1. Bolwell, Brian J. MD, FACP

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Sometimes, a movie will have a line that just catches me. One of my favorites is from Star Wars: The Empire Strikes Back, when Yoda says "Do. Or do not. There is no try." Then there is the line from Jaws: "You're gonna need a bigger boat." Every now and then, I will even hear a line that seems relevant to leading a cancer center.

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Bradley Cooper is an outstanding actor. I very much enjoyed Burnt, one of his recent films. It did not receive a lot of critical acclaim, but I thought it was fabulous. Cooper plays a very talented chef who strives to have the best restaurant in London, and, initially, he is a total jerk. His goal is to have a 3-star Michelin review. When reviewers first arrive, he goes ballistic in the kitchen, personally preparing everything, screaming at his other chefs. Of course, it goes badly. The film centers on Cooper's character's evolution to trust his team of chefs. When the reviewers arrive towards the end of the film, he says simply, "We do what we do, and we do it together." He does not need to do anything different or special because his team's standard of excellence is already superb. It's a movie, so the review goes well at the end.... Much of the movie is shot in the kitchen of a fancy restaurant. I am sort of a foodie, so the back-of-the-house look at how a high-end restaurant works was fun to see. It's worth watching.


I love the phrase, "We do what we do." I have used it for over 20 years. I teach it to fellows and residents. In medicine, I think the phrase means we strive to give superb care to everybody who asks for our help, regardless of whether they are rich or poor, regardless of ethnicity or gender. In fact, while I totally understand the quirks of taking care of VIP patients (dignitaries, actors, etc.), I tell fellows if they are going to try extra hard for any patient, make it one who is homeless and down and out, because likely all they have in their journey is you. It also means the quest to never take a day off, and to always give your best effort for every patient.


So that sounds good. But, how do you actually do this? How do you build teams to always perform at a high level?


Hiring Great Teams

I read the Harvard Business Review. There is a good article in the May/June issue entitled, "What Great CEOs Do Differently." It's a good read. The authors list four behaviors that seem to be very important: Deciding with Speed and Conviction; Engaging for Impact; Adapting Proactively; and Delivering Reliably.


"We do what we do" is about delivering reliably. The article says 94 percent of strong CEOs follow through on their commitments; they are highly reliable. They are strong in organizational planning; they use business dashboards; they have clear accountability; and they make rapid course corrections. The article then says, "Most importantly, they surround themselves with strong teams....the successful ones move decisively to upgrade talent. They set a high bar and focus on performance relative to the role rather than personal comfort."


The theme is to hire great teams. For those of us in medicine, the challenge is that physicians are neither taught nor trained to be team players. Many, in fact, choose to be a physician because they love being independent. Academic medicine in particular encourages individualism. Grants are awarded based on individual research success. One person-not a team-gives talks at national meetings. To achieve academic success, one develops skills in the art of self-promotion. My work is the best! My work is the most important! Whether it is true or not is irrelevant-these physicians frequently actually believe they are indispensable and superior. And such individuals frequently receive promotions to leadership positions because of their academic success, despite the fact that they have no skills whatsoever to be a leader.


Other caregivers totally understand the team concept. Nurses certainly do. They work with physicians, other nurses, schedulers, and social workers all the time, every day. They know that to operate at a high level, teamwork is essential. So do the schedulers. So do the social workers. These are the same team members who spend the most time with patients and their families. One can argue that, to deliver great care, no component of the team is more important than the nurses.


Nurses Vital to the Team

I have previously discussed how to recruit docs. But, how does one develop great teams with great nurses? First, similar to recruiting physicians, you must recruit for emotional intelligence. Second, it is vital that a culture supporting nurses exists. You must be willing to hire an appropriate number of nurses. Staffing is one of the first places bean counters look to cut expenses, so resist the temptation to do so. You never want your clinical personnel to be in crisis mode, such that if somebody gets sick everything falls apart. You must be willing to staff appropriately, and if there are budgetary consequences, you, as the leader of the center, must have the courage to fight for your nurses from a staffing perspective.


You also need to support your nurses. If they need new computers, they get new computers. You must let them know they are valued. Tell them so. Recognition is very important. Developing a just culture (values-supportive model of shared accountability), especially for safety, is vital. All team members should be empowered to speak up if they see things that concern them. Which leads to my final point about supporting your nurses: never let your physicians, or any employee in your cancer center, disrespect nurses. A minority of physicians-a small minority-lash out at nurses and others when under stress. Others repeatedly unleash sexually inappropriate comments. Totally unacceptable. The center leader must confront such offenders about the inappropriateness of their actions and hold them accountable. If this means moving these individuals outside of the organization, so be it. The culture will elevate once they are gone. If you hire for emotional intelligence, you will replace them with somebody much better, who understands the importance of treating all with respect.


Trust in the Team

The final point about developing great teams is the concept of trust. Trust the team members to do their work. Know that you have colleagues who "get it" and will manage issues and deliver great care. Try not to micro-manage. If you hire excellent people, and develop great teams, then trust them. They will thrive.


Bradley Cooper's character in Burnt ultimately realized he could not get what he wanted as an individual. He learned he needed to trust his team. When that happened, they all excelled. He said, "We do what we do." I say, if your goal is to deliver great cancer care to all of your patients, every day, then think about living the concept of "We do what we do."


BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.


Straight Talk: Today's Cancer Centers

Brian J. Bolwell, MD... - Click to enlarge in new windowBrian J. Bolwell, MD, FACP. Brian J. Bolwell, MD, FACP