Be Fearless, But Not Reckless

Podcast Transcript

Brian Bolwell, MD: Beyond Leadership, a Cleveland Clinic podcast at the intersection of leadership and everything else. In this podcast, we will co-mingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership and management.

Hello everybody. Welcome to this episode of Beyond Leadership. I'm Brian Bowell, your host, and today, is going to be a great podcast because we're featuring Dr. Brian Rubin, who's Professor and Chair of our Institute of Pathology and Laboratory Medicine here at the Cleveland Clinic. Brian, welcome.

Brian Rubin, MD, PhD: Thanks so much, Brian. It's really a pleasure to be here. Thanks for inviting me.

Brian Bolwell, MD: So, can you tell us a little about your career? Currently, you have a pretty big leadership role. How did that occur and tell us about the background?

Brian Rubin, MD, PhD Well, I mean, I trained as a physician scientist, so I have an MD PhD and like most MD PhDs, I went and did a residency. I picked pathology, which always interested me. I like histology, and I thought I could combine a career of medicine and science if I did pathology. So did that, did fellowships, and I ended up working as a doctor. So, I've been a pathologist for 23 years now, and early in my career, I had no interest in leadership. I didn't really think of myself as a leader. I think that's probably typical of a lot of docs. I wanted to practice medicine and I wanted to do science and did that for a long time. I would say about maybe about 10 years into my career, I started looking around and saying, yeah, leadership might be interesting because I wanted to do things. I wanted to change things. I wanted to impact more lives than just my own. And I started looking around, and so I started to take on some leadership roles. I became the director of soft tissue pathology, my area of expertise, and became a fellowship director. I did that for a while. Then I became the vice chair of research, and I did that for about eight years. And that was a great position because it taught me a lot about leadership in that. It's one of those positions that was pretty nebulous. It was sort of handed to me and my chair said, do something with research, Brian. Make it your own and do something.

And so, I always like that, and I thought that was a good opportunity to learn how to lead and to learn how to change things because I think leadership in its essence is about change and motivating people like that. And then about maybe six years ago, the position of Chairman of Pathology and Laboratory Medicine opened, and I remember sitting in my office one day and throughout my career, I think about every five years I've sort of reassessed what I'm doing and what I want to do. And I think this opportunity that was there kind of got me interested in taking my leadership to the next level. I sort of asked if I would be appropriate, talked to a couple friends and said, you know what, I'll throw my hat in the ring and see what happens. And lo and behold, I got the job.

So, then I went from leading a small group to leading a really huge, large institute and have done that now for five years. So, it's been a really fun journey, definitely taking leadership to the next level. Lots of things happened over the last five years that I had no idea what's going to happen. And basically, it's been fun.

Brian Bolwell, MD: So, we'll talk about COVID in a minute because you sure we're instrumental in the way the whole organization responded to COVID. But beyond that, going from a relatively small group of people that you were leading to ... I mean, for our listeners, PLMI is a very, very big institute. Touches not just our main campus, but also virtually all of our sites in northeast Ohio as well as nationally and internationally. What are some of the leadership differences, and what are the themes that you've learned in the past five years about leading such a big group?

Brian Rubin, MD: Well, I went from leading about 10 people to over 2000 pretty much overnight. And so, I think that the first thing was trying to figure out what the vision was. I mean, luckily, I came from the inside here at the clinic, and so I took over a position that I saw somebody else do for seven years. And so, I had my own ideas about what I wanted to do, and a lot of that was about supporting the staff here and creating a vision that I thought everybody could embrace and be enthusiastic about, and then being a cheerleader more or less for the group. And so, what I learned was you must really create a compelling vision for everybody, and then you must dive in and support, important. I did a lot of listening. I realized, I mean, I think the other thing about being a leader, is you must be humble and realize that you can't possibly know everything that everybody else knows, and that you must engage the entire group in the leadership journey.

And so, one of the things that I coined the phrase of, I later read it in leadership books, was what I call shared leadership. And so, I thought if I could create a vision, start supporting people, and then getting all the content experts involved and giving them leadership positions and engaging them and helping to create strategy and helping me to roll out my vision now, we'd get a lot done. And I think that's really the secret to motivating people is by getting people to do the things they're good at doing, listening to them, allocating and saying, oh, great, you do that. I'm not good at that, and I will trust you.

The other thing that I had to learn that I wasn't very good at early in my career was starting to trust people and of course, hold them accountable, but trust them to do things and get them involved.

