Building Relationships: The Secret to Success

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, everyone. I am your host, Dr. Brian Bolwell, and today I have the pleasure speaking with David Rowan, Chief Legal Officer at the Cleveland Clinic. Dave, welcome to Beyond Leadership.

Dave Rowan: Thank you, Brian. I look forward to our chat.

Brian Bolwell, MD: Can you tell us a little bit about your background and how you came to work for a healthcare organization such as the Cleveland Clinic?

Dave Rowan: Sure. Be happy to. So, I've been at the Clinic now for approximately 27 years as general counsel, and the title switched to Chief Legal Officer. But I think probably it's an example of being at the right place at the right time. And I have now worked for three CEOs, all cardiac surgeons, but just a total accident along those lines. But the law firm, which I was at which is a large institutional firm: Squire, Sanders and Dempsey. At that point in time, back in '94, had gotten the account for the Cleveland Clinic. And I had worked a few months as outside counsel working with the then general counsel. The decision was made that there was going to be a change, and so I was brought in on purely a temporary basis to fill that seat while a search was completed. And then Dr. Loop walked in one day and said, "Why is your title interim? You're the general counsel."

So, with all that fanfare, I became the general counsel. I remained partner in a law firm, Squire Sanders, for approximately 10 years through his entire term. But this is all the work that I did. And then when Dr. Cosgrove came in, he thought I should become an employee of the Cleveland Clinic. And I did so. My title became Chief Legal Officer, also Chief Governance Officer. I'm the Secretary as well. And so that continued. And then with the transition from Dr. Cosgrove to Dr. Mihaljevic, I remained the chief legal officer. So again, right place, right time and I love my tenure here. It's a totally unique opportunity as a lawyer to work at an institution like the Clinic.

Brian Bolwell, MD: What do you enjoy about it? What are the highlights?

Dave Rowan: I think it's never boring. And that's sincerely a trait. You get to work with extremely motivated people. The mission of the clinic is rewarding and the lawyers and the law department in a small way, but I think significant way, facilitates that mission of research, education, and also patient care. So that I was given the task of building then a law department, which I've done so over the years. And I think that I'm able to recruit and retain great people because they see what I see. You get a variety of work; you can never plan what your day's going to be like. And again, the mission of the Clinic is very rewarding, and I can't think of really a legal job where you have this kind of breadth of what you do, and it takes certain traits. But it's been great. I guess the reason I'm here is because I've worked with people in an organization, which I think is very ethical: do the right thing, reputation is critical.

Brian Bolwell, MD: Many of our listeners probably don't know what a chief legal officer at a healthcare organization does. And of course, the Clinic's unique because of our broad reach, which includes international reach. Tell us a little bit about the scope of what your team does here at the clinic.

Dave Rowan: And if I haven't said it twice already, I'll say it again. It's having a team that you build out, that you trust and really the team does a great job. So, the law department, which we're based here in Cleveland, is responsible for all legal activities no matter where the Clinic participates around the world so that the vast majority of the lawyers are here, but we have a growing department in Florida and we otherwise handle all the other locations by responsibility assigned to the law department, as well as working with other law firms. When I started, I thought that we should really develop in-house, the expertise in all the subject areas that are repetitive so that you can well imagine the Clinic's a highly complex organization. It's large. We have over 150 corporations that we need to maintain around the world to undertake the mission. At its core, the Cleveland Clinic is a tax exempt, not-for-profit organization, meaning that as I think people know, whatever we make every year goes into paying the operations salaries. But everything else is plowed into reinvesting in the mission.

And that's pretty unique around the world, certainly in the US. It's a standard where you've got for-profits or not-for-profits. But that's what we do here at the Clinic. And we carry the same model around the world so that people think of lawyers doing things like defending medical malpractice cases. And we do all of that: risk management and the like. But we also do a lot of transaction work. We review every contract, we look at all the labor employment areas, we look at the international areas. So, what we've done is really to establish individuals, and I have five deputy chief legal officers. They're then responsible for supervising people who do everything from the FDA to intellectual property work. The vast majority of what we do is not courtroom work, but we do all of that as well.

