1. Bolwell, Brian J. MD, FACP

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Dr. Joe Simone left us unexpectedly. He was known to be the Yoda of cancer center directors. He had been the CEO of St. Jude's Children's Research Hospital, Physician-in-Chief at Memorial Sloan Kettering Cancer Center, and Clinical Director of the Huntsman Cancer Institute at the University of Utah. He was the person you called if you wanted insight about academic cancer centers. He had seen it all and had an enormous fund of knowledge about academic medicine.

Joe Simone, MD. Joe ... - Click to enlarge in new windowJoe Simone, MD. Joe Simone, MD

Joe may be best known for his masterful paper published in 1999, "Understanding Academic Medical Centers: Simone's Maxims." This must-read begins by stating the truism "Institutions Don't Love you Back" and escalates from there. Read it today, regardless of whether or not you have read it before. You'll always learn something new.


Joe was a huge influence on me, for a variety of reasons. I met him several times, and served on a consultative committee with him. He was a man of good cheer, obviously extremely talented, but filled with humility. He knew how to run a meeting. He kept all stakeholders engaged and participatory, and adroitly avoided tedium by completing discussions efficiently and, if necessary, firmly. I learned a lot just by watching him-how he treated others, how he engaged others, and most importantly, how he led.


And that is how he influenced me most. He wrote about leadership. Whenever I write a column or essay about leadership, I always think about Joe.


My interest in leadership principles began when I received my personal 360 evaluation about my leadership skills about 20 years ago. I thought I was a wonderful leader and that I knew it all. Well, I received a 25-page evaluation about my leadership skills, and 24.5 pages of it were highly critical. I thought I was a good leader, but in reality I was nowhere close to being the leader I wanted to be. I knew very little about the entire concept. But it was a wonderful opportunity for me to learn and get better.


So I started reading leadership books voraciously. I realized that if I wanted to improve, I needed to change my behaviors and actions. Simply gaining insight was not enough-I needed to change. But I also learned that all the leadership books that were available were about corporate America. There was essentially no literature on leadership in health care.


That is when I started to read Dr. Simone's essays on leadership. First, I discovered Simone's Maxims. I must have read it 10 times back then. An entire section is about leadership. He wrote "Leadership does matter....the ill effects of poor leadership, at any level from the CEO to department head to housekeeping, insidiously permeate an entire institution...what makes great leaders is not a secret-they have courage and character, they remain focused on the important aspects of an issue in the midst of chaos, and they articulate a consistent, simple public vision." Wow. That is a playbook for leadership in a few sentences. I think the concept of remaining focused on the key aspect of an issue in the midst of chaos is especially true today.


The complexity of health care keeps growing. In the past 12 months, the pandemic has made such complexity more acute, but challenges with insurance pre-authorizations, financial toxicities for patients, disparities in care delivery, a new age of genomics and immunologic therapies, and more means that a leader can be easily drawn in an infinite number of directions. More than ever, staying focused on the core of an issue and not the stuff on the periphery is absolutely essential for effective health care leadership.


Dr. Simone wrote many leadership columns in Oncology Times. One of his best is "The Best Advice I Ever Received." He said that, when he first became CEO of St. Jude's, a mentor advised him to "take time to think; make it part of your schedule." He did so, and said that it was invaluable to him. This is something I have also tried to do. Not just to give me time to think, but also to have time to deal with the unexpected.


If you are a leader, such as chair of a big cancer center, unexpected challenges are ubiquitous and occur almost daily. They can create chaos if you are not careful. It's better to expect the unexpected and have time to think about how to manage the issue, and then address it in a well-thought-out manner.


Later in this essay Dr. Simone writes about his father, who told him "you should never hate anyone; you should hate what they do....I will never forget that advice, the best of them all." No need for me to add to that.


My favorite essay from Dr. Simone is one of his last, published in 2017, entitled, "What Makes a Great leader?" In this essay, he references Peter Drucker, W. Edwards Deming, and Abraham Lincoln. He ends this essay with a brilliant summary of the core principles of great leadership: "First, though he remains confident in his final decision, he must have humility in sufficient measure to mitigate arrogance and promote active listening to those holding other views.


"Second, he knows that at some time he will be asked to compromise basic principles. If his values cannot be sustained because of the environment, the great leader may choose to lose favor, be fired, or quit over a key principle. If the position or stature or pay means so much that the leader will not put his job on the line for a core value, he is no longer free and has taken a step down a slippery slope. Great leaders have the mindset upon taking a position of holding core values and principles dear, no matter what the cost."


This is why I believe that courage, and living your values, are the key ingredients that separate great leaders from others. Joe knew this, and lived it.


So you can always learn from Dr. Simone. But for me it goes further. He showed me that you could talk, and write, about leadership in health care, and specifically, in oncology. He was the only person that I knew who was doing this, and doing it so well. Writing about leadership, and teaching it, became my new North Star. I find the subject endlessly fascinating, and I keep discovering new opportunities to improve my personal leadership. But Joe was the pioneer.


When I wrote my first essay on leadership for Oncology Times, I sent it to Joe for his comments. He was gracious and positive. That validation gave me the confidence to start writing my leadership column on a regular basis.


So I will keep at it and continue to write about what I learn about leadership. But I will always be following in the great man's footsteps. As will so many others.


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