The Tyranny of the “OR” vs the Genius of the “AND”

 “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.”
~F. Scott Fitzgerald

Several people have asked how our strategic planning that goes through an iterative process will work when decisions must be made almost daily. How can this iterative process that allows faculty and staff to weigh in on decisions be agile enough to allow the School of Medicine to function? The answer is that we must have multiple approaches to decision-making.

The “Tyranny of the OR” is a concept touted by Jim Collins that dictates that one must choose from two seemingly contradictory strategies. An example is that all decisions must come from the Chairs/Deans or all decisions come from the faculty.

The opposite concept is dubbed the “Genius of the AND.” We can have both ideas percolating up from faculty discussions and make day-to-day decisions to keep the School moving forward. We can preserve our core beliefs and continue to invest in new initiatives.

We must embrace both ends of the continuum — preserve the true essence of UVA while we change. This is the genius of the “AND.”

What do you think? Please comment below.

Reminder: Today (May 27), there is a Town Hall Meeting to discuss Innovation. (5:15-6:15 p.m. in Sandridge Auditorium)


Nancy E. Dunlap, MD, PhD, MBA
Dean, UVA School of Medicine
James Carroll Flippin Professor of Medical Science


  1. I am excited and pleased with this dynamic model for strategic planning for the SOM. I realize that is a departure from the “norm” but the pace of the world around us demands a more nimble and flexible approach to mobilizing ideas and approaches that can benefit the SOM, our faculty, staff and learners.

  2. Dana Redick says:

    So my email subject box read “The Tyranny of the OR” and only when I went to read the whole message did I realize the email was not about the Operating Room and rather the conjunction “or”. This made me think – first does my subconscious mind feel like I am subject to the demands of the OR (yes – probably). Second how even subtle changes in wording or puncutation can have very important implications to meaning – READ CAREFULLY AND FULLY. Finally – it reminded me – we all bring our own very personal perspective and experiences to the table – I doubt an internist would have though Operating Room. All lessons for strategic planning. I will miss the town hall but hope it is productive. DR