1. Bolwell, Brian J. MD, FACP

Article Content

I am frequently asked how our cancer center is able to execute and deliver on our priorities. It turns out that getting things done in the medical field, especially in a field as complicated as cancer, is quite challenging. I believe this is especially difficult in academic medical centers, which have a variety of organizational entities that have different agendas (the medical school, the hospital, a health care network, etc.).

leadership; cancer. ... - Click to enlarge in new windowleadership; cancer. leadership; cancer

Even within a single organizational unit, however, success at delivering results, or success at operations in general, takes a lot of work. Yet, it is clearly one of the most important jobs of leadership. In the excellent leadership book The Speed of Trust, Stephen Covey writes, "Deliver results. Establish a track record of results. Get the right things done."


Here are 10 things that have worked for me to accomplish that goal.


1. Define the goal.


It turns out this is one of the most important parts of operational success. The goal has to be something that will be embraced by the entire cancer center. I will use our commitment to reducing the time it takes a newly-diagnosed cancer patient to receive their first therapy (Time to Treat) as an example. I repeatedly say our first and second priorities are quality and access. Time to Treat is an important measurement of access. Additionally, Time to Treat is important because a newly-diagnosed cancer patient is filled with fear and distress. The sooner we care for the patient, the better for all. I mention it repeatedly in monthly newsletters to all employees of the cancer center, as well as organizational leadership meetings. In fact, it is the leading topic of conversation with our cancer center executive committee. In short, I talk about its importance and my passion towards the topic over and over again.


2. Eliminate conflicting priorities.


A corollary to defining the goal is to eliminate conflicting priorities. In an earlier essay, I discussed the fact that we have three fundamental priorities in our cancer center: quality, access, and treating people well. One of the primary mistakes made by people trying to execute operational goals is having too many priorities. It is unreasonable to have caregivers in our cancer center focus on 10-20 "critical" priorities. It makes much more sense to focus their time and attention on a few.


3. Define roles and responsibilities.


One of the keys for optimal success is to get everybody in one room who will execute the task at hand. Clearly, a culture of openness and transparency must exist-all should feel free to speak up. It is also important for people to freely articulate barriers to success. Simply sending out an email telling people to do something will generate zero results. Staff need to know who is responsible for what. Team members need to know what defines success. Timelines need to be defined. These discussions should occur with all stakeholders present. The meeting(s) about roles and responsibilities should end with absolutely no confusion or questions about who is responsible for what.


4. Get data.


Acknowledging that data means extra work, and potentially the need for additional personnel to do the work, it is indisputable that data is essential to drive behavior. All physicians are taught to critically examine data; therefore, obtaining the right data can drive physicians towards priorities and influence changed behavior. Step one is to obtain the data that will define the desired goal. Frequently, new methods need to be used to generate the data that is required. Step two is to determine how to obtain that data. If this requires additional personnel, then resources will need to be added. However, data is vital to achieve an operational goal. Thus, one must first define what data is needed, secondly, ascertain how to best get the data, and lastly execute how to support that need with personnel to get the job done. The importance of data and additional staff to complete the task cannot be overstated. Acquire data, analyze, and influence change.


5. Socialize the data.


Our Time to Treat performance is extensively discussed in a variety of forums quarterly. We have dashboards that display results. Because we have socialized the importance of Time to Treat with organizational leadership, it has become part of the dashboard for the entire organization. The more a given goal is socialized, the more it is likely that results will be achieved and those results will be sustainable.


6. Share wins.


Each individual cancer program focuses on Time to Treat. While the breast cancer program has challenges that are different than the colon cancer program, similarities exist across disease-based programs. Therefore, opportunities exist to share "wins" across programs as well. Some would call this sharing of best practices. I think that the term "best practice" is overused in C-suite conversation; nevertheless, there is unquestioned value in sharing ideas that have worked. The breast cancer program, as an example, employed the use of huddles with nursing leadership to make sure that operating room access for patients in need of mastectomies is optimal and that nobody is left behind. This concept of huddles was then translated to other programs with similar success.


7. Make it a research project.


Clinicians enjoy hypothesis-driven pilot projects to test new ways of doing things. I think it is possible to make almost any operational exercise a research opportunity. In the example of Time to Treat, Alok Khorana, MD, of our GI cancer program, did an extensive review of the NCCN database and found that, for many cancers, delay of 1 week for the delivery of initial cancer therapy (Time to Treat) negatively affects patient survival (manuscript in press). This data energized many of our teams about the importance of Time to Treat. Research projects, in general, elevate engagement and enthusiasm.


8. Get personally involved.


In my opinion, any important operational task in our cancer center should have my personal involvement. I have to show that I am committed to the task at hand. I do not need to attend every meeting about a topic, but I need to be aware of what is going on throughout the cancer center on any given issue. How I invest my time and energy translates to organizational importance. Regarding Time to Treat, I have meetings, several times a week, with a variety of people. I know what is working and what represents barriers to success. This communication needs to go beyond the physician level, as nursing and other administrative personnel frequently are the keys to implementing and sustaining success. Since everyone throughout all levels of our clinic witnesses firsthand my involvement in Time to Treat, it becomes their priority, too.


9. Listen.


One of the hardest parts about operational success is sustainability. After initial enthusiasm, it is pretty easy to move on to other tasks. How does one sustain success and engagement? One must continue to make it a priority and continually listen. Indeed, I believe that one of the single most important talents that a leader should possess is to listen to their team about what is going on. You need to know what your team is thinking. If focus is waning, you need to know why. I prefer face-to-face meetings; I do this with administrators, nurses, and many physicians. One of the keys to being a serving leader is to listen, and remove obstacles, which are frequently political. Invite discourse. Invite input about problems. You need to know the challenges, acknowledge them, and be honest about them. Then, you can tackle them. Usually your team will have good ideas about solutions.


10. Finally, trust your team.


Several of my prior essays talk about the importance of recruiting great people. If you do just that, trust them to do their jobs. They'll do it at a very high level, and certainly much better if you trust them than if you micromanage. Show that you have confidence in them. They will thrive and lift the entire cancer center. Then give them credit, because they (and not you) deserve it.


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.

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

Get More Advice on Leadership

Brian J. Bolwell, MD, FACP, shares insight on the issues that impact cancer leaders. You can read all his articles online. Go to and click on the Blogs button to view all the archived features.


Straight Talk: Today's Cancer Centers