Brian Bolwell, MD: So that's wonderful. Obviously, in pretty much every leadership book, the word trust is used repeatedly. Trust is so important to cultivate, and it's also bidirectional. It's important that you trust people. And similarly, they obviously have to trust you. And I love the fact that you talked about listening. I think that so often, even if we're trying to be humble, sometimes people seem to run out of time to listen. But I think it's absolutely essential if you want to motivate people and you want to go from point A to point B.

So, as we tape this, it's March of 2023, and three years ago, almost exactly, COVID hit the United States, and one of the issues that all of us faced in healthcare was how to test for the virus. You got testing for the virus up and running here at the Clinic in a very short period of time. How'd you do that?

Brian Rubin, MD: Yeah, well, I think we saw comment a little bit, maybe earlier than people suspected. And so, the CDC was doing testing early on. We knew they were having problems, so we started to design our own test to get ready. And then when the CDC allowed us to test, we were operational within 48 hours. So, we had primers and that's a bit technical for most people. We were able to design a test and implement it pretty quickly. The problem though was scaling up because we realized, I mean, we were looking at New York City, which was really completely out of control. By the time that we were testing in March, people were in hallways, very sick there. We didn't know the extent to what COVID was going to hit Cleveland. Fortunately, we were blessed that it didn't hit us as hard as it did New York City for whatever reason.

But we had to be ready. And I realized very early on that to keep our hospital open, I was going to need to test all our patients, all the physicians here at the Cleveland Clinic. We have 70,000 caregivers at the Clinic. God knows how many patients, but it's a huge number of patients. And I knew that we'd have to be able to test all of them to keep this place open. So, we immediately developed a strategy for how we would do that. Now, that strategy ended up getting big. We started small, it was 200 tests a day, but right away, I knew I needed to get to 10,000 tests per day to get this place open, and I needed to do it in a very short amount of time.

So, I got the group together, we put a business plan together. It was a 40 million-ish business plan, Brian took it up to the C-suite. Thankfully, Dr. Mihaljevic is a listener, and he's also a guy that trusts content leaders. And so, he trusted me to do that. I put together a plan, even though it was quite expensive, he saw that to keep the hospital open, we had to do what I proposed, funded it immediately, and we got up to the level we needed to. We never actually tested 10,000 per day, but we did eight. And so, it was just a lot of having that vision of what we knew we needed to do using all the content expertise, and we leveraged all the people in PLMI. There's a lot of amazing technologists and techies in this group, and we brought them from all over the institute.

We turned essentially everybody into a COVID tester in this whole group at one point or another. And it was just building this huge machine to be able to do testing. And again, just leveraging everybody's strength and expertise. The Cleveland Clinic pitched in, and we were able to convince people that it was something they needed to support. And I think the rest is kind of history at this point.

Brian Bolwell, MD: So, the other thing that you did, I think extremely well during that time was communicate. Every day we had an update, a video call with organizational clinical leaders. And certainly, for the first few months, it seems that every day, you were one of the people giving an update. So, you were communicating on several levels. One was across the entire organization; one was obviously to your team in PLMI. What did you learn about how to communicate during that time? Because you were very effective, and you kept getting better. It was very impressive.

Brian Rubin, MD: Well, thank you. Well, I mean, you learn what you have to on the fly, right? So, I look at COVID. So, remember I said that I took over as chair like five years ago, and COVID kind of hit in my second year. And honestly, COVID was the best team-building exercise of all time. Because we had to function at a level that we weren't used to functioning. We had to move very fast, we had to function well, we had to get things done, we had to communicate, sort of all those things. So, we were meeting seven days a week, multiple times per day early on. And I think we learned how to communicate well during that time because if somebody didn't understand something, it hurt our ability to function. And so, we got very intentional in our communications. And I remember thinking when I first started presenting to the larger Cleveland Clinic community, I sort of started to freewheel it at first.

I'd have an idea what I wanted to say, and then I realized really quickly, all right, you got to write down what you need to say because you need to communicate very effectively. So, I started being more intentional. I started writing stuff down. And I didn't have speeches that I would give typically, but I knew I had had to cover a certain number of points and certain amount of content. And then of course, I would get feedback. That's where the listening part comes in. And somebody would say, ask me a question that I hadn't touched upon that told me what I needed to communicate with people. Because when I listened to their questions, I knew that there was something that I didn't communicate well. So, I started to fine-tune the communication to meet everybody's needs by listening.

Brian Bolwell, MD: And that's a pearl for our listeners. I think that that's a wonderful take home point, that one of the best ways to communicate is to listen and figure out what people need to know and what they need to hear. I remember reading a book about communication and it was talking about how to give a talk and the importance of reading a room while you're giving a talk. If you just follow a rote script, I think you miss opportunities to highlight or not highlight certain parts of your talk depending on how the room's reacting.

