For Young, pattern recognition became the tool that was central to his stance—he was a sales guy whose experience enabled him to solve problems by recognizing their characteristic patterns. Thanks to his experiences, he grew more and more confident that he could see what was likely to transpire and to make bold decisions on the basis of the patterns he recognized—including the decision to give away Red Hat software over the Internet.
The dynamics of your personal knowledge system are graphically rendered in figure 5-1. Stance guides the acquisition of tools, and stance and tools shape experiences, which in turn inform tools, which in turn inform stance.
The circular relationship between stance and tools was famously noted by communications theorist and philosopher Marshall McLuhan, who in turn was paraphrasing an observation made by Sir Winston Churchill. McLuhan argued that, “We shape our tools and afterwards our tools shape us.”3 I agree entirely, but I wouldn’t stop there. Our tools inform our experiences, which lead us to new tools, which expand or deepen or otherwise alter our stance. To follow McLuhan’s thought all the way out to the end, then, we shape our tools and, through experience, practice, refine, and incorporate them into our stance. In due course, they shape us.
FIGURE 5-1
The late Sumantra Ghoshal, a London Business School professor, made a similar point in his critique of MBA education. He argued that the economic and game-theory tools that are staples of the business-school curriculum teach students to play zero-sum games—in other words, to see only trade-offs in the universe of possibilities. Their experience using those tools, Ghoshal argued, eventually shapes them into executives who know only how to play zero-sum games. Exposure to different tools and experiences, he maintained, would have shaped their stances much differently, producing executives who were not only capable of playing and winning positive-sum games, but able to recognize them in the first place.4
Beneficial and Detrimental Spirals
As Ghoshal’s argument suggests, personal knowledge systems are highly path-dependent.5 When a person starts in a given direction, that direction is likely to be reinforced and amplified, not diminished or altered. This can happen for good or bad; that is, the spiral can be beneficial or detrimental. Operating at their best, the three elements of the personal knowledge system will reinforce each other to produce an ever-increasing capacity for integrative thinking. By the same token, though, stance, tools, and experience can conspire to trap perfectly intelligent and capable people in a world where problems seem too hard to solve and mere survival is the only goal.
A narrow and defensive stance will lead to acquisition of extremely limited tools and extremely limiting experiences. Those experiences then feed back into the acquisition of even more limited tools and the formation of an even narrower stance. Imagine a young man of color born into a fractured, chaotic inner-city household. His early experience and upbringing teach him to see himself as an oppressed person in a world that offers him few opportunities to improve his circumstances. With little to hope for or aspire to, this young man’s motivation is just to survive, and the tools he acquires are only those he thinks will enable him to survive. Using those tools exposes him to experiences that validate his initial view of himself as a person trapped in a world that offers no opportunities for escape or improvement. Under the circumstances, it’s almost impossible for him to imagine acquiring better tools that might give him a more expansive view of life’s possibilities.
Michael Lee-Chin’s story shows how a different stance can set a person on a far different path. Although Lee-Chin grew up a mixed-race child from the mean streets of Port Antonio, he saw the world as full of opportunities and himself as an achiever motivated to succeed. His outlook motivated him to apply to colleges in North America, confident that he could obtain the financial aid he would need to attend. At college, he acquired tools that further expanded his sense of life’s possibilities. He gained experience in investment management and continuously honed his sensitivities and skills. This experience reinforced his view of the world as a place in which his efforts would be rewarded, further strengthening his stance as someone capable of great success.
The spirals proceed powerfully in opposite directions. Lee-Chin’s positive spiral made it obvious which tools he needed to acquire and which experiences would deepen his sensitivities and skills. His experiences, in turn, reinforced his desire to invest in acquiring further skills, enhancing his view of himself and his place in the world, and sharpening his motivation to shape his world for the better. The negative spiral of the hypothetical young man from the inner city, by contrast, generates defeatism. Beginning with image of the world as a miserable place, his stance, tools, and experience conspire to confirm his original view of the world as a place where the best you can do is second best.
Neither spiral is foreordained. Your personal knowledge system—your stance, tools, and experiences—is under your control. You have wide latitude as to how to develop your personal knowledge system. You might not be able to change your height, IQ, or DNA, but as long as you can change your stance, you can change the tools and experiences you use to develop your thinking capacity—especially your integrative thinking capacity.
The next three chapters address stance, tools, and experiences, respectively. Each component of the personal knowledge system is illustrated by stories of integrative thinkers. From there, I draw out the implications for developing your integrative thinking capacity and show how my colleagues and I are building these capacities in students and executives. The hope is that these three chapters will reinforce a positive spiral in your own personal knowledge system, propelling continuous improvement in your own integrative thinking capacity.
C H A P T E R 6
The Construction Project
Imagining Reality
It is impossible to begin to learn that which one thinks one already knows.
