Kenneth Sharpe - Baccalaureate
This is your last class, and mine too. It was hard to prepare because I am doing my least favorite thing with my most favorite people: lecturing TO you in a huge class instead of puzzling WITH you in a small class discussion. Here are two things I want to puzzle out. First: I suspect that the most important things you have learned at Swarthmore are things that you may not know you have learned. Second: I suspect that many of things you’ve learned can’t be graded and they can’t be taught through reading assignments or lectures. But if they can’t be taught, how am I going to teach this last class?
It is about Matt Quin, a young professional who had been recently promoted from nurse to nurse manager at the Intensive Care Unit (ICU) of Cardiac Surgery at Brigham and Woman’s Hospital in Boston. He is headed for the exit door after an exhausting day at work. He does not know that a crisis is brewing in the nearby Operating Room. The surgeons can’t stop the bleeding on a 20 year old woman because of the blood thinner medicine she has been taking. Her kidneys won’t clear it out because they are not working.
They desperately needed the new hemodialysis (CVVH) machine that Quin’s ICU has—and someone who knows how to operate it. As Quin hits the automatic exit door button to walk out of the unit he hears the charge nurse say into her phone: “oh no, we don’t do that in this unit....Our management stopped us from doing that years ago.” Quin says to himself: “put your head down and keep heading out the door, you are so close.” But he turns back. “There was just something inside me that did not feel right leaving for the day.” The nurse reassured him: “it’s nothing, take off and enjoy the afternoon. We can take it from here.
It always works out, you know that.” Quin pressed: what was it we don’t do anymore? She tells him what the OR wants and explains it is no longer policy to send the machine and an ICU nurse down for this purpose. Quin is taken aback. But she quickly pulls together a group of other nurses to support her: they say its unsafe to practice hemodialysis with their new piece of equipment in a new environment.
“I quickly went to my office”, remembers Quin. “[I] took a deep breath, and then another deep breath. I had no ideas how to approach this situation since it was the first time in a predicament like this since I started as manager....there was no manager orientation or rule book on how to handle this specific sort of situation. I instinctively knew that we absolutely needed to respond...I knew what we had to do and knew it needed to be done quickly regardless of any policy that existed.” But how to do it in the face of staff resistance? He rapidly imagines alternative scenarios and hits on a plan: he quickly arranges for the educator who trained nurses on the new hemodialysis equipment to join him and an ICU nurse to go to the OR. He then pulls aside the two charge nurses and says: we will send someone. Relieve a nurse from their current assignment. The charge nurses resist: no nurse can be spared. Quin takes their “assignment” sheets and starts speaking to other nurses. He finds one with the right skills who agrees to go. He contacts the OR. We will be right down. 10 minutes later he goes back to get the nurse. She says: “I am sorry, I don’t think I can go anymore.” The other nurses had convinced her it would be an unsafe move to violate protocol.
“I could not believe my ears,” remembers Quin. “I was a bit panicked and began thinking through how to deal with this. It dawned on me that one of the nightshift nurses who was particularly skilled with this device” was about to come in. He had not yet been pressured to refuse. Quin contacts the nurse and he agrees. 15 minutes later Quin, the nurse, the educator and [CVVH] machine were all down in the OR. The next day the Cardiac Surgeon called the ICU to thank the nurses, and especially the nurse who went to the OR, for saving the patient’s life.
The next day the first thing Quin does is listen to his staff. He then organizes 2 staff meetings every day. He encourages them to talk about why they became nurses. “Once it was brought back to doing what was best for the patient there was really only one answer that everyone had,” says Quin. “It was agreed that in the moment of an emergent situation we need to do what we can for the patient. I was glad to know that I was not on an island.”
OK: let’s stipulate you read this article. And while we’re at it, let’s “stipulate” we’re in a small class. We’re going to discuss this article. Most of your teachers want to encourage learning through the process of discovery—and the process might be as important as what you discovered. To encourage us to learn how to notice the details of context I might ask you to describe the situation Quin faced: did you notice that it did not come pre-framed as an ethical problem? That it was messy, ambiguous, and fraught with conflicting aims: Send needed help. Obey rules and avoid punishment. Don’t risk operating a new machine in a new environment. I might ask us to wonder about the kinds of capacities Quin need to figure things out. He was caring; he had the right values. But was this enough? Did you notice that Quin also needed to know HOW to care. He needed the skills of good listening to have the empathy to figure out what the staff were thinking. Quin needed imagination skills to quickly see alternatives—and when they failed he had to imagine more. (We might pause to reflect on how your imagination was trained, could be better trained.) I would want us to grapple with the choice-making here. Quin was not being asked to just “think” about the right thing. He had to DO the right thing, to ACT. What character traits did he need to act? For example, how important was courage and why? Maybe we would discuss how you learned the resilience or grit needed to try again at a time when you failed.
