1. Bolwell, Brian J. MD, FACP

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Albert Einstein has a quote about success stating that it is driven by "curiosity, concentration, perseverance, and self-criticism." The part of that quote that may not be intuitive is self-criticism. I think it is important in any leadership role to be self-aware and reflective. It's part of the ongoing quest for self-improvement, to change for the better. That said, it's hard to always self-criticize accurately. It's human nature to give ourselves the benefit of the doubt. If we manage a situation poorly, we might acknowledge the flaws, but we also will quickly remember the context that contributed to the error. It makes the flaw, or mistake, less of a big deal.

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Thus, if one really wants to get better, one cannot simply self-reflect. One needs to invite constructive criticism from others. There are many quotes about the value of constructive criticism.


* "The trouble with most of us is that we would rather be ruined by praise than saved by criticism."-Norman Vincent Peale


* "The final proof of greatness lies in being able to endure criticism without resentment."-Elbert Hubbard


* "To avoid criticism, do nothing, say nothing, and be nothing."-Elbert Hubbard



Leadership roles attract criticism. The trick, as the leader, is to invite useful criticism, listen to it, and hopefully learn and grow from it. There are many ways to invite constructive criticism. In the corporate world, feedback and insight about leadership performance is often achieved with executive coaching, and a frequent tool used by coaches is a 360 evaluation.


A 360 evaluation is a series of interviews of people who work with the person being evaluated about their leadership strengths and weaknesses. The interviews are anonymous. The coach or facilitator then compiles a written summary of themes, using verbatim quotes for emphasis. This report is then discussed with the individual in a direct and forthright session. The idea is that nobody is fully aware how others perceive them, and this candid feedback will be new information-frequently new, negative information about their performance-that will hopefully be internalized and used for further development. It is, in short, an exercise of fairly intense constructive criticism.


I have previously received two 360 evaluations. The first was extremely illuminating and cast light on behaviors that I very much wanted to improve. In fact, my first 360 led to my interest in the study of leadership. In mid-January, I received my third. The session was a bit different, as the facilitator felt that he should read the entire report aloud, verbatim. Of course, while it was nice to hear what was going well, most of my focus was on what was not going well.


Hearing pointed criticism about your leadership behaviors is difficult. Extremely difficult, in fact. There are many things that you need to keep front and center. The first, if you are already self-critical like I am, is the knowledge that you are not a totally inept and thoughtless person or leader. The entire idea of the 360 is to build on your strengths and get better. Thus, you need to remember after a session like this that you in fact have strengths. At least a few.


Second, you asked for this. You want to improve. You are not doing this out of a desire to become depressed, you are doing this because you really want to be as good as you possibly can be. You like to learn, and learning about yourself is a good thing. After all, if you do not want constructive criticism, in the words of Hubbard above, do nothing and be nothing.


Finally, you need to remember that a lot of people that you work with every day spent a lot of time with this coach, giving their honest feedback, in the hope that you would listen, internalize the information, and improve. They want to help you. Allowing them to do so is a good idea.


Once you hear their feedback, and then read about it, the next step is to decide how to use this information in a positive way. A key to this is the concept of a growth mindset. It is a term developed by Carol Dweck, who contrasts growth-minded people with fixed-minded people.


Fixed-minded people believe you either have ability or you don't and have little interest in personal development. They tend to give up when the going gets tough and believe that they are what they are, and they have a finite amount of ability. Whereas growth-minded people believe they can develop and get better and keep learning. Such people have resilience, try hard, and are open to advice. Growth-minded people like challenges and want to grow. They have perseverance. So, if you want to grow and develop after a 360, you need to believe that you can in fact get better, you can grow, and you can figure out a positive path forward.


Obviously, it is easier said than done to always have a growth mindset. Frequently, leadership challenges are complex, and it is not easy to find the proper path forward. In fact, most aspects of leadership are in constant conflict. I have to support my team and push them to grow. I need to practice empathy and understanding but hold people accountable. Patients come first, but I must also keep the business of medicine in mind. I believe the softer aspects of leadership are essential for advanced leadership, yet so is courage and taking a stand. Above all, and my guiding principle, is to operate with honesty and integrity and attempt to find a balance with those principles and that of being too honest or forthright. Based on my 360, it is clear that I sometimes struggle with this balance.


What is a possible path forward? For me, step one is to own the issue. If I want to continue to grow and develop, then I have to own and be accountable for my behaviors and performance. I think that owning a problem is paramount to solving a problem.


Next is the belief that I will figure it out-the growth mindset. I must believe that I will acquire whatever insight I need to acquire and, in the end, I will figure it out. I actually think that a dose of creativity and imagination can also help address any difficult problem.


Third, perseverance and resilience are totally necessary because, I will make mistakes along the way.


Most importantly, you need to forgive yourself for messing up and not beat yourself up too much. I think that effective constructive criticism needs to sting. It needs to get your attention. But self-loathing accomplishes nothing. Just as it's important to forgive others, it's OK to forgive yourself (Oncology Times 2018;40(24):29).


Leadership is hard. Every day there are conflicting priorities to face, new challenges, personnel problems, unexpected events, and failures. Leaders are under a constant microscope. And leaders are human and therefore wonderfully imperfect. I think (and hope) the way forward is to be authentic, try to adhere to your core beliefs, appreciate feedback, forgive others (and yourself) when mistakes are made, and ultimately believe that improvement is possible. Believe you can, and will, figure it out. Usually there are a whole lot of people who will gladly help you along the way. Working with those wonderful people and problem-solving together are what makes leadership jobs worthwhile.


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