Candid Conversation with Rita Pappas, MD and Brian Bolwell, MD

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.

Brian Bolwell, MD: Hello, everybody. Today, I've asked a dear friend of mine, Dr. Rita Pappas, who's the Medical Director of Hospital Operations of the Cleveland Clinic, to join me and look back at 2021, from a leadership perspective and for what we've done here in the organization with leadership development.

Rita, actually, was featured on one of our podcasts, which was released on December the 15th, 2021, which was focused on leading in a time of crisis. Rita, welcome.

Rita Pappas, MD: Thank you. Thank you, Brian. It's a privilege to be back. As we look into 2021, I have some questions for you. I wanted to ask you, what have you learned from doing these interviews with leaders over the past year?

Brian Bolwell, MD: As most of our listeners know, Rita, I've been fortunate to have this role in which I'm leading physician leadership and development here at the Cleveland Clinic. And as part of that, I've had an opportunity to meet with almost all of our clinical leaders across our entire organization, from here in Northeast Ohio to Cleveland Clinic Florida, to Cleveland Clinic London, and even Cleveland Clinic Abu Dhabi. And so simply getting to know our clinical leadership has been fun. It's been enjoyable. There's a lot of talent. And so that's been pretty cool.

The other thing that I've been able to do is to meet with a lot of the folks who have been identified as having high potential for leadership. And so they may or may not be in formal leadership roles now, but they're curious about it. And the people who they report to believe that they have significant leadership potential. And that has even been, possibly, more wonderful because there are so many really wonderful individuals who embrace the fundamental concepts of leadership and are eager to have opportunities.

And so the first part of my answer is simply getting to meet these people and to see what's going on in the rest of the organization outside of the Cancer Center, where I spent most of my career, has been pretty cool. I think that most people are very, very interested in learning about leadership principles, which is really important. There are some people who think they know it all already, and that shouldn't come as a surprise to anybody in academic medicine. But it is factual. And so the question is, how do you reach them? And we've tried a variety of things to work on that.

And then I think that it's been interesting to see some certain themes of people who are succeeding and people who may be struggling. And those themes, I think, represent opportunities for us to focus on going forward.

Rita Pappas, MD: Oh. Can you talk a little bit about the themes that you're seeing? That would be really interesting.

Brian Bolwell, MD: Sure. So when people are doing well, you know, there's two fundamental principles, which I talk about all the time. One is that if you're a leader, it's not about your resume and it's not about some sort of cool thing to put on your CV. It's about serving your team. It's about serving the people who work for you and with you. And the people who are doing well, get that.

And they understand that one of our very most important things we do is to support our team and support our folks. I could argue pretty strongly that that's the single most important thing we do, is to support our team and develop our people. I think if you do that and you have really good people that you've hired, pretty much everything else will fall into place rather quickly.

And I think the other part of it is a constant quest to improve yourself; to learn about yourself, to reflect, to try to think about what's gone well in a particular day and what hasn't gone well. And if it hasn't gone well, why? And how much of that was because of, in my case, me? And how could I have handled that situation better?

You know Brad Borden talks about this a lot. Brad is our director of the emergency room. And when I recorded his podcast, this was really thematic and how he spends so much time reflecting on how situations might have been handled better. And the people who are doing well, have an ability to do that, the leaders who are doing well.

I think the people who think that they know everything already and don't have time for self-reflection, tend to be less agile, tend to be a little more autocratic, and tend to be less effective. As far as the other things that I think sometimes leaders have challenges with, there's different buckets. One is owning the problem. If you're a leader and you've got challenges, they're yours. And blaming somebody else or saying it's really not your turf, that doesn't lead to very much success. And that unfortunately, is not uncommon. And so that becomes actually, a pretty low-hanging fruit in terms of a coaching opportunity.

One of the things that we're seeing, another cool thing that we've done this past year, Rita, is launch a pretty formal curriculum with the Wharton Business School, for our high-level leaders to learn how Wharton teaches leadership. And one of the key parts of that is learning how leaders from other industries might approach certain problems.

Rita Pappas, MD: Sure.

Brian Bolwell, MD: And most of our high-level leaders really embrace learning from other industries and applying it to medicine. That's a concept called contextual intelligence. And we actually did a podcast featuring Matthew Kutz about this. He's an expert in it.

