“Leadership is getting in the trenches with those you serve and leading by example.” In this...
Leadership in Medicine: Lessons for Every Professional with Ian McCoog
"What you put out as a leader will be heard and will affect every level of the organization."
In this episode, Craig P. Anderson talks with Ian McCoog, Assistant Professor of Medical Education at Geisinger Commonwealth School of Medicine and author of Leadership Bites. Ian explores the challenges healthcare professionals face when transitioning from clinical expertise to leadership roles. Drawing from his book and personal experience, Ian shares how leadership theories can guide decision-making and foster team collaboration. He also emphasizes the importance of self-care for maintaining balance in high-pressure environments and discusses how storytelling can make leadership lessons stick.
After You Listen:
- Visit Ian’s website at ianmccoog.com
- Connect with Ian McCoog on LinkedIn
- Get a copy of Ian’s book, Leadership Bites
- Connect with Craig on LinkedIn
Key Takeaways:
- Build confidence by understanding that everything you say or do as a leader has an impact on your team and organization
- Develop competence by leveraging leadership frameworks and reflecting on lessons learned from experience
- Maintain calm by finding moments for self-care, even during hectic and demanding days
Things to listen for:
- (00:00) Intro
- (01:38) Ian’s early leadership journey
- (02:38) Lightning round: leadership insights
- (07:51) Challenges in medical leadership
- (16:01) Leadership theories and applications
- (18:24) Maintaining equilibrium in medicine
- (20:17) Resident leadership as a paradigm
Episode Transcript
This has been generated by AI and optimized by a human.
Craig Anderson [00:00:00]:
So I looked the president of the University of Florida in the eye. And I said, that seems like a really bad decision. Why did you make it that way? Welcome to Executive Evolution. I have over 25 years of leadership experience in corporate America. I learned a lot of lessons the hard way, and I created this podcast so that you won't have to.
Craig Anderson [00:00:23]:
Today's guest is the first time I've interviewed someone who has a degree in higher education administration, which is what my master's is in. And that got me to thinking about a story when I was in school and we had the opportunity to interview the president of the University of Florida where I attended.
Craig Anderson [00:00:37]:
And he'd made a really controversial decision early on in his tenure to go to the NCAA to talk about potential violations by the football program and missed his first graduation ceremony. As a result, I thought that was a terrible decision and set a terrible precedent. I was young, cocky 22 year old. So why not?
Craig Anderson [00:00:55]:
I asked the question and he really explained how in situations where there really is no wind, sometimes you just have to choose, especially when there's urgency in the heat of the moment. And that also. Resonates for me as I think about the interview with Ian McCoog who is an assistant professor of medical education and is recently written a book called Leadership Bites and it really tells us that in the heat of making decisions we have to make that decision so let's jump right into today's interview with Ian McCoog.
Craig Anderson [00:01:31]:
Ian, welcome to the Executive Evolution podcast. I'm so glad you could join us today.
Ian McCoog 00:01:35]:
Wonderful, Craig. Thank you so much for having me.
Craig Anderson [00:01:38]:
Absolutely. So yeah, I'm really intrigued because so much of what I like to talk to people about is what I call accidental leaders, people who never planned to be in a leadership role and then suddenly find themselves there.
Craig Anderson [00:01:50]:
And you really help people who are experts in one area learn how to lead on top of all their great expertise in medicine. Is that a fair summary?
Ian McCoog [00:01:58]:
Yeah, absolutely. So my day job is that I work with medical students on some of the skills that maybe you don't always think about when it comes to being a doctor.
Ian McCoog [00:02:07]:
And one of them is, is leadership. We know that our doctors are going to be the head of our healthcare teams, but we also know that there are times that they have to defer to other people that are on the team. So one of the areas that I focus in the class that I teach at the medical school where I work is on leadership theories of how you can take these tools and put them in your back pocket, and then when conflict or competition arises, you can pull the correct one out and help lead your team in the right direction.
Craig Anderson [00:02:37]:
Perfect. Love it. Well, before we dive into all those lessons, I would like to take you through our lightning round that we do with every guest. Are you ready to go?
Ian McCoog [00:02:46]:
I am ready.
Craig Anderson [00:02:47]:
All right. So talk to me. What was the first leadership role that you had in your life?
Ian McCoog[00:02:52]:
I was 23 years old. I was a brand new teacher.