—Epictetus (c. 55–c. 135)
“UNACCEPTABLE!” In a ninety-minute conversation, that was the only word that Victoria Hale, the founder of the Institute for OneWorld Heath (IOWH), spat out in disgust. She uttered thousands of words in the course of my interview with her, words by turns emotional, reflective, analytical, funny, charming. But when the conversation turned to the pharmaceutical industry’s failure to address the needs of the poor, and the medical profession’s shrugging acceptance of that state of affairs, Hale let fly with a sentence that carried an explosive charge of contempt for laziness, complacency, and the status quo: “It was unacceptable to me as a pharmaceutical scientist.”1
Hale isn’t just any pharmaceutical scientist. Trained in the world-renowned pharmaceutical chemistry PhD program at the University of California at San Francisco, she has worked as a senior reviewer of new-drug applications at the U.S. Food and Drug Administration and as a scientist at Genentech, the world’s leading biotech company. She was on a path to a senior leadership position, either in government or at a major pharmaceutical company, but in 2000, at the age of forty, she stepped off that path to found IOWH, the world’s first not-for-profit pharmaceutical company. IOWH’s mission: to change the way in which drugs are developed—or more to the point, not developed—for diseases afflicting the world’s poor.
Over the course of her career in pharmaceuticals, Hale had learned that the industry had two ways of getting drugs to the people who need them. The first was the traditional for-profit pharmaceutical model: A drug company spends billions of dollars to develop a pharmaceutical treatment for a particular disease or condition, a process that takes years of lab work and clinical trials. If, at the end of this process, a drug gains regulatory approval, the pharmaceutical company sells it for a price that covers its costs and earns an acceptable profit for its shareholders. The second approach, known as the public health model, involves using subsidies, either from governments or pharmaceutical companies themselves, to make expensive drugs affordable for poor patients.
Both models have their strengths. The for-profit model m
obilizes hundreds of billions of dollars in capital to find new drugs for endemic diseases. The public health model leverages government and pharmaceutical company resources to help millions of people buy drugs they can’t otherwise afford. But neither model addresses the massive needs of people in the poorest countries. For-profit pharmaceutical companies develop new drugs for people who can afford them. They have no incentive to address diseases that primarily affect poor people, because the drugs to treat these people won’t generate enough revenue for their developers to recoup their research and distribution costs.
Don’t take that as an indictment of the drug companies. They’re not greedy or heartless, but as public, for-profit corporations, they’re constrained by their obligations to their shareholders and employees. There’s not much future in targeting customers who can’t pay.
The public health model brings the cost of existing drugs within the reach of millions of poor people. But the public health market can only expand the market for existing drugs; it can’t bring new drugs into existence. Public health organizations aren’t in the drug-development business themselves, and they can’t offer the for-profit companies sufficient economic incentives to focus on diseases that primarily affect poor people.
Between the two models, then, lies a vast gap in which major killing diseases flourish, with no attempt to find a pharmaceutical solution. That’s unacceptable to Hale. She told me that as she studied the problem of developing drugs for poor populations, she asked herself, “Why couldn’t there be a not-for-profit pharmaceutical company? If we could put together the technology and the people and the resources to get through the development stage and we had a product in the end that would be affordable . . . Let’s try it. Let’s put it together.” And thus the IOWH was formed.
The next step was to zero in on a disease afflicting poor people that would be susceptible to pharmaceutical intervention. One candidate was visceral leishmaniasis, a parasitic disease concentrated in poorest Bangladesh, India, Nepal, Brazil, and Sudan that kills about five hundred thousand people a year, making it the second biggest parasitic disease killer in the world after malaria. Those infected with kala-azar (literally, black fever), as it’s known in the local Indian parlance, die a slow, agonizing death as the parasite destroys their internal organs. The disease is curable by a full course of an antibiotic known as amphotericin B, but its cost—more than the lifetime earnings of most black fever sufferers—places that cure beyond the reach of all but a lucky few.
Hale and her IOWH colleagues launched a search for an affordable treatment for black fever. Before long, they found a drug that looked as if it might be effective. Paromomycin was an antibiotic that was brought to market in 1961 and discontinued about fifteen years later when it was no longer profitable. Hale and IOWH hit the foundation circuit to raise enough money to carry out a large-scale clinical test of paromomycin’s effectiveness against black fever, in cooperation with the Indian government.
IOWH’s phase-three clinical trial concluded in November 2004, with researchers reporting that 95 percent of patients given paromomycin were cured. In August 2006, the Drug-Controller General of India approved paromomycin to treat black fever in India. Because the cost is a mere $10 per patient for a full course of treatment, the government of India was able to cover the entire cost for its citizens. IOWH is lobbying the other countries with large numbers of black fever sufferers to follow suit.
With the support of the Indian government, IOWH is now working with partner Gland Pharma Limited of India to produce and distribute paromomycin across India. For her part in achieving this breakthrough, Hale was named Outstanding Social Entrepreneur by the Schwab Foundation in 2004 and Executive of the Year by Esquire magazine in 2005. She was awarded The Economist Innovation Award for Social and Economic Innovation in 2005 and the Skoll Award for Social Entrepreneurship in 2005. In 2006, she won a MacArthur Fellowship, known colloquially as a genius grant. It’s given to individuals who demonstrate, in the MacArthur Foundation’s words, “exceptional creativity [and] promise for important future advances based on a track record of significant accomplishment.” 2
If there was an award for excellence in integrative thinking, she’d win that, too. After all, she forged a creative resolution of two entrenched business models—one that was brilliantly successful at developing drugs but was structurally unsuited to serving low-income markets, and another that served low-income markets well but was structurally unsuited to developing new drugs. Rather than simply accepting the limitations of either model, Hale took personal responsibility for devising something better. She used her opposable mind to bring something new to the world: a not-for-profit pharmaceutical company. The question I want to explore in this chapter is: What stances do Victoria Hale and other integrative thinkers take that drive them toward creative resolutions?
