Lessons from the NICU

“I think I’m having contractions”, said Debbie with a serious look of discomfort, driving home from a Chinese food feast with my folks. “Or is it the ginger beef?” I said, half-jokingly. Her pregnancy heartburn was ramping up. We decided to time the contractions to see if there was a pattern. Three of them, ten minutes apart. It was time to call family to help with our daughter, we needed to go to the hospital, stat (as they say). “He’s not supposed to be here yet. They can stop this.” pulsed through both of our heads.

The moment our son was born was, without a doubt, the scariest moment of my life. In an instant I experienced an immeasurable wave of relief that he was here, followed by an equal and opposite wave of panic as I realized he was blue and limp, plunked on my wife's chest with countless medical staff preparing to resuscitate him in the seconds that followed.

The next six minutes completed the whiplash as they got him on a CPAP machine, attached numerous leads, sucked meconium out of his mouth and airways, and we heard his first cry. Relief. I don't think I've ever cried as deeply as on that day.?

Our son Ariyan (“Ari”) was born at just over 35 weeks and 7 pounds -- a late premature baby boy. Apparently they are infamous for fooling parents and medical professionals alike into thinking they are ready for the world when they really aren’t. In the following 6 weeks, we stayed in NICU units at two hospitals. We (mostly Ari) navigated jaundice, transfusions, tube-feeding, respiratory, digestive, endocrine, nervous systems, surgery, infection issues, investigations and diagnoses throughout our stay. Once everything was ruled out by our incredible medical team, we were sent home with a tank of oxygen and a slate of follow-up appointments.?

Having a baby in the NICU is an experience many have had, and yet it was not an experience we were prepared for. We had unbelievable levels of support from our family on both sides who helped look after our 2.5 year old daughter whose world had been turned upside down. Debbie has been an unbelievable mom and partner throughout this ordeal, taking on so much of Ari's care. We’re back at home and both Ari and the family are doing much better. We’re developing routines, I’m back at work, and it’s starting to feel almost normal.

Aside from the ups and downs of this ordeal for our family, being literally immersed in another workplace and another functioning organization 24 hours a day for six weeks also gave me lots of time to observe the organization, systems and processes at play. The following are some of my reflections on what did and did not work during our stay and the lessons I could bring back home and to my work.

What did we learn?

Between Debbie and I, we were in the NICU almost 24/7 for 6 weeks. This level of immersion in someone else’s work environment, especially one with the degree of systems and process as a NICU teaches you a few lessons that can apply to any stressful situation, personal or professional. Most of what I observed was about communication and the way teams work. Here are a few takeaways, and how I think about applying them.

1. No amount of system, process or documentation will cover all blind spots.

The NICU is an organization designed for nurses who work 12-hour shifts. Every day at 7am and 7pm the nurse assigned to Ari hands off to another nurse. Often we’d have the same nurse for 2 or 3 days in a row. There is a consistent hand-off process where they go through all of the body’s major systems: respiratory, digestive, central nervous, circulatory, etc. with each other and discuss his status. BUT it still doesn’t cover everything because at the end of the day people are still at the heart of the system, and each person brings their own background, personality, circumstance and knowledge to the job. There were numerous occasions where Debbie and I filled in the blanks for a new nurse, or re-emphasized something that was covered in the handoff but not truly internalized by the recipient. Any process in a tech organization is similar, and we need to view it as something that always needs to be complemented with color and context from the people involved.

2. Advocacy is about context & continuity.

As parents we are often told “you know your kid better than anyone else.” When the doctors said that in Ari’s first week of life, I chuckled to myself.. ..do we really? He’s 3 days old. And of course we did, and we do. So much of effective advocacy comes down to being able to provide continuity and context to others around us to complete the picture and bridge the gaps between their assumptions and reality. This is a profound lesson as both a parent and a partner. This also applies to Product leadership and management, where my team’s job is to be the voice for what our customers find valuable and to bring that to the individuals in our organization, each with their own perspectives and assumptions, most of whom don’t live and breathe the customer’s context.

