Conditions Over Outcomes: A Lesson from the Ambulance

William N. Martin argues that leaders and organizations should focus on creating conditions that allow human potential to emerge rather than demanding outcomes, drawing on his experiences in emergency medicine.

LA Metrowire Staff
••Business
Conditions Over Outcomes: A Lesson from the Ambulance

Organizations invest heavily in improving outcomes, teaching leaders to motivate, increase accountability, and extract more performance from employees. But according to William N. Martin, those efforts often begin with the wrong question. "We strive for outcomes when we should be looking at conditions," Martin said. His perspective, developed over decades in high-stakes environments, challenges the conventional wisdom that poor performance automatically signals a lack of motivation, ability, or commitment. Instead, Martin urges leaders, educators, and parents to first examine the conditions surrounding an individual before trying to change that person.

Martin's background as a utility lineman, flight nurse paramedic, ski patrol member, and mountain rescuer has placed him alongside people making decisions under extreme pressure. One emergency involving an 11-year-old girl who had suffered a traumatic amputation of her leg at the knee remains with him. When Martin entered the ambulance, he found capable emergency personnel working on her, but the intensity inside was extremely high. Rather than telling anyone to calm down, he began asking clinical questions: What was her blood pressure? What had already been done? Why was a second tourniquet being used? What were her vitals? The questions were deliberate, and the atmosphere began to change. "The people in that ambulance knew what they were doing," Martin said. "I didn't need to come in and tell them how to do their jobs. What I could do was change the condition we were operating in."

Outside the ambulance, another problem was unfolding. The girl's mother was overwhelmed; her husband was unable to accompany her, and she faced a long drive to the trauma center while her daughter would be transported by helicopter. Martin handed the mother his phone and asked her to call herself, explaining that he wanted her number so he could remain in contact during the flight. He told her that her daughter was being cared for and that he could not yet know whether doctors would be able to save her leg. What he could give the mother was a role: her job was to get to the hospital safely because her daughter would need her when she arrived. The circumstances had not changed, but the mother now had something she could do. Martin could not determine the medical outcome, but he could influence the conditions surrounding it. For Martin, the patient's support system is part of the calculus of the patient's outcome.

This distinction became important to the way Martin began thinking about human behavior well beyond emergency medicine. He questions the tendency to assume that poor performance automatically means a person lacks motivation, ability, or commitment. "What conditions have we allowed to persist?" Martin said. "Are we giving somebody the ability to think and make decisions, or are the conditions around them teaching them to simply wait for someone else to tell them what to do?" The distinction matters because environments are rarely the product of one person or one decision. Some conditions are inherited; others develop gradually. Some are influenced by circumstances outside anyone's immediate control. For Martin, becoming aware of those conditions may be more useful than assigning blame for how they came to exist.

Martin often illustrates the idea with two seeds: a sunflower seed and a corn seed. He asks people to consider what each contains. They are different in appearance and carry different genetic information. Given the opportunity, they will become entirely different plants. Yet neither seed needs to be taught what it is capable of becoming. What matters is whether it encounters the conditions necessary for that potential to be expressed. "You put the seed in the appropriate soil. It needs water. It needs sunlight. There are conditions that allow what's already in that seed to emerge," Martin said. "I didn't create the potential in the seed. It was already there." But throw those same seeds randomly out a window and their future becomes dependent on where they happen to land. The potential inside them has not changed. The conditions surrounding them have.

For Martin, that is where the analogy becomes useful in conversations about people. An organization can recruit talented employees and still have an environment in which people become afraid to make decisions. A leader can ask people to take initiative while unintentionally rewarding conformity. Parents can want independent children while making every important decision for them. None of those outcomes necessarily begins with bad intentions. But demanding a different outcome without examining the surrounding conditions, Martin argues, misses part of the problem. His interest is not in removing difficulty from people's lives. Human beings are adaptive, he says, and difficult circumstances can reveal extraordinary capability. But there is a difference between conditions that allow people to adapt and conditions that gradually teach them to surrender their agency.

That distinction has become increasingly important to Martin as he thinks about younger generations and a future that will present problems their parents and grandparents cannot anticipate. "I don't know what problems the next generation is going to have to solve because some of those problems haven't even been invented yet," Martin said. "So giving them all of my answers isn't the answer. They need to be able to think, adapt, connect with other people and make decisions." For Martin, that changes the responsibility of leadership. "Profit and performance are lagging indicators of the quality of our decisions," Martin said. If that is true, leaders may need to spend less time demanding better outcomes and more time understanding the conditions under which those decisions are being made. Sometimes the obstacle is the individual. Other times, Martin believes, the conditions surrounding that person deserve a closer look. "We talk a lot about releasing human potential," Martin said. "I don't believe I can create somebody else's potential. What I can do is contribute to conditions that either allow it to emerge or help suppress it." That leaves leaders with a question Martin believes is worth asking before demanding the next outcome: What are we allowing to grow?

Blockchain Registration

QR Code for Blockchain Registration