Rita Pappas, MD: Hmm.

Brian Bolwell, MD: But it's fascinating in that some of our leaders don't enjoy trying to apply something from another business or industry to medicine, and have a challenge with that. And I think that trying to enhance their leadership agility becomes another opportunity. And finally, one of the common missteps that I see, involves communication in two ways.

One is having crucial conversations or hard conversations, or conversations that aren't easy. And some of our folks that I've touched this year, I'm not sure anybody enjoys this, but actually avoids them and then lets somebody else do the work. And that's deflection. It speaks to lack of ownership of the problem. But also I think is an avocation of part of their role and part of their job.

And the other thing about communication, which I think is really important is when you're communicating to a group of people, whoever they are, it's important that you realize that it's not just what you're saying factually that's important. It's also how you're connecting with them emotionally, because you need to be able to read the room and you need to be able to walk in their shoes. It's part of emotional intelligence, of course.

But sometimes when you think that it's very logical to go from point A to point B, the people listening to this message might not think it's so logical. They might think that from an emotional perspective, it's going to be very hard to do. It's going to be more work for them. They don't know how they're going to execute it. It's asking the impossible. And they're going to recoil and they're going to withdraw.

And being aware of the possible reactions of your constituents when you're communicating something, is I think, a skill that can be developed. And leaders have it to a variable degree.

Rita Pappas, MD: Those are really powerful insights that I learned so much, just listening to you and actually, listening to the podcasts and incorporating all of the tidbits and rules around leadership. So it's really helpful to hear you summarize that very nicely. I think one of the things I'm thinking about your podcast, they've been really wonderful to listen to. So, where do you see this going in 2022?

Brian Bolwell, MD: Realizing the emotional impact on my team, we're hoping to double the number of listeners this year, which I think is hopefully doable. And if we can't, just for the podcast team, if we can't, just for the podcast team, it'll be because I didn't connect well enough with our audience. Nothing to do with you guys.

Rita Pappas, MD: Awesome.

Brian Bolwell, MD: Actually, we've got a couple podcasts that are being featured right now in United Airlines. So for anybody listening, if you are in the skies of United, feel free to give us a listen. One is a podcast with Beri Ridgeway, who's our Chief of Staff. One is a podcast with Don Malone, who's our President of our Hospitals. And both are very charismatic, and I think you'll enjoy them.

They're a lot of fun to do, Rita. Everybody has a certain perspective. And it's fun to try to see what they focus on, and try to of relate that to the core fundamentals that we talk about all the time with leadership. I very much enjoy doing them.

Rita Pappas, MD: That's good to know. And I learn from you as well. And so we ended up starting a podcast to commemorate the voices of the women of Cleveland Clinic, like you've highlighted. So always, always engaging and watching what you're going to do next as a thought leader, so we can leverage the work that you're doing.

Brian Bolwell, MD: For those of you listening, Dr. Pappas' podcast was just wonderful.

Rita Pappas, MD: Oh, you're so sweet.

Brian Bolwell, MD: And if you're interested in how we managed the presidential debate, the first one which was here on our campus, it's certainly worth a lesson. As well as the fact that Rita's in charge of all of our hospital operations, and managing through COVID has been challenging to say the least.

Rita Pappas, MD: Thinking about 2022, what would you think is the greatest leadership challenge in 2022?

Brian Bolwell, MD: Well, I think that we still don't know what's going to happen with this virus. And I think the virus kind of dominates, because when it's surging, as it has been, we're having this conversation in the middle of January 2022. And for the past few weeks, we've had a major surge in Northeast Ohio to the point that it's disrupted much of what we normally like to do in terms of surgeries, in terms of just the delivery of basic medical care. And it's been disruptive for our workforce.

And so I think it's a combination of continuing to manage the virus, which hopefully, won't be as dramatically surging as it has been recently. But probably even more importantly, it gets back to what I talked about earlier. And that's your employees, your workforce. I think there's nothing more important than figuring out how to support and how to reward and how to keep your workforce engaged. The clinical workforce has been through a lot, and they've been through a lot for a couple years now. And we've got to put them front and center, in my perspective. And I think that that's really important.

