Extract | Revisiting lessons in leadership.

We look at management guru Stephen Covey’s theory of seven essential habits .

What do Edward de Bono, Peter F. Drucker and Philip Kotler have in common? They are all thought leaders whose work over the years has changed the way business is done across the world, making workplaces more efficient and work itself more logical.

A book that features theories of some of the major management gurus, Business Gurus That Changed the World is a must-read for anyone working in or studying business.

Stephen R. Covey was one of the well-known thinkers whose most prominent work is his book, The 7 Habits of Highly Effective People. We pick a chapter from Business Gurus that summarizes his theory and, more interestingly, describes its validity today and how real companies actually use these concepts. Edited excerpt:

Be proactive

This is concerned with exploring ways to take control of events rather than being the victim of circumstance. Covey suggests testing if you have the proactive habit by noting how often you use these expressions. ‘That’s the way I am’ = There’s nothing I can do about it. ‘He makes me so mad!’ = My emotional life is outside my control. ‘I have to do it’ = I’m not free to choose my own actions.’

Begin with the end in mind

Here Covey recommends developing a personal mission statement and acquiring what he calls the habit of personal leadership so that you can keep steering in the right direction despite changing circumstances. Developing this habit allows you to concentrate most of your energies on activities relevant to your end goal, avoiding distractions, and in the process becoming more productive and successful.

Put first things first

The previous habit involves self-leadership; this one is about self-management: putting first things first. Leadership, Covey states, ‘decides what the first things are, and management is the discipline of carrying out your program’. Covey introduces the idea of tasks fitting into four quadrants, with ‘important—not important’ on one continuum and ‘urgent—not urgent’ on the other.

Think win/win

Covey’s complete description is ‘win/win—or no deal’. This is one of what he calls the ‘paradigms of human interaction’. The others—win/lose, lose/win, lose/lose are to be avoided. He recommends that your attitude should be, ‘I want to win, and I want you to win. If we can’t hammer something out under those conditions, let’s agree that we won’t make a deal this time. Maybe we’ll make one in the future.’ Win/win is based on the assumption that there is plenty for everyone, and that success follows a cooperative approach more naturally than the confrontation of win-or-lose.

Seek first to understand and then to be understood

The key word in mastering this habit is ‘listen’. Listen to your colleagues, family, friends, customers—but not, as Covey states, ‘with intent to reply, to convince, to manipulate. Listen simply to understand, to see how the other party sees things.’ The skill he advocates here is empathy. The essence of empathic listening is not that you agree with someone; it’s that you fully understand him, emotionally and intellectually.


Synergy got a bad press when it was used as the logic for overpriced acquisition strategies. The acquisition of HBOS, it was claimed, would give Lloyds ‘crucial advantages in funding costs and synergies’ and made ‘clear sense’ for Lloyds. Such was the view in September 2008, but three years later such benefits were less than evident. But Covey uses synergy in the sense that creative cooperation—the principle that the whole is greater than the sum of its parts—encourages us to ‘see the good and potential in the other person’s contribution’. Developing this habit can produce a steady flow of 2+2 = 5+ type results.

Sharpen the saw

Covey illustrates this by telling a story supposing that you come upon a man in the woods sawing down a tree. ‘You look exhausted!’ you exclaim. ‘How long have you been at it?’ ‘Over five hours,’ he replies, ‘and I am beat. This is hard.’ ‘Maybe you could take a break for a few minutes and sharpen that saw. Then the work would go faster.’ ‘No time,’ the man says emphatically. ‘I’m too busy sawing.’ Habit 7 is taking time to sharpen the saw (you’re the saw). It’s the habit of self-renewal that makes all the others possible.


Source: http://www.livemint.com


Systemic Treatment for Brain Metastases from HER2-Positive Breast Cancer.

Two thirds of patients achieved a partial response; half experienced grade 3 or 4 adverse effects.

