How To Reinvent An Institution

Alan Merten, president, George Mason University
Wright Lassiter III, CEO, Alameda County Medical Center in Oakland, Calif.

The only thing more difficult than building a respected organization may be reinventing an institution that isn't performing to its potential. Even the best leaders often face an entrenched culture, the burden of an established reputation and resistance to change.

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan, in Washington.

The only thing harder than building a great organization is to transform an organization that already exists. Inertia, office culture, vested interests can all stymie the best efforts, and an old reputation can keep outsiders from seeing what's new.

We're going to try to find common themes at two very different institutions with very different problems: a provincial commuter campus that needed to grow into a major university and a deeply troubled public hospital that needed to get out of debt and survive.

But if you've worked at an organization that transformed itself or tried, we want to hear from you. What worked, and what didn't? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.

Later in the program, what happens after you've been voted Most Likely to Succeed? But first, transforming institutions.

When Alan Merten took over George Mason University in 1996, few outside of Northern Virginia knew it existed. Sixteen years brought a Nobel Prize, double the residential students, a jump in overall enrollment, and now Alan Merten plans to step down next year, and he joins us here in Studio 3A. Thanks very much for coming in.

Mr. ALAN MERTEN(President, George Mason University): It's good to be here.

CONAN: What was the first concrete thing you did when you arrived on campus to begin this transformation?

Mr. MERTEN: Well, the first couple days, I first of all tried to make sure what we should call our three campuses. We had a main campus, a Prince William Institute, and a law school campus. We changed the names to an Arlington campus, a Fairfax campus and a Prince William campus, just to send a message.

CONAN: Just to send a message: This is not going to be the same.

Mr. MERTEN: We're doing something that serves multiple communities. The second thing I did is just get out and walk around, met with faculty, got into the community, attended every event, had more nights filled than I could ever recall.

The third I did was create a kind of organization chart and got the people together that could make the place change. So I'm a strong believer in responsibility and authority, and we sent that message right away, and it worked.

CONAN: Your problem was growth, and growth may not be as easy as people think, but one of the benefits is you get to say yes a lot.

Mr. MERTEN: Yeah, we made the decision that we were going to get bigger and better at the same time. Now, people told us that was impossible, that if we got bigger, the quality of our students would go down, and exactly the opposite happened.

Now, we had to tell our story, and we told our story every possible way, in every possible hour of the day, week, month, whatever it meant to us. So we went out and we wanted to get big, we wanted to get better, and we wanted to serve the community. But equally, we wanted to take advantage of the community.

In my inaugural talk, I said we had to take advantage of this community.

CONAN: We'll get to that in just a minute, but telling your story, does that reveal hours of strategic planning and mission statements?

Mr. MERTEN: We have a little bit of that, but I think the strength of George Mason University is we have a plan, we have a vision, but we have a propensity to act, to make decisions, to make things happen.

I'm a strong believer in targets of opportunity. And we at George Mason University were presented with targets of opportunity in different areas. And so yes, plan; yes, have a vision; but more importantly, act. Make things happen, and in a sense make them happen as fast as you can.

Most universities are in the ready, aim, aim, aim, aim, aim, aim business. We are in the ready, aim, fire. Now, we had a couple ready, fire, aims, but better that than not at all.

CONAN: Not at all. And obviously not everything went perfectly.

Mr. MERTEN: Not everything went perfectly. Some programs we started didn't work out. Some people didn't work out. But when I look back at it, most of the people that we brought in, they worked out.

Now, they had to buy into our culture. It was not going to be a normal university, and if they look for a normal university, sometimes during the interview they felt it, we felt it, and the interview ended relatively quickly. So it takes a kind of individual. Most universities couldn't tolerate it.

As one of my friends said to me early on, he said there are very few universities you could tolerate, and he looked at me and he said, there are very few universities that could tolerate you.

(Soundbite of laughter)

CONAN: That's an interesting way to look at it. One of the opportunities that presented itself was you were in an area in Northern Virginia that was undergoing rapid growth. And a lot of new businesses, a lot of new technology was starting up in the corridor between Washington, D.C. and the airport out at Dulles. And, well, there's a couple of institutions everybody knows that are in that area: the Pentagon and the Central Intelligence Agency.