At ZayZoon, our customers are primarily low-to-middle-income workers struggling with liquidity and cash flow. Very few on our team bring that context from their personal lives, or have personally experienced the nuance of that circumstance enough to go beyond broad strokes in terms of what customers find valuable. We need to think about how to ensure that this context is hyper-present in our day to day so that we’re making the right decisions.

3. Over-communicate everywhere and be ok being over-communicated with.

At times we felt dumb telling the nurses things that likely already knew. We didn’t care enough for it to stop us, but we were amazed by how a majority of nurses were not only OK with us doing so but embraced being told something they already knew, just in case it could illuminate the 2% of information they didn’t have. Repeating yourself, often to the same person, was also part of the system by design.

In a tech context, there is nowhere both of these lessons hold more true than in Product. My approach completely changed many years ago when I learned to “take it all in” with arms wide open. Even if 99% of the content was already in there, the perspective from which the information came can always deepen my understanding. Likewise, repetition in different contexts, different mediums and at different resolutions is such a critical part of the Product function. It’s central to what we do.

4. Nature is not always shown in the numbers, and nature is important.

There were times in Ari’s care when the numbers we tracked (heart rate, pulse, respiratory rate, blood oxygen saturation) didn't look bad but there was something about his nature that was still off. We’d see this most during rounds when the respirologists, who were often less involved in his care over a 24 hour period, would report on his SpO2 histograms and the proportion of time spent with low saturations. The raw numbers weren’t bad, but there was something about the nature of his breathing that was caught by the nurses. He was periodic, he would wheeze occasionally but not always. Neither a snapshot of a three minute assessment nor a 12-hour histogram tell the whole story.

Luckily the data points were just that, and all of the qualitative aspects were taken into account in decisions about his care. I often reflected on the parallel role Product Analytics in our decision-making– the numbers tell a story but we have to keep our eyes open for the story the numbers aren’t telling, which is often about the nature or quality of performance.

5. Empathy and adaptability are by far the most impactful complements to competence.

Over 6 weeks we worked with 40+ nurses of all personality types and experience levels. We’d get excited when we learned that certain nurses were assigned to us because we knew and trusted them (and maybe Debbie could even sneak home for a shower and a sleep). Debbie and I often spoke about what we most valued in the nurses assigned to Ari. In the hospital setting, we’d often refer to it as “bedside manner”, but applying this to other situations it’s really an ability to read the room and operate within it.

We grew a strong adversity to student nurses, not because they were learning, but because they more often than not approached patient care as a list of things they had to do. For instance, one barged into a room at 3am where mom is finally getting her first 15 minutes of sleep for the day, flipping on the lights and waking up a refluxy baby to do an assessment. Assessments are supposed to happen every 3 hours, we get it, but if everything is stable then delaying it until the next feed wouldn’t be the end of the world.

In all cases we would gladly take a person who was 80% competent and truly empathetic and open to input, over a 100% competent but tone-deaf person. That said, we would take a competent nurse over an incompetent empath at any point during our stay. Over our stay we had some truly exceptional nurses (shoutout to Lisa, Tammi, Gabe, Julie, Hope, Blair, James, Dana, , Drs. Amin, Howell, Al-Sheikh, and Andrews) that were both incredibly competent, and incredibly kind. Both NICUs we were in had a “family can be there 24/7” policy, and they considered family to be an integral part of care (and they didn’t just say this, we participated in daily rounds actively every single day and were listened to attentively).?

Working with so many different people in such a short period of time gave us the opportunity to identify what mattered to us. In a different professional setting I reflect on how can I empower and coach my teams both with technical skills and this “bedside manner” that, in most settings, is such an amazingly strong and elevating factor in a person’s effectiveness.?

6. Effective conflict resolution comes down to emotional safety, vulnerability and humility.

There were a couple of occasions when we had conflict with a nurse over Ari’s care. It didn’t happen often, but when it did we would often have to continue to work directly with the person for hours, if not days.