So that I think the model we have tried to aspire to is to attract great people. We retain the people because they see what I see. It's very rewarding, challenging to work inside an organization like this. But when I say challenging, what our job to do is really to find ways to carry out the mission of the Clinic. We're a physician led organization and I think it's critical for us to be as rapid as possible. We have to help make decisions, but it's in all these subject matter areas where we have great people, and we also have liaisons out in each one of the clinical areas. And then in every location we have somebody not physically located always there, but to make certain that we are maintaining compliance with all of the legal, the regulatory functions.

In addition to that, I think that I've been blessed by having a situation where lawyers are included at the various earliest stages of strategy projects. And this is a team effort working with lots of other areas to ensure that we meet all those requirements. And I think that we have strived to be a department, which yes, when we need to say, "Here's a line you cannot cross," but to also help make risk decisions, to make decisions versus the on the one hand, on the other hand kind of advice. CEOs, the board, other people want to have people inside who can help make those decisions, facilitate the transactions. And speed of execution is something that I think is critical for any organization and certainly the Cleveland Clinic.

Brian Bolwell, MD: So, for our listeners, I've interacted with Dave's team on multiple occasions and it kind of depended on the stage of my career. Early on when I was leading the bone marrow transplant program, we were doing an awful lot of clinical research. I learned a lot about how clinical research works. And one of the things, of course, when you're partnering with a pharmaceutical company about a trial with a new drug, that requires a contract, and the law office looks at literally every single one of these things. And how you negotiate these contracts turns out to be very important because there are economic issues involved as well as other complex issues involved.

And boy, did I learn a lot with your team just about that whole part of research, which touches an awful lot of the organization. And that's true. Any time we have a contract with any outside entity, the docs have to work closely with the lawyers. And that was new to me and that was actually very educational.

What are your views about where research is right now with respect to your team and where we're going?

Dave Rowan: Well Brian I think that as you've laid out, having contract, and understanding of those issues is critically important. And I think that I'll come back to the speed of execution that we always want. So, I think that doesn't mean cutting corners, but I think that you need to have people with experience so that they've seen what has happened in the past. Everybody believes in a contract that is going to be wholly successful and the like, but you have to have the experience of what happens when things go wrong.

And that doesn't mean that you don't make decisions about risk tolerance because I think that we have a great team and I think that lawyers and doctors, and yes, I've heard every lawyer joke I think including ones in other countries, but I think that here, that kind of relationship of what do you want to achieve and the experience of running, I think a topnotch contract system. So that if it's X, Y, Z corporation, we don't have to start from zero. We've got contract databases. We know what we've done in the past. And I think research, we've got highly skilled internal lawyers, legal assistants, and other people to work repetitively with the researchers.

I think that one of the things that we also strive to do jointly in the industry is totally, I mentioned before, speed of execution. I think that when we deal with a physician, a researcher and the like, they're extremely busy. They're doing lots of things that are rewarding and they want to know that somebody is very attentive with regard to what's going on. If they're educated on where things are, and I hate the words, "Well, it's on the other guy's desk. I got out the door 40 days ago, but it's been sitting there," that's not a good answer to me. And I think that frankly, we have great people who keep the ball rolling and look for ways to cut time out of the research process.

If we go back to the COVID era, I guess we're still in it, that if you look, there were a lot of things that were done to take time out of review of vaccinations, but lots of other regulatory issues. I hope that we learned something through that whole process, that not cutting corners, but taking unneeded bureaucracy out of the regulatory process is critical. And I think we've seen what that can do. And so now I feel very good. It's always a changing topic. A part of it is also protecting intellectual property. And so, negotiations that using and protecting the IP which is developed here at the clinic or otherwise is critically important. And I'd say that again, coming back to having experience, negotiating, getting the things turned around as rapidly as possible is important.

And I think that I'll go back to why it's exciting to work here, because there are new and rewarding things being done every day. Partnering with industry, we're tax exempt, but we can partner under the right terms. And again, we're here to protect the Clinic's interest, but also to get things done. And I think that, I feel very good about it. It's evolving and we're carrying the same, let's say, good models to other countries and in other locations in the US with Clinics located.

