It is a distant memory at this point. I remember a single feedback session during my years as a pediatric resident. It was probably early in my junior resident year when senior residents and staff took call from home. My mentor was a respected senior oncologist. When we met, I could tell that he was struggling to summarize the staff’s evaluation of me.
He was finally able to put it into a single sentence:
“Chuck, you’re kind of perceived as being a loose cannon.”
It was a fair assessment.
I was the one who was most apt to forget to call the staff on call before starting a procedure. I acted at times as though I thought that policies and protocols just slowed us down. And I could stretch the rules slightly to help patients move through the systems more efficiently.
In retrospect, the eighties were a time when hospitals were much more dangerous. This kind of thinking didn’t help.
The term “loose cannon” originated in the era of sailing warships where muzzle-loading cannons were secured to the wall of the gun deck with a system of ropes and pulleys that allowed them to be pulled out of the gun port, reloaded, rolled back, aimed and fired again in as quickly as 90 seconds.
A loose cannon was one that had broken free from the ropes that restrained it. When it fired, it rolled wildly and unpredictably around the deck, damaging other guns, injuring or killing crew members, potentially destabilizing the gun deck, and rendering the other guns inaccurate. In fact, a loose cannon couldn’t be fired, couldn’t be aimed, was ineffective and a threat to the ships staff and mission. Victor Hugo described a “loose cannon” as a monster; a machine turned into a beast that was uncontrolled and uncontrollable (“Ninety-Three,” 1874).
The “loose cannon” feedback was unfortunately an apt metaphor for what I would have described as “leadership” at that point of my personal and professional development. It was in essence a measure of unhinged enthusiasm coupled with initiative untampered by wisdom or experience. And I would say that it has been something of a long journey to try to rid myself of these tendencies, just as improving patient safety has been a long journey for health care.
The concept of patient safety really moved to the front of our collective consciousness with publication of the book, “To Err is Human” by the Institute of Medicine in the late nineties and the Institute of Healthcare Improvement’s successful “100,000 lives” campaign (2004-2006).
As pediatric department chief in the early aughts, patent safety became personal when I first heard the preventable hospital death of the toddler Josie King and the revolution in patient safety her parents and providers subsequently led for the nation (2001). When I was a new hospital CEO, Dr. Atul Gawande’s pioneering research and 2009 book, “The Checklist Manifesto” was another milestone for me as was John Nance’s book, “Why Hospitals Should Fly,” comparing aviation safety to the ways hospitals operated (2008).
We have all witnessed the revolution of the past decades, and I am convinced that hospitals are far safer than they were when I was a first year resident forty years ago last summer. In July of that year, just 12 months and a handful of days out of medical school, I became the “senior pediatrician” in the hospital at night. That was the standard at the time. Thankfully, it no longer is.
We have come a long way. I’d like to think that I have, too.
But recently while I was leading a meeting as the director of a city-wide public health effort, I made a statement that I felt was helpful, but that the project’s senior leader had to take the time to clarify.
A day or so later, after having taken some time to think about it, she gently suggested to me that she needed me to be reliably predictable, and that by my making the statement she was not prepared to explain, I had not been the leader she needed.
In other words: I needed to not be a loose cannon.
I am not much of a beer drinker. When I moved to Baltimore, if I did have a beer, I tended towards a particular brand. The brewer was Heavy Seas. The IPA was “Loose Cannon.” It might have been the name.
The beer has been a good reminder of the continued journey for health care and my development as a leader. We are all still learning. “Loose cannon” is a brand better imbibed than embodied.
Chuck Callahan Henry V 4.3 – Lead from the Front https://henryv43.com/