities to help businesses achieve their goals. nargall@gmail.com

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