Part I. Identifying the Anomalies

Part II. EXPLAINING THE ANOMALIES

Shortly after posting Part I, Identifying the Anomalies, I came across a recent study with an insight that could reframe this whole discussion. For me at least, it seems to explain the anomalies. After considerable digging by colleagues (see below), here are the conclusions.

Authored by a number of academics and medical authorities in the north of Italy, the report links atmospheric pollution to the rapid propagation of the Coronavirus: it  attaches itself to minute particles  which can remain in the air—the report claims “even for hours, days and weeks, and that can be carried for long distances.”. But, importantly, other evidence suggests that most of it can remain active that way for only a few hundred meters.¹

If true, then this might explain why people can get infected with no direct exposure, just from the air they breathe where they live. This could also explain why the outbreaks do not hop much from central cities to surrounding towns, sometimes even local suburbs. It also suggests why some places, especially big cities, get major outbreaks, while some others do not: they can be especially polluted by traffic and industrial activity (Wuhan, New York). Compare this with most rural areas, maybe even with favelas that have few cars or big factories (also higher temperatures, which appear to be negatively correlated with the spread of the virus.) Consider terrain as well: cities that are surrounded by mountains that trap polluted air (such as Tehran), and that experience inversions and heavy smog (such as New York), could be more susceptible to large outbreaks than  those in flat areas with stronger winds (such as in the Arab states of the Middle East). 

China and South Korea have been lauded for the isolation of their people to slow the spread of the virus. True enough, but perhaps another significant benefit has been serendipitous: with less driving and many factories closed, pollution has been greatly reduced. Can this explain the two rather abrupt endings to their outbreaks?

Let’s put this together in three levels of transmission: Level 1 is direct and personal—immediate exposure in a room or a park to droplets in the air, from a cough (with evidence now that this can extend beyond two meters), or that fall on a surface that is then touched. Level 2 is local and atmospheric, from particles in polluted air presumably inhaled (or touched when grounded?), most likely in an industrialized city, but not beyond.

In between these first two levels might be institutional and confined, as in senior homes, cruise ships and wedding halls, where problematic particles (aerosols? microplastic particles?) could be traveling through central ventilating systems. This raises a key question: what kinds of particles are most susceptible to carrying this virus around?

Level 3 is global and geographic, namely travel from infected centers to other places in the world. Coronavirus is certainly moving worldwide, but when it lands, how extensively is it spreading? This third level seems to be a combination of the first two levels: The virus could be traveling personally, and spreading directly, for example as someone infected flies in without being quarantined. But it could, or could not, be spreading locally, depending on the local conditions, such as pollution, temperature, wind, and terrain, maybe humidity as well.

What to do with all this? We can reframe our thinking from “It’s coming! It’s coming!” to the virus is coming everywhere but the outbreaks are not spreading everywhere. Hence we can consider where it might it be likely to spread, and, accordingly, how to allocate efforts and equipment. We can study weather patterns, especially wind,  and predict movements of the virus in the immediate area. Areas with outbreaks may have to take aggressive actions to reduce their pollution, for example by closing down polluting plants immediately (also for the sake of global warming—remember that?). Is this the handle off the polluted well? And traffic can be restricted when the outbreak is severe enough (even relying on electric vehicles where possible in the interim).

Guess what Dr Snow, We're back to the air!

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Thank you Nathalie Duchesne for drawing my attention to the Italian study, and to Hanieh Mohammadi and Paola Adinolfi in Italy, as well as Nathalie, for digging out so much useful material.

¹ Most of the viruses are super fragile and if they are flown away by the wind, most of them get deactivated because the outer shell of the virus will be broken. Tests that show the presence of the virus in long distances from the origin of the virus are only tracing the RNA of the virus (ribonucleic acid, a nucleic acid present in all living cells), but most of those RNAs are not active (PCR tests). Previous studies about other viruses, such as Zika and Ebola, appear to reinforce this finding.

© Henry Mintzberg, 2020. 

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Première partie : RELEVER LES ANOMALIES

Deuxième partie : Expliquer les anomalies

Devinez quoi, Dr Snow, on revient à l’air ambiant!

Peu après la publication du billet précédent, j’ai eu vent d’une étude récente (en italien) qui offre une perspective redéfinissant le cadre de la discussion. De mon point de vue, du moins, l’article semble expliquer les anomalies. Après une recherche approfondie menée par des collègues (voir plus bas), voici les conclusions qui ont été tirées.

Rédigé par plusieurs intellectuels et autorités médicales du nord de l’Italie, le rapport établit un lien entre la pollution atmosphérique et la propagation rapide du coronavirus. Selon le rapport, le virus se fixerait à des particules minuscules pouvant demeurer en suspension dans l’air « pendant des heures, des jours, voire des semaines, et pouvant voyager sur de longues distances ». Toutefois, il est important de le noter, d’autres indices semblent indiquer que la plus grande partie n’est active de cette façon que sur une distance de quelques centaines de mètres¹.

Si cela est vrai, alors cela expliquerait peut-être pourquoi les gens peuvent être infectés sans être directement exposés au virus, simplement en respirant l’air ambiant. Cela pourrait également expliquer pourquoi les éclosions ne font généralement pas le saut des villes-centres aux villes avoisinantes, voire parfois aux banlieues locales. Cela semble expliquer également pourquoi certains endroits, particulièrement les grandes villes, connaissent d’importantes éclosions, alors que d’autres, non. Ces endroits peuvent être particulièrement pollués par la circulation automobile et l’activité industrielle (Wuhan, New York). Comparons-les à la plupart des régions rurales, voire des favelas qui comptent peu d’automobiles et de grandes usines (en plus d’avoir des températures plus élevées, ce qui semble avoir une corrélation négative avec la propagation du virus). Considérons également le terrain : les villes qui sont entourées de montagnes emprisonnant l’air pollué (comme Téhéran) et qui connaissent l’inversion thermique et une concentration importante de smog (comme New York [en anglais]), pourraient être plus susceptibles de connaître d’importantes éclosions que celles qui sont campées sur des terrains plats et venteux (comme les États arabes et le Moyen-Orient). 

La Chine et la Corée du Sud ont été saluées pour le confinement de leur population qui aurait ralenti la propagation du virus. C’est probable, mais un autre bienfait important est fortuit : avec moins de voitures sur les routes et plusieurs usines fermées, le taux de pollution a grandement diminué. Cela pourrait-il expliquer la conclusion plutôt hâtive de ces éclosions?

Rassemblons le tout en fonction de trois niveaux de transmission. (1) Le premier niveau est direct et personnel : exposition immédiate dans une pièce ou dans un parc à des gouttelettes en suspension dans l’air, en provenance d’une toux (et nous détenons maintenant des preuves établissant que le virus peut voyager plus de deux mètres), ou tombées sur une surface qui est ensuite touchée. (2) Le deuxième niveau est local et atmosphérique : exposition à des gouttelettes en suspension dans l’air pollué et sans doute inhalées (ou touchées après être tombées sur une surface?), fort probablement dans une ville industrialisée, mais pas au-delà de cette ville.

Entre ces deux premiers niveaux, on pourrait retrouver un niveau institutionnel et confiné, comme une résidence pour personnes âgées ou une salle de réception, où des particules problématiques (des aérosols? des microplastiques?) pourraient circuler dans des installations de ventilation centrale. Cela soulève une question clé : quels types de particules sont plus susceptibles de propager le virus?

(3) Le troisième niveau est mondial et géographique, à savoir que le virus voyage des centres infectés vers d’autres endroits dans le monde. Le coronavirus voyage certes à travers le monde, mais lorsqu’il se pose, quelle est la portée de sa propagation? Ce troisième niveau semble être une combinaison des deux premiers niveaux : le virus voyage personnellement et se propage directement, par exemple lorsqu’une personne infectée prend l’avion sans être mise en quarantaine. Cependant, il se propage ou non localement en fonction des conditions locales comme la pollution, la température, le vent et le terrain, peut-être également en fonction de l’humidité.

Que faire de tout cela? Nous pouvons recadrer notre réflexion. Le « Ça s’en vient! Ça s’en vient! » devient  « Le virus s’en vient partout, mais ne se propage pas partout ». Ainsi, nous pouvons estimer où le virus risque de se propager et comment allouer en conséquence les efforts et l’équipement. Nous pouvons analyser les phénomènes climatiques, particulièrement le vent, et prévoir les déplacements du virus dans la région immédiate. Les zones d’éclosion devront peut-être prendre des mesures drastiques afin de diminuer le taux de pollution, par exemple en fermant sans tarder les usines polluantes. (C’est aussi bon pour contrer le réchauffement climatique, vous vous en souvenez?) Également, la circulation automobile peut être réglementée lorsque l’éclosion est assez importante. (Nous pourrions être tributaires des véhicules électriques entre-temps.)