Ian McCoog [00:02:55]:
It was my second year in education, and in Pennsylvania, where I'm from, we had a grant program. It was to help with technology integration in the classroom. And part of that program was that there was a stipend for a teacher to leave the classroom, get some advanced training, and then lead the initiative with the other teachers.
Ian McCoog [00:03:16]:
And in a very strange way, I think a lot of the people that I worked with were afraid that if they left the classroom and a substitute was brought in for the year, perhaps they wouldn't have a spot to land when the grant was over. So for that reason, a lot of my coworkers were like, you know, I'm really interested in this, but it's just not something I'm interested in taking on.
Ian McCoog [00:03:38]:
But again, I was 23, I was still establishing myself. So I jumped at the chance to lead an initiative and to receive some training. And I learned a lot from that. I'm not going to say I was great at it. I'm not going to say that it was some foundational moment of a light switch turned on and I knew I was going to be a great leader someday, but it was good practice.
Craig Anderson [00:03:57]:
What surprised you? Cause 23 is pretty, pretty young for a leadership role. And I think we all have our preconceived notions of leadership before we actually have to do it. What surprised you the most when you stepped into that role?
Ian McCoog [00:04:10]:
I think really what surprised me, especially at that age, was the notion of there wasn't one set of traits or characteristics, and this is something I talk about in my book, so I guess maybe I pulled from that.
Ian McCoog [00:04:23]:
That you have this vision of what you think a leader is. You think that they have these characteristics. And I realized that we came from a large swath of the population, people with very different backgrounds, people with very different professional and personal lives. But the thing was that Anybody who is willing to put in the time and have the professional chops for it, had the ability to become a better leader.
Craig Anderson [00:04:48]:
I love it. I love it. All right. Question number two. Who is your leadership crush?
Ian McCoog [00:04:55]:
Okay, that's an easy one. My leadership crush is almost certainly Malcolm Gladwell. Just the way he tells stories. And honestly, that's what I try to do in anything that I write, but specifically with Leadership Bites coming out, I didn't want to just tell the stories of leadership. I didn’t want to tell theories of leadership. I want to tell stories that would make those theories stick for people that spend the time to pick up the book and read it and Malcolm Gladwell is just so good with that. I always joke around that. You pick up one of his books and you're reading and it's this very engaging story.
Ian McCoog [00:05:28]:
And then at the end, it's like, And that's why there's only one type of ketchup and there's four types of mustard and you're like, wow, I've really just learned something. It's something that's very useful. But if you would presented me with, you know, market statistics on Hunt's versus Heinz ketchup, I'm not going to read those because they're going to be boring.
Craig Anderson [00:05:47]:
Yeah, yeah, yeah. And it's just about trying to make this topic relatable because I don't think we always have great insights into it and Malcolm Gladwell obviously is huge and prolific writer on this topic and speaker and podcast host and so much great content about there. The next question is in 10 words or less, given all your experience, how do you define leadership?
Ian McCoog [00:06:07]:
I think leadership is definitely affecting change and it's affecting change in a positive direction. So I think your textbook definition is affecting change. We have good leaders, we have bad leaders. They are definitely affecting change. Some in this direction, some in this direction. But the goal I think, for anybody is to affect that change in a positive way.
Ian McCoog [00:06:29]:
And what the goal is, is kind of what's always up for debate. We all know people, we have all worked for people who maybe weren't. Best leaders from our perspective, but from their perspective, they probably had a vision of this is where I want this to go. And they honestly thought that that was the best approach.
Ian McCoog [00:06:48]:
And that was where they wanted the organization to go. I think it's that give and take it's that negotiation between what a leader does and what's going to be best for. Whatever the group is, it can be a business, it could be a school, it could be a club of just a group of individuals, a family is an organization that needs leadership.
Ian McCoog [00:07:07]:
It's finding that vision and bringing about change in a way that you think is going to be the best for everyone.
Craig Anderson [00:07:12]:
Yeah, that's so interesting because there's always the big goal, but how you get there is an important thing. You can be that leader who just constantly grinds and constantly forces your people and is abusive and you'll get there.
Craig Anderson [00:07:26]:
There'll be a lot of blood on the ground, but you'll get them there and you'll probably lose a lot of people. Or there's a leadership approach that we're all coming in at together. We're all going to row together. This isn't about me. This is about us. And we're going to get you there. I'm just casting the vision.
