Antifragile: How Lincoln and the Marines Can Help Transform Healthcare

I left off my previous post with a mention of becoming antifragile. Today’s installment deals with volatility of systems in healthcare and nature, and how we can recognize fragile organizations and help them become antifragile.

Nassim Nicholas Taleb created this concept. In his book, Antifragile: Things that Gain from Disorder, he categorizes systems related to the impact of volatility. He says there are three fundamental types of systems in nature – fragile, robust, or antifragile:

• Fragile systems display a much bigger downside than upside to volatility
• Robust systems are basically unchanged by volatility
• Antifragile systems are improved by volatility

This is one of the smartest frameworks for everything that I have read. It is my favorite book, and I have read it three times.

Let’s first examine fragile systems. According to Taleb, these systems are generally guided top down, by stringent rules and processes (note the connection to the last blog in the Netflix slide deck). These companies and business sectors are constantly threatened by perceived changes in funding streams for their organizational survival. Does this sound familiar in healthcare?

Taleb further thinks that these are the systems most susceptible to negative Black Swan events – statistically infrequent, but likely occurrences, like the Great Depression, the recent housing market crash, and 9/11. He outlined these thoughts in his famous book, The Black Swan, (Not to be confused with the Natalie Portman movie.)

Robust systems, however, are not greatly changed by volatility. Think about the skin of airplanes, roads, bridges, etc. While there are impacts of volatility over time, these things do not go through dramatic changes on a day-to-day basis.

Antifragile systems tend to get better with volatility. Almost anything alive needs volatility to survive. Think about exercise – energy production from oxygen and respirations with the volatile compound, oxygen. Also, bottom-up systems, like those entrepreneurs use, are antifragile.

Therefore, a key question is – how do you transform fragile systems into antifragile systems? The answers come from some unlikely sources.

Let’s go back to the 1860s. Abraham Lincoln was president and faced one of the most extraordinary situations in US history. We were at war with ourselves – brother against brother, family against family, North against South. Lincoln’s sole focus was restoring a single Union. That was his “why.”

The Doris Kearns Goodwin book, Team of Rivals, highlighted how Lincoln went from fragile to antifragile. This amazing book of leadership chronicles Lincoln’s journey: unknown lawyer from Illinois to coming out of nowhere to becoming President of the US.

Lincoln asked his biggest critics – and the country’s most capable leaders – to form his cabinet. He did so because he thought this group of gifted men could help him best resurrect the single Union. Acting selflessly toward a singular “why” allowed Lincoln to be committed to a pure purpose, rather than a specific plan. A true purpose can help us be antifragile.

Turning to modern day, the U.S. Marine Corps gives more insight into antifragile organizations. The Marines decided not to be the fighting force on land, sea, or air but instead the first to enter unsettled, complex situations (volatility) and come up with implementable solutions. In this way, they seek volatility. In this way, they have become antifragile.

In the book Corps Business: The 30 Management Principles of the US Marines, David Freedman provides several lessons to guide organizations on how to transform toward antifragile.

• Assess the situation and once you are 70 percent confident you have an implementable solution, do it. Plan, do, assess, and refine – like entrepreneurs. More doing and experimenting, and less constant planning.
• Simplify the problem to the essence.
• Limit the variables to three. People can keep track of only three variables in stressful situations.
• Focus on the small team.
• Reward failure and learning. Failure occurs when something doesn’t work and you quit. Learning is what happens when you fail, adjust, and keep going.
• Glorify the lower parts of the organization and demand to be questioned. Leaders are there to serve others. When leaders remember who is doing the real work, results improve.
• Manage by end state and intent. Focus on the purpose or “why.”
• Instill values that support the mission and keep plans simple and flexible.
• Experiment obsessively and always seek outside opinions.

How can we use this playbook in healthcare at West Virginia University?

Since our “why” is tangibly improving the health of our state’s citizens, any activity that gets us closer is valuable. By believing in our teams, empowering and supporting them in coming up with creative ways to get there, and relentlessly adopting the best plans implemented by different parts of our organization, we will become antifragile.

Smart people, pure purpose, teamwork, and connection to “why” give every organization the opportunity to become antifragile.

Can we achieve this goal and rise above the rest by Going First?