But I want to go back to one thing that you said, which I totally agree with. And there were some parts about the COVID pandemic that actually were unique opportunities. And one in fact was a team-building exercise in the cancer center. I don't think that we've ever been closer as a group of individuals because we were all in it together. There was a lot of fear then, but we were all showing up and we were all doing our best to still take care of a bunch of sick people. And it was very much that we were doing it collectively. And again, I mean, as you stood up this testing platform, it sounds like you know, and your entire institute felt the same way.

Brian Rubin, MD: I think the alignment was good during COVID, and I think alignment is 90 percent or greater of leadership. That means everybody rowed in the same direction to me. One of the great things about COVID, again, the silver lining was we all got alignment right away because we knew COVID was the enemy. COVID was the thing we needed to deal with. And that made our lives so much simpler because oftentimes we argue about what is the priority. That was the clearest priority that all of us ever had. And it was amazing how fast people moved. Even we think about space planning, which is the bane of our existence, because everybody needs space modified or built or whatever every day.

And I remember we were bringing in new devices, for instance, in the lab, I needed a wall knockdown or a new outlet or something, and we had the guys there that day doing it. There wasn't a lot of paperwork. And even to this day with our group, I always think, how can we move like we did during COVID, how could we be that nimble, that aligned? It's harder when there's multiple priorities.

Brian Bolwell, MD: So, in my role, I have the good fortune of interviewing clinical leaders from throughout the enterprise. And one of the things I've noticed is that you do a wonderful job cultivating opportunities for your junior staff, your junior faculty members and you've got an awful lot of talent.

How intentional is that with you? I mean, you clearly recruit well, because I'm very impressed with the talent level and the emotional intelligence of many of your people. But additionally, I think you're wonderful at creating leadership opportunities. You alluded to this a bit earlier when we were talking, but can you tell us a little bit about that?

Brian Rubin, MD: Yeah, I mean, again, talent development is so important and having the right team, as a leader, one of the other things that was kind of a penny dropped one day on me and I realized something important was that I had to have the right people working with me. And if there was any lack of alignment, there were no people in that group who weren't really a good fit. It just created all sorts of problems. And so, we're very intentional in how we recruit here, and I list out the criteria when I interview people, I say, this is what I'm looking for. And a lot of it for us is being an expert physician, I think that's bottom line at Cleveland Clinic. If you're not an expert doctor, you don't like doing medicine, this is not a good place for you.

But then also we talked about the Cleveland Clinic culture. You know that it's a culture where people are very helpful to each other. It's very hyper collegial. It does just say yes, culture. We never say no to anything here really. And we always try to help everybody else. I think it's a chip on your shoulder kind of culture. We're Midwesterners, I'm not really from the Midwest, but I'm a Midwesterner now and I've got that chip on my shoulder. I want to be better than the coast and do things better and I want to get better every day. These are the kind of things that we talk about when we recruit. So, we try to get that group in here.

Then I think the most important thing for me when I bring somebody in new is I tell them, and we have a very intentional talk, Brian. So, the first thing I tell them is, what is your vision of your career? Sometimes they say, well, I don't really have a vision. I say, you need a vision because if you don't have a vision for your career, somebody else is going to have a vision for your career, and that's not the career you really are probably going to want. You get torn in all sorts of different directions when you don't have your own vision and you're not intentional about it. So, I ask people to create a vision. Once they create a vision, whatever that is, then I look at it as my job to support it and help them to figure it out. Of course, in academic medicine, there's lots of roadblocks. It's not so easy to have a career half the time, but if you have a vision and you can at least have that to point you in a direction, then that's half the battle. And then again, it's my job to make it happen with them.

Brian Bolwell, MD: Well, I agree with that, and congratulations on your success because it certainly is noticeable to me. For our audience, just so you know, as we're taping this, I'm noticing that Dr. Rubin is wearing a sweatshirt with Wharton Business School on it. And one of the things we did last year was we had a formal curriculum for our institute chairs with Wharton, and I was fortunate enough to participate in it and boy, did I learn a lot. And I'm curious, Brian, what are some of the takeaways for you from a leadership perspective that you took away from our interaction with Wharton?

Brian Rubin, MD: It was a great experience, thank you for organizing that. And I would say one of the first things that really hit me was how complicated medicine is because all these guys were amazingly smart about business. They were all experts in their field and blew me away with how much they knew. But to one person, they admitted that medicine was confounding to the business leaders of the world and that there were many, many problems that people just haven't figured out. Even really simple stuff like call centers. As a patient, you call up the call center, try to get an appointment, nobody has really figured that out, and there's tons and tons of problems that we need to solve in medicine. So, the first thing I learned from that group was medicine's not simple, and it's going to take a lot of collective intelligence and a lot of real intentional work to solve all the different problems associated with modern medicine.