Craig Anderson [00:07:39]:
So it is an interesting thing to think about leadership. Isn't good or bad. It's just, you know, how we do it, but there's lots of leaders. Well, cool. You know, I joked before. You know, I have a master's in higher ed leadership, you have a Ph. D. in higher ed leadership, not something I run into a lot of people, and now you're taking that and teaching that to these young medical professionals, or I guess aspiring medical professionals.
Craig Anderson [00:08:02]:
You talked about how in your book, you've got a lot of stories about things, so. What are some of the things that somebody who's really good in medicine finds themselves in that first leadership role? Where are the struggles happening for them? Where are the challenges for them if they haven't had the advantage of getting some training up front?
Ian McCoog [00:08:18]:
I think just by the nature of medicine as a discipline, I think even layman, we all know that Medicine is a lot of science. I mean, students have to learn biochemistry and physiology and how the heart works and how the lungs work and how all of our organs interact and all that stuff. Pharmacology, which drugs help with certain ailments, which drugs don't mix together.
Ian McCoog [00:08:43]:
Those are all like, the very upfront things that we would expect our doctors to know and be trained in. The tricky part is when we get into like that next step of how well you deal with patients. What we always say like bedside manner and medical school I work with do a great job. We have courses that are in the sciences and we have courses that are in patient care and we blend that together to help our trainees become the best doctors that they can.
Ian McCoog [00:09:07]:
Then there's this whole other periphery stuff that we never really think about. A lot of my colleagues are specialists in medical humanities. We don't really think about, like, where do the humanities and people's stories come into training as a medical professional? And in my place in leadership, it's, it's the same way.
Ian McCoog [00:09:25]:
Of course, we want our doctors to be good leaders because we want them to be able to lead teams and to help patients and do all those things. But we're also training them to one day run the hospital. One of the things talk about a lot in my book, and when I talk to people about leadership is that we all have an expiration date, as much as that's not a pleasant thought, and I'm not just talking about us as people.
Ian McCoog [00:09:48]:
I'm talking about us as professionals. One day we'll retire. We won't do the things that we are doing anymore. And what we need to be able to do is hand that off to a competent professional who we know is going to take the mantle and run with it for the next 30 years. We have a great oral history project where we talk to retired physicians, but I don't do the interviews.
Ian McCoog [00:10:08]:
The medical students do the interviews. Because at some point it becomes this beautiful like handing of the torch of, hey, this is how I did it. It's yours now, here's some wisdom that I can pass on to you. And you know, it's a beautiful thing. It's that notion of we are our stories. There is no separating us as people from the stories that we are and that we live.
Ian McCoog [00:10:30]:
And you know, that's what I shoot for with that project. And it's what I shot for with Leadership Bites as well.
Craig Anderson [00:10:36]:
Love it. And so, yeah, and so as you're thinking about that and they tell those stories and you've accumulated those stories, where did they really struggle? In these early leadership roles, what are some of the touch points where they're like, I didn't do that well, and I could have done better. Where, where are those?
Ian McCoog [00:10:52]:
I think it's just human nature. We get that a lot from the physicians that we talk to. It's a matter of, I was presented with something that was brand new, that I had never done before. I used my knowledge, I used my training, I did the best that I could. And most of the time it turned out okay, because I was a competent professional for 30 or 40 years.
Ian McCoog [00:11:11]:
But there are times when it didn't turn out okay. And what I did was I learned from those places. And the other thing that I think we hear a lot is that you have a goal and you have a plan and you think this is going to be your path. And we just said about my professional career. And then it deviates into other areas and other places.
Ian McCoog [00:11:30]:
And you find opportunities to lead in fields or in disciplines or in literal geographic areas that you never thought of before. And it becomes the best thing for you.
Craig Anderson [00:11:42]:
Yeah, and when we talk about this, like an early leader as a doctor, is it over a practice? I guess it could be a lot of, what are usually the settings for them that they find themselves…I would imagine even as a doctor, they have a whole team of professionals around them that they're having to set a direction for. How does that kind of evolve for them to say, okay, you're now the decider?