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Je remercie Nathalie Duchesne d’avoir attiré mon attention sur l’étude italienne et à Hanieh Mohammadi et Paola Adinolfi, en Italie, ainsi qu’à Nathalie, pour avoir déniché tant de données utiles.

© Henry Mintzberg, 2020.

Traduction par Nathalie Tremblay

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¹La majorité des virus sont très fragiles et, s’ils circulent dans l’air, la plupart d’entre eux sont désactivés en raison de l’éclatement de l’enveloppe extérieure du virus. Les tests qui font état de la présence du virus à grande distance de son point d’origine retracent simplement l’ARN (l’acide ribonucléique, un acide nucléique présent dans toutes les cellules vivantes) du virus. La plupart des ARN ne sont toutefois pas actifs (tests PCR [en anglais]). Des recherches antérieures concernant d’autres virus, comme le Zika (en anglais) et l’Ebola (en anglais), semblent corroborer ces conclusions.

Première partie : RELEVER LES ANOMALIES

Deuxième partie : Expliquer les anomalies

La pompe

Il est temps de réexaminer l’histoire du Dr John Snow, qui a été élu par un panel de médecins britanniques comme le meilleur d’entre eux. Cette distinction est venue plus d’un siècle après qu’il ait été écarté par le corps médical britannique pour avoir remis en question la conviction admise portant que le choléra devait se transmettre par l’air. Pendant une épidémie à Londres en 1854, il a marqué d’une épingle sur une carte de la ville chaque endroit où il y a eu un décès. À l’exception de deux, ces épingles étaient regroupées autour d’un puits. Il s’est rendu à la maison d’une des deux personnes décédées ailleurs et a appris qu’elle aimait l’eau de ce puits, qu’elle envoyait sa domestique chercher. Sa nièce, qui buvait également l’eau de ce puits, s’avérait être l’autre exception. Ainsi, alors que le corps médical s’efforçait frénétiquement de contrer l’éclosion de choléra, le puits a été bloqué et l’épidémie a pris fin. Plus tard, on a découvert que des eaux usées s’écoulaient d’une canalisation à proximité et contaminaient l’eau du puits.

Ma spécialité, c’est la gestion, pas la médecine. Toutefois, j’ai examiné les mythes de la gestion des soins de santé (en anglais) dans un ouvrage intitulé The myths of managing health care. L’ouvrage décrit la grande force de la médecine moderne – sa capacité à catégoriser –, ainsi que sa faiblesse débilitante, à savoir le fait de s’enliser dans ces catégories.

Quelques explications viennent cerner la nature et la transmission du coronavirus, toutes vraisemblablement correctes (d’une façon ou d’une autre). Sont-elles toutefois adéquates? Il semble y avoir des anomalies dans les données largement véhiculées. Sont-elles simplement des curiosités ou révèlent-elles des angles morts? Est-ce que la façon qu’a la maladie de se manifester cache quelque chose? Je suis peut-être très mal informé sur ce qui suit, et les choses évoluent si rapidement que certaines notions peuvent être dépassées en quelques heures. Pourtant, si une des idées en apparence ridicules ci-dessous vient aux oreilles d’une personne qui est en mesure de la préciser, alors l’exercice en vaudra la peine. Ainsi, faites fi de votre incrédulité et voyez si vous pouvez en trouver une – une idée ou une personne.

• Partout, au pays comme à l’étranger, on entend : « Ça s’en vient! Ça s’en vient! ». Cependant, ça ne s’en vient pas partout, seulement à certains endroits. Pourquoi en ces endroits? Le taux d’infection et de décès varie manifestement d’un pays à l’autre, d’une région à l’autre, d’un endroit à l’autre, et ce, souvent de façon étonnante. Le virus vient de la Chine, ou du moins de la région de Wuhan. Pourtant les pays voisins sont peu touchés, à l’exception de la Corée du Sud. Il se propage en Italie et en Espagne, mais pas de la même façon en Scandinavie. L’Iran est durement touché; Israël compte de nombreux cas. (Ces deux pays sont d’origine caucasienne.) Toutefois, les pays arabes de cette région sont moins touchés. (Le virus touche vraisemblablement même moins le sud de l’Iran dont la population est plus d’origine arabe.) Y a-t-il quelque chose dans l’air, dans les pratiques, dans l’alimentation? Pourquoi le virus s’est-il propagé de façon catastrophique dans certains espaces confinés plutôt que d’autres : sur des bateaux de croisière, dans des résidences pour personnes âgées et à l’occasion de quelques mariages juifs, mais pas autant dans les favelas du Brésil (dont la densité de population est assurément plus grande que celle d’un bateau de croisière). Il est moins répandu également dans les régions rurales et les réserves des Premières Nations du Canada. Certains pays et certains endroits sont-ils intrinsèquement plus ou moins à risque? Et pourquoi? Nous avons quelques explications toutes prêtes, mais inadéquates. Et si on se penchait sur les anomalies?
• Pourquoi certaines personnes contractent-elles le virus sans y être exposées de façon flagrante? S’agit-il simplement de retrouver l’exposition ou y aurait-il une forme de transmission inconnue? Certaines personnes sont peut-être intrinsèquement immunisées contre le virus et d’autres intrinsèquement susceptibles de l’attraper?
• L’Italie et l’Allemagne sont des pays quasiment voisins. Pourtant, le taux de décès y est totalement différent. Cette donnée peut s’expliquer de plusieurs façons. Est-ce que cela justifie la différence? La population italienne ne peut pas être beaucoup plus âgée que celle de l’Allemagne. Et de vastes équipes chinoises travaillaient non seulement dans le nord de l’Italie, mais aussi dans d’autres endroits où le virus ne s’est pas répandu de la sorte. La planète se divisera-t-elle en plusieurs Italie et plusieurs Allemagne? Le cas échéant, trouverait-on une explication dans l’environnement, dans l’alimentation, dans le mode de vie ou encore dans la culture? Au New Jersey, une famille a été dévastée par des décès dans deux générations. Cette famille est d’origine italienne. Est-ce là une anomalie révélatrice de quelque chose d’important?
• Comment se fait-il que la Chine et la Corée du Sud semblent avoir mis fin à la propagation du virus (jusqu’à maintenant)? Le dépistage et le confinement peuvent-ils expliquer la situation dans un pays de plus d’un milliard d’habitants, alors qu’une personne dans une soirée ou un mariage en Occident peut contaminer des dizaines de personnes? Il n’y a eu aucune fête en Chine récemment?

D’une certaine façon, le Dr Snow est sorti des paradigmes reçus de l’époque. Les paradigmes d’aujourd’hui ne sont pas différents : ils orientent notre réflexion tout en escamotant d’autres possibilités. Le Dr Snow a employé une méthode de recherche inhabituelle au regard des normes médicales actuelles, semblable au travail d’un détective et mieux adaptée pour trouver la cause que le traitement. Son examen d’un échantillon de deux exceptions a éclairé sa cause. Il a d’abord eu une idée, puis il a analysé des données. Sa population était une communauté ciblée.

Grâce à Zoom, je discute deux heures par jour avec plusieurs personnes au Québec, principalement des urgentologues, dont certains travaillent pour le ministère de la Santé. Il n’a pas été facile d’avancer cet argument, et pour cause : ils devaient composer avec la situation. Finalement, au cours d’une de ces conversations, la Dre Joanne Liu, une urgentologue qui vient de terminer deux mandats à titre de présidente de Médecins Sans Frontières, s’est souvenue de l’histoire d’un camp de réfugiés au Bangladesh où une éclosion de choléra annoncée ne s’est jamais concrétisée. Elle s’était interrogée au sujet du sol argileux. Puis, une infirmière de la Colombie-Britannique, responsable du personnel d’intervention des réserves des Premières Nations de la province, a ensuite dit qu’il n’y avait pas encore d’éclosion dans les réserves. En fait, une personne d’une réserve qui avait récemment pris l’avion à côté d’une personne infectée n’a pas contracté le virus.