Mr. MERTEN: We had a lot of opportunities. There was so much ahead going on, the information technology area, in Northern Virginia and beyond. But we had to take advantage of it. We had to get out and meet the people. We had to hire the right faculty that could do the research and the teaching that could support this technology community.

But also there was the arts community and the global community around us, and again, it was a matter of saying: How can we contribute to those communities, and how can we draw upon those communities, and how fast can we do it?

CONAN: And was there also, as you looked at the competition in the Northern Virginia area - you've got the University of Virginia, of course - that's some ways away, but if you're looking in the Northern Virginia area, you've got prestigious institutions like Georgetown and George Washington. You've got the American University. Was there a niche there that George Mason was able to fill?

Mr. MERTEN: I think in most of the cases, the niche was really more culture-oriented. We had more of a propensity to get things done. When we would hire people from some of those institutions that you mentioned, they got frustrated where they were before, and they wanted to make things happen.

So the niche was technology, to a great degree, but beyond that it was really more of an attitude. Let's make things happen. Let's create an environment for our faculty and the students to succeed beyond their wildest expectations.

CONAN: We're talking with Alan Merten, president at George Mason University. We're talking about transformation of an institution. We'd like to hear from you. What worked? What didn't? 800-989-8255. Email us, talk@npr.org. Sherry's(ph) on the line, calling us from Hampton Roads in Virginia.

SHERRY (Caller): Thank you for taking my call, Neal.

CONAN: Sure.

SHERRY: We - I'm the founder of the nonprofit Hampton Roads Juneteenth Festival, and what Juneteenth does is look at our local history as it pertains to how slavery started and ended in America.

And with this, for the last 15 years, we've been doing this work of talking about how the past connects to our issues of today. So we go into a lot of schools and libraries and detention centers with these plays that deal with local history.

CONAN: And what's the change, the transformation you're going through?

SHERRY: Initially, it was June who, June what, and not understanding the value of celebrating this, you know, commemoration of this - how slavery started and ended in America.

But what we've been able to do is by looking at this difficult history, like the Nat Turner insurrection and Fort Monroe as the Ellis Island of the 19th century, we've been able to help people understand the roots of issues like racism and oppression in terms of what the roots of those things are and how they impact who we are today.

And that's been a hard sell, but we need to be able to get into schools and communities with this work because the people that we use to tell these stories, this history, are local people, people who are chronically unemployed, young people, seniors, people who are able to talk about this history in ways that help people understand how, how do we get beyond the anger and the hate and the frustrations based in the past and deal with solving problems of today.

And that's been a hard sell. As simple as it is and as simple as I think it should be for people to understand, it's a really difficult sell.

CONAN: President Merten, you were...

Mr. MERTEN: Well, I think one of the keys that we found early on, and I think the caller touches on, you have to do something every day with respect to transformation. You have to view every day as an opportunity to have the institution grow. Every day is an opportunity for you to bring people along.

SHERRY: Absolutely.

Mr. MERTEN: But it's just - it's hard work, and people who constrain themselves, they're not going to make - you have to have high goals, high vision of what you want to do.

SHERRY: What we want to do now is to make films about this history, and Hampton Roads is a large military area. We have (unintelligible), which has been downsized as a military installation, but it's a perfect movie studio in terms of what they have to offer in terms of equipment and so forth.

And we have all of this history that's been untapped, untouched and literally, as we celebrate the 150th of the end of the Civil War, this is the prime opportunity to do this work.

And so trying to knock on the doors of the city managers and the mayors in terms of getting an audience with the people who can help facilitate moving forward in this direction is incredibly difficult because we don't seem to - we don't have what would be considered a corporate presence.

You know, we're a small nonprofit doing theater work, and so how can we possibly be part of the answer to, like, bringing new jobs into this region and doing this work that would basically be of interest to the entire world?

And yet we're doing it on a daily basis, but one by one, as opposed to by the thousands (unintelligible) the way that it needs to be.

So I really appreciate this conversation because what you're doing is highlighting the importance of two very kind of emotional, intellectual pursuits which are the arts and, you know, and academics. And these are things that...

CONAN: Well, we're going to get on to health care too.