And I think some of that, we can do on a big scale organizationally, but a lot of it's local. And a lot of it is, what can you do in your area to make everybody's life as good as it possibly can be, as a clinical caregiver? So retention is really important. And, you know, I just read an article about this. And one of the things that I read was you might consider asking folks, what would their ideal job be? And then try to make it so. If you're going to ask the question, you've got to act on it. You've got to follow through.

But having some flexibility about what people might want to do with their careers and maybe giving them more training, or whatever it may be. But I think that, Rita, the clinical care workforce has been through a lot. And I just think that trying to figure out everything we can do to support them and even elevate them going forward, is probably our biggest challenge.

Rita Pappas, MD: Those are very powerful words, because I did see a statistic that one of every four healthcare workers have left healthcare as a result of the COVID pandemic. So focusing on retaining our people and elevate them is really very important moving forward.

I know some days I've been thinking about my journey in healthcare and trying to remain resilient as we have wave upon wave. So I think it's a very key insight that you have in terms of a leadership challenge for 2022.

Brian Bolwell, MD: Yes, I think it is number one. I think that there's obviously many others. I think that one of the new programs that I'm going to start is focused on physicians of promise, who I think will make future leaders down the road. And I mentioned earlier that I've met with an awful lot of folks around the organization. And it turns out that the vast majority of physicians of promise who I think are very eager for development and networking and peer development are women.

And so I'm going to start a series of small cohorts to talk about leadership and to serve as networking opportunities. And so, one of the keys to this is simply to be able to meet in person, because so much of what we learn, isn't just from the lecture. It's not just from me. It's from your peers. It's from people you work with. It's from people that you meet and has a good idea. You can call on the phone and say, "What do you think about this?"

And being unable to meet in person has been really challenging from that perspective. So I think in going forward, one of the real keys is to be able to just have some normalcy about social interaction. And I'm really hopeful that we can do that.

Rita Pappas, MD: I am so hopeful, too. We usually have our annual meeting in March for WPSA, for the Women's Professional Staff Association. And not having the ability to meet in person has really impacted our engagement with our staff members, because it's that palpable energy when you're all in the room together that really brings all of you together. So we're also looking forward to the opportunity when we can all get together.

Brian Bolwell, MD: Yeah, very much so.

Rita Pappas, MD: I know. This has been really interesting in talking about all of these issues with you in the podcast, but I want to flip our conversation a little bit and learn something more fun about you, something about your fun side that I don't usually have the opportunity to ask you.

So I love music. And so, could you share with, what was your favorite band in high school? And how about now? Is there anything in particular you like to listen to?

Brian Bolwell, MD: I try to stay current.

Rita Pappas, MD: Mm-hmm (affirmative).

Brian Bolwell, MD: Back growing up, I loved the Beatles.

Rita Pappas, MD: Mm-hmm (affirmative).

Brian Bolwell, MD: But right now, it's pretty eclectic. I work out every day and I listen to music every day. So I like to make different playlists on my phone or my iPod. So I'll give you 10.

Rita Pappas, MD: Oh, good.

Brian Bolwell, MD: Jimmy Eat World is a great band whose album, Surviving, is wonderful. I really like Dua Lipa. Her album, Levitating, and the song in particular, Physical, is great. Despite the fact that personality wise, she's a lot out there, I always liked Britney Spears' music. It's great to exercise to.

Rita Pappas, MD: Mm-hmm (affirmative).

Brian Bolwell, MD: Liz Phair was kind of an indie rock goddess many years ago, who has a new album this year. Made a bunch of top tens. It's called Soberish, which I highly recommend. There's a two-female band from Australia called the Veronicas, who had an album this year called Godzilla, which is great. And I probably lost everybody in our audience, so I'll stop there.

Rita Pappas, MD: This is really fun. I didn't realize your tastes are really, really fascinating to hear about it.

Brian Bolwell, MD: I like Rihanna. I've always liked Madonna. Golly gee, what else have I ... What was I listening to this morning? The Churches. The Churches is this indie rock band who are really good. And their last album is fabulous.

Rita Pappas, MD: That's awesome. So, what are you personally looking forward to the most in 2022?

Brian Bolwell, MD: You always hope that your family's healthy and happy. And so that's number one. Actually, my daughter's going to get married in a few weeks and-

Rita Pappas, MD: Oh, congratulations.