Brian Bolwell, MD: Yeah, I agree with that. I think that one of the things as I said, I learned a lot in doing clinical research about contracting, about how to work with outside organizations. But I always felt that your team were real partners and really helped facilitate getting things done quickly. And the holdup was really never with the contracting part. It might have been with the negotiation with the drug company, but that's a different issue. So, one of our biggest partners is actually a university. We're partnering with Case Western Reserve University and that's probably one of the most important things we do from an educational perspective as well as from a research perspective, because this alignment with CWRU affects our status at the National Institute of Health when it comes to grants. That happened, what, about 20 years ago now. Can you walk us through a little bit about how that started and what it looks like today?

Dave Rowan: Sure. Happy to. And this will be a very abbreviated view of how this all happened. But I think that our relationship with Case evolved through collaborations in a number of areas, certainly in the cancer area, which you're well familiar with. But we also then became affiliated through a medical school relationship and using the infrastructure of Case Western Reserve have the very successful five-year term for the Lerner College that operates under Case. To kind of look at, "How did this all happen?" I think that it involved a lot of relationship building at the board level, also at the CEO level and with a lot of the other successful relationships that are out there. I think that just focusing on the legal aspects of it, I think that the two law departments: the general counsels, myself, most recently Libby Keefer who deserved a great amount of credit for the continued evolution of that relationship.

And then we had the health education campus, which was built, which was a huge undertaking. And thought all of that, you had the relationships with, I'm just going to use the most recent one, Barbara Snyder, Toby Cosgrove, Tom, our CEO currently. And again, I won't name all the names, but those kinds of personal relationships and certainly the lawyers, that idea of, "We have to bridge gaps, we have to deal, we're committed to both. How do you get through that? And part of it's legal, but a part of it is just common sense. Part of it's just kind of getting the relationship going and then showing the mutual benefits to both of the parties.

And I think that this is also carried through to most recently the innovation district that we have with the State of Ohio, where Case is an important party there with the Cleveland Clinic and three other organizations. But I think it comes down to that personal and let's say trust, integrity and looking past the "Gee, Is this a zero-sum game?" If you look at that relationship, it's grown and it's been good for the city, it's been good for both organizations and it will help us with our mission. And I'm just going to say, Brian, you were one of the first with regard to the Cancer Consortium and working through all that and you know it's personal relationships, getting past the friction points and showing that there's a greater good.

Brian Bolwell, MD: I couldn't agree more. And so, for our listeners, a couple really key themes here. So, number one work is about relationships and the more you can develop strong relationships with whoever you're working with, the better. And with our relationship with Case, we're two entities. But certainly, from a cancer center perspective, we're part of the Comprehensive Cancer Center core grant, the P30 grant. And that's an organization that consists of ourselves at the university as well as our clinical competitors: University Hospitals. And the only way to make it work is with strong relationships. And we also have a memorandum of understanding that needed to be written and revised. And the way we did that, again, was with relationship building. And actually, the last one, I remember working on it on a Saturday for several hours with Barbara Snyder on the other end of the phone who was the president of the university.

And that's how you get things done. And the other thing that David has talked about repeatedly is trust. If you can have strong relationships, the trust follows. And that's just critical to achieving speed, execution, success, and etc. One thing you touched on about the Case relationship, which I didn't really understand very much about initially, is how important our board of trustees is. And I know that you play a big role with our board of trustees here at the clinic, which some of it's called the board of directors. Can you educate our listeners a little bit on what a board of trustees does with a large healthcare organization such as ours?

Dave Rowan: Sure. So, I think that as a tax exempt organization, again, we've got a lot of other entities that fall below the Cleveland Clinic. But we have a fiduciary board, ultimately the board of directors, roughly 30 individuals who are members of the community. And I say members of the community wherever we serve. There are many other people involved. They serve without any compensation. We do have a few: the chief of staff, Tom is on it, three members from the Board of Governors. But those individuals serve without compensation. They put in an enormous amount of time serving on committees and otherwise to provide oversight. We're a physician led organization and we also have the Board of Governors, which is another critical entity composed of researchers, physicians, educators, and then people like myself who serve as officio on the board.