Nous avons mis sur pied un plus petit groupe sur Zoom, trois penseurs parallèles et trois médecins chevronnés, pour tenter d’expliquer certaines de ces anomalies. Le travail de détective pour trouver la cause doit explorer toutes les avenues possibles. Ainsi, voici quelques pistes plausibles, certaines probablement invraisemblables. Est-ce possible que certains médicaments, outre le fait qu’ils traitent des maladies, rendent des personnes plus, ou moins, susceptibles au virus? On pourrait en choisir quelques-uns des plus courants, des médicaments contre l’hypertension, le cholestérol et/ou l’anxiété, et recueillir des données sur leur utilisation dans des endroits où le virus est plus ou moins actif. (On émet des hypothèses. Alors que je rédigeais ces lignes, Hanieh Mohammadi, une étudiante au doctorat que je supervise à l’Université McGill, m’a envoyé un courriel concernant un rapport en Italie portant que le virus toucherait peut-être plus durement les personnes qui ont une carence en vitamine D.) Ou encore une comparaison entre Israël et les états arabes, et ces mariages juifs? Est-ce qu’il y aurait quelque chose en lien avec l’alimentation, la génétique ou les problèmes cardiaques? La consommation de sel ou de sucre pourrait-elle jouer sur la susceptibilité ou la sévérité? (La vitamine D faisait à l’origine partie de cette liste, mais on l’a retirée parce que l’idée semblait trop tirée par les cheveux!) Et que dire de ces minuscules particules de plastiques qui sont peut-être plus nombreuses dans l’air de la ville et des régions développées? D’une part, la pollution de l’air affecte les poumons; d’autre part est-ce que cela affecte le déplacement du virus qui pourrait voyager sur plus d’un mètre ou deux? (J’allais retirer cette hypothèse également, mais je me suis ravisé.) Frank Fan Xia, un professeur d’école commerciale de Rennes, en France, a fait le commentaire suivant : « La transmission fécale-orale pourrait expliquer l’éclosion du SRAS-CoV à Hong Kong en 2003 (Cotruvo et al, 2004, et Yeo et al, 2020). Il est permis de penser que le SRAS-CoV-2, que l’on retrouve dans les matières fécales des patients (Holshue et al, 2020) et dans les cuvettes des toilettes (Ong et al, 2020), puisse également emprunter la voie fécale-orale. Si vous habitez un immeuble d’habitation/hôtel ou si vous êtes sur un bateau de croisière, et qu’un voisin est infecté, veuillez désinfecter les toilettes et les drains avec du javellisant ». Revient-on à l’histoire du Dr Snow? (Frank a également mentionné les aérosols et les conduits de ventilation.) Qui sait?

Ce que je sais, c’est qu’il faudrait explorer toutes les avenues possibles, parce qu’une explication évidente de la cause est peut-être à notre portée, comme c’était le cas pour le Dr Snow. Y a-t-il un autre Dr Snow quelque part?

Cliquez ici pour lire la deuxième partie.

© Henry Mintzberg, 2020. Notre groupe Zoom, « Blind spot [angle mort] », a été organisé par des participants stimulés et des diplômés de notre programme international de maîtrise en gestion de la santé (mcgill.ca/imhl), un programme dérivé de notre programme international de maîtrise pour gestionnaires en poste (impm.org). Je tiens à remercier Rick Fleet et Jean-Simon Létourneau, de la cohorte IMHL 2020, qui ont réuni le groupe malgré leurs responsabilités d’urgentologues à Québec.

Suivez ce TWOG sur Twitter @mintzberg141, ou recevez les blogues directement dans votre boîte de réception en vous abonnant ici. La diffusion de ces blogues se fait également sur nos pages Facebook et LinkedIn.

Part I. Identifying the Anomalies

Part II. EXPLAINING THE ANOMALIES

The Pump

Now is the time to revisit the story of Dr John Snow, who was selected by a poll of British physicians as their greatest one ever. This came more than a century after he was dismissed by the British medical establishment as a maverick for having questioned the accepted wisdom that Cholera had to be transmitted through the air. During an 1854 outbreak in London, he plotted pins on a map of London where each person had died. These clustered around a well, except for two outliers. He visited the home of one of them and was told that she liked the water in that well, and sent her maid to fetch it. Her niece also drank that water; she turned out to be the other outlier. And so, while the medical establishment was frantically dealing with the outbreak, the well was disabled, and the outbreak ended. Later, sewage was found to be seeping into the well from a pipe nearby.

My field is management, not medicine, although I have investigated the myths of managing health care in a book by that title. It describes the great strength of modern medicine—its capacity to categorize—as well as its debilitating weakness, namely getting stuck in those categories.

We have a number of explanations for the nature and transmission of the Coronavirus, all presumably correct (in one way if not the other). But are they adequate? There seem to be anomalies in the widely reported data: are these just curiosities, or do they reveal blindspots? Is there something else going on in the way this disease is manifesting itself? I may be badly misinformed about some of what follows, and things are changing so quickly that some of it might be outdated in hours. But if one seemingly ridiculous idea below reaches just one person who has the capacity to make something of it, then it will all be worth it. So please suspend disbelief and see if you can find one—the idea, or that person.

• Everywhere I turn, locally and abroad, I am being told that “It’s coming! It’s coming!” But it’s not coming everywhere, only in some places. Why these places? Infections and deaths vary markedly across countries, regions, and spaces, often surprisingly so. It did come in China, or at least in Wuhan, yet not in neighboring countries, except South Korea. It has come to Italy and Spain but not Scandinavia that way. Iran has it badly, and Israel has many cases (both countries Caucasian), but not in the Arab countries in that region (even, apparently, less in southern Iran, that is more Arab). Is there something in the air, the practices, the diets? Why has this virus spread catastrophically in some confined spaces but not in some others: cruise ships, seniors’ residences, and a few Jewish weddings, but not so much in the favelas of Brazil (these surely being more densely populated that any cruise ship). Nor in rural areas and First Nation reserves in Canada. Are some countries and spaces intrinsically more—or less—at risk, and if so, why? We have some ready but inadequate explanations for this; how about some maverick ones?

• Why do some people get the virus with no obvious exposure? Is this just a question of tracking down that exposure, or can there be some unknown form of transmission? Or might some people be intrinsically immune, and others intrinsically susceptible?

• Italy and Germany are almost neighbors, yet the death rates have been vastly different. There are many explanations for this. Do they account for the difference? Surely the Italian population is not that much older than the German. And large teams from China were working, not only in northern Italy, but in a number of other places that have had no comparable outbreaks. Will the world continue to split into the Italys and the Germanys? If so, might there be something in the environment, the food, the lifestyle, the culture? One family in New Jersey has been devastated by deaths in two generations. They are of Italian origin. Is this an outlier that can explain something important?

• How is it that China and South Korea seem to have arrested the spread (so far)? Can testing and confinement explain this in a country of over a billion people, whereas one person at a cocktail party or wedding in the West can infect dozens of others? Has nobody in China had a party recently?

Dr. Snow thought outside the paradigm of the time, so to speak. Our paradigms today are no different: they focus our thinking while blinding us to other possibilities. Dr. Snow used an unusual method of research by today’s medical standards, akin to detective work—better suited to investigating cause, if not to testing cure. His probe of a sample of two outliers made his case. He began with an idea and then looked at the data. His population was a targeted community.

I have been spending two hours a day on Zoom with a number of people in Quebec, mostly emergency room physicians, some working with the government health department. It has not been easy to make this argument, for good reason: they have to cope. Finally, on one of the calls, Joanne Liu, an ER doctor who just completed two terms as president of Doctors Without Borders, recalled a refugee camp in Bangladesh where an expected Cholera outbreak never materialized. She had wondered about the clay ground. Then a nurse from British Columbia, who is heading up the staffing for the response in the First Nations reserves there, commented that there had been no outbreak so far. Indeed, one member of a reserve, who recently flew in an airplane next to someone who tested positive, didn’t get it.

We set up a smaller group on Zoom—three lateral thinkers, and three seasoned physicians—to try to explain some of these anomalies. Detective work for cause has to go up every possible avenue. So here are a few, some probably absurd. Can certain medicines, themselves, beside treating a disease, make people more, or less, susceptible to the virus? We could take some common ones—for hypertension, cholesterol, anxiety—and get data on their usage in the places of high and low incidence of the virus.  (We’re trying. Hanieh Mohammadi, a doctoral student I supervise at McGill, emailed me as I write this about a report in Italy that the virus may be hitting people with Vitamin D deficiency harder.) Or how about Israel compared with the Arab states, and those Jewish weddings. Is there something in the food, the genes, the heart conditions?  Does salt or sugar consumption have something to do with susceptibility and severity? (I had had Vitamin D in this list originally, but took it out as too far-fetched!) Or those tiny plastic particles, that may be more in the air of urban and developed places? On one hand, air pollution damages the lungs. On the other, might it affect the travel of a virus that might somehow go farther than a meter or two? (I was going to take this out too, but reconsidered.) Frank Fan Xia, a business school professor in Rennes, France, wrote to me with the following comment: “Faecal-oral transmission may explain the 2003 outbreak of SARS-CoV in Hong Kong (Cotruvo et al, 2004, and Yeo et al. (2020) suggest SARS-CoV-2, which is found in patients’ faecal (Holshue et al, 2020) and toilet bowl (Ong et al, 2020), can also transmit in a faecal-oral route. If you live in an apartment/hotel building, or a cruise ship, and if any of the neighbors are infected, please use bleach to clean your toilets and drains.” Do I smell the Dr Snow story here? (Frank also mentioned aerosols and ventilation pipes.)  Who knows?

