The result?

In one hospital:

• 10-day infection rate went from 11% to ZERO
• Prevented 8 deaths
• Saved $2million in costs

Across ICU’s in Michigan:

• In three months cut infections by 66%!
• Typical ICU cut infection rate to ZERO
• In 18 months, prevented 1500+ deaths
• In 18 months, saved $175,000,000

These are amazing results, and his book on checklists, “The Checklist Manifesto,” was recently published. Click below to order it from Amazon.

This book is inspiring, educational, engaging, riveting and fascinating. It’s extremely well-written, and is a fairly easy read. I’ve never written a blog post immediately after finishing a book, but I am now because not only is it GOOD, but this book is IMPORTANT.

Dr. Gawande led a huge study of a “safe surgery” checklist, a simple set of steps to be checked in each surgery. It was used and studied in eight hospitals: four in the developed world (US, UK, etc.) and four in the developing world (Tanzania, New Delhi, Jordan, Manila). Thousands of patients were studied for months before and after checklists were implemented. The results?

• Rate of complications fell by 36%
• Deaths fell by 47%
• Infections fell by nearly half
• Even in advanced hospitals in developed world, complications were decreased by one-third

I mean…. WOW! Cutting infection rates and death rates in surgery by half (with marginal differences between developed and developing countries) is simply incredible.

But here’s a choice quote from the book:

Take the safe surgery checklist. If someone discovered a new drug that could cut down surgical complications with anything remotely like the effectiveness of the checklist, we would have television ads with minor celebrities extolling its virtues. Detail men would offer free lunches to doctors to make it part of their practice. Government programs would research it. Competitors would jump in to make newer and better versions. If the checklist were a medical device, we would have surgeons clamoring for it, lining up at display booths at surgical conferences to give it a try, hounding their hospital administrators to get one for them – because, damn it, doesn’t providing good care matter to those pencil pushers?

Checklists are powerful, and not just for surgery. Gawande writes about data from investment managers and venture capitalists that shows that those that use checklists are much more successful than those that don’t. They’ve been used in aviation for 70+ years, ever since airplanes became so complicated as to be dangerous without checklists. The modern construction industry uses checklists to ensure their projects are safe and properly constructed.

I’m very familiar with checklists; operating a nuclear reactor in a US Navy submarine means you live with checklists in everything you do. But I accepted it without too much thought since we had no idea there was any other way of running such a complicated machine. It’s amazing to me that other complex professions don’t also use the same procedures.

Checklists are threatening to many people and professions. Using them implies that professionals don’t know what they’re doing, that they don’t have the ability to do their jobs. Even with the results described in surgery above, many surgeons still don’t use them. (Despite the fact that they continually prove to save patients’ lives, everywhere.) As Dr. Gawande describes above, if the same results were achieved through a pill or machine, doctors and hospitals would be racing to adopt them!

Dr. Gawande goes into real detail not only in what makes a good checklist and how to develop them, but also why they work. They work by simply making sure that key simple steps are accomplished, and by freeing your brain from concerning itself about the easy stuff (since the checklist will catch anything you miss). This frees the brain to think about the hard stuff, and able to deal with complications more directly. Good checklists also make communications easier, so that when things do go wrong, the experts involved can address them more directly.

Fundamentally, time after time, in study after study… checklists WORK.

Summary

This is a hugely important book, and I honestly can’t recommend it more highly, It doesn’t matter what industry you’re in, if you deal with or manage complexity, you NEED to read it.

If you want to efficiently improve your performance or your teams’ performance quickly and substantially, a checklist is your way to do it.

I got my bachelor’s degree (Aerospace Engineering) from the University of Michigan, which is located in the lovely town of Ann Arbor, Michigan (about a 45 minute drive from Detroit). As one of the top research universities in the US, the greater Ann Arbor area is home to major R&D facilities and company headquarters from the pharmaceutical, automotive, and engineering industries. There are interesting, fun things to do all the time in Ann Arbor.