Ian McCoog [00:12:03]:
So we use what's become now a famous vignette, a colleague and I, we use it when we're meeting with the students. And in the vignette, it's a young resident physician who's in charge of interns for the first time. It's usually a first year doctor who's maybe a little too big for his britches. Maybe aren't the most professional, you know, belittling people, not willing to work on a team in an effective way. That seems to be one of the first places where doctors are presented with that notion of leadership.
Ian McCoog [00:12:30]:
The reason I say that is because my colleague who I do this with, she is an MD. She is an attending physician. And she always tells our students, and I always say this like makes us both feel old because we're both in our early forties, that there is nothing like an early career in medicine, like the TV show Scrubs.
Ian McCoog [00:12:49]:
So you should go and watch Scrubs and all of the haphazard things that seem to happen in a day to JD and Turk. And that's what her experience was as a young physician. So whenever I kind of run an idea past her and say like, Hey, what do you think about this? We make this adjustment to the lesson this time.
Ian McCoog [00:13:05]:
She runs it through the filter of like, was it on an episode of Scrubs or did it happen to me? And if the answer is yes, then it's probably a good experience for the students.
Craig Anderson [00:13:14]:
And I would imagine as a leader in those situations, just what you're describing, you're going from, I don't know, a stubbed toe to a life and death situation and then back again, and it's kind of a whipsaw. How do you teach them or how do they maintain equilibrium through all that? Because those are a lot of emotional highs and lows, plus leading a team. How do you help them to think about maintaining equilibrium?
Ian McCoog [00:13:39]:
Yeah, we talk a lot about self care with our medical students, because they're going into a stressful field. They're going into a very rewarding field. But as you said, Those are two opposite ends of the spectrum and you could experience both of those in a morning. You could have a very fulfilling interaction with a patient where you really help them and they're very thankful and then the next person is screaming and yelling at you because you're not doing what they want even though the standard of care is being met. The best standard of care that you know of as the practitioner. It's wild. It's one of those things where I always say, like, I would never want to be in the position that our students are in. But I am so thankful that we have people who say, I want to do all this advanced study. It's easy for me to say I want to help people, me personally, because I do genuinely want to help people.
Ian McCoog [00:14:27]:
But to have to make those decisions and to find that balance of your own life and your professional life. It's certainly difficult. I give all the credit to our young doctors out in the field.
Craig Anderson [00:14:38]:
Yeah. And I would imagine when you talk about self care and you talk about the pace, like all I know about medicine is right, watching scrubs, watching ER, all those sundry things, but there's a hecticness to it.
Craig Anderson [00:14:49]:
So where do you find the moments? How do you help them see where these are the moments to find self care? How do you find the five minutes to? Breathe, meditate, whatever it is. How do they start to prioritize that?
Ian McCoog [00:15:00]:
I think in a lot of ways, it's the students finding out what works for them, and for how hectic medical school is, for starters, I think it's a good practice. And then when they go out into the clinical space, it becomes, how do I balance my learning? The care for patients that I'm helping the residents with and also finding that place where I'm still a trainee. But I'm also going to be expected to lead this team and this interaction someday. And again, I think it's where everything comes together.
Ian McCoog [00:15:33] :
If the students don't have the scientific knowledge. Then they're not going to be an effective doctor. However, if they don't have the bedside manner to meet the person where they are and really explain things to them, they're not going to be successful. And then we have that third piece, which is leadership of either talking to the patient, leading the team that you're on, or if you further down the line in your career, an entire unit, an entire discipline or an entire hospital.
Craig Anderson [00:16:00]:
Yeah, and let's pivot to that kind of doctor who's been practicing for 20 or 25 years and has made it to maybe chief of staff of a hospital. What does successful leadership look like for them at that level?
Ian McCoog [00:16:13]:
Yeah, I really think that's where your leadership approach, your leadership style, I'm always kind of nervous to say the word style because that suggests that there is like a bucket of specific things that you would do for one specific style, but you know, what are the goals of your health system?cc What are the goals for you personally and professionally? You have to balance all of those things out when you get to that level. And in a lot of ways, this is where I hope that the students remember some of the theories that we teach them about in the elective course that they take.
Ian McCoog [00:16:44]:
Their favorite is almost always Bolman and Deal's four frame model, just because it's so flexible. So. In the course, we have the students make, we call them podcasts, but they're really video casts with PowerPoint slides of five theories. So we have four frame model - Bolman Deal, we have situational leadership, we have adaptive leadership, we have resonant leadership, all those good ones.