What I do know is that we should be thinking of everything possible, because some key explanation of cause might be staring us right in the face, as it did Dr Snow. Is there another Dr Snow out there?

Click here to Part II.

© Henry Mintzberg, 2020. Our Zoom group, "Blind spot", has been organized by galvanized participants and alumni of our International Masters for Health Leadership (mcgill.ca/imhl), a spinoff of our International Masters Program for Managers (impm.org). Thank you Rick Fleet and Jean-Simon Létourneau, IMHL class of 2020, who pulled the group together despite their ER responsibilities in Quebec City.

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La Malbaie: scene of the G7 meeting. Photo credit: Elaine Martin

Will the G7 collapse in Quebec?  Then what, in a world has had it with an American President who is out of control—personally and politically—as well as with a Congress that lacks the decency to stop him. Shall we all just wait, heads in sand, for this to pass, so that noble America can once again replace nasty America?

We would do better to face the reality. A great many Americans not only voted for Donald Trump, but continue to support him. When he goes, how can trust in America be restored when we know full well that next time, or the time after, back could come the likes of him, or worse?

This tells us that the problem goes deeper than Donald Trump, far deeper: American society is dangerously out of balance, ironically in much the same way that the communist regimes of Eastern Europe were out of balance, just on the other side of the political spectrum. The public sector dominated those regimes; the private sector dominates America.

This problem has been festering since Thomas Jefferson expressed the “hope [that] we…shall crush in it’s birth the aristocracy of our monied corporations, which dare already to challenge our government to a trial of strength...”(sic). Unfortunately, the founding fathers addressed another problem, the one that provoked their revolution: excessive power in government. Hence, they imposed checks and balances on the public sector, with no comparable checks that might have limited the power of any other sector in society.

Half a century later, the U.S. Supreme Court recognized corporations as “persons” in the eyes of the law, and took that over the edge with a decision in 2010 that extended the rights of these and real persons to fund political campaigns to their hearts’ content. In effect, the Supreme Court of America legalized bribery in the United States, and the country has not been the same since.

Who is to blame? Hillary Clinton blamed the “deplorables” who supported Donald Trump. Were they more deplorable than the established people who drove so many of them to support him: not only Hillary Clinton and the people of Goldman Sacks, but everyone else who benefits from tax advantages, union busting, meagre wages for workers, and the rest. If I want to see this kind of deplorable, even here in Canada, I look in the mirror.

Into this swamp came Donald Trump, ostensibly to drain it. Instead, he has been wallowing in it, providing the U.S. with more of the same business as usual, not least his own. Thank you Donald Trump for putting the handwriting on the wall.

A healthy society balances the collective power of governments in the public sector with the commercial interests of businesses in the private sector and the communal concerns of citizens in the plural sector (or “civil society,” if you prefer). In such a society, the three sectors hold each other in check while cooperating for constructive change. Canada maintains a better balance than does the U.S., as does Germany, France, and Japan, all members of the G7, as well as the Scandinavia countries, New Zealand, Uruguay, Costa Rica, perhaps South Korea, and maybe Brazil when it gets its act together again. The G8 lost Russia; this G7 will likely lose America, in one way or another. That’s not crisis; it’s opportunity.

Imagine a city with weak government and no police force. Gangs would roam the streets and battle with each other, or else carve up the place for their own convenience. This is our “global village”, dominated by three superpowers. A G6 has the opportunity to begin countering this, perhaps joined later by other democratic nations that have no aspirations for superpower status or recent histories of belligerence. Is this impossible? Hardly: we see the budding of it in the Trans-Pacific [Trade] Partnership that proceeds without the United States. We need solutions that seem impossible until they become obvious.

© Henry Mintzberg 2018. See Rebalancing Society…radical renewal beyond left, right, and center.

Canada is 150 years old this Saturday—as a political entity, at least. The land has been here forever, the Europeans for hundreds of years, and the aboriginals for thousands. So the number 150 is somewhat arbitrary. But this is certainly a good time to celebrate Canada: looking around the globe, including due south, where we are so inclined to look, we are an island of sanity in a sea of turmoil.

True, we have been suffering from no Stanley Cup for our cherished hockey teams since 1993. But there is one thing even more sacred here than hockey, namely our state-funded Medicare, and that, mercifully, remains intact. Maybe this is what enables us to get on with sanity. And with democracy too, which has likewise remained intact, perhaps never better. Most of us really do strive to be tolerant in this country, and, you know what, it feels good to aim for the highest common denominator.

French culture in Quebec has long been vibrant, more recently, English-Canadian culture has become so. The multi-culturalism promoted by Prime Minister Trudeau (the elder) has been a major factor. Turn on CBC in English, or Radio Canada in French—jewels in our cultural crown—and marvel at the variety of people and faces and origins and opinions that make up this country today. In Canada, even the beavers do art, as you can see above, and more.

It was not so long ago that my uncle could not get into medical school because my own university, McGill, had a quota on Jewish applicants. Now the last three deans of medicine have been Jewish. The Conservative Party of Canada had a leadership race this year, and one of the candidates campaigned on screening immigrants for “Canadian values”. This may seem innocuous enough, but to many of us it sounded racist, a throwback to the old days of white Anglo-Saxon dominance. At the convention, in ballot after ballot, this “ideal leadership candidate” (in the words of our main newsmagazine) never made it to 8%. And this was the Conservative Party.

Twenty universities around the world have granted me honorary degrees. Yet no award do I wear as proudly as my Order of Canada. The pin we recipients wear is small—Canadian-size—yet it means so much to us, perhaps because we try not to confuse pride with patriotism in this country.

Canada is another America. It expresses another perspective by which people everywhere can see the major issues of our time, in terms of a just and tolerant world based on balance and reconciliation. We may look much like our powerful neighbor to the south, but in significant if sometimes subtle ways, we are quite different. The world at this juncture desperately needs another perspective, and quiet Canada, hidden up here in the north country, might just be providing it.¹

So happy birthday Canada! After 150 years of striving to get it right, to paraphrase from Quebec’s own Happy Birthday song, it is time to let you speak of love.

© Henry Mintzberg 1 July 2017.

----

¹Three of us—a quintessentially Canadian trio, French, English, and Rumanian-born Canadians (Yvan Allaire and Mihaela Firsirotu)—have been working on a book entitled Another America: A Canadian Perspectives on World Issues. It is a collection of writings from prominent Canadians who for many years have been expressing themselves on a variety of important subjects in a remarkable cohesive way.

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When the results of the British election came in on June 8, I posted a blog that I had written when the election was first announced, on April 18. I can't say that I called the surprising result, but I felt that my earlier comments were close enough to take them public. So, confidence intact, here come some early comments about the future of the Trump presidency.

I am a pattern recognizer, who defines strategy as pattern in action. Watch what people in power do, and don’t do, not just what they say. The pattern in the actions and inactions of Donald Trump since his election seems evident to me. Consider this:

• Massive cuts proposed in the budgets of some key American departments, including State
• Many significant government posts left unfilled, some after firing the incumbents
• Certain cabinet secretaries appointed who are diametrically opposed to the mission of their department.
• Fights picked with many of America’s most trusted allies—including Angela Merkel, of all people—plus the badmouthing of NATO and the EU, while cozying up to the likes of Putin and Erdogan
• Proposed tax breaks that would squeeze the government while exacerbating income inequalities, a major grievance of the very people who elected him
• Despite all the promises, surprisingly little enacted legislation

All of this cannot be explained by a normal neoliberal agenda. (And surely Donald Trump cannot be so totally under the influence of Steve Bannon’s abnormal one.) The pattern—namely strategy—seems evident: Donald Trump is determined to dismantle the American government. He is not just draining the swamp; he is emptying the reservoir. I am not particularly paranoid, nor do I tend to fantasize, but I do know a pattern when I see one.

What could Donald Trump possibly have to gain from going this far? Surely, we can rule out simple greed, and even his narcissism, to rule in what seems more obvious: He looks to be under the influence of some powerful force that does have something to gain from the dismantling of the American government. What can it be other than Putin’s Russia? If this seems excessive, then find me a more plausible explanation for Trump’s steady stream of actions that have themselves been excessive.