Matt Quin was an advanced novice; he was learning the practical wisdom to become an expert nurse manager. This is not the capital “W” WISDOM that we might associate with a sage, or with Plato’s Philosopher Kings, or with the prophets. Or even with Yoda. It is what Aristotle called phronesis. Practical wisdom, small p small w. It is knowing the right purpose (telos) of a practice. And, very concretely, it is also knowing how to do the right thing in the right way at the right time for this right purpose. Quin was learning practical wisdom not through books but through practice—the experience of trial and error.
I also might want us to notice that I’ve framed the discussion so far around Quin as an individual struggling to do the right thing. But what does he do the next day? He does not punish his staff or lay down the law (“this will never happen again”). Instead he designs a process to transform the culture in his ICU unit. First he creates a safe space for the nurses to reflect together instead of “gotcha” environment. He gets them to think about why they are nurses: is this the kind of nurse you want to be? Is this the kind of unit you want to practice in? He has his staff practice good listening and resilience and group noticing, imagining, reflection, and deliberation. And those are exactly the same things we would be practicing if our class discussion were well designed.
You’ve probably noticed that I have been using the word “design” a lot. It is an increasingly common term these days. You hear it used to describe what architects, builders, artists, illustrators, clothing designers, web master and IT geeks do. My focus is on a different kind of designer—one who designs systems that help develop the character and judgment of the people so that they can practice better.
My favorite political philosophers are all aiming to connect their institutional designs to human character. I teach Hobbes because he designs political institutions to contain the worst in people. Hobbes looked into the soul of man and saw only disorder: unregulated emotions and an insecure ego that sought gain, glory and power. That meant that life always risked being “nasty, brutish, and short.” Beneath the thin veneer of civilization was a seething disorder; chaos always lurking, waiting to break into war of all against all. Order, Hobbes argued, depended on a strong man—a “Leviathan”—that could use our fear of death to get us to obey his laws.
Aristotle is always another staple in my classes. Writing over 1900 years earlier, he understood Hobbes’ vision: the potential for human beings to be what Aristotle called “barbarians.” But human nature held another potential as well: people could become social beings who sought happiness—flourishing—through family, friendship and community; Aristotle saw the possibility that people could learn the habits of that enabled this flourishing: courage, patience, equity, justice, self-restraint and love. Reason gave men (and, alas, he really did mean men) the human capacity to design systems to nurture these virtues. How, he asked, could communities be designed to encourage the right character traits? How could people learn the practical wisdom to choose well—and to do good design.
It turns out that Quin himself was part of a program designed to develop character and practical wisdom. He and half dozen other novice nurse managers were part of a pilot program at Brigham and Woman’s Hospital in Boston: 8 one-week seminars spread out over two years. A seasoned nurse manager and facilitator designed the program to encourage the learning of reflection and practical wisdom. Quin and his colleagues wrote stories about their ongoing experiences and discussed them with each other. The course was designed to provide a safe space for them to talk about their struggles and mistakes, to reflect on what had gone wrong, to carefully listen to each other, to imagine and deliberate about alternatives.
So Quin was becoming a kind of Aristotelian statesmen. In the ICU he was designing a slow but transformational process of cultural change. His staff had lost their way in knowing the right thing to do and how to do it. He helped them get back in touch with that. The new design was so successful that the staff went on to win several prestigious Beacon Awards of the American Association of Critical Care Nurses for excellence in practice.
Many of you will be called on to design relationships and institutions after you graduate: friendships, communities, workplaces, organizations. You didn’t take courses on this at Swarthmore but I’m suspecting that the hidden curriculum here has encouraged you to learn more than you think you’ve learned.
When I was a student at a liberal arts college I thought my classes were designed to teach me “the material” and prepare me to be examined and ranked. But teachers here that we are also designing our classes to encourage much more. For example: the wisdom it takes to know when and how to talk to each other, when and how to listen. How to imagine. How to reflect. How to have the courage to talk up in class, to defend a difficult or unpopular idea, to make a mistake, to learn through trial and error. How to be empathic: if you can’t understand the perspective and feelings of students or authors with whom you disagree you can’t have a fruitful class discussion let alone learn how the world works.
You learn not just from the course design. You also learn from how we teachers interact with you. What questions we ask in class teach you how to ask questions. How we pursue the dialogue with you models reflectiveness. You watch who we call on, or don't, and learn about fairness. We teach you when and how to interrupt—by when and how WE interrupt YOU. We teach you how to listen by how carefully we listen; if you hear us repeating what you’ve said to clarify a point, you learn that it is OK to be uncertain if you don't understand something. If you see us admitting that we don't know something, we encourage intellectual honesty. If you see that we have the courage to admit our mistakes, to reflect on them, to learn from them, we encourage your resilience and courage to learn through your own trial and error. We teachers are always modeling character and practical wisdom—for better, or for worse! And you are always watching!