But the board of directors is the ultimate decision-making body. And they ensure that we do everything that a large entity like the Cleveland Clinic is. We have all the committee structures, finance, audit, conflict of interest in managing innovations. I'm leaving out some, not intentionally, but that oversight in involvement is critical. It's critical because the relationships that they all have with entities such as Case or otherwise, they are subject to strict conflict of interest procedures just like Brian, myself or everybody else at the Cleveland Clinic is. That they help provide guidance and also inevitably crisis situations happen. I want to speak about that at some point in time. But I think that that working relationship, the approval, it's part of the tax-exempt system. And when you then look at how we form relationships with Case, they help in many different ways. Al Lerner, Mal Mixon, names that people may or may not recognize now, but captains of industry. Beth Mooney, currently our board chair, Bob Rich before then, and all of the other members of the board provide invaluable information and really suggestions in a cooperative way with regard to our leaders.

And that relationship is also a matter of trust. It's a matter of trust that we as executives, physicians, researchers, educators, are staying within our mission. And I'm happy to say in all the years I've been here, I think that the touchstone is always, "Yes, we're going to apply with all the legal regulatory issues. Yes, we're going to make risk evaluations." But we all know that we are mere stewards of a period of time and that going back a hundred plus years now, that the reputation of the Clinic is critical. How are you going to respond when something goes wrong? And I think that doing the right thing is kind of a simple phrase, but I felt very good that that touchstone is something that should be always maintained.

And I am, Brian is, everyone else, we're employees of the corporation. But we are stewards in the same respect. So that critical element there of trust and do the right thing is protected, not only by the executives but by the directors. I'll also mention that we have over 200 additional trustees because of all the locations those individuals can serve on committees. It's important because we need to know what the communities that we serve, what's important to them. That's part of our community benefit partner service.

Brian Bolwell, MD: One of the things I didn't realize is how much oversight the board really has. So, the CEO is reappointed every year by the board of trustees. And I think aren't the medical appointments approved as well?

Dave Rowan: Yes.

Brian Bolwell, MD: Everybody we hire is approved by the board of trustees from a physician perspective.

Dave Rowan: Right. So there are a lot of rules that we have to comply with. And again, part of the governance function, which a lot of people are involved, but clearly the law department is involved in running all the meetings, trying to make certain everything is being done. But yes, the CEO is annually selected, or elected by both the board of directors and synonymous with board of trustees, as you say, and also by the board of governors. And that really serves our mission well because there's alignment with respect to those key positions. I'm annually elected, we have one-year contracts. Ultimately, all of those things work through board approval.

But I think it's also, as I mentioned before, a physician led organization so that we have a strong CEO model with a lot of delegated authority. And I think that one of the things that all of us do, we have to delegate responsibility. We need to trust our people, let them have the opportunity to use judgment. And I think this system does a very good job. I've looked at some of the podcasts you've done, Brian, I think that's evidence of the fact that you have to have people who carry the mantra through, who carry the DNA through.

Brian Bolwell, MD: Yeah. I totally agree with that. I think one of the cool things about our organization is the way we're organized. And I had the great fortune of sharing the Taussig Cancer Institute for about 11 years. And this is a wonderful place to execute a vision and to kind of do that hopefully successfully in a way that's fairly streamlined compared to many, many other academic organizations, which I think is really liberating and exciting and fun. So, you brought up managing in crisis, how the legal department assists or even directs, I suppose to some degree. Tell us a little bit about that, and if you can give an example or two, that'd be great.

Dave Rowan: Sure. And I think as in everything, it's a team effort. So yes, I think we play roles in this. But it's really in many different areas, in something as complex as the Cleveland Clinic and with all the organizations, it's inevitable with all of the systems you have in place that things can go wrong, and they will go wrong. I think as we go back through history, you look at how organizations respond. I think you try to respond with transparency as rapid as possible, but you have to be right. But people will accept the fact that a mistake is going to be made. You're going to be committed to getting it right. You cannot be cavalier with regard to preparation and the like.

But with that, it's also a building those trust relationships with the board and then looking at something. And I'm just going to pull something out, which is easy these days. Cyber security. So cyber security, if you look at how that, we look at it from a risk standpoint, we have a risk management system, we have a board committee that looks at our preparation for that. We do a lot of time inside looking at those issues. We do tabletop exercises, "What would happen?" so that we're prepared for it. You cannot be cavalier about it so that you establish the relationships, the contractual relationships with who you're going to use to respond. And then you're ready. You'll never exactly get what it is that's going to happen. But that's where you have to have those trust relationships. You have to have those contractual relationships put together.