Brian Bolwell, MD: We're definitely trying to figure out how to do it safely without it being a big Petri dish for COVID. So I'm cautiously hopeful that we'll be able to pull it off, but that's a big deal, obviously. I'd like to travel again. I think everybody would. I'm actually hopefully going to go to New York City in the next couple weeks and see a couple shows. And I really like the theater.

Rita Pappas, MD: Mm-hmm (affirmative).

Brian Bolwell, MD: It's a lot of fun. And so I just think that the ability for normalcy would be nice. I like playing golf with my sons. They're both much better than I am, but hopefully I can start to play a little better this year. That's a constant quest that as I age, tends to not be a quest that I succeed in achieving, but we'll see. And professionally, this is a really nice opportunity for me and so I very much enjoy it.

Rita Pappas, MD: That's great. Thanks for sharing. Is there any specific country you'd like to visit in your travels? I know you talked about New York City. But once things open up and we're able to travel again, is there something on your bucket list, a country you haven't been to?

Brian Bolwell, MD: I'm not a huge big bucket list guy. A lot. I actually haven't traveled abroad nearly as much as I'd like to. I've been to Japan once. I'd like to go back. I've never been to Austria or Czechoslovakia. I'd like to go there. I love London, not in a small part because the theater there is so wonderful. And that's always a lot of fun. I'm more of a city and cultural person than a beach person.

Rita Pappas, MD: Mm-hmm (affirmative).

Brian Bolwell, MD: So I was talking to somebody last night, actually, who suggested that we go see the Northern Lights. And given that it snowed 19 inches where I live that day, going someplace cold, Rita, is actually not high on my agenda in the next couple months.

Rita Pappas, MD: Thanks. That, that I agree with you. This snow makes me wish for much warmer days to coming ahead.

Brian Bolwell, MD: My goodness.

Rita Pappas, MD: Yeah, being snowed in.

Brian Bolwell, MD: Rita, what are you looking forward to next year?

Rita Pappas, MD: Well, like you said, I'd really want to take advantage of ... I have family members who live in Montreal, Canada. And with the COVID pandemic, these are close family members that we've only just been allowed to do virtual visits with over like Zoom. And I haven't seen them because they keep opening and closing the borders. And so, one of the things I'd love to do is to go to Montreal this summer and visit with them in person. That, you know, is, it's definitely a wish on my list. I'm not sure if it's going to happen. I definitely want to do that.

And then the other piece I think, I rode in VeloSano this year or last year. So I would like to do that again and support VeloSano. And hopefully, I'll do a better training program than I did last year, where I had to finish the 25 miles. And it was not a pretty sight at the end when I was done with it. But a goal of mine is to actually train more in advance this time for VeloSano. So those are just a couple of things

Brian Bolwell, MD: For those of you on the podcast, VeloSano is our bike ride that we have in the Cancer Center to raise money for cancer research. So we're very appreciative that Dr. Pappas rode last year. There's no time, so whenever you came in, it's all good. Actually, this year I got a Peloton, and that's one way to go about training for it.

And as long as we've got you, you mentioned the WPSA a couple times. So, can you explain to our listeners what that is, and you're president of it, and what some of your goals are for the Women's Professional Staff Association here at the clinic?

Rita Pappas, MD: Yeah, thanks. So the Women's Professional Staff Association was assembled around 1983, 84, in order to try to develop and advocate for women physicians for the Cleveland Clinic. Its key tenets are around professional development, as well as what you stated, networking and developing those relationships for women. And it was actually started because at the time when the data was released, that greater than 50% of all medical school graduates were going to be women. So it was the foresight of our leaders to say, "We need to actually work on and have an association where the women can continue to grow and develop."

So I'm very proud to tell you that currently, there is 40% of the professional staff of Cleveland Clinic are women. So every year, it's jumped at least 1%. And what we hope to do in the following year is really focus on two key areas, one around what I said previously, professional development. So the opportunity and partnering with the Global Learning and Leadership Institute around developing every physician. So not necessarily key formal leaders. And then the other piece is around networking. A lot of our networking events that we had hosted in the past, were in person. And so we want to give back to doing that again.