You also learn these things from the design of classes that take you out into the community. You engage with the daily struggles and hopes and tragedies of people that inhabit the world outside of you books and classrooms. But you are not just having a random experience. This experience is designed to encourage you to reflect on how lived reality challenges your theories; it is designed to encourage you to learn how to see and feel multiple viewpoints; how to balance conflicting ethical positions in ambiguous and contradictory circumstances. Take for example the Politics of Punishment course which meets every week inside the prison in Chester with half Swarthmore students and half inmates. Keith Reeves and his colleagues have carefully designed this experience. Swarthmore students and prison insiders are reading the same things but they are encouraged to get inside each other’s hearts and minds. The friction caused by rubbing the different lives and perspectives against each other is designed to foster judgment, reflection, empathy. When the students in Sa'ed Atshan’s class on the Israeli-Palestinian conflict went to the region they sat down with people on multiple sides of the conflict. They practiced noticing where the often radically different frameworks and understandings came from, deliberating about policies, imagining alternatives.
Think about the projects you have undertaken in the “service learning” or in the “engaged scholarship” programs the Lang center sponsors: The explicit aim of these courses and projects (like the Lang Fellows) is to encourage students to serve their communities and to learn how to put their academic theory, reading, and research into dialogue (tension) with hands-on experience. But you are learning so much more. You are learning the courage it takes to put yourselves in new and uncomfortable non-academic experiences with people who do not understand your jargon and are suspicious of your motives, to put yourselves in the shoes of people from classes and cultures and ethnic or religious groups that are totally different from yours.
Then (of course) there are sports programs at Swarthmore. They are designed to teach the athletic skills and prowess to compete and win. Coaching and constant practice is there pedagogy. But most of the coaches at Swarthmore—as many of you know—are encouraging you to learn how to work together to bring out the best in each other. Your development IS the team’s development and the team’s excellence depends on character traits and judgments that are exactly what Aristotle was trying to design for: courage...resilience....good listening... Note the design of the pedagogy here: coaching and practice, reflection and deliberation, more coaching, more practice.... Think for example of the post-game review: you are encouraged to learn through the experience of trial and error, to reflect on what worked and didn’t, to deliberate not only about how you can do better but how you can work with others so that they—and the team—can do better.
We’ve been noticing how design encourages a certain kind of learning at Swarthmore. But let’s also notice how you have been encouraged to practice design.
Think about your efforts to design and fund programs in places like Chester, often with Lang Center support: tutoring programs, expanding the Chester Youth Court, helping high schools students to find alternatives to suspension for disciplinary problem, helping them stay out of the school to prison pipeline. Think about the design work you have done on War News Radio, Dare to Soar, Learning for Life. Think about the study groups and review sessions you are constantly designing . You sit down, sometimes late at night and learn how to listen to each other, to give counsel, to empathically think backwards and figure out why a fellow student is confused.
Those of you who have worked as Writing Associates (WAs) or Resident Assistants (RAs) are always working on design. The programs are designed to train you to do this. WAs, for example, take a whole semester course followed by an apprenticeship program. (If I had more time I would love to talk about how Jill Gladstein and her colleagues designed this training because I think it is a spectacular model). But what I want to notice here is that the WAs and the RAs are sent out into “the world” to practice being designers. As RAs you have to figure out how to design a process in your dorm by which you can mentor and model and coach a group of eager, sometimes frightened and unruly freshman who have never met before to talk and reflect and deliberate and empathize their ways through the crises of the first year at Swarthmore. WAs are learning to think backward with those they mentor, to figure out what they don’t understand—and this demands extraordinary patience and empathy. You have to notice when the obstacles they face are not simply a lack a lack of skills but a lack of confidence. You have to figure out how to critique them without leaving them feeling helpless and ignorant, believing that they got into Swarthmore by mistake and that soon they will be found out. You get training to do all this. You get coached. You get mentored. There is back up. But then we step back. We don’t micro-manage. The design encourages you to gain the capacities you need to be good system designers yourselves through practice and reflection.
Let me conclude by reflecting for a moment on your upcoming transition, to what you call the “real” world after Swarthmore. Most of you are still novices in system design—like Matt Quin was--and you are facing a tough world: a world of finding jobs and paying off debts, a world of institutions aimed at gain, glory, and power—institutions designed to control your behavior with their rigid standardized procedures or incentives. But let me conclude by giving you a glimpse of a few examples that I would not have thought were possible.
