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  • In Oxford in the 1950s,

  • there was a fantastic doctor, who was very unusual,

  • named Alice Stewart.

  • And Alice was unusual partly because, of course,

  • she was a woman, which was pretty rare in the 1950s.

  • And she was brilliant, she was one of the,

  • at the time, the youngest Fellow to be elected to the Royal College of Physicians.

  • She was unusual too because she continued to work after she got married,

  • after she had kids,

  • and even after she got divorced and was a single parent,

  • she continued her medical work.

  • And she was unusual because she was really interested in a new science,

  • the emerging field of epidemiology,

  • the study of patterns in disease.

  • But like every scientist, she appreciated

  • that to make her mark, what she needed to do

  • was find a hard problem and solve it.

  • The hard problem that Alice chose

  • was the rising incidence of childhood cancers.

  • Most disease is correlated with poverty,

  • but in the case of childhood cancers,

  • the children who were dying seemed mostly to come

  • from affluent families.

  • So, what, she wanted to know,

  • could explain this anomaly?

  • Now, Alice had trouble getting funding for her research.

  • In the end, she got just 1,000 pounds

  • from the Lady Tata Memorial prize.

  • And that meant she knew she only had one shot

  • at collecting her data.

  • Now, she had no idea what to look for.

  • This really was a needle in a haystack sort of search,

  • so she asked everything she could think of.

  • Had the children eaten boiled sweets?

  • Had they consumed colored drinks?

  • Did they eat fish and chips?

  • Did they have indoor or outdoor plumbing?

  • What time of life had they started school?

  • And when her carbon copied questionnaire started to come back,

  • one thing and one thing only jumped out

  • with the statistical clarity of a kind that

  • most scientists can only dream of.

  • By a rate of two to one,

  • the children who had died

  • had had mothers who had been X-rayed when pregnant.

  • Now that finding flew in the face of conventional wisdom.

  • Conventional wisdom held

  • that everything was safe up to a point, a threshold.

  • It flew in the face of conventional wisdom,

  • which was huge enthusiasm for the cool new technology

  • of that age, which was the X-ray machine.

  • And it flew in the face of doctors' idea of themselves,

  • which was as people who helped patients,

  • they didn't harm them.

  • Nevertheless, Alice Stewart rushed to publish

  • her preliminary findings in The Lancet in 1956.

  • People got very excited, there was talk of the Nobel Prize,

  • and Alice really was in a big hurry

  • to try to study all the cases of childhood cancer she could find

  • before they disappeared.

  • In fact, she need not have hurried.

  • It was fully 25 years before the British and medical --

  • British and American medical establishments

  • abandoned the practice of X-raying pregnant women.

  • The data was out there, it was open, it was freely available,

  • but nobody wanted to know.

  • A child a week was dying,

  • but nothing changed.

  • Openness alone can't drive change.

  • So for 25 years Alice Stewart had a very big fight on her hands.

  • So, how did she know that she was right?

  • Well, she had a fantastic model for thinking.

  • She worked with a statistician named George Kneale,

  • and George was pretty much everything that Alice wasn't.

  • So, Alice was very outgoing and sociable,

  • and George was a recluse.

  • Alice was very warm, very empathetic with her patients.

  • George frankly preferred numbers to people.

  • But he said this fantastic thing about their working relationship.

  • He said, "My job is to prove Dr. Stewart wrong."

  • He actively sought disconfirmation.

  • Different ways of looking at her models,

  • at her statistics, different ways of crunching the data

  • in order to disprove her.

  • He saw his job as creating conflict around her theories.

  • Because it was only by not being able to prove

  • that she was wrong,

  • that George could give Alice the confidence she needed

  • to know that she was right.

  • It's a fantastic model of collaboration --

  • thinking partners who aren't echo chambers.

  • I wonder how many of us have,

  • or dare to have, such collaborators.

  • Alice and George were very good at conflict.

  • They saw it as thinking.

  • So what does that kind of constructive conflict require?

  • Well, first of all, it requires that we find people

  • who are very different from ourselves.

  • That means we have to resist the neurobiological drive,

  • which means that we really prefer people mostly like ourselves,

  • and it means we have to seek out people

  • with different backgrounds, different disciplines,

  • different ways of thinking and different experience,

  • and find ways to engage with them.

  • That requires a lot of patience and a lot of energy.

  • And the more I've thought about this,

  • the more I think, really, that that's a kind of love.

