Bring back the Humanity

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, and welcome to today's episode of Beyond Leadership, and I'm delighted today to welcome Dr. Margaret McKenzie, who currently is Vice President of two of our very important regional hospitals, South Pointe Hospital and Marymount Hospital. Margaret, welcome.

Margaret McKenzie, MD, MS: Thank you very much Dr. Bolwell. Good to be here today.

Brian Bolwell, MD: So, Margaret, tell us a little bit about your career, how you started, what you spent your early days doing, and then ultimately, how you became a hospital president.

Margaret McKenzie, MD, MS: Thank you, Brian. So, during my early career when I first got out of residency, I was really focusing on perfecting my craft as an obstetrician gynecologist and stretching the limits of my skillset and focusing on perfecting what I call the art of medicine. I wanted to try to incorporate as many innovations of practice as I could, because when I left my residency program, laparoscopic surgery was in its infancy, and there were lots of rapid changes happening, and I wanted to make sure that I would be prepared to incorporate those changes and learn new skills as I moved along in my career.

I also focused a lot on relationship building, both with my peers and with my patients, because obstetrics was clearly the most litigious specialty, and certainly had the highest risk of liability because you're dealing with two patients.

And all this time, I was also trying to build a family and basically reflecting on growing a personal brand, and also how could I really live my values as I continued to practice in medicine. So that's where I started.

Brian Bolwell, MD: And then?

Margaret McKenzie, MD, MS: I started to see challenges in the way that care was being delivered in my specialty, in how some of my peers were assimilating into practice. And that really helped me to sharpen my problem-solving skills. Instead of complaining or pushing back, I would always take myself into a space of, "Let's go ahead and see if I could find a solution first before I complain." And so, I started to become very focused on organizing my thoughts around challenges and looking for solutions before taking it up the ladder to you know, my chairman and so forth. I think that I took a lot of initiative in many of the challenges that we faced at a time, which involved starting a new obstetrical service at the Cleveland Clinic after not having one for probably a good 35, 40 years, and trying to figure out how we were going to reinvent that, especially in a city that already had such mature obstetrical practices. And so, I found myself in a place starting to lead out very easily because I had that kind of focus.

In addition to that, I also tend to practice the behaviors of being very agile and adaptable to change, and really believed in collaborative practice. Started to work with pharmacy and nursing around a lot of the challenges that we had at that time, so that we could really bring comprehensive care to the obstetrical patients that we were taking care of.

Brian Bolwell, MD: Can you give me an example of that?

Margaret McKenzie, MD, MS: So, when we first came to the Cleveland Clinic, they weren't really used to having obstetrical patients in the house. And so, a good example is regarding medications while patients were in labor focusing on drug reactions, also practices that would affect the outcome of the baby.

So, for example, even with anesthesia, giving general anesthesia versus regional anesthesia, with many of the antibiotics we give in labor, that can be associated with some defects in a newborn. And so, we actually started to make rounds every day while we were in the ward, and we'd always have nursing and pharmacy with us as we were caring for the waiting obstetrical patients who were in the house.

Brian Bolwell, MD: It's very interesting to hear this, because we take our OB program at the Cleveland Clinic for granted. But the fact is, what was it now, about 25 years ago or so? I mean, we didn't have an OB program and I think Dr. Loop decided that we needed to do that, and obviously you were one of the people who helped lead that effort. It must've been a pretty big deal and full of a lot of challenges.

Margaret McKenzie, MD, MS: It really was definitely a paradigm shift, because when you're not used to taking care of the obstetrical patient, the first sign of anything it's, "Call the OB, call the OB, call the OB," and so it was pretty common for us to be running around the hospital whenever an obstetrical patient came in with another serious medical problem, to make sure that we could really take the best care of both the mother and the growing fetus. And that actually started, it was actually about 28 years ago that we started obstetrics again. Now it's become so natural, it's like breathing, right?