I got/am getting my MBA degree from Cambridge University, in the ancient town of Cambridge, UK (about a 45 minute train from London). As one of the top research universities in the world, Cambridge is home to major R&D facilities and company headquarters from the semiconductor, software, and general technology industries. There are interesting, amazing things to do all the time in Cambridge.

Theory on resources

I believe strongly in the notion that prosperity leads directly from two things: natural resources and population size. (It’s a big reason why the US economy has been so dominant: amazingly large & diverse land mass with a large enough population to exploit it.) As an example, there is an extraordinary correlation between the Olympic medal table and just five factors:

• GDP
• Population size
• political structure
• climate
• home nation bias

The same elements apply to cities and their business cultures. As most of the western world generally has the same political structure, and home nation bias is irrelevant in this argument, the only things that matter are GDP, Population size and climate. It’s here that Ann Arbor and Cambridge are strangely similar.

According to Wikipedia, Ann Arbor boasts a population of 114,000 with students making up 32% of that. Greater Cambridge boasts a population of 130,000 with students making up 17% of that. As I mentioned above, both are home to major tech employers. (Strangely, both have engineering centers that are both well away from the main University centers… in Cambridge: the West Cambridge site, and in Ann Arbor: North Campus.) Even the climates are fairly comparable, though Cambridge doesn’t get quite as warm, or quite as cold, as Ann Arbor.

But what I want to address are the differences. As I am now tied more strongly to Cambridge, I’d like to show how those differences can provide lessons to the Cambridge community.

Advantages of each

Cambridge’s advantages over Ann Arbor

A huge advantage that Cambridge has over Ann Arbor is its next largest neighbor. Ann Arbor is closest to Detroit, which is slowly coming to grips with the fact that it will never come close to being the legendary Motown again. Detroit (and the entire state) is suffering from severe economic hardship, and unfortunately it’s not going to end anytime soon.

Cambridge is lucky in that the closest city is London. London has weathered the recent economic hardships well, and is still a leading center for the financial and media industries throughout Europe. Being an easy 45 minute commute away truly puts the world at Cambridge’s doorstep. (Key airports also put most of Europe less than half a day of travel away.)

Another advantage Cambridge has over Ann Arbor is Cambridge University. Where the University of Michigan is one of the best US universities, Cambridge is world-class. Literally, Cambridge University been ranked as one of the top 3 universities in the world. The number of incredibly smart people around the city is vast.

Finally, Cambridge has a huge funding advantage. Because of Cambridge’s history in the last 50 years in the tech world, there are a lot of accomplished investors between the angels and VC’s in the city. The city is still seen as a strong source of leading-edge technology; for example, Xen Source (since acquired by Citrix) was one of the few international investments from Kleiner Perkins.

Ann Arbor’s advantages over Cambridge

Ann Arbor has its own advantages over Cambridge. For one, the standard of living is cheaper. (Partly because of the general malaise in Michigan, partly because it’s a student town, and partly because exchange rates favor the dollar.) This makes it generally easier to start a business since your cash lasts longer.

Ann Arbor has some great facilities. I highly encourage people in Cambridge to check out this site: Tech Brewery.

The Tech Brewery is an old brewery that’s been converted to offices for entrepreneurs & startups for just $50-$250 a month. It’s pretty close to both central Ann Arbor and the College of Engineering campus. Looking at the site, twelve companies are located there, including Hab.la/Olark, a Y Combinator company. That’s a space that will attract interesting, vibrant startups.

(On this note, there is a bit of a shining beacon in Cambridge. Red Gate Software, through its co-CEO Neil Davidson, has built something a bit similar at their headquarters in Cambridge. In addition to hosting the new Springboard program, they’re also home to a group of startups that work from the Red Gate offices and get to share in the free food there.)

But Ann Arbor also has the Workantile Exchange, located in the center of town. It’s essentially a cool (and again, attractive) co-working space attached to a coffee shop.

