Cleveland Clinic Canada CEO Mike Kessel on Authentic Leadership

Podcast Transcript

Introduction: Welcome to Beyond Leadership - At the Intersection of Leadership and Everything Else. In this Cleveland Clinic podcast, we will commingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership and management.

Brian Bolwell, MD: I am Brian Bolwell, your host. I am very pleased to have Mike Kessel with us today, who is the CEO of Cleveland Clinic Canada, and who is here to talk about the importance of authentic relationships and driving results. Mike, it's great to have you with us today.

Mike Kessel: Thanks, Brian. I really appreciate it. It's a huge honor.

Brian Bolwell, MD: Tell us a little bit about your current role and how you came across this opportunity and what you did to prepare for it. Fill us in.

Mike Kessel: Yeah. Yeah. I appreciate it. Essentially here my role is to strategically guide and grow our organization in Canada of which we have two outpatient clinics serving close to 100- to 120,000 visits each year at these sites. My opportunity arose, I would say with the Clinic a little over 11 years ago, where I had previously done some work with Northwestern Memorial Hospital, another teaching hospital in the United States. And I got a call from leadership in Cleveland, and I wound up for 45 minutes in an interview with, at the time, Dr. Toby Cosgrove [former CEO and President of Cleveland Clinic], who I'm sure you know and love. He was staring at me with those big eyes in the final interview. I'll never forget that time we spent together.

At the end of the time, I said to him, "If I'm so lucky and fortunate to receive an offer from this esteemed organization, are there any hesitancies that you have about bringing me on board?"

And he said to me -- there was a pause for 10 seconds, I was extremely nervous -- he said, "Well, there's a couple items, Mike, that I would mention." He goes, "Number one, you aren't a physician."

And I smiled and I laughed. I said, "Well, I'm not going back to school to get my MD. I think I've got a good education right now."

And he goes, "I'm not as worried about that, though, with you." He goes, "The second thing I'm more worried about: you don't have Cleveland Clinic in your blood. And I would highly suggest that if you're lucky enough to get this offer, you make trips to Cleveland to get it in your blood and carry it and the culture to Cleveland Clinic Canada."

So in my 11 years with the Clinic, I've made 373 trips to Cleveland. It's a 38-minute flight or a four-and-a-half-hour-drive. And I've gotten it in my blood. And hopefully it is part of the DNA of our organization here. And of course, numbers of physicians and nurses and technicians, et cetera, have also made a significant amount of trips and a number of buddies, I call them, within our system. The support has just been tremendous and really important to our growth here.

So for me, my story is growing up in Chicago, having the opportunity 11 years ago in 2009 to interview with the Clinic and be presented with this opportunity.

Brian Bolwell, MD: Before we talk more about Cleveland Clinic Canada, tell us about what Cleveland Clinic blood is. What did you find our culture is that makes it different?

Mike Kessel: Yeah. I'll tell you, it's very aligned to my own values, how I was brought up. I was brought up to treat everyone with extreme respect. I played team sports, a significant amount of soccer. And as you know, I played some table tennis with ... which yes, there is doubles in table tennis. And most importantly, empathy and caring and authentic relationships. So to me, the four physician founders of the Cleveland Clinic, as I dug and I learned more, that's what they believed in. This is a big team sport. It's an authentic environment where people are trying to put people first. Those people could be fellow caregivers. Those people of course, could be in our patients, and that resonates with my own upbringing, quite frankly.

Brian Bolwell, MD: So you're presented with this opportunity to go start Cleveland Clinic Canada from basically scratch. What did you do?

Mike Kessel: It's the million dollar question. So I came in and the Clinic had opened up, as you mentioned in late 2006, and there were a couple other leaders in before me. And I realized at the time that starting up essentially an organization in another country has a lot of risks. Starting up anything has a lot of risk. And then starting up a healthcare organization in the most arguably restricted country in this vertical healthcare also carries with it a lot of risks. And on top of it selecting the most restricted province of the 10 provinces in Canada has a lot of risks.

And so I walked into the situation and I looked at some of the indicators such as, at the time, the turnover of our team, all of our caregivers was rather high at 65 percent a year. I also noticed that our demand was sporadic in terms of patients coming to visit us. And I also noticed that I was an American coming to Canada; I need to understand this environment, my culture. So I spent a lot of time with the community and in the community and with other healthcare ecosystem members trying to build a strategy.

And so the strategy was complement the system in a meaningful way. Don't compete against it. So we started by literally showing who we are, our true colors of Cleveland Clinic, and actually giving away --gratis -- some of our knowledge and some of our services, if you will, to the community. So other folks, other teaching hospitals, other community hospitals, other associations, would talk positively about us and would say, "Oh, Cleveland Clinic Canada. They do complement the system in a meaningful way and they're helpful. They're great."

