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Nothing is rotten in the state of Denmark

17 May 2018

I am sorry to correct Shakespeare, but nothing is rotten in the state of Denmark. I should know—I just spent a few days there. True, I didn’t get into any of the deep, dark Danish secrets, the way Shakespeare did. But I did have enough exposure to be charmed by the Danish differences.

Denmark has its act together. In today’s world, that’s different!

The first thing you see, as you line up at border control, is a sign that says “Find your passport”, then another that adds “Open passport on photograph page”, followed by a third that states “Hand over passport like this.” Charming… and telling. You’re not even in the country yet, and the stage is set: do your bit of personal effort for the collective good.

I am sorry to correct Shakespeare, but nothing is rotten in the state of Denmark. I should know—I just spent a few days there. True, I didn’t get into any of the deep, dark Danish secrets, the way Shakespeare did. But I did have enough exposure to be charmed by the Danish differences.

Denmark has its act together. In today’s world, that’s different!

The first thing you see, as you line up at border control, is a sign that says “Find your passport”, then another that adds “Open passport on photograph page”, followed by a third that states “Hand over passport like this.” Charming… and telling. You’re not even in the country yet, and the stage is set: do your bit of personal effort for the collective good.

Into Copenhagen you go, to find out that the prices are outrageous. That’s because the income disparities are not outrageous. I read somewhere that McDonald workers here earn about $25 an hour (they are unionized, like 70% of the Danish workforce), so they live middle class lives. Hence a Big Mac costs about a buck more than in the U.S. Is this too much to pay for inclusive democracy, let alone social harmony?

You take a taxi and hand your credit card to the driver, who declares “no tip” as he enters the amount on the meter. No subordination here. No Uber either. Instead, bicycles, galore. The Danes discovered the obvious—that what is destroying almost every city on earth is more roads to accommodate more cars that attract more cars which require more roads. Instead of going with this flow, the Danes reversed it and brought back the bikes, favoring them in the city as well as installing paths for them in the countryside. In the capital, bikes can ride on some subway cars and buses, and parking for them is plentiful in the center. Hence 60% of Copenhagen commuters now go by bike, 46,000 of them daily across one bike bridge alone. The guy who designed that bridge says that Copenhagen has the most beautiful rush hour in the world!

If you rent a kayak in the harbor for an hour, you pay nothing if you bring back a bucket of trash. Imagine that: imagination! In the hotel where I stayed, the carpet in the elevator tells you which way to go to your room. (Don’t we all stare down anyway?) More imagination. And then, in your room, you find a basket balanced across the three sectors of recycling.

More soul too. We visit a war memorial for fallen Danish soldiers. It’s a subtle, simple place.  The names of just over 100 soldiers are inscribed, and so are the 47 countries where they fell. Turns out this is to commemorate peacekeepers. How many countries have a memorial dedicated to the soldiers who fell for peace?

Had I stayed a few more days, I’m sure I would have found something rotten in the state of Denmark. (Good thing I didn’t, for the sake of this title.) Maybe I would have found garbage that was rotten in the state of Denmark, or at least rotting. But then again, in Copenhagen they built a big incinerator to burn it—and, being Danish, they designed it with a long slopping roof, using some of the energy generated from it to make snow for the skiers of this flat country. Charming, so charming.

In polls, the Danes come out as the happiest people on earth. Is this why they get their act together? Or is it because they have their act together? Yes.

Helping all this along, the Danes keep the financial sharks at bay, so to speak: most of the major Danish corporations, such as Carlsberg, LEGO, and Novo Nordisk, are controlled by foundations. One figure put the number of such Danish companies at over 1300, with the publicly-traded ones comprising about two-thirds of the total market capitalization of the Copenhagen Stock Exchange.1 This can help them to do better for all, instead of grabbing more for the few. In 2015, the Harvard Business Review named the CEO of Novo Nordisk the best-performing CEO in the world… and he was one of the lowest paid among the top candidates! Does he suffer? Maybe he hides a Maserati in his garage while cycling to work, thus helping to keep the country in balance.

I have written much in these TWOGs about balance across the public, private, and plural sectors of society. On the roads of Denmark, you have this balance exemplified: the community pluralism of the bikes, the private individualism of the cars, and the public infrastructure of the state, all working together. A true PPPP—public, private, plural partnership. These little islands are leading the world, just as they have been in the use of renewable energy.2

Something is rotten in the state of the world. If the Danes can get their act together, how about the rest of us?