Additionally, Ann Arbor has the Center for Entrepreneurship. It has a pretty focused goal: it’s a “Michigan Engineering venture that empowers students, faculty and staff to pursue entrepreneurial achievements that improve people’s lives, drives the economy and helps innovators bridge the gap between inventors and venture capitalists.”

(Compare that to the Cambridge Centre for Entrepreneurial Learning. It’s goal is more educational: “to ‘Spread the Spirit of Enterprise’ by providing educational activities to inspire and build skills in the practice of entrepreneurship.” In other words, while Cambridge focuses on learning, Ann Arbor focuses on doing.)

Finally, there is simply a bit of a culture gap. I’ve simply been told too many times, “Of course; it takes an American to start Cambridge Tech Meetup / Cambridge OpenCoffee.” It’s honestly a little depressing that that was the case.

What can Cambridge take from this comparison?

Entrepreneurs will naturally cluster… help them

I would LOVE it if Cambridge had a space similar to Ann Arbor’s Tech Brewery. A cool, convenient, cheap place to work with fellow geeks. While there are hopeful signs between Red Gate and the Hauser Forum, I think there simply needs to be a space near the center of Cambridge that can accommodate 10-20 startups, or around 60 people.

I don’t think this can or should happen at St. John’s Innovation Center or at the Cambridge Science Park… they’re too far out from the city center. (Red Gate’s office works because they’ve got amenities like proper food on site.) Young startups need to be in a vibrant atmosphere, which generally doesn’t exist right now.

There is the CityLife Social Enterprise Centre, which has very cheap office space and is home to a number of small companies. (Some who were there last year have since moved to Red Gate’s offices, though new ones have also moved in.) This is absolutely the right idea. Unfortunately, I understand that the owner of the building is looking to tear it down & redevelop it; CityLife is in there for the next year or two until that happens.

Unfortunately, finding/creating an attractive space takes effort, resources (both time and money), and a decent business plan. I know the economics can work, though it might require a bit of “barn-raising” to make it happen. Just take a look at the space that Ann Arbor’s Tech Brewery has to offer above… surely Cambridge can do something similar!

A focus on Doing, not Learning

The Cambridge Centre for Entrepreneurial Learning is a good institution. My criticism is its focus on Learning… not Doing. Business plan competitions are fine, Enterprise Tuesday is interesting the first year or two (until you’re tired of hearing the same sessions/advice every year), and teaching students the elements of building a business is great. But it never extends to actively supporting the startups that are trying to get off the ground. A simple example… where is the list of student startups from Cambridge? Here’s the one from Ann Arbor.

Cambridge Enterprise should be in a position to help, but its focus is on commercializing university IP… not helping generic startups get off the ground. (Where a startup is leveraging university IP is clearly a different story, and they do offer free 40-minute business “surgeries” to anyone.)

This is one of the main reasons why I started the Cambridge Tech Meetup… to celebrate Doers. To help promote the entrepreneurs and businesses that aren’t just learning about taking a new technology to market, but those that are actually doing it. (There were many others, but this was a big one.)

Now, this isn’t to say that people in Cambridge just talk about new technologies and products, and don’t develop them. There are plenty of companies around that are “doing”. But the University and the organizations in orbit around the University, those that have the biggest effect on potential student entrepreneurs, need to switch their focus from learning to doing.

There are amazing lectures in Cambridge all the time; it’s all part of the 800-year-old Cambridge tradition of learning. To help breed more and better startups, the culture needs to believe in building and making things just as strongly. Which leads me to the next point below…

More smaller, dynamic groups

Here is a sampling of Ann Arbor groups: Ann Arbor New Tech Meetup, a2geeks, a2buildbunker, CoffeehouseCoders, Ignite Ann Arbor, A2 Mini Maker Faire.

