1. Bolwell, Brian J. MD, FACP

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I recently revisited one of the first leadership books I read many years ago, titled Loyalty Rules! by Frederick Reichheld. The first 20 pages alone are worth the read. The first chapter is called "Timeless Principles" where he introduces the subject of loyalty-customer loyalty, employee loyalty, and essentially loyalty in all work relationships. In this chapter, he writes that "building loyalty is the acid test for leadership-it is a test most leaders are flunking." This made me pause and ask, why are leaders flunking? It turns out that fewer than half of employees of U.S. companies believe their employer is worthy of their loyalty.


That's a startling statistic. Ok, message received. So how do you demonstrate that you are worthy of your employees' loyalty? Reichheld says "the center of gravity for business loyalty is the personal integrity of the senior leadership team, and its abilities to put its principles into practice." He then (still in the first 20 pages!) describes the six principles of loyalty, with my personal comments in parentheses:


1. Play to win/win


2. Be picky (this is about recruiting-recruit great people)


3. Keep it simple-complexity is the enemy of speed and responsiveness


4. Reward the right results


5. Listen hard, talk straight (leaders MUST solicit honest feedback, even if it is bad news)


6. Preach what you practice-actions often speak louder than words, but together they are unbeatable



As I was re-reading these six points, I was struck by the last point-preach what you practice. Years ago, I thought this point was a bit of a throwaway point. After all, I was used to public speaking. I gave scientific presentations all the time. Now, after doing what I do for almost 7 years, I think I totally missed the point about "preach what you practice." Upon further reflection, I feel it is one of the most important skills a leader can have.


When I was appointed Chair, talking about our cancer center was a challenge and a new role for me. I was often speaking to physicians who had mentored me at some point in my life. I felt somewhat awkward and insecure talking to them about what they did. And, while talking about my area of clinical expertise was fairly easy, talking about all aspects of cancer care in our cancer center was difficult. My knowledge had gaps and there was much to learn.


It took about 18 months to elevate my public speaking as a cancer center leader. And it is something I continue to work on and develop. The first key for me was to identify my vision. While my vision continues to evolve, at its core it is about the importance of being focused on the patient and the necessity of teamwork including complete multidisciplinary care. This attention on identifying and honing my vision allowed me to focus the message. Additionally, it allowed me the freedom to chill. I do not know everything about cancer medicine and I never will. We have plenty of physicians in all areas of subspecialty expertise. It is silly for me to aspire to have all of their knowledge. When I have a question, I simply ask.


Once I honed my vision and message, I needed to establish an effective method of communicating that message at all levels. The best way to communicate my message is to tell a story. Regardless of the audience-the media, a philanthropic event, a cancer center meeting, or a discussion with organizational leaders; tell a story! Telling a story always resonates. If you want to make a point about patient support services, tell a story about a newly diagnosed cancer patient and all the fear that they experience. The art of storytelling is invaluable. Storytelling is a skill that can be developed. Anyone can practice it and get better at it. Most of us have opportunities to do so on a daily basis.


Additionally, it is important that you reinforce your message consistently. You need to communicate it to all levels, all the time. In my case, a good example is how I have messaged the importance of access for cancer patients, which led to our focus on Time to Treat (the time from initial diagnosis to the first definitive treatment-surgery, radiation therapy, or infusion therapy). I have discussed Time to Treat at every opportunity, and now it is part of our organizational dashboard and all organizational, non-cancer leaders are aware of its importance. You need to reinforce your most important messages over and over. You need to be a preacher.


There is something meaningful about the word "preach." I believe that another responsibility of mine is to set goals that are inspiring. I am sure that many of you are familiar with Steve Jobs of Apple and his leadership quirks. But one thing that Jobs did as well as any leader in our lifetime is set lofty goals. He believed he, and Apple computer, could change the world. He said this again and again, and in time, all Apple employees believed they could change the world-and they did!


I believe our cancer center can change the world. Even if the only thing we accomplish is to show the rest of the cancer community how to optimize Time to Treat, that is a big deal, and potentially practice-changing. If you want to change practice, you need to believe that you can, and your team needs to believe that you can. Your job as the leader is to make them believe that they can. Set goals that are realistic, but also set goals that inspire. Believe in those goals. Communicate them. Be passionate! Personally work on achieving them. Demonstrate that you walk the walk. But always remind folks about the big picture, and inspire all about what you are collectively capable of. To change the world, you need to believe it, and you need to talk-to preach-about it.


Finally, do not ever give up. As Reichheld says, to be a successful leader you must demonstrate that your leadership is founded on principles worthy of loyalty. There are always challenges, failures, and frustration. But your entire organization is watching you, and taking cues from you. Keep trying. Do not compromise on your core beliefs. All will appreciate your resilience, your perseverance, and the passion for your values. Hopefully, with time and effort, they will believe that you are, in fact, worthy of their loyalty.


I really like Reichheld's first five points, especially No. 5-Listen hard, talk straight. His sixth point, preach what you practice, is not intuitive, but your team is looking to you for inspiration. Give it a try.


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