Ian McCoog [00:17:06]:
And then we have them reflect upon it and think about a time in their life where they. Could apply that theory had they known about it. So really, when they're in that chief staff role or lead attending, that's where we hope that they reach back to those skills and say, okay, so if I look at this situation from a Bolman and Deal perspective, human resources, these are the people I have at my disposal that can help me solve this. Political, where is there a competition or conflict? How do we deal with that? Structural, what are the rules? How are we operating within the system that we have? And then I always think the biggest one is symbolic, which is hard for students to wrap their heads around, but what does the health system stand for that you are working in?
Ian McCoog [00:17:47]:
What's beautiful about that model, and the reason why I like to apply it to a lot of different places, is you can take that out of a hospital setting, put it in a business setting, put it in a school setting, really anywhere you have those frames that you could consider.
Craig Anderson [00:18:01]:
That's really interesting. So it's both taking those hypothetical leadership models, all their experience and blending all that together as they're kind of in crisis mode to start making these big decisions for hundreds of people, not to mention the patients, which probably takes it to thousands, right?
Craig Anderson [00:18:16]:
I would imagine when you're in a senior leadership role at a hospital, you're really driving to a whole lot of people or impacting a whole lot of people with that. How do they handle that pressure? Sure. Like when they realize their decisions are impacting this huge group. How do they deal with that pressure?
Ian McCoog [00:18:33]:
I almost think it's a personality trait. I have no science to back this, but it's my assumption. I think we all, doctors, podcast hosts, professors, I think we all have a career trajectory, and we know when you hit that comfortable spot of, I want to keep climbing the ladder. I want to grow in my leadership role.
Ian McCoog [00:18:54]:
I want to continue my leadership journey. But at some point you settle into that place where you say, all right, I feel like I'm good here. To do anything that I had done in the past, I probably wouldn't be happy because I've already done it, but I look at my supervisor or say like, I don't know that I, that I ever want to do that.
Ian McCoog [00:19:12]:
So yeah, I mean, to get into those senior level positions and to be at the beck and call of finance and things like that. Patient care and the team that you directly work with, and those competing needs of limited resources for each department, that's tough. One of the things that our health system does is we offer actual MBA programs to our practicing physicians.
Ian McCoog [00:19:35]:
They can take some classes in the evening over, I'm not sure how long it is. I think it's multiple years of just here's management, here's business, here's leadership. If you're looking to move out of the clinical space where you're taking care of patients and you want to move into the health system space, this is a useful degree and useful knowledge for you to have.
Craig Anderson [00:19:56]:
I love it. So if you think about all this and all these lessons that you have shared in the book. If you could distill it down for that kind of young position, maybe the intern or whatever, distill that down into kind of one lesson that would make them more effective or to deal with this better, whatever it would be, what's the one thing they should be keeping front of mind that would help them be a better leader?
Ian McCoog [00:20:17]:
The leadership theory that I hearken to a lot is resident leadership, which funny enough, It doesn't have a book called Resident Leadership. It's Primal Leadership by Daniel Goleman, Richard Boyatzis, and Annie McKee, where they talk about how your message as the leader resonates throughout the organization.
[00:20:38] Ian McCoog:
It's just the nature of being the leader. So always keep in mind what you put out there will be heard and will affect every level of the organization, even if it's someone who you have no interaction with. By virtue of you being the head and the person who is making the decisions, you got to make sure that you're putting things out that are going to spur positivity in your people.
Ian McCoog [00:21:01]:
Because they talk about reaching differentiation, they talk about dissonance. It's again, that balance, but somebody has to do it.
Craig Anderson [00:21:10]:
Yeah, yeah.
Ian McCoog [00:21:11]:
You have been chosen for some reason. There is some personality trait or performance quality that you have shown over years that have made you the leader of this organization that they trust you and that they know that your person is going to do a good job.
Ian McCoog [00:21:25]:
So the one piece that I was keep in mind is that notion of resident leadership of if I am in charge, what I put out. It's going to affect everyone, so I have to make sure that what I'm putting out there is going to affect that positive change.