I would say the second thing that I learned was to be absolutely fearless, to be brave, and to not be afraid of change to a person. What I got from that group was to approach the problems of today, you've got to really be open-minded again, I think fearlessness is important, and in this time, can't be afraid of change, we must embrace it. I mean, it doesn't mean to be reckless, but it means we need to do things better and we need to keep pushing the envelope. And so, I would say that's kind of the major thing. Of course, I learned a lot of just very practical skills of how to look at spreadsheets, how to think about business planning, some tricks to how you do business from some guys who just spent their entire lives thinking about leadership and how to it promote change and so forth. There was just one great talk after the next.

Brian Bolwell, MD: One of the things that I took away in terms of how to execute change was the importance of doing pilots, just trying stuff out. It doesn't have to be perfect, man, with the whole phrase don't let perfect be the enemy of good. And how these, at least several faculty members really embraced, try little pilots, just try it out, see what happens, learn from them, and then go from there. Did you feel that too?

Brian Rubin, MD: Absolutely. And I think that maybe I couched it as sort of being fearless, but yes, I love that talk on that one guy, I can't remember his name. But the level of piloting that he did was so astounding. It was hundreds of pilots as I remember it. I mean, physicians like to be perfect. We don't ever want to make a mistake because it could really impact somebody's lives negatively. And that's in our brains stems. We're hardwired to want to do everything perfectly, but you're absolutely right that we can't be afraid to just try stuff. I mean, it has to be done in a safe way, of course, and we wouldn't try new things on people that were vulnerable and that in an unsafe way. But yes, we have to be absolutely unafraid. And I think that one of the other things that we do, and I think fear comes into it, is that we sit around and ponder about things way too long. We should make decisions more quickly and execute them. And I think that is definitely something that was promoted by that Wharton group that I took home as well.

Brian Bolwell, MD: Did you do it? Do you practice it?

Brian Rubin, MD: Yeah, it's interesting because right now I'm doing something very outlandish with our group. We have a business deal we're trying to do with another company, and it's really a stretch for my group, and there's a lot of fear in the group. And we even have a couple guys who are really so afraid that they keep warning me. And I said, look, you guys, you got to trust me. We can all join hands and jump into the deep end together, but we're going to jump in and we're going to do this. And I have absolute confidence that we'll be able to do this project and join with this company and this partnership that will really do a lot of really great things for our group and the Cleveland Clinic.

But yes, I'm fighting fear and I'm fighting the reluctance to get out of our comfort zones. Doctors like being comfortable, doctors don't like change. I mean, maybe nobody really likes to change, but in any case, that's the job. And yes, absolutely we are doing it.

Brian Bolwell, MD: So, one of the things you've talked about several times now is managing fear, and there's many leadership books that say the most important character trait that a good leader has is courage. Do you find that to be true?

Brian Rubin, MD: Yeah, I think so. You’ve got to, and again, having that vision that compels the group, I think is such an important thing. But yes, you must get everybody out of their comfort zones, teach them to be a little bit fearless. I mean, there's always going to be some kind of fear that you have to mitigate as a leader, and there's ways to do it. You can move a little bit more slowly at times. I mean, I think that I'm a person who does like to move fast, and one of the things I've learned is I've got to have the whole group moving with me again in alignment. I can't leave people behind. So, if I have to take a little bit more time to get people on board, so be it. But yes, promoting a fearless workplace I think is probably one of the most important jobs of being a leader. Again, it doesn't mean being reckless, but it does mean getting people out of their comfort zones and moving in a new direction, everybody together hopefully.

Brian Bolwell, MD: Yeah, I agree. And I think it also means, you know, highlights the importance of psychological safety because if you're going to remove fear, it's certainly part of that, it has to be allowing people to say what they think and without any sort of fear of retribution or any negative consequences. And that generally leads to better decision-making.

Brian Rubin, MD: I couldn't agree more. And I have experienced this recently with this project I was talking about where one of the guys in our group is very thoughtful. He digs down deep and really considers every possible thing. I mean, it can slow the group down, but it's an important exercise and we have to listen to a person like him because he adds that extra element that will make the project so much better. And again, yes, I think this is the way a good group's function is when everybody feels free to express themselves, add their talents. We're all a little bit different, but then when you can do it as a collective, it's always going to be more successful.