As new targeted agents have improved outcomes in HER2-positive breast cancer, studies have suggested that survivors might have a longer time to be at risk for developing brain metastases. Radiation therapy is the mainstay for treatment of breast-cancer brain metastases, but it causes adverse effects, and whole-brain radiotherapy (WBRT) impairs cognitive function. Alternatively, systemic therapy seems to have relatively little penetration into the central nervous system (CNS), and evidence of it producing a CNS antitumor effect is lacking. However, recent studies have shown that the oral tyrosine kinase inhibitor lapatinib — administered as monotherapy or in combination with capecitabine — might be an effective treatment. To determine whether this approach could delay radiation therapy, French investigators conducted an industry-funded, single-arm, open-label, phase II (LANDSCAPE) trial of lapatinib and capecitabine involving 44 evaluable patients with HER2-positive breast cancer who had not received whole brain radiotherapy (WBRT).

Treatment was administered in 21-day cycles: patients received oral lapatinib (1250 mg) daily and oral capecitabine (2 gm/m2) on days 1 to 14. Clinical assessments of toxicity and neurological effects were conducted every 3 weeks. Patients underwent computed tomography and magnetic resonance imaging studies to detect CNS lesions every 6 weeks. More than 90% of patients had received prior trastuzumab, 57% had neurological signs and symptoms at enrollment, and 84% had extra-CNS sites of disease, most commonly in bone, liver, and lung. The primary end point of the study was the rate of objective CNS response, defined as a 50% volumetric reduction in CNS lesions without progression of symptoms, extra-CNS disease, or use of steroids.

At median follow-up of 21.2 months, 66% of patients achieved objective CNS responses, all of which were partial responses. Patients were equally likely to attain CNS response whether previously treated with trastuzumab or not. Median time to CNS progression was 5.5 months, and median time to radiotherapy was 8.3 months. The majority of patients (78%) had CNS as the first site of disease progression. Nearly 50% of patients had at least one grade 3 or 4 adverse event, most commonly diarrhea or hand-foot syndrome.

Comment: Brain metastases remain a significant therapeutic challenge, and patients who have a relatively long survival after WBRT might experience some of the well-described cognitive and functional deficits. The LANDSCAPE trial offers patients with HER2-positive brain metastases the potential to delay radiation therapy. However, the combination of lapatinib and capecitabine has the potential to produce substantial adverse effects, which can also negatively affect quality of life.

Source: Journal Watch Oncology and Hematology


Patients with Online Access to Medical Records Use More Services.

Office and emergency department visits, telephone calls, and hospitalizations all rose when online access was available and used.

Electronic health record (EHR) systems are capable of providing portals for patients to access medical records and laboratory tests, as well as to communicate with physicians by e-mail. Some studies suggest, and enthusiasts hope, that virtual visits and physician communications by e-mail will decrease need for face-to-face medical visits, improve outcomes, and lower costs.

Through an integrated healthcare system in Denver that uses a comprehensive EHR with a patient portal, researchers compared about 44,000 members who voluntarily signed up for online access to medical records and clinician e-mail with 44,000 who did not. The two groups were matched for demographics, chronic disease burden, and baseline office visits. Portal users attended an average of 0.7 more office visits and made 0.3 more telephone calls per member per year than did nonusers. All other evaluated services also were used significantly more frequently by portal users, including hospitalizations, after-hours visits, and emergency department visits, (20, 19, and 11 more per 1000 members per year, respectively).

Comment: The authors calculate that, in a primary care practice of 1000 patient-portal users, these results would translate to about 10 more office visits and 5.5 more telephone calls weekly — this increase is not trivial. Whether higher use of services translates to improved outcomes cannot be assessed from this study. Users and nonusers were not matched for healthcare-seeking behaviors and medical decision-making behaviors. Editorialists note that this is just the beginning of technological and nontraditional approaches to providing medical care; whether higher quality and lower costs can be realized is far from clear.

Source: Journal Watch General Medicine