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The Immediacy of Need

November 16, 2011

When I travel to Boston for an EMBA session, I arrive a day early so that I can work the Emergency Department (ED) at Massachusetts General Hospital (MGH). I study the logistics of patient flow for BluPanda, one of Disruptive’s subsidiaries. It’s something that I’ve done at other hospitals for the last three years. I began working the ED at MGH on Orientation Weekend and will likely continue to do so throughout the entirety of the EMBA program.

Each time that we begin a new EMBA session at Sloan, I walk into class that first morning still processing the immediacy of the prior day’s MGH experience. It drives me. It brings out an aggressive need to soak up absolutely everything that Sloan can throw at me. The ED wads up all of your achievements and shoves them right down your throat. The ED strips you naked and hammers you with the realization that you just aren’t good enough. You know it the moment you face your first rape victim. Your first burn victim. Your first overdose. In that moment the Immediacy of Human Need  kisses you fully with fetid lips. Throw your scrubs in the laundry. They’ll come back clean, but your soul never will.

I know I’m not good enough. It’s why I’m at MIT.

The Human Experience of the Emergency Department disturbs. Clinicians develop a fairly tough emotional shell in these environments, but I have not managed to do that yet, perhaps because I don’t work there every day. My inability to remain detached is a significant and regular contributor to my MIT EMBA experience. MGH creates a sense of immediacy in my education. It creates powerful, visceral, and incredibly clear human motivators that remind me of why I need to become a better leader and a better manager. The MGH experience reminds me that ordinary people are depending upon me to change the world. In the ED, you see it in their eyes. Go to class and learn… for our sake.

Last Thursday, I worked Acute, which is where the most serious emergency cases are cared for. Motor vehicle accidents, severe burns, heart attacks, strokes, and other emergent conditions that require or may soon require advanced emergency care are sent to Acute. Of all of the patients requiring acute care, I find that Stage IV cancer patients get to me the most. In the latter stages of cancer, patients come to the ED in need of very powerful pain control medication as the disease essentially destroys their bodies. The pain that they experience is simply awful.

One of my patients this week was a man in his mid 50’s with Stage IV cancer. He presented in need of pain management, accompanied by his wife and his 70-something father. He was in such severe pain that his body kept shaking, yet he did not complain despite what he was going through. When I’m studying logistics, I stay with the nurse through everything. It’s important to watch the details of what she’s doing as she delivers care. So I’m always right there  on the periphery of the point of care, with the nurse, the patient, and the family. You see it all, whether you want to or not.

It was the father that got to me.  You could see it in his face, as he sat there watching his son suffer, waiting for someone to bring him relief. I have four sons and absolutely reeled at the thought that one day, forty years from now… can’t even write it. There but for the Grace of God go I. That is the Immediacy of Human Need.

Immediacy of Need cannot be avoided in the ED. It splatters on you, if you aren’t careful. But Immediacy of Need exists in every industry because every industry ultimately serves a human end. Whatever you’re doing, wherever you’re working, you’re part of a value chain that ends at a human being. When you’re in the ED, every sense of abstraction is torn away. The human is right there, lying in front of you on the gurney. There’s no data. No layers of management… there’s nothing between you and him. Between you and her. Two of God’s creatures sharing the ultimate management experience – one in need, one trying desperately to figure out how to fulfill it.

The limitations of management are on display all around you in the ED.

Adam Smith proposed capitalism as the social system most capable of efficiently providing for the needs of humanity by cleverly harnessing man’s inherent greed (profit motive) toward the betterment of mankind (unmet market needs). It’s a rather intriguing notion that our self-serving nature can, when properly rewarded, best provide for the needs of those around us. I am a huge proponent of Capitalism, yet despite my enormous respect for the institution, it is showing its cracks. Businesses have reached a scale and complexity far beyond what I believe Adam Smith could have imagined. This scale has created enormous distance between managers and owners, on the one hand, and between managers and customer need, on the other, almost Invisible Hand.

Managerial capitalism is the malignant effect of scale imposed  upon the Agent Problem, where management teams become more focused on enriching themselves than on performing their fiduciary duty. The corollary between managers and customers has no formal name, so far as I am aware, but manifests itself as the inability of management teams to understand their own customer’s experiences. Our own clients become invisible to us and we lose touch with the very problems that our businesses exist to solve. The Invisible Client lies hidden in the data, three levels down in the bureaucracy, even as he lies on the gurney in desperate need of pain medications. He’s only Invisible if you choose not to walk into the room.

Walk into the room. Go there and live that man’s Immediacy of Need. Yes, it’s painful. But it will make you a better manager. It will put you in touch with the very reasons that you should be pursuing a management education. Businesses exist to fulfill some unmet need. I’m asking you to go and experience that need first hand. Live it. Touch it. No matter what it does to you and you’ll be a better person. A better person. A better person. And your desire to help will make you a better leader and a better manager. When I walk into class at Sloan, I bring these experiences with me. It makes me a more serious, more driven student and I learn… for his sake.

The Immediacy of Need is what Action Learning is about. We have reached a point of scale and complexity in business that senior managers, the very people who are responsible for driving the entire organization to find and fulfill that unmet need, cannot ask the world around them to stop while they learn. The kinds of managers who come to the MIT EMBA program are desperately needed to solve their organization’s problems today, not two years from now. They can’t ask the dying man to lay there for 24 months while they figure out how to be a better leader. The world is waiting. Tick tock. Tick tock. No one can stop the clock.

Action Learning says that you CAN help the dying man. Come to MIT. Become a  better leader and then rejoin the fight. Go back to your work. Build a better, more capable organization and relieve some of the suffering that you see around you. Nelson Repenning wants to create the people who will change the world. Let’s make damn sure that we begin by rejecting the notion that changing the world takes decades. 37 years have now elapsed since Wally Broeker’s seminal paper on global warming was published in Science. How much carbon was needlessly emitted into the atmosphere in that time?  The Immediacy of Need calls for us to apply our talents such that the human, global response to the very problems that impact our quality of life, our dignity of living, and ultimately our very lives matches the time scale of our needs.

Action Learning doesn’t work without the right candidates. There is an Immediacy of Need in the MIT EMBA program for just the sort of people who, without hint of cynicism, believe that they are here to embody a new generation of leadership. MIT needs people to offer themselves up  as the very matter that will carry out Nelson Repenning’s charge to change the world.

If you are thinking about applying to the MIT EMBA, you may be wondering when to do so. Should I apply now? Or should I wait another year… or two… I struggled with exactly that issue in my own application process. I thought about delaying even after my acceptance. Upon being accepted, a few of my advisors told me that perhaps I should decline or seek a one year deferment. Many reasons were cited. The company was too young. Understaffed. Underfunded. The twins were only two years old, how is your wife going to manage five children without you. The doubts crept in, or were surfaced by others.

If you doubt… walk through the waiting room of your local Emergency Department and feel the needs of humanity sitting all around you. Look at these people and then look deeply at your capabilities as an executive. You’ll feel like you just aren’t good enough… we all did… we still do.

Come to MIT and help us to address the Immediacy of the World’s Needs…



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