© Henry Mintzberg 2018. My book Rebalancing Society was unintentionally written about the state of Denmark.

1Steen Thomsen “Industrial Foundations in the Danish Economy”, (Center for Corporate Governance, Copenhagen Business School, 19 February 2013)

2See our article “Worldly Strategy for the Global Climate”,  forthcoming in the Stanford Social Innovation Review in September.

Can a loose cannon have a strategy?

30 April 2018

So…can a loose cannon have a strategy? Sure, once we realize that we use the word strategy in a way that we never define it.

Strategy may be defined by intention, but it has to be realized in action.  An intended strategy looks forward, as some sort of plan or vision into the future—whether or not it will be realized. A realized strategy looks back, to some existing pattern in action, namely consistency in behavior—whether or not it was intended.

So…can a loose cannon have a strategy? Sure, once we realize that we use the word strategy in a way that we never define it.

Strategy may be defined by intention, but it has to be realized in action.  An intended strategy looks forward, as some sort of plan or vision into the future—whether or not it will be realized. A realized strategy looks back, to some existing pattern in action, namely consistency in behavior—whether or not it was intended.

How about Donald Trump? With regard to migrants and refugees, Muslim and Mexican, he has certainly had strategy, intended as well as partly realized: keep them out and get them out. In other words, his actions have been consistent with his stated intentions: With regard to much else, however, by the dictionary definition of strategy, Trump has been a loose cannon, shooting off his mouth in all directions, frequently contradicting, not only reason, but also himself. Where’s the strategy in that?

As for realize strategy, a host of Trump’s actions speak louder than his words, and differently, in fact rather consistently. Consider the following ones: picking fights with established allies while cozying up to autocrats; challenging existing trade agreements and long-standing alliances; repeatedly attacking the FBI, the Justice Department, and the intelligence agencies; emasculating the Department of State by leaving so many posts unfilled while proposing drastic reductions in its budget, alongside that of other major departments; and championing tax cuts that could paralyze the government and wreak havoc in the society.

Pattern may be in the eyes of the beholder, but it is tough not to behold this one, however outrageous it may seem: Donald Trump appears to be taking down the government of the United States of America. This is not your usual neo-con agenda of less government; it looks to be a concerted attack on the American state itself. 



Why would the president of the United States do such a thing? In his own terms, what’s in it for Donald Trump? Maybe more to the point, what’s in store for Donald Trump if he does not do this? To answer these questions, please understand that realized strategy need not be driven by an actor’s own intentions; it can be driven by the force of circumstance, even by the intentions of some other person able to exercise power over that actor.

Who might be able to do that? The answer seems evident enough. Were Vladimir Putin president of the United States, could he be doing any better for Russia? “Trade wars are good” said Donald Trump. Sure, for Putin’s Russia. It looks like Donald Trump’s realized strategy is executing Vladimir Putin’s intended strategy.

On the other side of this coin, the Mueller Inquiry has indicated that the Russians were determined to see Donald Trump elected. But why would they want a loose cannon in the White House, such an obvious threat to their security? Because, in Putin’s pocket, Trump has not been a loose cannon at all, but a straight shooter—consistently in the direction of Russian interests. (Has his recent rash of actions in the Ukraine, Syria, and the sending home of Russian diplomates changed that? Coming suddenly and all together, they look suspicious: a smokescreen to obscure his real agenda?)

What might Putin have on Trump? Some video shot in a hotel room? Undisclosed evidence of Russian collusion in the Trump election? More likely, the capacity to call in loans that would bankrupt Trump’s businesses. Regardless of the reason, what matters is Trump’s behavior. What matters more is the threat this poses to the security of all of us.

© Henry Mintzberg 2018. Following on this, I am preparing an article entitled “Donald Trump is not the problem.”

The Great Strength and Debilitating Weakness of Modern Medicine… and Management

30 March 2018

Medicine has made profound advances in treating many diseases, but in its great strength lies its debilitating weakness.

Organizing for Professional Work 

To understand this, consider how professional work tends to be organized. Much of it is rather standardized, carried out by highly-trained people with a good deal of individual autonomy—at least from their colleagues, if not from the professional associations that set their standards. Just as the musicians of a symphony orchestra play in harmony while each plays to the notes written for his or her instrument, so too can a surgeon and anesthetist spend hours in an operating room without exchanging a single word. By virtue of their training, each knows exactly what to expect of the other.