I'm a very simple thinker. In this environment where it's a unique system, from what I'm told; there's 200 countries in the world; there's only one other country like Canada that has a single payer like this where the public system and the private system really can't compete against each other. I truly believe that you could either be a good participant or a not good participant. And so the brain is simple in that way. I wanted people to tell the community that we are good participants, even though we are a foreign founded organization and considered private here, even though we are part, as you know, of a non-profit foundation. I wanted the word getting out there that we're doing things for the right reasons.

So the big part of the strategy was giving away and being gratis and being kind, fitting into the system, and letting other people tell other participants and patients that we're a complementary player.

Brian Bolwell, MD: Give me an example.

Mike Kessel: A great example of that would be a local teaching hospital named Sunnybrook Health Science Center. I'd basically toured the five major teaching hospitals in the greater Toronto area to find which one was the most progressive. And Sunnybrook, at the time in 2009, 2010, seemed to be that. The CEO was an emerg. doc. The old coroner, here in Toronto, for the city, a wonderful gentleman by the name of Dr. Barry McLellan. Him and I hit it off right away. I told Barry, I said, "Look, I'm new in town. I'm an American that came here. I'm trying to understand the system." He says, "Mike, it's okay. We respect your organization. We respect your team and we're happy to work together."

What we did at the time, I told Barry, I say, "Look, I'm trying to establish ourselves as a good complementary player. Why don't we partner and do something together and we'll share our knowledge." We looked through probably five to 10 projects that we could potentially do together.

At the time, I don't know if you remember, it was Dr. Mark Harrison who led medical operations for the Cleveland Clinic. I approached Mark and I said, "I know we've got an 86-person continuous improvement team. I'm also aware that I don't think we've ever done a continuous improvement project outside of the Cleveland Clinic. Would there be any interest in doing a CI project in the Emergency Department for Sunnybrook to show good faith? And literally maybe there'll be a few people from our CT team that could come here for a few months and can work with the emerg. group here. And our local Cleveland Clinic Canada team. And then the Sunnybrook team would come not only to Cleveland Clinic Canada, but they'd also go to Cleveland to see how we approach CI, as well." And Mark said, "I think this is a great opportunity." And so we did that project together.

Normally, as you know, we would get reimbursed for those efforts of our incredibly talented people on our team. We didn't this time and the press and the publicity was phenomenal. All of the work we did went on what's called the Sunnybrook intranet called SunnyNet. And all the physicians and scientists and researchers and clinicians, and any caregiver at Sunnybrook read about that.

That was our starting point. Literally the week after that was announced publicly, all the other CEOs of the hospitals called me up and they said, "If you're going to do that again, choose me." And from there it led to just amazing, amazing things, such as, a number of our clinicians are dual credentialed at local teaching hospitals, community hospitals and with us at the Cleveland Clinic, helping us provide care for our patients. From a reputational benefits perspective, because social and political permission in this country are so, so important it really opened up the door for Cleveland Clinic here in Canada to pave the way. So I was extremely grateful.

Brian Bolwell, MD: That's a great story. Thank you for that. I assume the CI project went well in the emergency room.

Mike Kessel: It went extremely well. I have to thank not just at the time, obviously Mark, but Dr. Lisa Yerian, who I'm sure you know well and love, has been a staunch supporter of Cleveland Clinic Canada, not only for that project, but internally helping us build here at Cleveland Clinic Canada, our culture of continuous improvement. It's gone extremely well.

Brian Bolwell, MD: So you established goodwill, and you started to form relationships. And what then?

Mike Kessel: I'll kind of fast forward over time here. You're amazed with this kind of learning from mistakes. The most important thing in life are people, really authentic relationships. I would get heavily involved in handpicking all of our people. I would say I made a lot of mistakes and learned from those mistakes. I think the biggest, most profound mistakes that were made were cultural fit mistakes, where the individual would be putting the team ahead of the individual. And in turn, once they get into our setting and working with all of our caregivers, it may not have worked out that way.

Over time you get that right. Whether it's personality testing and profiling or extended coffees, getting to understand the person better and understand who they are personally, what their values are, their capabilities, their skillset. Did they play team sport? Did they not?

You probably remember Dr. Johanne --who was one of my fellow Buckeye, and I interviewed with very early on in my career -- beat that into my head that you should be looking for team players. Eventually, we all learn that. And I would say fast forward years later, the team has grown at the time from 50 people over the last 10 or so years to 250 caregivers. I would say the quality of caregiver has increased dramatically.