Brian Bolwell, MD: No, it's true. Kudos to you. It's actually very interesting because I was reflecting two weeks ago on a big philanthropic event here at the Cleveland Clinic for our cancer center. It's a bike ride called VeloSano, and it just celebrated its 10-year anniversary, and everybody takes it for granted now, but a lot of years ago it didn't exist, a handful of people. And so, you're kind of one of those handful of people who basically stood up OB in this massive organization. That's pretty cool.

Margaret McKenzie, MD, MS: Yes, it was a challenge, but here we are 28 years later, and it's well established and growing. In the beginning, it was just four of us who practiced obstetrics, without any idea regarding the onslaught of volume that was going to come toward us. And I remember we took an in-house call. And so, if one person was ill or on PTO, we would do every second to every third night call, in-house as an attending physician.

Brian Bolwell, MD: Wow.

Margaret McKenzie, MD, MS: The program has grown tremendously since that time.

Brian Bolwell, MD: You must've learned a lot about leadership. I mean, obviously this is a leadership podcast. What were some of the early lessons you learned?

Margaret McKenzie, MD, MS: I would say that the first thing that you learned was that leaders lead, and you don't look for somebody else to try to solve issues that arise. You've got to really be able to corral a team and inspire people to take ownership, and build on lessons learned, and figure out how we grow from them. Right?

Brian Bolwell, MD: Yeah.

Margaret McKenzie, MD, MS: I think that the hardest lesson was remembering every time there was a challenge, that you're dealing with humans, right? Sometimes we forget that, and we act and look for perfection. And I think that you've got to bring humanity back to everything that you do and realize that other people have challenges in their lives. You should really look to understand, rather than to be understood when you're dealing with challenges.

So, I would say in the beginning, it was very challenging. We didn't have many solutions. We couldn't really look for a chairman, because he was out of that game for a long time. And so, as obstetricians, we had to gather together and figure out how we were going to grow the practice, overcome many of the challenges that we had at the time.

Brian Bolwell, MD: You just said a bunch of pearls. So just for our audience, one of the most important things I see here in this organization right now in terms of leadership is owning issues, owning problems. And that's actually the first thing you said, Margaret, is you've got to own it, and you can't depend on somebody else to solve your problems. If you've got a problem or your team has a problem, you've got to view it as your own responsibility if you're a leader. And I think that's a really important point, and I think it's a point that some people struggle with. You then talked about team building, which is clearly, I think, one of the essences of leadership.

And then I really liked what you said then about humanity. People are human beings, and everybody has stuff in their lives, and I do think that it's important for all of us to remember. I mean, everybody wants to do a good job. Nobody wants to screw up. And the fact is that usually if people mess up, they feel terrible about it. And I remember a few years ago, I wrote an article about how important forgiveness is, and it actually takes courage to forgive people sometimes. And so, I think that's a pretty important point that really isn't discussed very much when we talk about leadership. So, thank you for those.

So, there you are. You built this OB practice, and it's growing, and that's really cool. And then I think you had some organizational opportunities in the leadership realm before you became a hospital president, correct?

Margaret McKenzie, MD, MS: Correct, yes. We actually had started to have an OB/GYN clerkship that we shared with Case Western, and Ohio State University, and Hershey in Pennsylvania. The clerkship director took a year off, and I was asked to step into that role as clerkship director, without any knowledge at all of how to run a clerkship, and no guidance or mentorship. And so, I had to really reinvent myself then.

And I ended up joining our national organization, the Association of Professors of Gynecology and Obstetrics, and really started to look for mentors in that space who could actually help me to walk this road. That resulted in me acquiring the skills of being a clerkship director and making our clerkship the best clerkship in the city, that the students wanted to come through.

Inherent in that role was the entire learning how to build curriculum from scratch, learning about assessment and also instructional theory. That then, when I say right opportunity, right time, as Lerner College of Medicine was coming online, we were getting ready to start that from scratch. After we got an endowment from our Lerner, a philanthropist here at the clinic. I remember all of the clerkship directors, and we formed a curriculum steering committee, and we started our work of and visioning what the end should look like.