(Soundbite of laughter)

CONAN: Thanks very much for the call, and good luck to you.

SHERRY: Thank you so much, Neal.

CONAN: Joining us now is Wright Lassiter III, who serves as CEO of the Alameda County Medical Center in Oakland, California. He's with us from member station KQED in San Francisco. And nice to have you with us today.

Mr. WRIGHT LASSITER III (Alameda County Medical Center): Thank you, Neal.

CONAN: And I wonder, in 2004 a civil grand jury issued a scathing report the year before you came onboard, which says the management and finances of ACMC were a shambles, headed for crisis, blamed it squarely on poor management. I wonder, in some ways did that make it easier?

Mr. LASSITER: Well, you know, Neal, when you're facing a crisis, oftentimes it's a little bit easier to coalesce people around a goal and around a vision. But unfortunately, our organization, it faced that kind of scathing report before. And so just the fact that we had a crisis, I think, didn't necessarily mobilize everyone.

CONAN: And so what did you do the first thing you did or the first couple of things you did to indicate that this was going to be a new day, something different?

Mr. LASSITER: Well, I think first and foremost I tried to help our organization understand that the path that we had been on before, while it serves some purposes in terms of providing good health care, it didn't serve the purpose of creating an organization with long-term financial viability.

So one of the first things that we did in our organization is we sat down with all the leaders, and I was more transparent with them than I think some of my predecessors had been around how big, deep and wide our problems were.

And I simply said to them: Look, the CEO doesn't have all the answers. And frankly, in this, in this circumstance, I've just arrived in this community from, you know, more than 1,000 miles away, from Texas. So I don't have the answers for this organization. So it's up to you to solve many of these problems.

And so we started by sort of shifting the sphere of influence and power from being in the executive office to sort of across our health system.

CONAN: But as opposed to President Merten, who got to say yes a lot, I suspect you had to say no a lot.

Mr. LASSITER: Well, we did. We did have to say no a lot, and the no was not because it wasn't a good idea. The no was because we simply hadn't honored our obligation to our community, to sort of organize ourselves in a fiscally viable way.

And so what I said to a lot of our organization, a lot of our physicians and our managers and staff, was that we could say yes a lot more if we got a handle on how do we change things. How do we stop doing a lot of things that we've been doing that didn't have the kind of economic value that we needed to have for the future?

Mr. LASSITER: Wright has raised an issue, Neal, that in my case we were in good shape. The university was doing quite well. But the question is how we were going to make it a better university. And we didn't have the crisis. So it's important to be able to transform an institution even when you don't have a crisis. And I think sometimes that's even harder.

CONAN: Rahm Emanuel will be remembered for many things, as White House chief of staff, but I think probably most famously for the phrase never let a good crisis go to waste.

We're talking with Alan Merten at George Mason University and Wright Lassiter at Alameda County Medical Center. If you worked in an organization that transformed itself, give us a call, 800-989-8255. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

We're talking about remarkable transformations, organizations re-imagined and reinvented, from schools to hospitals to manufacturers. Our guests helped lead changes at two very different institutions, Alan Merten, president of George Mason University and widely recognized for transforming the campus from a commuter school into a respected national university; and Wright Lassiter, CEO of the Alameda County Medical Center in Oakland, California, profiled in this April's Fast Company magazine as an example of a leader who turned his institution around.

If you've worked in an organization that transformed itself or tried to, we want to hear from you. What worked? What didn't? 800-989-8255. Email us, talk@npr.org. And you can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

And I wonder, between the two of you, Alan Merten at a university and Wright Lassiter at a hospital, you both had people who worked there and probably had worked there a long time who pretty much assumed they knew everything and all the answers.

Mr. MERTEN: Well, one thing that I think Wright have in common is individuals, in his case maybe the medical staff and in my case professors who really care about the institution, but in many cases they care about the institution as long as it doesn't change. Change is something they want someone else to undergo.

I think you've got to bring them along. You bring most of them along, but I'm sure as Wright found out, there's some who don't come along. They don't want to change, and you're stuck with the fact that some are going to be with you, and some aren't.

I don't think there's anything wrong with that. Just get on with it. Don't whine.

