I don't know about you, but it seems like many of my work-related e-mails and other requests frequently have a ring of unreasonableness. Can turnaround time be faster? Can we do more work (clinical, research, teaching, you name it) with fewer people? Can we give free testing and other free support for research? Can we ensure human error is a complete impossibility? These are just a few – you can probably think of more questions that you have to field – or that you want to pose yourself. Even if these aren't totally unreasonable, it's not easy to give a quick 'yes' answer to any of these questions.

It is budget time, and aspirations are high and money is limited – just like every year. Budgets are all about determining priorities, managing constraint, and distinguishing the unreasonable from the reasonable. I was on vacation a couple of weeks ago, trying to forget about budgets, constraints, and unreasonableness for at least a little while — but I made the mistake of looking at my e-mail and saw a new message about a big campus deficit and a request to tax the medical school's departments from their reserves to help cover this debt. As you might imagine, this request was seen as unreasonable by many, and prompted the department chairs to write a letter sharing their considerable lack of enthusiasm to this financial solution.

A Beautiful Constraint: How to Transform Your Limitations Into Advantages, and Why It's Everyone's Business
“In their book, authors Adam Morgan and Mark Barden share that 'One of the leadership challenges of today – like it or not – is the requirement to grow within constraints' – a view that certainly resonates with me and my duties as a department chair.”
— Lydia Howell

I always find vacation to be a good time to step back from everyday issues like this, take a deep breath, and reflect. I also love to read on vacation, which is a good opportunity to learn from the experience others. My extended family was with me on vacation, and one of my daughter had brought along the book “A Beautiful Constraint: How to Transform Your Limitations into Advantages and Why It Is Everybody's Business” which had been recommended to all of the employees at LinkedIn where she works. This book's title struck a chord with me, given our circumstances, so I started reading it, too, and as you probably suspect, I found it interesting and even inspiring.

In this book, authors Adam Morgan and Mark Barden share that “One of the leadership challenges of today – like it or not – is the requirement to grow within constraints” – a view that certainly resonates with me and my duties as a department chair. The premise of their book is that constraint can become “beautiful” (i.e, the title) because seeking solutions to constraint can spark creativity and transformation. They give the example of the early days of Southwest Airlines in which the airline had to sell some of their planes due to financial difficulties, leaving only three planes to fly a four plane route – obviously, a considerable constraint of resources. Southwest could have decided to give up their ambitions, scale back, and do less. But instead they coupled their ambitions to their constraint and asked themselves an unreasonable question — how can we fly a four plane route with only three planes? By asking the right question and a challenging one, they were propelled to think differently and creatively to find a transformative solution. Ultimately, they determined that shortening the gate turnaround time via open seating and other novel process changes would allow three planes to do the work of four. Southwest's beautiful and innovative solution has been a game-changer in their industry, and has become standard processes in many airlines today.

Creativity, innovation, and transformation should be what a university and academic health center are all about – so my message in this month's blog is that we should all be challenging ourselves to think like Southwest Airlines. We should be coupling our many ambitions to our considerable constraints and creating the compelling (and slightly unreasonable) questions that will propel us forward to transformational solutions. I'm sure that any of you are rolling your eyes as you read this and are thinking, “Right — we could but…” and what follows the “but” are all the barriers and constraints that we battle every day and that seem so insurmountable – university policies, union rules, the wrong technology, not enough people, too many unreasonable clients, patients, administrators, etc. But authors Morgan and Barden emphasize the importance of reframing our knee-jerk response more optimistically to “we can if…”. A “we can if” perspective is oriented toward solutions, and provides a mindset that can spark creativity.

I'm proud that we have a great track-record of creativity and “we can if” thinking in our department that is a great foundation to build from in these times of unreasonable constraints. Our coagulation service is undergoing considerable transformation without many extra resources. Our faculty and staff in that section said “we can if” and have creatively redefined their own roles and duties to keep the highest level of patient care, despite retirements and personnel changes. The clinical chemistry and special chemistry/toxicology teams have made many changes this past year that have created savings of more than $470,000 without sacrificing quality, thanks to in-sourcing, and changes to workflow, equipment, and quality programs. Our recent Lean process “Share the Gain” meeting highlighted many impactful improvements throughout the lab which were created and led by staff at all levels, clearly demonstrating that beautiful solutions truly are everybody's business, just like the title of the book states. And last month's faculty research retreat included many insightful “we can if” conversations – plus great new opportunities, including a new collaborative relationship with Taiwan University made possible by Vice Chair of Research Yvonne Wan — that will help us grow our research programs, despite the unreasonableness of cuts to the NIH budget.

Nancy Gibbs, the editor-in-chief of Time magazine once wrote “It is actually the neuroscientists and evolutionists who do the best job of explaining the reasons behind the most unreasonable behavior.” This may be true – but I say that it's the pathologists and laboratory scientists (both clinical and research scientists) who find the ways forward despite unreasonableness in academic medicine. Here's to a “we can if” attitude as we move toward the end of this academic year and into the next one!