Craig Anderson [00:21:40]:
I really like that point because a lot of times I'm coaching business owners or younger leaders. They don't realize the impact of their every utterance. The most casual remark you make, and for me it was always a challenge because I'm kind of a smart-ass. And so I would always defer to sarcasm. And people would take it seriously. Because you're the boss and people really take every word you say. So you have to learn how to be very intentional about the way you talk to the team because they're taking that lead and making decisions based on that.
Craig Anderson [00:22:14]:
So I love that point. That's such a solid point. It's also funny that the book is, it's probably cause Primal Leadership sounds a lot sexier as a book title than Resident Leadership. That's gotta be the only reason.
Ian McCoog [00:22:23]:
It's true. Primal Leadership makes you think of like, we're wolves on the hunt for this perfect thing, as opposed to, be careful what you put out, because it goes throughout.
Craig Anderson [00:22:32]:
There you go. Well, Ian, if people want to follow you, or great opportunity to talk about your book that's coming out. Leadership Bites, what are the best ways for them to get a hold of those things?
Ian McCoog [00:22:42]:
A couple different ways. I have a copy here next to me. Since I don't have a blurred background, I just have to make sure I hold it correctly.
Craig Anderson [00:22:49]:
Perfect.
Ian McCoog [00:22:49]:
It is backward on the screen, but that's okay. So yeah, Leadership Bites comes out on January 28th. So when this airs, perhaps it's already out, any number of ways to get it, Amazon, Barnes & Noble. If you have a local bookshop, they can order it for you. There's a magic database of books that once your book gets put out there into the publishing world that pretty much any bookshop can order it in for you.
Ian McCoog [00:23:12]:
My wonderful publisher is Rootstock Publishing in Montpelier, Vermont. Great, wonderful people. You can order directly from there as well. I do have a website, so I am at ianmccoog.com. Make it as easy as possible for people to follow. I'll be updating that with things such as this - podcast appearances, bookstore interviews, readings, all that good stuff.
Ian McCoog [00:23:33]:
I'm planning right now to hit my stride and take this thing on the road and see what people think about it.
Craig Anderson [00:23:38]:
Excellent. We'll drop all those links in the show notes so people can get a hold of the book. So Ian, thank you so much for sharing the story of the Executive Evolution to such a crucial part of our daily lives that we probably don't think about enough.So thank you very much for being on.
Ian McCoog [00:23:52]:
Thank you, Craig. It was wonderful.
Craig Anderson [00:23:56]:
I really appreciated the discussion today, you know, writing a book about leadership, especially with what I consider accidental leaders, which is people who've gone through medical school and have trained to become a doctor and then find themselves in leadership roles.
Craig Anderson [00:24:08]:
A lot of the kind of people I talk about who have these great specialties and these great talents and skill sets, and then suddenly find themselves leading, you know, people who run a business and they grow it and suddenly they're surrounded by five or six people and it's slowly descending into chaos because they really just love what they do.
Craig Anderson [00:24:25]:
And now they have to lead other people doing it. So I love that he's actually intentionally teaching people in the medical profession. How to think about leadership as they progress through their career. And as he said, it even starts when they're just interns and much less becoming chief of staff of a hospital.
Craig Anderson [00:24:40]:
So as always, I like to break down the key takeaways for me from the interview into the areas of confidence, competence, and calm. In the area of confidence, Ian talked about using the resources around you. You have to realize as leader that you do have resources around you. And when you can tap into those, that gives you the time to maybe focus on other things that you also need to be working on.
Craig Anderson [00:25:02]:
So tap into those resources. So you have the confidence that things will get done when you're focusing in other areas. In the area of competence, you know, he talks about taking the opportunities that are available to you to learn. His classes on leadership for medical professionals are optional. They don't have to take them, but they're really important to take these opportunities to learn how to lead.
Craig Anderson [00:25:21]:
A lot of times we don't see these opportunities in front of us, but we can build our competence when we take them. Finally, we talk about the area of calm and in calm, he talked about the importance of self care, finding those moments, even in the hecnic this, which I'm not even sure is a word of being a medical intern, all the pressure you feel and decisions and things moving quickly, find that moment of oasis to do some self care and at least take care of yourself.
Craig Anderson [00:25:46]:
So thanks, Ian, for sharing the stories about how your training is really helping medical professionals in the future. As always, remember, you can go from being an accidental leader to the greatest leader of all time. All it takes is developing your confidence, competence, and calm. See you next time on Executive Evolution.