Mr. LASSITER: I would agree with that, Neal. You know, I think that we did have some of those on-the-bus, off-the-bus kind of conversations with some of our leaders early on, in sort of saying to them that this is a collective effort, it's not an effort of a small group of leaders. It's not just an effort of a new board of trustees. It takes a collective effort to change some of the things we had to change.

But clearly, you know, you have a bell curve of those individuals who early adopt to changes and those who are sort of laggards and sort of wait for objective evidence that change is going to be forced upon them if they don't willingly go along. So I would agree with Alan's perspective on that.

Mr. MERTEN: We've also - I think in all these cases, it's important to have a board that's supportive of what you're trying to do as a chief executive officer. In our case, the board is appointed by the governor.

But for majority of early years, my presidency at George Mason, Ed Meese, former attorney general, was the chairman of the board. And his support was invaluable.

The other thing I'd just throw on the table that I learned that shocked me is how important facilities are. You know, you look at the intellectual property, you look at the capital of any institutions, and you think, well facilities are also part of it.

I learned early on that you - there are certain things you can't do, no matter what kind of vision you have, unless you have good facilities. And you've got to get on with that right away. You can't wait until some other point in time.

Mr. LASSITER: Well, you know, I would just add, certainly governance is a key success factor. I would agree with Alan that a lot of our success has been significantly predicated on having a very strong board of trustees that provide governance for our organization.

Similarly, our board is appointed by the local county board of supervisors, and so, you know, an effective partnership between the appointing board, in our case the county board of supervisors, and a very effective trustee board has been a significant part of our success, as well.

CONAN: Let's get BJ(ph) on the line, BJ calling us from Savannah.

BJ (Caller): Yes, the first thing I did, I took over a - running a 150-year-old daily newspaper that was on the verge of collapse. And as I suspected, after my first initial discussions with all the employees and people in town and so forth was that there was a lack of trust between the ownership and the employees.

And I set about gaining that trust, and I think that was critical in having everyone follow the plan I then put into place. And I assure the - all the employees and colleagues that, should they could along, would have to work hard, but we would all share in the success as we went along. And we turned it around in the matter of 18 months, and they are still thriving today, in spite of all that's going on in the daily newspaper world.

CONAN: Were you an outsider, BJ?

BJ: Yes, I had come from another newspaper group and came into this privately held operation. And I was, oh, younger than many of the employees. But that didn't bother me.

I simply laid out the guidelines and the goals after talking to everybody, and that was a key. I sat down and talked to people. I found out what they did, even if I knew very well what they did. I heard their side of it, and I then I said: Okay, let's develop goals together.

And as we attain those goals, we'll all share in the success. And basically I said if you didn't want to come along, then, you know, go somewhere else.

Mr. MERTEN: I think BJ hit on something, and also Wright did that I learned early on, and that is you have to have a good relationship with the public officials around you. You can talk all you want about the corporate support that you need for whatever you want to try to do, but you've got to have the public officials.

And it's a different story, and you've got to establish those relationships when things are good.

BJ: I had more chicken dinners in those...

(Soundbite of laughter)

Mr. MERTIN: It's the food of choice, yes.

CONAN: The default dinner. Wright Lassiter, you not only had to have good relationships with public officials, you worked for public officials.

Mr. LASSITER: Yes, you know, we are a public health authority. And so we have a mission that is supported by the public. We receive sales tax revenues to support part of our mission, as well as county funds to ensure that we provide care for vulnerable populations. So for us, clearly we have to walk the line as a public organization that's one that's accountable to the community.

I do want to just highlight a point that BJ made around trust, and you cannot underestimate the importance of building trust with leaders and their organization and the community, particularly when you're coming in from the outside.

That was very, very important for me and our organization, and a lot of that trust is built around transparency. It's around not sort of holding back, you know, "secrets," quote-unquote, in the ivory towers of the executive suite but being more open with your staff, with your physicians, with your key constituents regarding what are the challenges.

CONAN: It's hard to do sometimes, and those are personnel issues, though.

Mr. MERTIN: I think they are also issues of success. Success sounds great, but we're a public university, and I'm very proud of that. So we get money from the state and other sources.