What might the Russians have on Donald Trump?  Take your pick: money owed to them, knowledge of some dubious business or personal deal, manipulation of the election in those four states. Whatever it might be, the Russians could well be using something to get him to do their bidding. Why else would he be so concertedly pro-Russian? Aside from admiring bullies, why the great love affair with the Kremlin?

If this is true, then Donald Trump will not be able to resign. But since the true truth has a habit of getting out, he may well be impeached, and removed from office. And from there, he may well go broke, since he has not proved himself to be a particularly adept businessman, short of depending on his brand. The problem with brands is that they are double-edged swords. They can cut back a lot faster than they have been developed to cut forward. But, more significantly, he could end up being charged with treason, namely “giving [to the country’s enemies] Aid and Comfort.” If Russia has been doing this, they are the enemy.

An American friend of mine who read a draft of this blog wrote back that, with so much uncertainty, “for now it feels like a fool’s errand to place particular bets.” Maybe so, but we do need to speculate beyond the usual banalities. Besides, patterns discerned in early signals can sometimes be necessary to avoid later crises.

© Henry Mintzberg June 2017

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Well, not exactly “Reporting live”: I wrote this on April 18, just after Theresa May called the British election. I sent it to three British friends, also to the Canadian Globe and Mail that said it was too short. I post it here today exactly as I wrote it then (aside from adding “British election” to the title, and regretting having included two words in the first sentence: Jeremy Corbyn).

There are 64 million Brits and yet they can’t do better than Theresa May, let alone Jeremy Corbyn or David Cameron? Of course, the Americans couldn’t do better than Donald Trump. The world is now a strange place indeed. 

I thought there was one overriding message from David Cameron’s snap vote on Brexit: don’t call snap votes when so much of the electorate is restless. She is, I guess, as sure as was he. Labor is ill-led, and how can the Liberal Democrats possibly come back?  The British prime minister may be in for a surprise.

There is another message too, from other snap elections in different places. Be careful of sending voters to the polls too early: they might read this as political cynicism rooted in cocky confidence, punishable by purgatory.

What has happened to good sense in politics, to decency, to wisdom, to modesty? (At least here in Canada we have a prime minister who doesn’t pretend to be president.) There is the story of an old lady in Maine who said: “I never vote. It only encourages them.” In these days at least, that’s wisdom. How come she was never elected president?

© Henry Mintzberg 2017

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20 January 2017   Eating breakfast this morning, looking for diversion, I turned on CNN, only to be reminded of the event I had forgotten about, one that apparently “the whole world is watching.” I could take only so much of this before I banged out this rant.

It was the repeated claim about the resilience of American democracy that really got to me—this wonder of handing over power from one elected president to another. After decades of McCarthy, Vietnam, Iraq, income disparities, and now someone who lost the election but won the presidency with a vile campaign, you will have to forgive me for asking: When will the United States take its head out of the sand and face its condition?

Sure it’s nice to celebrate, and to be proud of one’s heritage, even understandable to put a good face on a difficult situation. But not when this masks—and it has repeatedly masked—the reality facing the country. Serious problems have been festering in the United States for decades, and they have not been seriously addressed.

And when will the rest of us face the fact that a world of America the great, even if sometimes true, is a world of perpetual conflict, as other countries that think of themselves as no less great, weigh in.

I will stop here, except to refer you to my previous blog, where I suggested what concerned people might be able to do about this, and to my book, Rebalancing Society, that describes this deterioration, in the U.S. and worldwide.

© Henry Mintzberg 2017 

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We are masters at running successful experiments in failed events. On Wednesday, as part of the World Social Forum in Montreal, our event in the McGill University football stadium was entitled “On the earth, for the Earth: acting together for a cool planet.” We had no way to know how many people would attend.¹ I predicted between 50 and 5000, which made our organizing rather difficult. Suffice it to say that we did not hit the high side.

Undeterred, we improvised. We adapted much of our design to the numbers present. It worked, rather well in fact. The intention was to self-organize in small groups, to come up with cool ideas that could be taken home for dealing with climate change. That we did, albeit with few groups, including our super-enthusiastic volunteers. Each focussed on one of four questions:

• Getting it about climate change doesn’t mean we live it. How can you and I live it?
• What can we do with food: producing, processing, distributing, consuming, and wasting?
• How can the plural sector [civil society] get its collective act together?
• How can we build societies of better and better instead of economies of more and more?

What we lacked in quantity (more and more), we made up in quality (better and better). The discussions were great, and animated: we had to stop them after 90 minutes. I joined the group on getting the plural sector act together, a conversation I have had with many other groups, but never this good. All the groups shared what they found, and everyone seemed to leave on a high.

Was this event a failure? Not for the people who attended, and not if, as an experiment, it leads to something more successful. (One attendee hopes to use the design in an event he is organizing later. And we shall be doing so as well, and capturing the learning, in a forthcoming GROOC—a MOOC for groups—in the Spring, probably under the same title. (Check it out on edX in the new year.) But yes, it was a failure by the standards of more and more.²

So, the next time I consider doing something else unusual, should I be asking myself “Why?” instead “Why not?” Never! We have too many events that succeed in numbers—look at the turnouts Trump in the U.S. and Erdoğan in Turkey have been getting lately. We need many more successful experiments, and thoughtful ideas, to make the world a better place.

Later in the day we held a more conventional event—a panel on how the plural sector can get its collective act together. That succeeded both ways: about 200 people turned out, for 90 minutes in a McGill amphitheater, and the discussion was stimulating and animated. Ian Hamilton, who heads up Equitas, the International Centre for Human Rights Education, explained why the sector often does have its collective act together, while Alex Megelas, of the Office of Community Engagement at Concordia University, claimed that one of the great strengths of the sector is its messiness. The five of us were one about the need for pluralism in the plural sector! Yet we live in a world in which the dominant private sector is highly organized. How can dis-organization correct that? This is our dilemma, all too evident in both these events.

And all too evident as well in the coverage of the Forum by the Gazette, Montreal’s English-language daily. It is part of a chain of most of the country’s dailies that were ordered to run the same editorial in the last federal election, endorsing the Conservative Party. This we call a free press. Aside from an initial article on August 4 (straight reporting, that mentioned our event), the Gazette has run only two pieces on the Forum, both about the same issue.

Yesterday the headline read “Protesters hurl insults outside the World Social Forum in Montreal.” Ten members of the Jewish Defence league were yelled at by a number of pro-Palestinians. So many other events during the day, and this received the only headline. A few days earlier, an opinion piece was headlined “World Social Forum shouldn’t grant a platform to anti-Israeli agitators.” True enough. But hardly true enough was what the piece went on to proclaim: “The tone of the conference is fundamentally at odds with” the WSF’s belief in living together. How did this become the tone of the conference? Thousands of concerned and well-meaning people doing wonderful work to make the world a better and more balanced place all dismissed by the excesses of a few. So much is happening in this Forum: discussing youth inequality in Peru, promoting people’s rights to affordable housing all over the world, facing the problem of climate change and of the demise of democracies, even questioning the Canadian government’s refusal of visas for many people trying to attend the Forum itself.

It’s as if the newspaper was sitting in a tree like a panther, waiting to pounce on some cause célèbre to reinforce its own agenda. The first reader comment on the opinion piece tells it all: “This [Forum] is just a platform for socialist ‘anti-everything’ agitators.” Mission accomplished.

Here we have a perfect reflection of the imbalance we live with every day. In Canada we may get to elect our government, but our corporate press continues to use its power to sway public sentiments in favor of private interests—by what it reports, and especially by what it does not report.

The World Social Forum is eclectic. All kinds of tones and voices are being heard inside of it, a few that I personally don’t care for. Yet all but one of these get ignored by a newspaper acting as a platform for its own agitation—essentially to intensify the existing imbalance. Concerned people will have to learn how to use dis-organization to rebalance a world headed for disaster, environmentally and politically.

© Henry Mintzberg 2016. My thanks to Debbie Hinton, Karla Flores, Laura Cardenas Berdugo, Jessica Xiao, Calolina Cruz-Vinaccia, et al. for so wonderfully organizing our experiment, to Joe Ross and Clelia Cothier for so enthusiastically animating it, and to the Office of McGill’s Vice-Principal External Relations and its Desautels Faculty of Management for their support. 