Whereas in Cambridge, I know about Cambridge Tech Meetup, Cambridge OpenCoffee (which has been a bit anemic lately), SuperHappyDevClub, Refresh Cambridge, Cambridge Geek Nights and Cambridge Geek Day. (There are also paid events, like FOWA Tour Cambridge and StackOverflow Dev Day).

Oh, but wait… there are over 50 more groups for Ann Arbor listed here.

Cambridge needs to have people just plant a flag in the ground and start a group that focuses on cool stuff. This seems to be far more of a cultural issue than a capability issue. Individuals with some talent just need to get a small group together, do cool stuff, and make sure people talk about it. Of course some aggregation will be necessary to help people find the right groups… I’d be happy to advertise any and all of these at Cambridge Tech Meetups to help spread the word.

Summary

This started as a tale of two cities, but ended in lessons for the city of Cambridge. I’m just one person, these are just my opinions, and I’m sure there will be plenty of people that will disagree with me. But being in the midst of the startup scene in Cambridge has left me with an overarching feeling: poorly-tapped potential.

Cambridge is a fantastic city. There’s amazing talent, reaching from university labs to local startups to the R&D centers that are scattered around the city. There’s money ready to invest in cool new technologies and products. There’s mentors all over that have lived their startup experience and can help others’ with theirs.

What Cambridge needs is a cultural tune-up. (aka, a collective swift kick in the ass to go out there and MAKE something.) Some of the important things I think should happen:

• A place for startups to cluster
• A new focus on doing
• A whole mess of small, dynamic groups that do different cool things

Going to see speakers and hear talks is fine. (There are millions in Cambridge.) But lets start taking that knowledge and turn it into action, products, and companies.

What are your thoughts?

Simon has had a fascinating career. He skipped his A-levels (similar to SATs for the Americans reading this) to join the crew of a merchant ship as it sailed around the world. Eventually he found his way to the French Foreign Legion, where he served for five years in Algeria. Passing up the option to become an officer in the Legion, he came back to the UK. Simon eventually became a hugely successful and highly regarded businessman in Hong Kong and Southeast Asia. Probably the most prominent of his current activities is being on the Board for Vodafone. More recently, he became the oldest man to reach the South Pole unsupported, at the age of 63. (It was a two-month trek!)

Career Advice

Simon had some really interesting insights for us as we approach our future careers. Specifically, one of his key points was that when thinking about jobs, we need to separate what we want TO BE from what we want TO DO. As long as you’re doing something you like, it really doesn’t matter who you become. (And if you’re doing something you like you tend to be really, really good at it!) What YOU DO is what YOU BECOME, so live your life to become the best at whatever you enjoy.

Another of his main points is that you have to grab opportunities as you see them. It was just a chance meeting that originally got him connected in Hong Kong, and Simon talked about how grabbing it was a seemingly small thing but an event that was a key to his future success.

Simon had two quotes that I thought were really interesting. Take them as you will:

• “Don’t go where the path may lead. Go where there is no path and leave a trail.”
• “On bad roads you meet good people.”

Finally, he told a story about trying to get to the heart of what a potential candidate really wanted to do with his life. Simon, not getting an answer, finally asked him what he would do if he had the next day off with nothing to do. The guy (a recent university graduate) thought about it, and told him “windsurfing.” Simon at the time owned a company that made windsurfing sails. The new graduate was sent to that company and became a great success and has gone on to very significant successes since. That concept, that we decide what to do in our career based off what we would do if we had a day off, is interesting. As Simon mentioned, it may lead to unexpected places, but as long as we do what we enjoy it should be fruitful both personally and professionally.

Summary

Simon was a fantastic speaker. His mix of great stories and fascinating personality made it one of the top tier talks this year. I’m definitely going to have to buy his book and learn a bit more about his early years in the French Foreign Legion.

Kevin Roberts, the CEO of Saatchi & Saatchi, is also the CEO-in-Residence at Judge Business School. He came in to talk to us recently about Winning with an MBA, which was particularly useful considering the somewhat dismal job market that we’ll be entering later this year.

