1. Bolwell, Brian J. MD, FACP

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I recently led a retreat of our institute leaders. The goal was to discuss challenges and opportunities in our current health care environment and to discuss leadership approaches to some of the issues we face every day. Reimbursement for most of what we do in clinical medicine is declining annually. This leads to budget shortfalls that need to be addressed. Physician burnout is real, and many physicians feel less autonomy. For those of us in academic medicine, the pressures to fulfill both our clinical obligations and our academic mission can be difficult to achieve simultaneously. All these issues (and more) make clinical medical leadership particularly complex. So we convened clinical leaders to discuss these topics, and I was to lead the session.

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I planned an agenda and crafted an introduction to frame the morning. The group was from all over the organization, but the challenges were fairly consistent. I devoted time for people to openly, and in a safe environment, articulate why their concerns seemed daunting and difficult to manage. The first hour was a calm, honest, and highly participatory dialogue of these items. In fact, I did not devote enough time to this part and extended the session discussing our collective challenges.


Importantly, the next step was to focus on what we could do as leaders in a positive and problem-solving way. There were two reasons for this. First, as I recently wrote, the environment is what it is, but all of us as leaders can respond as we wish. It makes sense to me to respond to difficulties, whatever they may be, by being the best leader I can be. Secondly, there was an abundance of knowledge and talent in the room and I knew our time together was an ideal way to harness this collective wisdom and strategize practical solutions to some of our problems. To set the stage for both of these goals, we decided to ask the question-what were you like when you were at your best?


It's a good question. When I posed this question to the group, one basic theme emerged. Some viewed themselves as leaders, and some as managers. Those that were self-described managers tended to take organizational edicts verbatim. Those who felt they were leaders tended to carry out such organizational imperatives in a more nuanced, individualistic way, not necessarily applying the requests broadly to all. The discussion led me to ask the question of myself.


To clarify, I am not referring to when I was at my best athletically when I was younger. That is admittedly a low bar. I am not referring to when I was at my best as a parent. In reality, it's the times that I messed up as a parent, and not any successes, that are still quite fresh in my brain. I am not referring to my personal academic career. This is a leadership question. As a leader, when were you at your best?


It turns out that when I feel that I am doing well in my leadership role, it's really not about me, but rather the team. The team is doing well. The "team" can be the cancer center as a whole or a program-the compartmentalization is not important. When I feel good about myself as a leader, it's usually because the team is thriving.


So how does that happen? The individuals on your team matter. It starts with recruiting and continues with retention. I spend a lot of time on recruiting. I look for people who are smart, who care, who can work in a team environment, who have resilience. Not just those individuals with a killer resume. While important, their resumes or CVs are a fairly small part of the equation. The more you recruit, the better you get at it. Unfortunately, I see too many leaders who treat recruiting as an afterthought or who delegate it to others. This is a mistake. Leaders must be active in recruiting.


Once you have them, how do you keep the good people? You create an environment that they are proud of that has many good people to work with and where people are held accountable. Some leaders do not "get" accountability, perhaps because they shy away from hard or uncomfortable conversations. Perhaps they delegate accountability. Maybe they fear that accountability will set a negative tone. In fact, accountability lifts the team. If you have high-performing people and you ignore the underperformer, you will only deflate your good people. Trust will erode. Culture will diminish. Whereas if you address personnel challenges in an empathetic but honest way, all will appreciate it, trust will rise, and culture will elevate.


When things are going well, clarity exists. Responsibility is fully defined and socialized. Data is shared frequently. Transparency is the rule. The group discusses and agrees on who is responsible for what. Tasks and issues are communicated in simple and clear ways. Clear communications is not trivial and should not be relegated to an afterthought. For some reason, academics thrive on ostentatious vocabulary and have an uncanny ability to make simple things complicated. Please avoid this temptation! Talk in simple and direct terms. Be clear and to the point.


Additionally, actively cultivate a safe environment for feedback. Invite your team to disagree with you, and/or to tell you when you are wrong. Address challenges and problems openly and honestly-no sacred cows. If there are obstacles, then the role of the leader is to remove them. Frequently these are political obstacles. So be it. My job is to deal with those barriers. Then, when success is achieved, credit is dispersed freely. My role as a leader is to credit others. Credit the team that is in the trenches and actually doing the work. When part of your organization is going well, others want to emulate it. They want to see how success was achieved and mimic it. The more good people you have, the more good people want to join you and be part of the organization. Everyone wants to be part of a successful, nurturing, and enjoyable culture. Good teams attract good talent.


Thusly, I am at my best as a leader when my team is at its best. I provide transparency and honesty. I talk in simple terms and I address what needs to be addressed. I hire good people and have their back. I admit when I make mistakes. I ask for advice and listen. I provide a safe environment for open dialogue.


How about you? When were you at your best as a leader? If your answer is all about your personal success, then I suggest reading any of the leadership books I have previously referenced in this column. Work is about people and relationships. Step one as a leader is to go beyond ordering people to do things because you are the boss, and instead form connections with people in your organization. If you believe that your personal success as a leader is all about you, please stop, put your title on the shelf, and go talk to your people and get to know them. You will be pleasantly surprised at what happens next.


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

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