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1¢ and 10¢ 

It is interesting how simple resourcefulness can defeat sheer massiveness. David brought down Goliath with a slingshot. In the 1960s, people in San Antonio, Texas were fed up with the utility company so they overpaid their bills by 1¢. This tied the bureaucracy in knots; it responded to their demands.¹

Climate change is a massive problem; it needs more resourcefulness, constructive as well as confrontational. 10¢ to The March of Dimes addressed the crisis of polio years ago. People all over America, many of them children, mailed dimes to the White House—Franklin Delano Roosevelt, who lived with the consequences of the disease, was president when this began. Seven billion dimes were collected. Some of that went to the laboratory of Dr Jonas Salk; it came up with the vaccine that eradicated the disease. Simple 10¢ resourcefulness!

We need to eradicate global warming, and that will take a great deal of human resourcefulness. To do our bit, on Wednesday August 10, we are hosting an event called “On the earth, for the Earth: acting together for a cool planet.” It will take place in the McGill University Football Stadium, as part of the World Social Forum in Montreal. Think of this event as a do-it-yourself climatic picnic, to address one of the big problems of the world. To set the tone, here are some “cool facts” about climate change that I will present in my opening remarks.

Some cool facts about climate change

1.    Norway now generates almost all of its electricity using renewable energy. Of course, Norway is a rich country with considerable hydroelectric power, and it does produce a great deal of oil and gas for other countries. But …

2.    Tiny Bhutan, a poor country in the Himalayas, wedged between Tibet, India, and Nepal, some years ago committed to reducing its carbon emissions and increasing its forest cover to 60%. That it did; the country now absorbs more carbon than it produces.

3.    Clean energy now employs 8 million people worldwide.

4.    The average Canadian household wastes 47% of its food. [S LINK AT END]

5.    Better recycling of textiles, now with the lowest rate of any reusable material, could be the equivalent of taking a million cars off the roads.

6.    By unplugging when unnecessary your computer, phone charger, microwave oven, and video wave consoles, you could reduce your energy consumption by up to 10%. 

7.    Hundreds of you are attending the World Social Forum for the admission price of one of you to the World Economic Forum. Climate change is a social problem more than an economic one. Yet the WEF gets hundreds of times the press coverage of the WSF. 

Here is what we will be doing for the Earth, on the earth of the stadium on Wednesday:

Some cool ideas for climate change

We expect several hundred participants from around the world to join us for this 9:15-15:00h outdoor living lab. We want to generate truly novel ideas for dealing with climate change. Everyone will form into small groups to share insights and build on each other’s ideas, the best of which will be presented at the end. Each group will choose to work on one of these seven basic challenges:

1.   Getting it about climate change doesn’t mean we live it: how can you and I live it?

2.   What can we do with food: producing, refining, distributing, consuming, and wasting?

3.   How can we make our own city more energy friendly?

4.   How can we wake up our governments to 0 degrees, not +2 degrees?

5.   How creative can we be about challenging the most destructive environmental practices?

6.   How can we build societies of better and better instead of economies of more and more?

7.   How can the plural sector (civil society) get its collective act together to balance the power of the private sector?

The various groups discussing each challenge will sit together in one area of the field. Those that believe they have come up with a truly cool idea will present it to the others in their area, and the best of these will be be presented to everyone, in the hope of inspiring collective action back home. (I hope to present the best of these ideas in next week’s TWOG.) If we get 3 great ideas, and 100 people leave determined to act, the event will be a great success.

If you are tired of being a human resource, and wish to put some of your human resourcefulness to work for the sake of our future, please join us if you can. If you cannot, while saving the carbon energy to get here, please join us in live streaming starting at 9:45 Eastern Daylight (NY) Time.

© Henry Mintzberg 2016. Thank you to Carolina Cruz-Vinaccia and Myko for the research on the cool facts. Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing here. To help disseminate these blogs, we now also have a Facebook page and a LinkedIn page.

You have likely heard of the World Economic Forum (WEF), or at least its annual conference in Davos. Every January, 2500 of the world’s movers and shakers descend on this Swiss resort to shake the world, while keeping it firmly planted in economic globalization.

Have you heard of the World Social Forum (WSF)? It expects twenty times as many people to descend on Montreal next month in the hope of doing a little moving and shaking of their own, for example to loosen the roots of the “crisis of capitalism”. This will be the twelfth bi-annual conference of the WSF, but the first in the “North”. (Others have taken place in Brazil, India, Tunisia, etc.)

Don’t feel badly if you never heard of the WSF. Recently I gave a talk to 300 people at HEC, Montreal’s main French-language business school. Barely 10 knew about the WSF, let alone that it was meeting soon in their hometown.

A Tale of Two Forums  Such is the state of our world today: focused on the economic while obscuring the social. The WEF calls itself “The International Organization for Public-Private Cooperation.” Cooptation too, thanks to its success in promoting globalization at the expense of national sovereignties. The private sector leads and the public sector follows while the plural sector (civil society) struggles.

I have been to Davos as a speaker a few times. In 2006, I attended a session entitled “Global Business: Survivor or Scapegoat.” Some choice! (Of course, it’s the choice we’ve been hearing from those pundits quick to dismiss the recent Brexit vote.)

Don’t expect to see anything like Davos in Montreal next month. The WEF attracts elites; its agenda is loaded with big names, not necessarily with anything new to say; and the organization is big on “young global leaders” (presumably selected by old global leaders).

The WSF attracts activists, organizes its conferences around “self-managed workshops”, and promotes collaboration—what I like to call communityship, in contrast to leadership. This is a meet-up of people concerned less about doing deals than about the consequences of doing such deals.

The WEF conference gets enormous press coverage. The WSF conference has barely received mention in its host city, let alone around the world. If the WEF is about power in the name of change, then the WSF is about change in the face of power.

Here, then, we have the two main models for changing this world, neither of which is working. One fails because it brings together the people who have benefited most from some of our main problems—income disparities, consumptive economics, lop-sided globalization. The other fails because it lacks the power, and the attention, to do something about these problems, not to mention its own lack of organization. (Business gets its collective act together for what it wants—such as tax cuts—while the plural sector associations do not. To paraphrase a song by Tom Lehrer, the WSF may have the good songs, but the WEF wins the big battles.) Together, this is not a happy combination for a troubled world.

The theme of the Montreal conference is “Another world is needed.” Another model too. Imagine if one day the two forums—social and economic—marched as equal partners for a balanced world. While holding our breath for that, let me tell you what we will be doing in Montreal to nudge the world slightly in this direction.

Our March  Our little team at McGill has been busy preparing three events. I will be speaking about Rebalancing Society, and we have organized a panel about how the plural sector can get its collective act together to help restore balance in this troubled world.

We are especially excited about our self-organizing event, entitled “On the earth, for the Earth: acting together for a cool planet.” It will be held on Wednesday August 10 from 9:15-15h in the McGill University football stadium—on that earth. (Please see the Facebook event for details.)  Participants from around the world will meet each other and form small groups, each to focus on one issue, such as:

• What can we do in our personal lives to reverse global warming?
• How can we get creative about challenging the most destructive environmental practices?
• What can we do to make our city energy friendly?
• How can we build societies of better and better instead of economies of more and more?
• How can the WSF become the force that the WEF has become?

The groups will share their proposals for change, and select the best, for presentation to the whole throng. Five really cool proposals will do it (although we will not complain if we get 50). Then we will all consider what each of us can carry home for action—starting the following week. If 100 people go home determined to make a difference, we will be happy; if 1000 do so, we will be delighted.

Please join us. We promise you a low fee for the whole conference: at $40 it comes to .0005 that of Davos (finally a chance to join the 0.1%!). (You can register here.)We can also guarantee you a lot more fun: a living lab and do-it-yourself climactic picnic, on the ground. Who knows, we might even move the Earth!

© Henry Mintzberg 2016 Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing here. To help disseminate these blogs, we now also have a Facebook page and a LinkedIn.

It’s Friday, June 3^rd. Early this morning, I found myself giving a talk at the Harvard Business School. It was an awful experience. I arrived 5 minutes late, and suffered the consequences. The professors there were rude and dismissive; nobody wanted to listen. I was interrupted twice by some weird ritual: a huddle of people chanting and dancing off to one side, like cheerleaders at a college football game.

Suddenly, everybody was gone, except one guy—a visitor, he said, quite pleasant. He confirmed that the rest of them were punishing me because I was 5 minutes late. You don’t do that at the Harvard Business School, he said. 5 minutes!

I wondered what would happen if I was 5 minutes late for an audience with the Pope. Surely he would have been kind and attentive, even curious to know why I was late. Of course, the Pope professes what most Harvard Business School professors do not: he challenges capitalism, and consumption.

Then I woke up.