First off, he’s really an incredible speaker. His staff has a virtual command center to run his presentation, with multiple laptops and a sound mixer! Impressive, and it certainly created a good first impression toward Saatchi & Saatchi. I’m really, really looking forward to the Creativity Workshop that he’s going to be running for the MBA class later this year. From what I’ve heard, it’s a very unique experience.

I don’t want to write too much about his talk with us, but do want to point out three challenges that he set out for us. I think these apply no matter who you are or what stage in life you’re at. We’ve been tasked with thinking about these and writing the answers down; you should do the same:

• What’s my 5-year dream?
• When am I at my best?
• What will I never do?

Particularly on the 5-year dream, he pushed us to push ourselves. He called the 5-year dream of running your own business, etc., “pathetic.” It was a bit of a shock, but a fair point. That’s not much of a dream; we can do that right now if we chose. What’s our real dream, something that seems completely impossible right now? That’s what we should be aiming for.

The other two questions are more straightforward. Still, we need to be brutally honest with ourselves when we answer them in order to really get an insight into our own abilities and preferences.

I went out to dinner with some of my classmates straight afterward, and we started talking about these questions – specifically our dreams. It was interesting to hear what people thought. Perhaps it’s the current job market, but it was generally difficult for everyone to really expand their horizons to answer the question.

While I think I’ve come up with my answer, I’m going to hold off from writing it publicly. But I invite you to really think (and feel) hard and answer the questions above for yourself; it could make for an interesting revelation.

It’s a short & simple video from Will Smith (the “Fresh Prince”) and his two keys to life: Running and Reading. Because if you want to succeed, you’ve got to be willing to work harder than anyone else.

Though I can’t help but be struck at how this reminds me of the balance I keep trying to strike between Creating and Consuming. Lately I’ve been focused on the mantra Create >> Consume because I need to remind myself that I have to make progress on my plans each day. But this reminds me that I have to consume in order for my creation to make sense in context.

Anyway, enough of my babbling. Here’s Will Smith:

I want to say a public congratulations to Doug Rowe, a fellow Cambridge MBA student. Just yesterday he was named as the scrum-half for the Cambridge University Rugby Union Football Club 1st XV in their Varsity Match against Oxford at Twickenham Stadium next Thursday (the 11th). He will be a bit of a rare commodity; an MBA student that achieves a sporting “Blue”.

It’s hard to express how big a deal this is in the sporting world of the University. A sporting blue is the highest level of sports achievement, and comes with a distinctive blue blazer. While the Rugby Union Varsity Match isn’t quite as high-profile as the Boat Race (in rowing), it’s been played since 1872 and now takes place in the UK’s second biggest stadium, seating 80,000! Doug did used to play on the US Rugby Team, so top-level competition certainly won’t be foreign to him.

So a hearty congrats to Doug… well done! (Match photos of questionable quality taken by yours truly at a very cold home match a few weeks ago.)

On a completely different note, it’s already the last week of classes in Michaelmas Term! I really have no idea where all the time has gone.

Just this last weekend we finished a lengthy take-home exam for our Business Modelling class (lots and lots of Excel… thus the need for a take-home exam). In the next two weeks we’ll complete our term’s consulting project, a final essay for Management Practice, and the essay portion of Organizational Behaviour. Then it’s a month of holiday and revision for exams in the first week of January.

Finally, I just found what is quite possibly the best-written internship cover letter I’ve ever read. Check it out here.

On Monday this week our MBA class had the opportunity to hear Michael van Swaaij speak to our class. He is the current Chairman of Skype, having previously served as CEO of Skype and Chief Strategy Officer (amongst other roles) at eBay.

First of all, I have to say that he was a fantastic speaker. I’m always impressed with speakers that don’t need the crutch of PowerPoint slides to make their point, and Michael was a very engaging speaker for 40+ minutes solid. (Before the Q&A.)

