Hands On Medicine and Management

Hands on is good.

My GP is a board certified cardiologist (probably a good thing at my age). Dr. Richard Daum used to run a huge practice in Boston.  Several years ago he moved to Vermont.  He is affiliated with the very good Fletcher Allen Hospital in Burlington but he is a sole practitioner with no medical assistance.

So when you get an EKG and a stress test from Dr. Daum, as I recently did, there are no assistants involved either in placing the probes or administering any part of the tests.  There is the latest technology from the monitors to the tablet he uses for entering history, observations, prescriptions and everything else.  But he places the electrodes, reads the charts, and makes the adjustments.

In a standard American practice I might never have seen Dr. Daum unless he had some bad news to give me.  A technician would have placed the probes, taken the readings, and told me how fast to run on the treadmill.  Dr. Daum would have seen the results and drawn his conclusions from them.  The idea, of course, is that someone as highly trained as a cardiologist shouldn’t waste his or her time in the routine work of administering the tests.  I’m sure the people who do nothing but give the tests are very good at doing that.

But there were some anomalies.  Dr. Daum quickly traced those to instrumentation problems (and too much hair on my chest).  The instruments were replaced; the hair removed; and testing resumed.  During the stress test the computer measuring my heart gave me too many beats per minute for the work I was doing.  Dr. Daum could see from  simultaneous charts that it was counting some of the minor beats as major beats so he could adjust his observations and conclusions appropriately ( he didn’t offer to let me reprogram the computer).

Turns out my heart works fine for now except for a little valve leakage.  But, if Dr. Daum had been reading the results of a test administered by someone else, I think it is quite possible that the anomalies would have led him to the wrong conclusion.  At best I would have had to take the tests again.  At worst I might have been scared or gotten the wrong medical advice.  Being hands on meant that Dr. Daum was seeing the real data and NOT the anomalies.

Same thing works for management – especially for a CEO. You gotta be hands on.  Obviously doesn’t mean you know everything or do everything but you still gotta be hands on.  Otherwise you end up managing either to the anomalies in the data or to badly filtered second-hand information.

I was too hands on as a CEO, didn’t delegate enough.  But I did know what was happening in my companies.  From the beginning we built web access into our monitoring systems at wholesale VoIP carrier ITXC.  Wherever I was in the world, I could watch the flow of voice minutes through our system or between any two locations or carriers in the world; the reports were at most 15 minutes old.  I watched obsessively from the initial trickle until the time we were doing nearly a billion minutes a month and were one of the largest wholesale international carriers in the world.

Often when I thought I saw something wrong, it was an instrumentation error.  Then  I could make sure the instrument was fixed.  Once Network Operations gets too many false alarms, they start ignoring the real ones.  It’s human nature.  Sometimes I spotted things other people didn’t.  That meant either that we needed better tools, better training, or better people. Sometimes I saw opportunities to make things better; sometimes I saw business rather than technical problems – sudden loss of traffic from a specific carrier or too much traffic from a carrier, which meant we better run a quick credit check and make sure we weren’t getting the traffic because everybody else had cut them off.

In departmental reviews or staff meeting, people knew to be prepared to discuss what went wrong and how they planned to fix it.  It’s very important that everyone in the company believe that you have eyes in the back of your head and never sleep so that they will not try to hide problems from you or gloss over them.  It is important that you discover problems before your customers do.

BTW, I had great people at ITXC.  Sometimes my hands on approach probably frustrated them.  I think it also gave them assurance that I knew who was contributing and who wasn’t and that I cared passionately about what they were doing and how they were doing it.  I’m also sure I didn’t know as much as I think I did about what was going on and that they could tell you plenty of what I missed.

When I was at Microsoft in the early 90s Bill Gates was very hands on.  He reviewed every product and strategy regularly and personally.  We always assumed he was attentive although this was a little hard to tell because he often rocked back and forth with his eyes closed during presentations.  But he drilled down.  You brought the people doing the work to many of these reviews and Bill didn’t hesitate to question (or terrorize) them.  Bill remembered stuff from one review to another.  I’m sure he didn’t remember everything but you couldn’t tell what he was going to remember so subtly changing your story (or dates, especially dates) was dangerous.

Being hands on let Bill Gates make the transition from single talent to startup guy to CEO of a fast growing company to world domination.  Don’t know how hands on Bill is now but he certainly was with 10,000 employees.

They say the captain of a ship wakes up if the pitch of the engines or the motion through the sea changes.  You have to have the same sense for your company.  You don’t get it by being an imperial CEO too important to have hands on or talk to the crew.