But we've gone, at the freshman class, from something like 5,700 applicants for the freshman class to 16,500 applicants. So we send out a lot more rejection letters than ever before, and some of these public officials who really (unintelligible) on my case early on to improve the quality of the university, when their constituent doesn't get into George Mason University because the quality is up, they're not so sure that they're my friend anymore.

So this business of making institutions better, which is the business we're all in, there's a cost. And it's sometimes a not very hidden cost.

CONAN: BJ, thanks very much for the phone call.

BJ: Thank you, guys.

CONAN: Here's an email from Michael Bedford(ph): Having tried over 18 months to change a 40-year-old NGO in San Francisco, I found that the key point was to make sure all stakeholders are on the same page.

But the hiring of me as a change agent did not match underlying sentimentality of the NGO. I ultimately left, due to board wanting change but resisting my changing the culture. The culture trumped the necessary change, and the NGO faces some serious realignment in the 21st century.

And I think, Wright Lassiter, you must have faced some similar kinds of problems.

Mr. LASSITER: Well, certainly, you know, the adage that culture eats strategy every day is alive and well in most organizations that I think that oftentimes leaders underestimate how deep-rooted culture can be and how simply creating a new strategic plan doesn't change your organization.

I think the point that your emailer referenced is one that both Alan and I have talked about, and that is alignment between the executive of an organization and its governing board. And for me, we certainly experienced some challenges early on around governance and sort of direction we were heading.

But I've had, since my tenure here, six years now, three extremely effective board chairs, and those individuals assisted me greatly as a partner with ensuring that the board ultimately bought in to the direction we were heading and then gave the CEO, appropriately so, the latitude to implement the change that we all agreed on.

Mr. MERTIN: There has to be a strong alignment between the culture and the values of the leader and the culture and the values of the organization. When we started having successes at George Mason, people would say to me: Well, how do you like being a university president? And my answer always was: I'm not sure what it's like to be a university president. I know what it's like to be George Mason's president.

And I think sometimes that's where we make mistakes. We have good leaders and good organizations, but if they're culturally different, if their values are different, it's not going to work. And I think that the email before reminded me of that, that, you know, it might have been the right person but at the wrong time, the wrong place.

CONAN: Let's go next to Robert, Robert with us from Nashville.

ROBERT (Caller): Yeah, hi. I love your show. Thank you so much.

CONAN: Thank you.

ROBERT: My experience, I was in the military during the Tailhook scandal, and that had very rapidly, wracking changes in morale, and, you know, cohesiveness, all of those big words that they throw around nowadays over gender. And I think that a very important aspect of changed management is having a visionary who can look to the future and see down the road, a year or two, a change in the culture that then can lead to a change in the direction the organization is going, such as they're having to do now with gender identity, the DOD very smartly got ahead of the process and is meeting it under their terms, not under terms dictated to - by others or the situation or the politics.

CONAN: For those who don't remember, Tailhook was a scandal involving severe sexual harassment of women at the very top levels, including some of the very top levels of U.S. Naval Aviation at their annual Tailhook Convention, and this was a matter of culture going back many years.

Robert, though, as we now get ready to do away with "don't ask, don't tell," do you think they're going to be able to handle that cultural shift in the same manner?

ROBERT: Well, I think that it'll be a much easier transition, because if the military is already rolling out the change process well in advance of any rapid shifts in doctrine, and the other issue, it's much like the difference in race back in the mid-'50s or late '40s for Korean War. They had to use mixed units, and slowly, as differing races were mixed in unit, then people said, oh. He's not such a bad guy. Oh, he's not such a bad guy or lady, using men between blacks and whites and other mixed units.

So I think in the same way there's many people who apparently are serving now who they already trust and count on as other members of the team who might or might not eventually come out. It's their choice. And then they go, oh, well, he's gay or lesbian? Oh, well, he's not such a bad guy. What's the big deal? And I think that's going to be the difference, as opposed to, oh, here's a court case. You must change tomorrow.

Dr. MERTEN: I think when we talk about change in organizations, we have to keep in mind that there - not everyone's going to be on the boat with us, I think, as Wright touched on earlier. The key is to find out what's bothering people. And, I mean, I don't - in my case, and I'm sure most leaders' cases, you know, sometimes it's always refreshing early on to have people come up to me and say you're going to fail. And I said...