I'll give you an example where I think that we responded as an organization extremely well. And it goes back many, many years. I won't use particulars. But it's an issue with regard to conflict of interest and how I'll say the industry. I don't like to call healthcare the industry, but academic medical centers, we know that it's been a continuing issue as far as disclosure and the like. We had our own experiences, which were on the front page of some newspapers. And how did we respond? I think that we quickly rallied around the board committees. We kept people informed internally and we rapidly decided that we were going to, yes, look at and defend what the clinic was doing, but be very proactive and become transparent. And I think many other people are out there, I don't want to say a leader, but among the entities that were very transparent. So, we established a new conflict of interest procedure. We had ones before, but we got more rigorous about it, disclosures that every researcher, every physician had to make.

We also went and had our board, and we do already have every director, every trustee discloses relationships. And then we put together I think a very good system about, "How do we weave all that information together?" So we went from the situation of, yes, something that was very embarrassing on the front page, several newspapers to something that I think helped lead academic medical centers along with others into that full disclosure, which is now firmly established. But that was something that we responded, our board was involved, trusted us, and became very good proponents for how we dealt with it.

And it wasn't always easy. When it comes to something about crisis communications too. I think that if we look at the timeline for response, some of us will remember, didn't have anything to do with the Clinic, but the Tylenol or some disaster that was out there. The timeline was basically the evening news or the next stage paper, something like that. Right now, we all know that the timeline is maybe a few minutes because of all of the internet. So, you need to be prepared. You'll never know exactly what it's going to be, but be prepared with great communications people, the standard messaging.

In the tax-exempt area, we know some repetitive issues that are going to come up. Don't be defensive. Defend the institution, but also involve the right board committees, the executives get the people together, anticipate, because the response time is a matter of minutes sometimes. And again, you got to have the right people and you have to drill this stuff because as we like to say, it probably happens at 4:15 on a Friday. So you need to be prepared, know who to go with and then keep your credibility.

Brian Bolwell, MD: The conflict-of-interest example's a really good one. I remember that well. And this organization pivoted very rapidly to, as you say, this is about 20 years ago now, to be becoming a leader in COI disclosure in academic medicine. And boy, we did a lot of work to get there, a lot of work quickly to, "What does it look like?" And certainly initially there wasn't a lot of agreement about what we should be doing and how we should be doing it. But Dave, you're right. At the end of the day, we did it quite successfully. And we're very transparent and continue to be. And it's embedded really right now into our annual professional review, which is kind of a key part of our culture. So, thank you for that example.

Dave Rowan: I think that it's really good business too. I think that running through a few situations, nobody, no researcher, no physician, no lawyer wants to be in a position, "I knew the risk." The regulator knocks at the door. That's not a good feeling for anybody. And that's a very important point where I think the law department and others have to be calm in a crisis situation. You need to know what to do. You need to have the right executives in place. But reputation, not only institution, but somebody's individual reputation is something that, I think it's a little bit of preparation. But it helps both the individual and the organization.

Brian Bolwell, MD: I think that's another great point. You're 100 percent correct. And again, I think that that was actually a really big deal for us at the time. And now we take it for granted. But just getting that lift wasn't easy. It was a lot of work, but I think it was executed very well. You mentioned earlier the importance of building your team and that you think you've done it successfully. And I certainly agree, it's a very high functioning team with a ton of talent. How have you done that and how do you recruit and what do you look for? And once you've got your team in place, how do you continue to get it to thrive?

Dave Rowan: So I think it's something that I feel very good about where we are. It's an evolutionary process, as you know. And I'll lay out a few things that I think are important to do that. One, recruitment. I think that it doesn't have to be a long process, but recruitment and making certain you touched all the bases. Have I had some misses? Yes, I've had some misses. Everybody does. But I think that what I've done is to try to include as many people in the interview process as possible, including with regard to some key hires, having the business people, for example, Steve Glass in finance, we'll have each other look at key people that would be involved so that that chemistry is there as well. And that's just one example. But you recruit great people. I think that those people, then are leaders. I mentioned I have five deputies, I also cover government relations. But those deputies then are talented people with regard to running the teams, giving those people opportunity for face time and using judgment. I think we are an innovative organization. Dr. Cosgrove used to tell me I had to say innovation 10 times every day. I joke a little bit, but it wasn't much of a stretch. But that means that you need to empower people to make decisions and then realize that they've looked at all of the right issues. And this applies across the organization. And something doesn't go right, you cannot be a second guesser so to speak. You need to be able to say, if you did all your homework, you did all this stuff, you took risk the right way and you were not cavalier about those issues, that you have to support your team. And that doesn't mean you don't learn from it, you don't make corrections, whatever.