In that space, we thought that we wanted to avoid all of the perceived errors in our own training, and to really train medical students who were going to be very holistic in their approach to patients and to their peers. And to not just acquire skills and attitudes using traditional methods, but instead to learn how to conceptually learn medicine, and to be able to build in the concepts in a way that was not just memorization, but it was really conceptual. And to also know when you didn't know enough, right, and that you needed to go and find that information or get a consultation with somebody else.

The best challenge I would say that we overcame in that setting was we did not have grades in the medical school. And so, we ended up having an assessment system that was based on internal motivation rather than external motivation, which was the problem with most of our education at the time. We were always looking to our faculty for the answers, to how things should be done. And instead, this methodology actually was forcing students to start to reflect on their performance, to seek feedback on their performance, honest feedback, to be able to do their own self-assessment and self-regulation. And so that was my biggest journey, because I then had to transform the skills of a clerkship director to now thinking more globally about medical education.

And so then, I ended up being asked to train the physician advisors who would help to mentor and guide and advise the medical students on how to self-assess and self-regulate, how to build a portfolio based on your performance, and to give an honest appraisal, and to be accountable, and to have some good self-motivation.

And so, in inheriting that problem, in that process, we actually didn't have a model out there in the world. And so many of it, we had to figure out how we are going to train the physicians to advise without bias, to be aware of all of the LCME guidelines for medical education, and then to be able to give them guidance on how to be an advisor in that space. That was entirely new for us.

Brian Bolwell, MD: So, give me one example about that. What was one key that they needed to understand?

Margaret McKenzie, MD, MS: Well, I think that like a really good coach, you know medical students are brilliant people. When they come into your space, they're actually capable of thinking. You have to really give them space, so that they can learn how to look at their own performance, figure out what it is that they need to know and learn, and then to trust them on gathering the information.

I think that the hardest part was helping them to do the reflection internally and stop looking outside of themselves for approval. And so that was hard, because many of us as professors wanted to tell them what it is that they needed to do. And so that was the hardest part, getting the advisors to learn how to give the student the space and the time, so that they could really internalize that motivation and learn, because there were no grades and no AOA, it really removed obstacles to deep learning, and collaboration, and peer mentoring on a level that now has become normal for even me as a leader. I've adopted those methodologies as well in my leadership.

Brian Bolwell, MD: So, for our listeners, what Dr. McKenzie's describing is a pretty remarkable thing. Again, we didn't have a medical school 25 years ago, and Margaret was one of the people who helped design what we wanted. And as she just said, it's a very team-based approach. We don't have grades. And it's really cool, and it's innovative, and certainly it's a very popular med school. The success has been pretty remarkable. So, number one, congratulations for lifting that up as well, and that's quite an accomplishment. And secondly, that must've been a lot of fun.

Margaret McKenzie, MD, MS: Thank you. It was a lot of fun. It was great for all of us advisors because we were reinventing ourselves and our careers along with the students. And we became really deep reflectors. And I have definitely seen in every single advisor that transformation in their professional and personal lives, so that we are actually living this internal motivation as well, as our students did. Yeah, so it was a good thing.

Brian Bolwell, MD: So how did you become a hospital president?

Margaret McKenzie, MD, MS: Well, I believe that the Cleveland Clinic, most times you don't have to apply for jobs. Because when you're leading out in your everyday roles, totally independent of whatever's going on, you're doing the right thing, it is pretty common for you to get tapped on the shoulder and asked to lead.

And so, in my case, I was actually asked to lead. After some reflection, I decided that I would give it a try. But I think it was definitely based in my leadership in my institute, the Women's Health Institute, where I served as a section head for about six years or so, and really had a chance to practice leadership in a collaborative way while holding our team accountable and being able to motivate and inspire them as well. And so of course, you know, that ended up serving me in the space of the hospital that I ended up being assigned to, and then it grew from there.