A challenge you will soon face is sustaining your close Swarthmore friendships when key design elements that encourage such close relationships here disappear: shared activities, shared food, shared dorm life, shared studies. Facebook and email alone will not substitute. I learned of a remarkable effort at what intentional design can do from a group of 8 women Swarthmore graduates from the class of 2003. They came back to campus to spend a weekend with the Practical Wisdom seminar Barry Schwartz and I were teaching in 2013. It turns out they were already worried before graduation about what would happen to their close friendship group after they dispersed around the country. They discussed with our seminar the plan they designed to meet once a year for a long weekend. They would hang out over cooking and walks. But they also designed a structure to assure good telling and good listening. One example: they scheduled uninterrupted time for each to tell the others what was on their minds about their lives—and then to get feedback, reactions, support. Another example: they set up a mutual check-in system throughout the entire year—by voice if possible. They also talked with us about the complex design details and tough decisions they had to take in order to make it work—like should significant others and children be invited or just the intimate group of friends.
Another example, from my research on the drug war and the criminal justice system. Back in the 1980s and 90s both the Republicans and Democrats tried to prove their tough-on-crime bona fides by promoting a harsh system of mandatory minimum sentences for drug possession. Prison building boomed as cells were filled with mostly poor, mostly non-white minorities. Critics came to call this “mass incarceration.” There have been recent and successful efforts to begin changing these laws. But long before there were wise and courageous reformers that started designing a parallel, alternative court system: drug courts, veterans courts, mental health courts, juvenile courts. In the drug courts, for example, someone stealing or dealing to support their addiction—or their families—could be sentenced to treatment, rehabilitation, community service, job training and mentoring. State and local judges teamed up with parole officers, social workers, and even police and prosecutors to build this system. Instead of just punishing—instead of bringing out the worst in people—they designed a system to encourage these law breakers to reflect and deliberate; to choose paths that would heal their illness, restore their dignity, enable them to work and rejoin a better community.
One more example, this one from the world of medical care. Medicine’s extraordinary ability to treat acute disease successfully has kept people alive longer. But longevity makes people ripe for chronic illnesses: arthritis, congestive heart failure, hypertension, obesity, diabetes, AIDS, low back pain, osteoporosis, long term cancers. So: how to care when there is no cure? How to work with them—not on them. How do you design practices to encourage providers to learn the practical wisdom—they would call it the “clinical judgment”—to become partners in care in institutions increasingly dominated by increased bureaucratization and pressures to cut costs. By a love affair with algorithms. By medical record keeping that keeps doctors eyes on their laptop screens instead of ours.
Take the example of the palliative care service at Dartmouth Hitchcock Medical Center designed to care for chronically ill patients, especially those with cancer. Every day, 8 a.m. the morning “huddle.” Twenty people crowded around the table, preparing to go off and see patients. Palliative care doctors, nurses, social workers, chaplains, a massage therapist, residents, medical students, and medical fellows. An opening poem. Then bereavements for patients of theirs that recently died. Then a discussion each of the inpatients and outpatients they will see that day. The medical reports: what’s happened in the last 24 hours? Are the pain medications working? But in addition: the patients stories, hopes and fear. It’s her 9-year-old grandson that’s giving her something to live for. What can we do for this patient’s spouse who does not have enough money for a taxi to the hospital? Or for this patient who is stressed out at not being able to feed her kids? The huddle over, the team heads for their work in the wards.
Once a week the team engages in “Wisdom Wednesdays”. Two staff present an ongoing case that troubles them. The whole team joins in to question, reflect, deliberate. What doctors or nurses called you in on this case? How did they initially present the patient’s situation to you? What did you expect before you walked into the room? What did you find? what did you notice or fail to notice, and what were the clues? What was the particular context and history of this patient and family? How did you feel when so and so said such and such? How did you deal with your frustration and anger? The team created a safe environment to learn through reflection, not through fear and evaluation. They designed a work environment that encouraged the development of character, purpose, and practical wisdom.
I could go on....and my classes do tend to go on...but let me conclude. You and I have learned much here at Swarthmore that was not part of my job description and not part of your transcripts or resumes. We’ve begun to learn the character traits and moral skills to act well and to design systems to bring out the good in each other.
My flourishing as a teacher here for the last 45 years has depended on your flourishing as students. That what has given meaning to my work and to the work of almost all my colleagues.
The reason why you will go forth and design systems to bring out the good in people when you leave Swarthmore is not because someone has “charged” you to do this. You will do it because of your faith, because of your commitment and idealism, and most of all because you want to flourish with others. Thanks for the great education. And may the wisdom be with you.