But you support that approach because if you're going to delegate authority, which I firmly believe you have to, those people have to have the right to make decisions and be supported if they've done things the right way. They need to have exposure to other key individuals. They need to find that successfully rewarding. They also have to know that if the time comes where they want to become the general counsel, I've had I think five people who I supported. They went off and became general counsels at other organizations. It's a success. I don't want to lose them. I've recruited one back after, that kind of thing. But you have to support people like that. But also, I'd say that you need to provide a track internally for people to advance and succeed in various positions. Also, I think that with a strong CEO model too, that it's really empowering to let people have exposure to the board, let them have exposure to the CEO.

That's empowering to the leader in my case, because that's one of the most important things I can do, is to give additional responsibility. And I learn from everybody in our area. One other thing that I think is critical is that early on I said, "I don't care what your position is within the law department, whether it's you're a lawyer or paralegal, you're an assistant, you're somebody walking by the department. I want everybody to be able to raise their hand and say, 'Gee, I'm not comfortable with something.'" And it's not only ethical, but otherwise. And I think also it's common sense. As you mentioned before, we have a lot of business relationships and the like. And we have some people who have done a lot of business, others who have not so that I want the lawyers to raise their hand so they're next in command, so to speak, if there's a business term that we should be getting a better business term or anything else like that.

I think also, I'm going to bridge into another topic that maybe hits a question you have. But I think it's how we deal with the CEO. And I'll say that, as I've said, I've worked with three. I think in the law department, certainly in my role, you have to be able to speak to power. And I mean that you need to be able to say, "Here's my thoughts." In some areas, it's a line that can't be crossed. In other areas, it's, "Gee, here's advice." And I found the following: leaders, CEOs do not want to be on an island. They want people who are going to give them views that are not their own. It's too easy for people to fall into, "That's a great idea." And if that situation happens, then you haven't done your job. And you may not stand up in a big room and say, "That's a bad idea." But you have to have access to the CEO. And I think in every case I have.

And you need to be able to say, "Have you thought about this? Have you thought about that?" And it's not always legal. It has to be a position of trust. It has to be a position where you're willing to stand forward and say, "No, we can't do this as an organization," but do it in the right kind of manner. I will say I've had that relationship. I've had conversations with every one of the CEOs that no one else knows about. And you have to be confidential about things.

And in every case I went back to before, I think the decisions have been made on an ethical basis. You want to do that. That's a very important part of the role that you cannot be, let's say, reluctant to bring up issues. And also say with the board and otherwise, part of the role... And again, it's not unique in regard to just the lawyers, but when you look at what's happening with good governance, what's happening with regard to sexual harassment issues, you have to be somebody who's going to help look around the corner and say, "We could do better." And that may be sometimes, gee, not so much legal, it may be the organization. But I think that's part of the exciting part of the job too. And you have to do it. And if you don't, you regret it.

Brian Bolwell, MD: Two really good points there. So, when you talked about your own team, you talked about how important it is for people to be able to raise their hand and say, "Can we please stop and have a conversation?" And that certainly speaks to psychological safety, which is something that we talk about a lot on this podcast. And there are studies that show that the most successful organizations or those that have great psychological safety, allowing everybody to basically put up their hand and say, "Can I give you an alternative opinion?" And then the other point, which I think is totally crucial, is to have the relationship with your CEO or whoever your superior is organizationally to do the same thing. To basically say, "Boy, we might want to look at a couple other perspectives on this particular issue. We might want to look at it in a bit of a different way."

And sometimes that takes courage, but inevitably I think it's the right thing to do. And I think that as you said, almost always, the recipient of that information will appreciate the fact that you've kind of put up your hand and said, "Can we pause?" There's different ways to do it. As you said, I think in general it's nice to do it one on one if you've got that opportunity. Anyway, it's something that I've always thought is very, very important. And the reality is not everybody can do it. So being able to do it is a big deal. As you look at successful leaders at the Cleveland Clinic, whether they're CEOs or institute chairs or chief of staff, any common themes that you've seen over the years?