I want to quickly paraphrase a few of his top-level points:

• If your first job isn’t great… don’t worry. Things will happen. To a group of MBA’s that will likely graduate during what will likely be an extended economic downturn, this was encouraging. While we may not be able to do exactly what we want to straight away, I did get the sense we’ll get there in the end. (And probably by a route we had never anticipated.)
• Don’t focus on the press. Focus on the consumers. The press doesn’t reflect the reality that we need to live if we’re growing and innovating. The press is a lagging indicator of where industries are going. If you keep focused on consumers you’ll rarely go wrong.
• Great products/services allow people to do something they’ve never been able to do before. Enough said there.
• In growing a startup, you must hire well ahead of the curve. Companies and roles grow so quickly that the people you’ve got must be able to do the job above them, and likely the one above that. If they can’t they’ll hinder your growth. Unfortunately, few people want to have a job where they’re capable of doing so much more.
• In high-growth startups, missing an opportunity is much worse than not taking full advantage of the opportunity. I’m not sure I 100% agree with every implication of this, but certainly do agree that you’ve got to grab every opportunity you can.
• Leadership isn’t about you… it’s about the team. Enough said.

The Q&A portion was also enlightening and quite straightforward; unfortunately the most interesting bits were strictly off the record!

What’s this photo about? Well, about 15 students have the opportunity to have dinner with the “Leadership Series” speakers after their talk. I was very pleased to have the opportunity to continue discussions with Michael and the Director of Judge Business School, Arnoud De Meyer (also a Fellow at Jesus College) at a beautiful room in Queens’ College.

First of all, I have to say that Michael van Swaaij has to be one of the most down-to-earth senior business leaders I’ve ever met. He’s had a lot of important jobs and done a lot of interesting things, and has come out of it a very wise man.

But what I really feel like looking back on our talks (where I didn’t take any notes) is how inspirational (yet down-to-earth) he was. Whether or not it was what he was saying, I came away with a feeling that we’ll be well-prepared for life post-MBA, and not to be too worried about it. We need to work hard, keep our eyes out for good opportunities and take advantage of them.

[UPDATE]: The Judge Business School women have posted about this, too. Check it out here.

For those of us in Business School, I think it’s critically important to keep a holistic vision of our life and goals in mind. This video really says it all.

I’m incredibly happy and proud for the United States to have the new leadership that we will soon have. It’s going to be an incredibly challenging time, and the next four years will not be easy for Obama or the country. But I feel that we have a wise, capable and visionary leader.

But I wanted to take some time to reflect on some themes around Barack Obama and his campaign. Fred Wilson posted his list of what he believes the country can expect from an Obama administration:

1. A world class management team
2. Honesty
3. A steady hand
4. Diplomacy
5. Fairness
6. Leadership

There’s a reason that “A world class management team” is at the top of the list, and it’s closely tied to “Leadership.” It’s clear from articles like “Near-Flawless Run is Credited in Victory” that Obama built a solid team. Not only that, but he had the confidence to push out a tremendous amount of responsibility to his organization. From a military outlook, it was an excellent example of what is called “maneuver warfare.” But there’s a great example of his management and leadership styles colliding in this video of his talk to his Chicago campaign headquarters just after securing the Democratic nomination. I encourage you to take 10-15 minutes to observe what Barack Obama is like as a leader:

Obama is clearly a charismatic leader. Just take a look at this incredible collection of photographs from the Boston Globe. And because I think they’re both still so meaningful, check out his New Hampshire concession speech and the video that was made from it. Even in defeat he lifted people up and inspired them.

Finally, I’d like to remind everyone that elections matter. I recently created a prediction market on Hubdub for something that I think will become very critical quite soon: Supreme Court nominations. I encourage you to register on Hubdub and predict for yourself!

How many US Supreme Court Justices will retire by the end of 2009?

For people that are interested in Obama, his grassroots/volunteer movement, or politics in general, I would encourage you to watch this short (2.5 minute) video. It’s a very touching story about an elderly volunteer in one of his Colorado offices.