In actual fact, the last time I spoke at the Harvard Business School it was a wonderful experience, even though the room full of faculty knew how critical I had been of their case study method.  I promised not to talk about that, but to describe what we had been doing instead in our own masters programs. They were attentive, kind and considerate, not unlike the Pope. But then again, I didn’t arrive 5 minutes late,

I discussed this dream with Dulcie, my better half, who comes from a different world yet has been so helpful in improving these TWOGs. It’s just the discomfort you feel by so often being five minutes late for things, she said.

I think it’s something else: I worry that my ideas are not being taken seriously enough, whether they are ignored, or dismissed—with me being labelled a “contrarian.” While I am proud of having passed 10k “followers” on Twitter, some of those Harvard professors have passed 100k. Is it because they are Harvard, or mainstream, or better?

Last year I was on a panel with a prominent Canadian. As he left, he told me that I was a contrarian. I took that to mean he didn’t understand what I had said, or at least didn’t care to entertain ideas than ran counter to his mainstream beliefs. How much easier to dismiss me as a contrarian. (Sadly this guy now sits as a minister in our federal government.)

A contrarian opposes for its own sake. I oppose for the sake of trying to improve things. That I oppose so many mainstream ideas no more makes me a contrarian than does it make the world any less screwed up. And it certainly does not justify people who prefer not to notice what is going on. I am sorry Mr. Lincoln, but these days it is possible to fool most of the people most of the time. Or as Paul Shepheard put it in his book What is Architecture, “the mainstream is a current too strong to think in.” It can also take you over a cliff.

Anyway, thank goodness for you. Having read this far, you are at least attentive, maybe even supportive. I do apologize if this has made you 5 minutes late for something. Do take another 5 and tell your “friends” and “followers” about this.

Henry watching the mainstream going over a cliff. Or is it Lisa, his daughter who takes the photos, warning him about going over that cliff?

Because... Before this was posted, Lisa wrote to him about this TWOG:

·      “It takes a while to build up a following.” [Must I skip the quarterly reports, every 15 minutes?]

·      “People who like your work, like your body of work, not necessarily 140 characters of it.” [Are you trying to say that this is about rousing reflections in pages or 2 beyond pithy pronouncements in sentences or 2?]

·      “Far better to have 10 likes/followers, who you can engage in discussion with… than thousands signed up, who don't even notice that you've posted something…” [You mean it’s about quality, not quantity?]

·       “And you never did care about 'fitting in' for the sake of it, so why start now?”  [I get it; I should be good, not strive to be the best.]

Has Lisa been reading my TWOGs? More to the point, have I??

©Henry Mintzberg 2016. I apologize for delaying the TWOG promised last week, about the old New Public Management. I’m working on it. I just don’t control what I dream. About our own programs, please see the International Masters for Managers (impm.org) and the International Masters for Health Leadership (mcgill.ca/imhl). Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing here. To help disseminate these blogs,we now also have a Facebook page and a LinkedIn.

Marina (Brazilians call their politicians by first name) has run for the Brazilian presidency twice, in the hope of being the first black woman of poor origins to attain that office. In the last election, she garnered 22 million votes, but lost to Dilma Rousseff, who has since been mired in scandals. Marina has become something of a legend in Brazil, with views that break with the traditional politics of the country. Many prominent Brazilians believe she will be the country’s next president.

In October, I gave a speech in Sao Paulo. I was unaware that Marina was in the audience. She came up afterward, introduced herself, and asked if I would give the opening keynote for the launching of her Sustainability Network (she finds the term political party too narrowing). “Why not?” I replied. This is going to happen next Thursday.

“You see things; and you say ‘Why?’ But I dream things that never were; and I say ‘Why Not?’”  (George Bernard Shaw)

In 2012 I published an article with Gui Azevedo about the “Why not?” people of Brazil (see also the TWOG of 7 May). There is something about the spirit of the country, its history and peaceful pride, large size with linguistic isolation, that has fostered a kind of “Why not?” mentality among the people. As Gui and I wrote, “Brazil is a civilization-under-construction, full of freshness and brashness, much like the United States of earlier times.”

For two centuries, the United States was the “Why not? country of the world. It remains so economically. But politically and socially, it has become more of a “Why?” country, as private sector interests have come to dominate so much of American social and political life. As other countries have followed suit, this has been fostering a dangerous imbalance throughout the world.¹

Brazil is remarkable for its many imaginative social initiatives. Participatory municipal budgeting, started in Porto Alegre, has been adopted in many municipalities; there is a prominent landless workers movement that works unoccupied farmland; the favelas have provided affordable housing for many poor people²; and the country dealt remarkably with its HIV/AIDS crisis, challenging pharmaceutical prices and the international agencies that supported them. (See the photo of a famous ad, modeled after the one for the movie “American Beauty”, displayed at Carnival to encourage men to use condoms.) These days, when I hear about a really interesting new social initiative, the first question I ask is if it started in Brazil—because so many do!

We desperately need rebalancing in this world, and I believe this will require a “Why not?” attitude, socially and politically. Beyond our obsessiveness with exploiting resources, including ourselves as “human resources,” has to come the exploration of our human resourcefulness. I can think of no people more inclined to show the way than those of Brazil, just as soon as they get past their scandals and recognize their substantial strengths. So why not go to Brazil next week?

© Henry Mintzberg 2016.  Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing here (link fixed).

If you are Canadian, this is my take on our new prime minister and government. If you are not Canadian, please read on because what is happening here could suggest a different way forward elsewhere.  (This TWOG is adapted from a blog that appeared last week in huffingtonpost.ca.)

In 1962, Saturday Night, the quintessentially Canadian magazine, was bought by a right-wing zealot who immediately shifted the content. He could change the script but not the institution, and so, in a year, the magazine was collapsing. As the previous editor resumed control, he opened the next issue with the line: “Before I was so rudely interrupted…”

Capital “L” Liberalism—the reign of the Liberal Party of Canada—was certainly rudely interrupted this past decade. It deserved to be, with its scandals and backroom deals. But did our small “l” liberalism, for which the country had been distinguished, deserve to be rudely interrupted?

Hardly. Has not the world been seeing enough of the bullying of big office by the likes of Bush, Cheney, Netanyahu, Putin, el-Sisi, and Erdogan, with more all the time? Did Canada really have to chip in too? And within the country, did we really need an intensification of the mindless dogma that is now creating so much havoc across the world, with its presumptions that greed is good, markets are sacred, governments are suspect, and all the resulting entitlements are necessary?

The world needs quite the opposite, and Canada had been one of the countries bucking the trends that have been undermining democracy. So it’s good news that “Canada is back!” as the new prime minister put it on the podium election night in October. At home and abroad.

Of course, that particular Canada never really left; it just hunkered down. Thanks to our small “l” liberal democracy, at the end of the Harper decade the CBC remains a model to all of what non-corporate media can be; our Supreme Court remains as progressive as is the American one regressive; and only one of our ten provincial governments can be called conservative.

Now Justin Trudeau is defining Canada, at home and abroad. But of course, Canada has defined Justin Trudeau. It is difficult to imagine anyone who is more quintessentially Canadian, in his open, thoughtful, and thoroughly bilingual style. Leadership does not turn us into something that we are not, but it can bring out the best that is within us. In Canada, that has been to look out with compassion and good sense, in the pursuit of balance in a world that now so lacks it.

The new prime minister is off to a good start. Just look at his cabinet—half of it female, a turban atop the head of Canada’s new minister of defence. (When asked why he selected so many women, Trudeau replied: “Because it’s 2015.”) 

Can he keep this up? Time will tell. But there is one especially encouraging sign: interesting ideas are bubbling out of this administration. How refreshing: we have a creative politician at the helm! How many other countries can claim that? After enduring all those lawyers, economists, academics, and corporate types for decades, now we have a schoolteacher running the government. Have we not always prided ourselves on our diversity?

Justin Trudeau had a hard time early in the election campaign. Too many people were taken in by the Conservative propaganda that he is a lightweight—including a corporate press that lives in mortal fear of the private sector losing its entitlements. Even an old Liberal friend told me a couple of years ago that the Party will be doomed when people discover the truth about Trudeau. Well, during the long election campaign enough Canadians discovered the truth about Trudeau! Now the rest are.

Of course the honeymoon will soon be over. The devotees of democratic capitalism (notice what’s the noun), having failed to stop the surge, are waiting in the trees, like panthers, ready to pounce—to take Canada back. They will find reason, whether or not justified. Balance between social and economic needs is not high on their agenda.

I wrote in last week’s TWOG that people in positions of authority are flawed, like the rest of us. They succeed when these flaws are not fatal under the circumstances. So we shall have to wait and see. Some people succeed despite their flaws, while others are brought down by their flaws (as was our last prime minister).