(Soundbite of laughter)

Dr. MERTEN: ...gee, thank you. And then I'd say, well, why am I going to fail? And they say, well, you're - you do it a different way than your predecessor, and my predecessor was extremely successful, and I didn't plan on doing it his way. But I - looking back at it, when people tell you you're going to fail, you have to probe and say, well, why? And the answer is, in many cases, they don't understand your style, let alone your vision.

Mr. LASSITER: You know, I would just add to that that, you know, early on in my tenure, there were a couple of individuals that I listened to fairly regularly who were naysayers. And I found that the comments that they made to me oftentimes were helpful in sort of balancing, you know, your exuberance around early wins or around early spread, and it didn't - I didn't use their comments as a deterrent, necessarily, but it always sort of gave me a sense for: So what are the people who are less likely to adopt to the folks who are more entrenched, or who aren't really willing to change? What are they thinking? And that was very, very helpful for me.

I mean, your prior caller and talking about sort of the balance between culture and a leader's culture versus the culture of the organization, I think, is really a critical point, as well.

You know, public organizations normally have one thing in common, and that is we have lots of employees or key stakeholders who have joined or affiliate with our organizations because of its public mission. And so it's really important for leadership to demonstrate that they are respectful of that public mission. Otherwise, no matter how great your ideas are, it would be very difficult for people to sort of buy in to what you're trying to accomplish.

CONAN: Robert, thanks very much for the phone call.

We're talking about transformation of institutions. You're listening to TALK OF THE NATION, from NPR News.

And let's see if we can go next to - this is Robin, Robin with us from Evansville, Indiana.

ROBIN (Caller): Hi. I work for a medium-sized hospital here in southern Indiana that really did transform itself by reminding everyone who works there why they went into medical, or the medicine field.

CONAN: So, that mission again.

ROBIN: That mission again. And he - the new CEO really bought into the mission, but then he empowered all of the staff - from the bedside nurse to the housekeepers to the people down in sterile supply - he empowered us to make the changes that need to be made. And then he communicated the expectation that we will be responsible for our own careers, and that we are responsible for our happiness at the institution.

And as a result, our provider scores, the provider satisfaction surveys, they've gone way up. The employee satisfaction surveys have gone way up, and we're more fiscally responsible. There's a lot less waste in the system now. And we've obtained level-two trauma status because he gave us the confidence that we could do it.

Dr. MERTEN: I've noticed that since I - and I was recently there. I'm stepping down within a year, you know, keeping track of the comments. And fortunately, most of them, or all of them, have been very positive. But the one that struck me, as mentioned by the caller, and that is people thank me for empowering them. And I just hear that more than I expected, and I think that's the trick.

One of the things that drives me, and I think we - probably all of us in leadership - is that we believe in management by walking around, getting out there, seeing your employees.

CONAN: I wonder if somebody else in the health field, Wright Lassiter, if you have a quick response to Robin?

Mr. LASSITER: Well, I think her comments are right on. I talk in my organization oftentimes about we would be the ideal organization if every one of our 3,000 or so employees felt that they were the CEO of their 20-square feet. And so the notion of pushing accountability, decision-making down to the lowest possible level is an absolutely fabulous strategy that most organizations that are, you know, really pursuing excellence are trying to accomplish.

We are attempting to do that same thing, because the reality is the people who are down in the trenches are much more equipped to solve problems than, you know, than a senior executive or a director of a department. So I absolutely agree with her.

CONAN: Robin, thanks very much for the call.

ROBIN: Well, I just want to say, there is nothing more frustrating than being at the bedside of somebody and knowing what you need to deliver -quality care - and not being able to do it because somebody downstairs who's not a nurse does not understand, and that's how you get frustrated, cynical hospital workers.

CONAN: Well, Robin, thank you very much for the phone call. We appreciate it. And our thanks to our guests, Alan Merten, the president of George Mason University. He plans to retire next year. We thank you for your time. He joined us here in Studio 3A. Wright Lassiter, the third CEO of the Alameda County Medical Center in Oakland, California, joined us from KQED, our member station in San Francisco.

Coming up, the burden of most likely to succeed.

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