As parents we didn’t want the conflict to affect Ari’s care, just as any parent may not want a disagreement with a teacher to affect that teacher’s approach to their child. On the rare occasion when conflict happened there was a cool down, an apology for the upset, and an honest expression of our fears, concerns and intent. There were occasional tears from both us and the nurses, as we embraced our humanity. Ultimately, some of the nurses we adored most were those we had issues with initially. At the end of the day, we knew that laying it all out as quickly as possible would lead to the smoothest care for Ari and I think this approach should be adopted at home and at work as well - provided there is an environment of emotional safety and enough self-awareness to be honest about where the issue truly lies.?

7. Diversity Part 1: Diverse goals and backgrounds lead to better outcomes.

Our care teams in the hospitals were extremely well-rounded. The team was composed of a nurse, a neonatologist and their fellow, a respiratory therapist, a dietitian, lactation consultants, a social worker, etc. They would all review Ari’s case each morning, and often these individuals would pop in to talk and listen to us. Occasionally, perspectives would be at odds. For example, the caffeine used to reduce periodicity in breathing causes reflux which affects eating, or a strict minimum volume on food meant “stuffing the baby so he would grow” where a baby-led nursing regime might feel more natural and sufficient.

In all cases concerns and perspectives were shared, decisions were made, and importantly, were re-evaluated regularly. I think about the times in my profession where my team’s goals seem to be at cross-purposes with another person’s – it happens often (e.g. growth vs. risk, release fast vs. tech debt). This parallel in the NICU setting was a good reminder that the best outcomes likely include advancement of multiple goals in any setting. We should not only embrace different backgrounds and perspectives and look to hire those who are different from us, but also adopt curiosity as a cultural strength in an organization as a way to improve outcomes.

8. Diversity Part 2: Diverse attention scopes lead to better outcomes.

This one is less obvious but I think it really applies strongly to Product work in tech companies. There have been numerous occasions over the course of Ari’s care where having Debbie and I provide continuity of context was an essential input to the decisions being made. Likewise there were numerous occasions when fresh eyes, new to his case, were able to identify something more familiar eyes could not. Finally, we had lots of valuable input from those who stepped away from something and came back, like a nurse who was reassigned to Ari after a few weeks and could see progress/regress in broad strokes that we as parents missed being so close to him day in and day out.

As a leader and a manager this is one of the most profound observations that will reinforce my approach. Knowing that continuity, freshness and periodic involvement each brings something different to the outcome, I’ll welcome and appreciate the value of input given by those who are involved day-to-day, those who have a new perspective, and those who are able to leave and come back and strive to ensure those voices are part of any initiative we undertake. Most importantly, we should not blind ourselves or take it personally if outside perspectives add something that we simply didn’t see from the inside. The more open we are, then better.

9. Progress comes in big leaps and small regressions.

Having spent the majority of my career in startups and scaleups, I know this to be true but the parallel with my son’s progress was startling and continues to be a good reminder that you HAVE to look at the big picture. Local minima and maxima give important clues as to whether adjustments are needed in the short term, but the journey to a globally optimal outcome comes with big leaps, and many small regressions peppered in. We’ve seen this time and time again with our daughter’s development milestones, and over Ari’s care to date as well. It’s a see-saw on an angle, and I think the same is often true of business, particularly in Scale Ups.

Wrapping up...

I was initially amazed at the parallels between this drastically different organization and work environment and my own. A group of people with varying perspectives trying to achieve an outcome, with systems and processes to support them will inevitably bump into their own humanity and social hurdles. Upon reflection, it shouldn’t be surprising that the lessons have a certain degree of universality.?

Still, with Ari home with us, safe and sound and on track, and our family back in the swing of things, I can say that being able to participate in and observe another organization’s operations, and draw parallels with my own experiences and lessons to bring back from parental leave was an unexpected silver lining.

Oh and.. obligatory proud daddy pic. Here he is this week doing his tummy time exercises.. Such a strong little guy. ?? ?? ??