As noted, Justin Trudeau took to the stage on election night to announce that “Canada is back!” Not a moment too soon. Small “l” liberalism is back, and the world may well benefit. To paraphrase from our national anthem, we need to keep our land glorious and free, so that thee, O Canada, can stand on guard for a better world.

© Henry Mintzberg 2016. Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing at mintzberg.org/blog.

by Henry Mintzberg and Wolfgang Műller

HM:  I have been writing in these TWOGs about the role of the plural sector in rebalancing society: first to recognize that it must take its place alongside the sectors called public and private (hence calling it “plural”, rather than civil society), and second to realize that the restoration of such balance will depend especially on this sector. The private sector is too powerful these days and the public sector overwhelmed by that power.

Some people don’t get the idea of the plural sector, perhaps because it has been so marginalized by the great debates over left versus right—private sector markets versus public sector governments. Where to put the plural sector, comprising all these community-based and other associations that are neither public nor private? NGOs, clubs, churches, unions, mass movements, social initiatives, and so on? Wolfgang Műller, Chief of Operations of the City of Vienna, who had read my book about Rebalancing Society, got the idea—in principle. Then he experienced it in action.

I met Wolfgang last Wednesday when he organized a workshop I did with his colleagues at the City of Vienna, before I attended a conference in that city. He recounted a story about how this understanding in principle suddenly became an understanding in practice. I asked him to write his story down.

WM:  On Friday September 4, I was sitting in my office in Vienna City Hall when I learned on twitter that refugees from Syria and Afghanistan, some with children, had decided to walk the several hundred kilometers from Budapest to the border of Austria, determined to get to Germany, their land of hope.

Suddenly, within hours, Vienna’s train stations became organized as hubs for thousands of refugees—buses in, trains out. In such a situation medical care, food, and overnight shelter had to be organized, usually in association with NGOs such as the Red Cross.

While my staff was coordinating the crisis management network, I needed to get a hands-on impression of what was happening. I went to the new central station, where I saw all kinds of people helping with translation, providing medical aid, and distributing blankets, clothing, and food. Among them was a group wearing shirts emblazoned with “Sikh Help Austria”; they were dishing out warm meals from big pots that they had brought.

Something truly amazing had happened. Citizens young and old, some the children of immigrants or themselves earlier immigrants, decided to take action. They asked themselves what in Henry’s book is called “the Irene question”—“What can I do?”—and here they found an answer. Using social media, they organized themselves into a sort of citizens’ start up, dedicated to helping the refugees. They called it The Train of Hope (@trainofhope).

Here are some statistics: 180,000 meals were served in September alone, by 350 volunteers every day, including about 5,000 warm meals by Sikh Help Austria. (These statistics are from what could be called the management accounting “department” of that Train of Hope! Even that sprung up, as if from nowhere.)

Now, when The Train of Hope asks via social media for bread or bananas, the items usually appear within the hour: hundreds of kilos. Social media entries are updated regularly and the posts are now followed avidly by about 300,000 Austrians.

At first, we in the city administration were very surprised. But then we realized that this was not uncoordinated. It was a highly professional, high speed performance. That is when it dawned on us that here was the self-organizing plural sector in action. So we in the city administration decided to give The Train of Hope all the technical support it might need, including background support on call. We then invited The Train of Hope to join the city’s crisis management network, an offer that was accepted. I am delighted to report that this cooperation has continued to perform consistently well, with no end date yet clear.

This is a PPP of a different kind: a public-plural-partnership, agile and flexible—sharing the governing of a crisis. Why Not? Isn’t this smart government? Much has been written about the sharing economy. But this is not like sharing lodging, as in Airbnb. It is about sharing concern, and help, and hope.

I am passionate about my work for the city of Vienna, and I feel privileged to be part of these very special events. Thanks to The Train of Hope, and the contribution of plural sector as a whole, I am now even more positive and optimistic about our future. If you are near Vienna, just go and take a look.

HM: I went on to the conference the following two days. On Friday, Wolfgang sent me his email with the story. I read it late that evening. My alarm was to ring in time to get me to my plane the next morning, but I woke up earlier. What to do with the extra time? Of course: just go and take a look.

It was quiet in the station at 8 am. (Turns out that it is now cleared in the evenings so that every refugee has an overnight bed.) But I was able to walk through where several people were still there, some in family groups, many sleeping, while other young men were talking together, killing time. I asked one family if I could take a photo but a young man waved me off.

Outside, clothing and supplies were stacked up neatly in tents. I saw a rough sign that read “Refugees Welcome.”  Nearby was a plastic sheet meant to be a door. I went in: this turned out to be the volunteers’ area. A woman at a desk asked “Do you want to help?” “I’m sorry, I can’t”, I said, “I have a plane to catch.” But then I realized that I too had an answer to the Irene question: “We’re writing a blog about this.” About hope.

© Henry Mintzberg and Wolfgang Müller 2015. The opinions and views expressed in this article are those of the authors, and do not necessarily reflect those of the institutions to which they are affiliated.

This weeks’ TWOG, and maybe the next, are being brought to you live, so to speak, from our International Masters for Health Leadership (mcgill.ca/imhl). I will be in class most of these two weeks, so I decided to bring you along, to some of the interesting happenings. (On Monday April 27, from 9:45 am to about noon NY time, you are invited to a live streaming I will be doing from this class, on myths, managing, and health care.)

Thirty-five people from around the world, all experienced in various aspects of health care, are here, in the Château Montebello near Montreal—the world’s largest log cabin. This is a new class, for the first of five 11 day modules, called the Reflective Mindset. Among these participants, please meet, in the photo below (clockwise from the top), Seble, who is a flying doctor for emergency medicine in Ethiopia, Danny, a forensic psychiatrist from Australia, Nick, a sales manager in a medical records firm in Canada, Khuzama, a dermatologist, and Mohammad, a radiologist, both from Saudi Arabia. Here is some of what’s been happening.

Turning the Tables

Professionals see themselves as providers of services. So to set a reflective tone, on day 2 we turned the tables and asked everybody to tell each other stores about their experiences as users of these services. Great stories came out—happy ones, as you might expect, but horror ones too. The latter indicated that the people who are supposed to know the system best are apparently not immune to its problems. “No-one ever teaches the non-physician how to navigate the health care system” someone had said. Nor physicians themselves?

Listening to both kinds of stories, someone else asked: “We know how to get it right, so how come we so often get it wrong?” In other words, why can’t there be better learning, more reflecting, across health care organizations themselves? We’ll get back to all these questions in later modules.

Turning our Backs

The participants in the IMHL don’t sit in nice neat rows, listening obediently to some professor. They sit at small round tables so that they can spend about half the class time sharing insights from their own experience. Every day begins with “morning reflections”: first they write their thoughts in an Insight Book, then they discuss these with the group around the table, and finally they sit in a big circle to bring out the best ideas.

A great deal of thoughtfulness comes out of this. Morning reflections are, in fact, the glue that binds the learning of the IMHL together. These first days, the ability to listen has been getting a lot of attention. For example, “Why don’t we let go and really listen---listen with the ears and see with the eyes of the other?” Physicians listening to their patients, and to each other (bearing in mind that all “patients” are people, but not all people are patients, at least if the promotion of health is to matter); managers listening to the professionals, and professionals listening to the managers. After all, if they can do it here, why not in their institutions?

So for morning reflection on the fourth day, we turned, not the tables, but one person at each table--in the above photo that’s Danny with his back turned—to be the “keynote listener.” (Thanks to our colleague Jonathan Gosling for this term.) Then, as you can see in the second photo, these listeners sat in the middle of the big circle and became the talkers—about what they heard. “We thought we’re taught to do [listening] as clinicians, but maybe we’re learning it for the first time.”

Welcome to the Confusion

With these kinds of things happening—not usual in most development programs, let alone in the everyday life of most people—it was not surprising to hear from more than one that “I’m confused.” Good thing, because as Jack Welch once observed, “If you’re not confused, you don’t know what’s going on.” So not long after came this comment: “I have started to discover that being confused can be a good thing. It means I am letting go of my own fixed way of viewing things and getting ready to appreciate how others see things.”

Welcome to the Reflective Mindset!

“Experience is not what happens to you. It’s what you do with what happens to you.” (Aldous Huxley)

© Henry Mintzberg 2015, who is also involved in such things in the International Masters for Practicing Management (impm.org) for business managers. The next class is November 2015.

Tatiana Saliba has been organizing the tweets for this TWOG for eight months now, every single week since September 2. Thank you Tatiana for so much help in getting it going!