Brian Bolwell, MD: So, you show up at South Pointe, and what'd you do the first week?

Margaret McKenzie, MD, MS: I will tell you, when you transition from a very academic place to a community hospital, there's a little bit of deep reflection that is really required for you to make the assimilation. The benefits were that I really had this robust background in medical education, and South Pointe Hospital has, had, residency programs that are osteopathic, that they have the American Osteopathic Association accreditation, but they all needed to become ACGME accredited. And in addition to that, we also have an affiliation with a medical school, the Osteopathic Medical School. Ohio University has a campus at our hospital. Having that medical education background gave me a lot of confidence that I could come into that environment and really change things, allow them to gain accreditation, and to sort of align the way that they work with the Cleveland Clinic. The hospital really was 80 percent, and still are 80 percent, private physicians who have an entirely different style of practice. I think that the biggest challenge was trying to align them to the values of the Cleveland Clinic.

So, in the beginning when I got there, it was mostly a lot of listening and observing, really trying to understand rather than to be understood. And so those are the things that really helped me to navigate the change.

Brian Bolwell, MD: Thank you for that. That's again, a lot of insight there. So, I am curious though, about private physicians. I mean, they are a different breed, and asking them to align with our organizational values is tricky. How did you approach that?

Margaret McKenzie, MD, MS: Well, I will tell you finding allies who already have relationships was one, I would say the biggest secret sauce. Because then once you've got trust with somebody who already has trust with those physicians, then it allows you a door that's open for them to listen to what it is that you're bringing to the table.

One of the things that I've always learned about negotiation is that you have to really, first of all, build trust. You've got to think win-win. And then you have to really try as much as possible to get their perspective and figure out what the change is going to do. If it's going to be threatening, then you're going to get a lot of pushbacks.

And so, you really have to, like my mom says, you've got to ease and press, and ease and press is what she'd say, so that you can really help them to start to see why we're doing the things that we do, particularly regarding the model of care where we're trying to practice the safest care. We're trying to build trust in the patients. We're trying to improve the practice. Because we have some competition right up the street. And so, showing them the win-win really was a big deal.

And then shortly after that, the hospital became a Magnet hospital, so the highest level of quality of nursing. And they will tell you that they noticed the difference between that hospital and other hospitals that they practiced at, because of the level of nursing care, particularly in the evening hours. And so, leveraging those pieces of, pearls are what I would call it, actually were a big part of how I was able to navigate getting them on board. And now, the culture has changed. It's taken a good five and a half, almost six years. To watch them align to the Cleveland Clinic style has just been nothing short of remarkable to me. Yeah.

Brian Bolwell, MD: Well, congratulations again. So again, for our listeners, there are a lot of pearls there that I'll briefly mention. One is the importance of building relationships and trust, which is certainly fundamental to any leader. Any leadership book talks about trust. And I can't overemphasize that. It's certainly been thematic of these podcasts, but you've got to keep your word, you got to be straight. You have got to be authentic. You have got to tell the truth. You can't spin. People can see through fakes pretty easily.

Margaret McKenzie, MD, MS: They can.

Brian Bolwell, MD: But one thing you mentioned that we haven't discussed all that much is the importance of finding allies. And I remember Margaret, about 16, 17 months ago or so, you and I, and about 20 of our best friends went to Wharton Business School and spent a day in Philadelphia with them.

And I remember one of the faculty members talked about how to lead through change, and he talked about finding allies. He said, "You need about 60 percent or so of people to at least understand what you're trying to do and hopefully are on your side in terms of what you're trying to do if you want to achieve success."

And so, I think as people think about change management, finding allies is really important, and you mentioned it, and I think it's a really key thing. Then of course, looking at things from the perspective of the other folks is obviously incredibly important. So, a lot of pearls there. And again, culture change isn't easy. It takes a lot of time, but congratulations.