  • Because you simply won't commit that kind of energy

  • and time if you don't really care.

  • And it also means that we have to be prepared to change our minds.

  • Alice's daughter told me

  • that every time Alice went head-to-head with a fellow scientist,

  • they made her think and think and think again.

  • "My mother," she said, "My mother didn't enjoy a fight,

  • but she was really good at them."

  • So it's one thing to do that in a one-to-one relationship.

  • But it strikes me that the biggest problems we face,

  • many of the biggest disasters that we've experienced,

  • mostly haven't come from individuals,

  • they've come from organizations,

  • some of them bigger than countries,

  • many of them capable of affecting hundreds,

  • thousands, even millions of lives.

  • So how do organizations think?

  • Well, for the most part, they don't.

  • And that isn't because they don't want to,

  • it's really because they can't.

  • And they can't because the people inside of them

  • are too afraid of conflict.

  • In surveys of European and American executives,

  • fully 85 percent of them acknowledged

  • that they had issues or concerns at work

  • that they were afraid to raise.

  • Afraid of the conflict that that would provoke,

  • afraid to get embroiled in arguments

  • that they did not know how to manage,

  • and felt that they were bound to lose.

  • Eighty-five percent is a really big number.

  • It means that organizations mostly can't do

  • what George and Alice so triumphantly did.

  • They can't think together.

  • And it means that people like many of us,

  • who have run organizations,

  • and gone out of our way to try to find the very best people we can,

  • mostly fail to get the best out of them.

  • So how do we develop the skills that we need?

  • Because it does take skill and practice, too.

  • If we aren't going to be afraid of conflict,

  • we have to see it as thinking,

  • and then we have to get really good at it.

  • So, recently, I worked with an executive named Joe,

  • and Joe worked for a medical device company.

  • And Joe was very worried about the device that he was working on.

  • He thought that it was too complicated

  • and he thought that its complexity

  • created margins of error that could really hurt people.

  • He was afraid of doing damage to the patients he was trying to help.

  • But when he looked around his organization,

  • nobody else seemed to be at all worried.

  • So, he didn't really want to say anything.

  • After all, maybe they knew something he didn't.

  • Maybe he'd look stupid.

  • But he kept worrying about it,

  • and he worried about it so much that he got to the point

  • where he thought the only thing he could do

  • was leave a job he loved.

  • In the end, Joe and I found a way

  • for him to raise his concerns.

  • And what happened then is what almost always

  • happens in this situation.

  • It turned out everybody had exactly the same

  • questions and doubts.

  • So now Joe had allies. They could think together.

  • And yes, there was a lot of conflict and debate

  • and argument, but that allowed everyone around the table

  • to be creative, to solve the problem,

  • and to change the device.

  • Joe was what a lot of people might think of

  • as a whistle-blower,

  • except that like almost all whistle-blowers,

  • he wasn't a crank at all,

  • he was passionately devoted to the organization

  • and the higher purposes that that organization served.

  • But he had been so afraid of conflict,

  • until finally he became more afraid of the silence.

  • And when he dared to speak,

  • he discovered much more inside himself

  • and much more give in the system than he had ever imagined.

  • And his colleagues don't think of him as a crank.

  • They think of him as a leader.

  • So, how do we have these conversations more easily

  • and more often?

  • Well, the University of Delft

  • requires that its PhD students

  • have to submit five statements that they're prepared to defend.

  • It doesn't really matter what the statements are about,

  • what matters is that the candidates are willing and able

  • to stand up to authority.

  • I think it's a fantastic system,

  • but I think leaving it to PhD candidates

  • is far too few people, and way too late in life.

  • I think we need to be teaching these skills

  • to kids and adults at every stage of their development,

  • if we want to have thinking organizations

  • and a thinking society.

  • The fact is that most of the biggest catastrophes that we've witnessed

  • rarely come from information that is secret or hidden.

  • It comes from information that is freely available and out there,

  • but that we are willfully blind to,

  • because we can't handle, don't want to handle,

  • the conflict that it provokes.

  • But when we dare to break that silence,

  • or when we dare to see,

  • and we create conflict,

  • we enable ourselves and the people around us

  • to do our very best thinking.

  • Open information is fantastic,

  • open networks are essential.

  • But the truth won't set us free

  • until we develop the skills and the habit and the talent

  • and the moral courage to use it.

  • Openness isn't the end.

  • It's the beginning.

  • (Applause)

In Oxford in the 1950s,

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