Medicine has made profound advances in treating many diseases, but in its great strength lies its debilitating weakness.

Organizing for Professional Work 

To understand this, consider how professional work tends to be organized. Much of it is rather standardized, carried out by highly-trained people with a good deal of individual autonomy—at least from their colleagues, if not from the professional associations that set their standards. Just as the musicians of a symphony orchestra play in harmony while each plays to the notes written for his or her instrument, so too can a surgeon and anesthetist spend hours in an operating room without exchanging a single word. By virtue of their training, each knows exactly what to expect of the other.

Accordingly, much of modern medicine does not solve problems in an open-ended way so much as categorize patients’ conditions in a restricted way. Each is slotted into an established category of disease—a process known as diagnosis—to which an established, ideally evidence-based treatment—referred to as a set of protocols—can be applied.

This standardization is not, however, absolute: it takes the form of tailored customization. (See our article Customizing Customization.) The predetermined standards—those protocols—are tailored to the condition in question. The patient presents with a pain in the chest; the diagnosis indicates a blocked artery; a particular stent is installed in a particular place; and an administrative box is ticked so that a standard payment can be made.

Misfits 

The great strength of modern medicine lies in the fits that work. The patient enters the hospital with a diseased heart and leaves soon after with a repaired one. But where the fit fails can be found modern medicine’s debilitating weakness. Fits fail, more often than generally realized, beyond the categories, across the categories, and beneath the categories.

Beyond the categories lie those illnesses that fit into no predetermined category of disease. The patient may not be treated at all—indeed, sometimes dismissed as a hypochondriac—or forced into an inadequate, if convenient, category. Think about IBS (Irritable Bowel Syndrome), a label for ignorance, or some auto-immune conditions.

Across the categories fall those patients with multiple conditions that fit several disease categories concurrently. If these can be treated sequentially, the professional model of organizing is preserved. He or she is sent from one specialist to another. But where the conditions interact in more complex ways, as in many geriatric cases, more open-ended, collaborative problem-solving can be required. (The chief of geriatrics in a Montreal hospital, big on teamwork, used to say that a physiotherapist was their best diagnostician.) While geriatric departments may be encouraged to engage in such collaboration, much of the rest of medicine, where multiple diseases implicate different departments, each grinding in its own mill, does not. How often do we hear from frustrated patients: “Why can’t they just speak with each other, instead of passing around these little notes while I am being asked to describe my condition again and again?” 

Beneath the categories lies a misfit that is no less common, or significant, than the other two. The fit is correct, but insufficient for effective treatment. Here medicine has to get past the “patient”, to the person.

Dr. Atul Gawande, in a New Yorker article entitled “The Bell Curve” (6 December 2004), reported on his observation of a renowned cystic fibrosis physician. He wrote the protocols that others used, yet had much better results. Meeting a young woman, and seeing a reduced measure of lung-function, he asked if she was taking her treatments. She said that she was. But he probed further, to discover that she had a new boyfriend and a new job that were getting in the way of taking those treatments. Together they figured out how she could alter her schedule.

Here, then, lay the good doctor’s secret: he treated the person and not just the patient, by delving beneath the medical context, to her personal situation.

Management and Medicine Alike

Of course, too much contemporary administration hardly encourages this kind of probing. If the administration of that doctor’s hospital was managing in the modern way, it may have questioned why he was spending so much time with this one patient. True she might live longer, but how to measure that in a budgeting system focussed on current expenditures?

Before any physician jumps on this point with great glee, he or she would do well to recognize that the management weakness here is not fundamentally different from that of medicine. Both suffer from an excessive tendency to categorize, commodify, and calculate—indeed, much like the rest of modern society. (See my TWOG on pat and playful puzzles.) Are managers who claim that “If you can’t measure it, you can’t manage it” any more sensible than physicians who claim that “If it’s not evidence-based, it’s not proper medicine”? Subscribing to either canon would close down both management and medicine.

Evidence-guided medicine is fine, as is evidence-guided management. That good doctor used the evidence presented to him. But he probed beneath it, to that woman’s experience. Within and across the categories called medicine and management, physicians and administrators alike would do well to get past their common debilitating weakness, to engage collaboratively for better health care.

© Henry Mintzberg 2018, drawing from my book, Managing the Myths of Health Care