The Integrative Thinker’s Stance
Integrative thinkers are a varied lot, as we’ve seen. But their stances have in common six key features. Three concern the world around them; three concern their role in it. First, they believe that whatever models exist at the present moment do not represent reality; they are simply the best or only constructions yet made. As Hale said of the state of pharmaceutical development before IOWH entered the picture: “This is reality? It’s the way things are? No! No! There’s a much messier situation behind that and around that and enmeshed in that.”
Second, they believe that conflicting models, styles, and approaches to problems are to be leveraged, not feared. “We have some individuals who are very pharmaceutical and very technical and not oriented to fieldwork,” Hale told me, “and then we have some individuals who are very field-oriented and relationship-oriented and culturally sensitive and not technically oriented or trained. But we need all of that to come together to make this world.”
Third, they believe that better models exist that are not yet seen. Hale described how she responded to fellow scientists who dismissed her idea for IOWH before she had even attempted it: “I would say, ‘How can you, as a scientist, say that?’ Sure, this is a huge undertaking, but if no one has ever tried it, how can you conclude that it won’t work? We have to do the experiment.”
Fourth, they believe that not only does a better model exist, but that they are capable of bringing that better model from abstract hypothesis to concrete reality. “I viewed [the problem of drug development for poor populations] first as a scientist, and said to myself and to others, ‘We should try it,’” she said. “My verbs are important here: We should. We should try it. And then, I actually can try it. And then, I will try it. And then I am trying it.”
Fifth, they are comfortable wading into complexity to ferret out a new and better model, confident they will emerge on the other side with the resolution they seek. “I can see a big picture, and I can imagine, and fear doesn’t come with that,” Hale said. “I can go deep, and I can go wide. While I’m disrupting my world and looking for mess, I’m actually looking for peace and calm. I’m not afraid of the mess.”
And sixth, they give themselves the time to create a better model. “I will know what I need to do when the time is right,” Hale said. “I just know. Whenever I have wanted to know, I gave it the time and the space and the energy—it takes substantial work. I just stay with it, sit with it, spin it around. You can’t rush it. You know, it happens when it happens.”
This is an inherently optimistic stance. Integrative thinkers understand that the world imposes constraints on them, but they share the belief that with hard thinking and patience, they can find a better outcome than the unsatisfying ones they’re presented with.
We have already seen Isadore Sharp of Four Seasons look at the existing business models for the hotel business and come up with something better: “the best of small motels combined with the best of large hotels.” We have seen Tim Brown determine that IDEO designs had to satisfy users’ functional and emotional requirements simultaneously, instead of trading off one for the other.
&n
bsp; K.V. Kamath took the helm of a small Indian government-backed development bank in 1996 and turned it into ICICI Bank. ICICI swiftly grew to dominate retail banking in India and is now globalizing rapidly and taking on the world’s long-established banks and winning. Like Sharp and Brown, Kamath rejected conventional wisdom, which held that he faced an irresolvable trade-off, in this case between quality and efficiency. He has structured and managed ICICI Bank to achieve both aims.
Most integrative thinkers quite explicitly refuse to accept tradeoffs that the rest of the world tells them are unavoidable. Meg Whitman, CEO of eBay, is typical. She describes the secret of eBay as “this idea of ‘and.’ It’s not just community for community’s sake, and it’s not just commerce for commerce’s sake. It’s the two of these things combined, which is quite powerful.”3 Nandan Nilekani, the builder and CEO of what is perhaps India’s most successful global IT powerhouse, Infosys Technologies Limited, says that when he’s confronted with two fundamentally opposed sets of requirements, his first inclination is to ask, “Are there solutions that satisfy both?”4 And when asked whether he thought strategy or execution was more important, Jack Welch, the former chairman and CEO of General Electric, responded, “I don’t think it’s an either-or.”5
Integrative thinkers also share an uncanny composure in the face of complexity. They wait patiently for the multifarious strands of a problem to become apparent and shape themselves into some kind of pattern. Ramalinga Raju uses a rich metaphor to describe the process. Raju founded Satyam Computer Services in 1988. Since then it has grown to more than $1 billion in sales and thirty-five thousand employees around the world. “If you are swimming on the surface,” he said, “then you are very unlikely to find pearls, because they are deep underneath and you have to dive down; you have to go into a fair amount of depth on any particular issue that you take up.” And what, I asked him, is your process for depth-diving when you’re faced with a complex problem involving clashing models? “I meditate,” he said.6
The Opposable Mind Page 10