Dave Rowan: I think that that intellectual curiosity of, "How do we need to change?" Change is critical to any organization. It's, "How do we get better?" I think all the things about working hard, being intellectually curious, looking at how we can get better or where we can go, all that is taken as kind of a given because we have a lot of the type A plus plus whatever personalities. I think it's important too, that as somebody comes into the organization from the outside or they're elevated to another position, that it's important and I think that people are successful if, I'll use my own example. Our job is to obviously stay within certain lines and that kind of thing, but to try to make them successful. I'm not here to substitute my legal judgment for well based physician or other advice or medical advice.

In fact, that's part of how we blend this all together. But people who work well together with not just the law department, that's not the issue, but across the other domains and are intellectually curious and push the envelope in the right kind of way I think are very, very good. I think we reward those people. I think that they have to have all the emotional security. You have to know what you don't know and some other things that are stated out there. They need to have the tools, and your group in providing those next tools as far as how a leader, I've been trained in school to do a lot of this. And most weren't. And it's highly complex. And we as an organization provide a lot of support. And then some people, we plop people down in foreign countries and we need to provide the support mechanism. But they have developed leadership skills that none of us can really hone over a year or two.

So, I think, but also trust. Politics, everything in one sense is a political decision. In the other sense, you can't play politics too much. That's the bane of any organization. It's, "We're in it for the greater good." I haven't talked about quality, patient safety, patient experience. But Brian, you and I know that we spend an enormous critical amount of time on those base issues that are key to what we need to do to get better. And I think that the interpersonal skills, the trust, and the ability to speak to each other, certainly you and I have talked about issues over that period of time, and it's got to be that common good. We're going to make things better. And I'll tell you something, I haven't done it yet. I probably haven't shown it yet. But I think sense of humor is critical. It has to be. And it's good for leaders. You look at successful leaders, they can look at themselves, be a little self-reflective and humor. And I can think about that. And I'm not going to rate the three CEOs and who's got the best sense of humor.

Brian Bolwell, MD: I totally agree with that. I think that there's a huge upside to certainly being able to laugh at yourself. I think it, actually, it's healthy, number one. And I also think it's elevating for the group, whoever with at the time. It's interesting how the organization has evolved just in how much attention we pay to leadership development over the years because 20 years ago, we didn't spend a lot of attention to this. But we do now in a big way. And certainly I'm a big believer in it, and I'd like to think it's going to yield positive results. Any closing thoughts that you have about leadership here in healthcare or otherwise?

Dave Rowan: Well, first of all, thank you for inviting me to this series. I think that it's good to reflect over a career that I've enjoyed so much and be repetitive with respect to that. But I think the leadership development is particularly important here because it is a physician led organization. And I know there are others that really support the similar concepts. But I think we put physician leaders and nurses and others in leadership roles, and we are much better for it. That's one of the things of our secret sauce. If I think back to doing business deals with regard to some of the regional hospitals and acquisitions that made us different. And those leaders get parachuted into their position sometimes and so that not only the business skills, the other skills, but that leadership ability is something important. And it's important because we need to have a strong bench because there's always something new on the horizon.

So, I fully support the leadership efforts, and I think I've seen how that plays out. It's not just with regard to the physicians. It's with respect to the administrative people throughout. So, I will make these closing remarks and not keep going on. But thank you for what you're doing. I think that the fact that we can go to other locations, we can relate to physicians and nurses and whatever, and that carries over into, as I mentioned, government relations. Anne Hamilton, who heads that up, is a deputy. The ability to take people like Bob Wiley, who I think you had on a podcast, take Tom, take others, that's a real differentiator. And it's not just good for the Cleveland Clinic, but it's good for the issues. So, thank you, and I'll try to be concise, which is another thing I think is a lost art.

Brian Bolwell, MD: Dave, thanks so much for joining us today for this excellent podcast. Thank you for your time. To our listeners, I hope you've enjoyed today's conversation, and we thank you very much for tuning in and look forward to subsequent episodes of Beyond Leadership. Have a good day, everybody.

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 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.