So, do you have a leadership philosophy? I mean, you've talked a lot about it. You've talked about, I find it very interesting about your medical education background and about, you know, kind of, introspection. Can you say a little more about that?

Margaret McKenzie, MD, MS: What's fascinating about humans, particularly those of us who are in medicine, is, I think, that we forget that we're already unique in the sense that we're goal setters. We actually don't mind delayed gratification, and we can persist for a very long time. And there is no such thing as "arriving" for us, and we have to continually reinvent ourselves. There's a lot of new changes around us in healthcare, in technology, in skill, and we have to constantly pay attention to all those changes that are happening. And we have to adapt our life to it. So, I would say reflection often with constant goal resetting, very important for us.

And let us remember that mentor's matter. Many times, we can get lost and stuck, and sometimes mentors can actually help you to see where you're at. And so, mentors matter, and exposure matters. Going to different places and seeing how other people things do, learning from other people is really important.

So, for me, my philosophy is that you can always begin again anytime when you're ready. Exposure matters, mentors' matter, and don't be afraid to walk the road less traveled. And also, that for us in healthcare, especially at a crucial time right now, thinking of new ways and thinking outside of the box is really important, because the world is not the way we found it when we walked into medicine or into our careers. And if you don't reinvent yourself, you're going to get stuck.

I also think it helps with burnout, because it gives you a fresh perspective and you can revel in changing directions. And I think that's really critical as we are moving forward with the next generation, and with the new healthcare model that we're going to have to come up with here in order to handle the changes that are happening in medicine today.

Brian Bolwell, MD: So again, a lot of pearls there. I like a couple things a lot. One is the ability to reinvent yourself. I think that that's really important. You're right, obviously the science of medicine changes very, very quickly. Certainly, what we know about genomics and immunologics right now are very different than what we knew 10, 20 years ago. And all of those things are in our practice. But additionally, you talked about taking the road less traveled, and I think that if you're going to be a really good leader, you have to do that. You have to have... This gets into Brene Brown territory about having the courage to be vulnerable and not always following the crowd. And ultimately, you mentioned this earlier, Margaret, living your values.

And if you live your values, that may take you down some paths that are different. And there may be stuff in those paths that aren't a whole lot of fun. But if you want to live your values, you got to be willing to take the road less traveled. I think that's a fabulous bit of advice for anybody who was an aspiring leader, or just in how people live their day-to-day existence. So, thank you very much for that.

Any closing thoughts?

Margaret McKenzie, MD, MS: Yeah. I think that when we're managing teams, sometimes, especially in times of change, we can experience a lot of pushbacks because it's uncomfortable to be in times of change.

But if you can focus on the humanness of everyone that you're dealing with in your team, and remember that as humans, regardless of what it is we do, we really are looking for three things. And that is happiness, success, and freedom, right?

And if you can build your team so that people can feel those three things are reachable for them, I think that they'll be all in. People respond negatively when they think something is being taken away from them or when they're losing control. And so, if you could manage those emotions as a leader, I think that people will show up and give you their very best self. And that makes your leadership satisfying, right?

Brian Bolwell, MD: Yeah.

Margaret McKenzie, MD, MS: And successful, because then it's easy for you to be able to achieve your goals.

Brian Bolwell, MD: I think that's brilliant, and I think that's a great way for us to end. So, Dr. McKenzie, this has been one of our best podcasts. Thank you so much for spending some time with us.

Margaret McKenzie, MD, MS: Thank you, Doctor. Take care, and I appreciate you.

Brian Bolwell, MD: And for our listeners, thank you for listening. I wish you all a fabulous day, and I look forward to sharing some time again with you on future podcasts of Beyond Leadership. Take care everybody.

This concludes this episode of Beyond Leadership. You can find additional podcast episodes on our website, clevelandclinic.org/beyondleadership, or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcasts. 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.