Brian Bolwell, MD: And I definitely think that's a true statement. So, you are in fact a very successful scientific researcher. You've been funded repeatedly by the NIH and other governmental organizations. Medicine's changing. How do you think the future of academic medicine in today's healthcare environment looks? What are your thoughts about that?

Brian Rubin, MD: Yeah, I mean, it's a great topic. I think we get along just on this one topic for quite a long time. As reimbursements come down, as costs go up, I think physicians are inevitably going to have to spend more time doing clinical medicine, maybe a little less time doing research. However, I think as leaders, we need to strategize and think about ways that we can maintain research and promote research. I think one of the things that I'm doing in my group is focusing our group on one research area and intensively investing in that area. That area is artificial intelligence, which I think has the ability to really transform the way that we both diagnose disease but then also treat disease.

What I like about AI is I think it can make us more efficient so that we can practice and work more at being at doctors and doing less things that are more mundane and we can spend our time better. I think if we can do that, then we can do more research and do more of the things that really kind of move our field forward. So again, yeah, I'm interested in AI. I do see that the future of research as being something that we need to protect as a group. If we get into the mindset that doctors are just here to produce revenue, that's not something that's going to serve the field well in the long term, and we have to have a long-term strategy. Again, promoting research, trying to move the groups forward, trying to learn new ways of diagnosing and treating disease. It's all important. If we stop doing that, then we really fail.

Brian Bolwell, MD: Yeah, I agree, totally. I mean, just picking out one part of current research is genomics, and genomics is very, very important in oncology, but I think it's also increasingly important virtually every medical specialty. And to your point about AI, I mean, if you're really going to look at whole genome sequencing or some very large amount of data, you're really going to need AI to help understand it, to help use it for some sort of positive benefit. I mean, that field’s exploding, and I think we have an obligation to learn as much as we can about it going forward in every disease state.

Brian Rubin, MD: Yeah, absolutely. I’m excited about it. I mean, I'm a cancer geneticist, so of course I've always been excited about genetics, and I do think that now the time is ripe with the explosion of technology that allows us to sequence a genome in a day. You're right. We have tons and tons of data and we've tried to analyze it using bioinformatics platforms and things like that, but I think AI will take it to the next level. And it's interesting because AI, you know, every new technology has a lot of hype, and of course, nothing ever lives up to their hype in the early years. But when things stick around for a while, like early in cancer genetics, I think a lot of people say, well, it's just a lot of data. It's not really going to matter much. Now we're starting to really be able to mine that data very well, understand it. We personalized cancer medicine, other types of personalized medicine, we can prognosticate using molecular data.

I mean, it's turned out to be an absolute gold mine, but I think it stood the test of time. To me, artificial intelligence is at that inflection point now where it's just starting to show its promise to us. And I think applying AI to molecules is just very natural. And of course, a lot of groups are doing that.

Brian Bolwell, MD: So as rewinding down, Brian, do you have any leadership themes that you'd like to share with the group beyond what we've discussed? You talked about the importance of vision and shared leadership and trust and how intentionally you are about developing your junior faculty. Anything else you'd like to share?

Brian Rubin, MD: Well, I think the other thing that I really stress is to be present and be around. And so, it's gotten a little bit harder during COVID where people got comfortable being at home. And I was at home a bit even during the pandemic, but I have a really big group and I intentionally visit everybody in the group, not all at once, but I do what I call town halls everywhere. I do about 50 town halls a year, and I go out all across the organization to meet with the caregivers because A, I want to hear from them very directly. But then also they really like seeing their leadership and realizing that we're just like they are, we're just a regular member of the group. Yes, we have leadership skills, and we try to lead, and we're responsible for certain aspects of the whole group. But I think being present, getting together, listening to people, again, almost in a one-on-one way, is something that's very important for leadership. And some leaders that I've seen fail, have failed to do that. They isolate themselves. And I think isolating yourself from the group you're supposed to be supporting is probably one of the worst mistakes a leader can make.

Brian Bolwell, MD: Yeah, I think that's totally accurate. Well, thank you so much. This has been an outstanding podcast. I know our listeners are going to be delighted to review this a couple times. Thank you very much, Dr. Rubin. And for our listeners, we hope you enjoyed this episode, and we look forward to seeing you again on the next episode of Beyond Leadership, and I wish everybody a great day.

This concludes this episode of Beyond Leadership. You can find additional podcast episodes on our website, clevelandclinic.org/beyond leadership, or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcast. We welcome any topic ideas you may have for future episodes, comments and questions about this or any past episode. You can let us know by emailing us at executiveeducation@ccf.org.