Switching It Up: How Dale Sanders Went From Nuclear Warfare to Healthcare

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When healthsystemCIO.com asked me to write this blog (HealthsystemCIO original post), I was a bit reluctant to write a piece with so many first-person pronouns, but I hope the readers will look past that annoyance. This blog is not about me. It’s a story of the unpredictable combination of fate, luck, planning, and preparation that rolls together and creates a career. I’m sure many of you could tell a similar story. I don’t know anyone who can honestly say they planned and executed each of the steps in their career with 100 percent foresight of the future.

Below, you’ll find a description of odd events that acted like a series of switches on a railroad track in my life. If not for those switches, the path of my career would have been much, much different. There is, of course, the element of human self-determination at each of these switches that a headlong train cannot exercise. I had a choice; a train does not. Early in my career, those choices were motivated more by career progression, professional prestige, and money. Later in my career, those motives evolved toward the metaphysical: which path offered me the opportunity to give back the most to humanity? Where could I learn the most about the world and myself? Which path would allow me the greatest opportunity to nurture relations with family and friends? Where was the greatest challenge and adventure? The older I got, the more selfless and philosophic the motives became.

This is the timeline of events early in my life that set me on a course that continues to this day.

5th grade:  Mom and dad buy me the most incredible chemistry and biology kit imaginable — totally illegal by today’s standards. By the sixth grade, I could balance complex chemical equations and describe the progression of electron orbits in the periodic table of the elements. Together with my best buddy, James Dunlap, we studied everything that could be fixed to a glass slide under the 750x microscope, including samples of his blood, not mine.  🙂  We also put the chemicals to good use, including our prized creation of a waxy substance that smelled like a cross between a skunk and rotten eggs. We stuck it to the back of our teacher’s desk drawer and they never did find it.

11th and 12th grade:  My father — the anchor of my boyhood life — suffers a stroke and passes away four days after I graduate from high school. It turns my psychological and academic lives upside down. Mom, already having lost two children — my brother and sister — to very early and sad accidents, is left reeling, emotionally and financially. My plans to attend the University of Colorado and pursue an architecture degree are shelved.  In a stunned daze, I stay behind in our small hometown of Durango, Colorado and attend the local four-year liberal arts school, Ft. Lewis College. Ft. Lewis doesn’t offer an architecture degree, so I reach for a degree in the comfort of my old friends, chemistry and biology, to pull me out.

1983, senior year in college:  The economy is bad.  Grad school in chemistry (or biology) won’t do much to help, unless I go for a PhD, which is neither appealing nor affordable. We are not a wealthy family, by any means. By accident, I stumble into a US Air Force recruiter in the campus student union building.

“What are my options in the Air Force?”

“You wear glasses so you can’t be a pilot.”

“OK, I get that.”

“Have you had calculus and physics classes?”

“Yes. My chemistry degree required them.”  [At that time, architecture degrees did not require calculus.]

“Good. That gives you three options. The Air Force will send you back to school to get a master’s degree in one of three areas. They will pay for your degree and you’ll draw an officer’s salary at the same time.”

“That sounds appealing. What are the three areas?”

“Meteorology, electrical engineering, and this new program called information systems engineering.”

[Quietly thinking to myself, ‘Meteorology: Interesting but not compelling as a career. Electrical engineering: Brutal. Those Maxwell Equations in physics sucked. Information systems engineering?’]

“What’s an information system?”

“I’m not sure, but I think it has something to do with connecting computers to telephones.”

[More quiet, momentary contemplation.]

“Hmmm… I bet there’s something big in the future for that information system thing you’re talking about. How do I apply?”

1984:  I graduate from the US Air Force Information Systems Officer technical training program. While my classmates are applying for assignments in places like Europe and Hawaii, I applied for assignment to Offutt Air Force Base in Omaha. Not exactly Hawaii. But it was home to the Strategic Air Command and nuclear warfare, and second in-line to the National Military Command Center in the Pentagon, in the event of a nuclear war. I figure SAC must be loaded with the most advanced information systems, and my hunch is right.

For six years, I learned and served in the most data-intensive environment in the world at the time, including three years flying as a CIO aboard the Looking Glass. As we liked to say, “To err is human, but to forgive is not SAC policy.” It was an intense environment, with no tolerance for mistakes in execution. But, that unforgiving, data-intense environment, in which we fused huge volumes of data together to support enormously critical, real-time analytics and decision support, set me on a path that prepared me for the data-intense, critical decision making environment of healthcare.

As in healthcare, data-driven decision making in SAC could be summed up very simply in six steps:

  1. Assessment of the situation
  2. Diagnosis of the situation
  3. Avoiding false positives and false negatives in that diagnosis
  4. Options assessment for reacting to the diagnosis, based on “best practices” in historical evidence and current strategy
  5. Executing on the decision and communicating that decision to those affected
  6. Monitoring and adjusting after execution

Who knew there would be parallels between nuclear weapons delivery and healthcare delivery? The older I get, the more I appreciate I am part of the repeating patterns in human society and behavior. And the older I get, the better I get at spotting those patterns and applying what I’ve learned from the past to the new situation in front of me.

To that degree, fewer experiences in life seem completely new. Things are starting to look the same, at some level of similarity, over and over again, like a Mandelbrot fractal– the same, but different. Being aware of these semi-repeating patterns helps me move faster through the cycle of decision making. I wish I would have been more aware of this phenomenon, earlier in my career. Better late than never.

I’m going to pause on this blog for now, and pick up next time on my odd transition from nuclear warfare operations to healthcare that was, once again, equal parts preparation and totally random luck.

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