And then, most importantly, too, last year was the first year we had a team for VeloSano. So that's a commitment from us to continue the team. The podcast that we've been doing, we've gotten great support and views, and hopefully the expansion of that will include more leaders that we've chosen to interview. One of the things that we're looking at is how we can perpetually continue to fund all of these activities. And so we have a legacy fund that we're working on continued endorsement for. So really looking forward to next year. Silvia Perez Protto is the president-elect for this year, so she'll be assuming in January 2023.

Brian Bolwell, MD: So, what are your developmental opportunities' themes that you've seen through the WPSA?

Rita Pappas, MD: One of the things that's pretty interesting to understand is that just empowering women to know that they have a voice at the table. And so that seems to be one of the key needs for women to understand, is that by empowering and learning skills to raise that voice in a way that's actually going to be received appropriately, and engaging them in tactics that they can help bolster each other, working within the organization. I think that's probably one of the biggest key themes that we see within WPSA.

Brian Bolwell, MD: Say more about that. Give me an example.

Rita Pappas, MD: A good example, and I'm sure you've heard this, as you're sitting in a table and you might raise an idea as a woman, having another woman in the room actually reinforce your idea as your idea. Because sometimes what'll happen is if there's a more male voice in the room, they'll say the same idea. And then maybe the person who actually raised the idea in the first place, doesn't actually get credit for the idea. So those are just some key little tactics that we're teaching the women within WPSA and how to advocate for their voice.

And I want to be clear, too. I've had very supportive mentoring relationships with male physicians, you included, and Dr. Robert Wyllie being the other. And so leveraging those relationships as well. So it's not what I believe, that these tactics actually make us a better, stronger organization because it increases diversity of thought at the table. And it's not necessarily meant to be exclusive. And so by doing this, we are stronger together as an organization. And everyone's raised, the men and the women, not just the women. Those are just my personal thoughts on that.

Brian Bolwell, MD: No, I think it makes a ton of sense. It's one of the things that I think is very important. Again, I'm focusing on having small cohorts with women who I think have unlimited potential as feature leaders. I mentioned earlier, this article that I read in the Harvard Business Review about retention. And one of the things that it mentioned was sometimes we have too detailed job descriptions for opportunities.

And sometimes people just need to, if they're interested in trying something new, just going for it and giving it a shot, and throwing their hat in the ring. And whether this is true or not, I don't know, but it is said that men have less worry about doing that and just throwing their hat in the ring than do women.

And so, one of the things that I think I've tried to focus on is simply say, "Look at it, there's no harm in giving it a shot and having the exposure." But I also think that sometimes our job descriptions get a little too rigid. And the article mentioned that if you want to have a flexible workforce, you want to give people an opportunity to explore new things. And one of the things that might be perceived as a barrier is a very extensive job description for whatever it is you might want to apply for. And we need to be a little more flexible with that as well.

Rita Pappas, MD: That's a great point. And I've seen that, personally. So what we do is highlight all the key leadership openings. So they're actually, through your leadership, are posted on the internet. And so we've seen a large number of women inquiring about those leadership positions. And so what we've done proactively is reached out when we see a position that's open and encourage women to apply. And just as you said, they will create a checklist and say, "Well, I don't have five years of experience. I have four-and-a-half."

And so what we are trying to do is empower them to put their name in the hat. And that's not necessarily, if they don't get the position, it's still a great learning opportunity to sit and interview and understand how to conduct yourself in a professional interview. So we want to encourage that because once you apply, you get your name out there. And then if another opportunity arises, they'll remember that you tried and applied previously, and that you might have interest in this new opportunity.

Brian Bolwell, MD: A lot of these kind of harp back on a lot of themes that we've talked about. Having an environment where everybody feels psychologically safe to voice their opinions and to be willing to give new things a shot, I think is something that we all can contribute to. And the other thing is just having the courage to try new stuff and try to be true to your values.

And if your values are such that you want to grow, you want to develop, you want try something a little different, that's great. And we should do everything we can to support that. And so the WPSA is a very good partner in that space. And so I think that's very, very positive.

This has been wonderful. Thank you so much, Dr. Pappas. It's always fun to chat with you. To our listeners, thank you for listening. And I wish everybody well. Take care.

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 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.