What this team has done in basically 10 short years, the indicators are profound in what this team has done. Such as when in 2009, I mentioned our turnover was 65 percent, that's for everybody, it's now less than three-and-a-half percent. The team has taken care of close to a million visits through these facilities. I would say from a growth perspective, we typically grow 15, sometimes 20 percent a year, which is amazing because as we all know, growth brings opportunities to work with people for a long time to provide for people. And most importantly, take incredible care of patients in making consistent and continuity is so important. You come back and you get to see Dr. Bolwell every year. How amazing is that? So super proud of this team and what they've accomplished.

Brian Bolwell, MD: I want to come back to that in a minute, but can you share with our audience what services Cleveland Clinic Canada provides. If we're growing by 15 percent a year, is that in primary care, is that in sports medicine? Just kind of fill us in.

Mike Kessel: Yeah. Thanks for asking. In this system, we provide public care and private care and some un-reimbursed care. So the services that we offer are primarily health, wellness, screening, specialty care, subspecialty care, imaging. We also do a lot of strategy work, which I'll explain in a minute. We do a lot of virtual care work. And now that we're in COVID, we help the community out significantly with testing--corporate testing for COVID--as well as strategies that employers can use for safer entry into the work environment. What that means taking it down a level would be we offer executive health and wellness services, we offer concierge medicine services, longitudinal family med, if you will. We offer specialty care around dermatology, orthopedics, cardiology, a lot of sports medicine and musculoskeletal rehab, a significant amount of that.

We also innovated a program six years ago, where we are the medical director for large organizations that are domestic and are global, where we provide medical directorship strategy services for populations of people. It's focused on strategy, so we basically took a McKenzie-esque management consulting mind, many of these clinicians worked there, and a practicing Cleveland Clinic physician, melded their mind together. We provide that clinician part-time to the global or domestic organization in 10 to 15 sectors, if you will. And they provide strategy services for that organization by relying on, not just their own expertise, but as you know, the close to 5,000 physicians in 15 countries and 160 cities known as the Cleveland Clinic around the world. Those are the big services that we offer here.

Brian Bolwell, MD: So which ones are taking off in the pre-COVID era? And then we can talk about COVID.

Mike Kessel: In the pre COVID arena, if you will, I would say the big ones that took off were executive health, sports medicine services, and rehab services. I would describe it as how can we here in Canada help our patients move better, and lead healthy lives from a longevity perspective? Those are the services I would say, pre-COVID that did very, very well.

Brian Bolwell, MD: About a year ago, almost exactly, COVID was invading North America. What did you do? How did you manage that? What happened?

Mike Kessel: Yeah, thanks for that question. We're a pivoter here. We will pivot because we're believers that what may have gotten you here may not get you into the future and you need to constantly pivot. The pivot we made two years ago, pre-COVID, was stealing in a good way from the software industry, software and computer science industry, if you will. What I mean by that is there are SAS models out there. SAS software is a service. I'll put it in a very relatable context for your audience. Netflix is a subscription model and Adobe is a subscription model, and these organizations basically charge a smaller fee and they have developed an incredible relationship with their viewers or their users, because they are constantly innovating and constantly pushing things out. Similar as well as a Peloton, where you jump on the bike and you notice there's an update automatically that occurs and it keeps going and they charge a small fee, a user fee, if you will. It's an amazing way to develop very close relationships with your users.

So we took that model two, three years ago, pivoted, and we use that here at Cleveland Clinic Canada with a number of our services. These are the ones that have taken off. Such as our express care online services to individuals or corporations, where they pay a per employee, per month lower fee, and they access us for our services. So virtual care has taken off. The other service that I mentioned before were our medical directorship services. Because during COVID, as you can imagine, everyone has needed clinical insights and knowledge and evidence-based information. So what started out as a few corporate medical directorship services, in the last 12 months that program has increased by 400 percent. And so it now covers probably close to three quarters of a million lives, where we provide strategic clinical insights to organizations to help them protect enterprise health risk. That's also taken off. Those are two big programs.

The last one, I would say, which you mentioned very early on was around family medicine. So we started a concierge medicine program as well, pre-COVID, and it's essentially longitudinal care either virtually or in-person. And during COVID, relationships, authentic relationships where the family medicine doctor here is at the core 24/7 for the patients, has taken off significantly. It's been really helpful for all of our patients.

Brian Bolwell, MD: You mentioned that you assisted with COVID testing. How did that work?

Mike Kessel: It's actually worked incredibly well because we have a phenomenal clinical leader who is a talented nurse who gives her heart and her soul to testing. Basically while we don't have an onsite lab, we partnered with a local teaching hospital, just down the road, a few blocks away. We will send our nurses out to do PCR testing at any of these organizations that need to reopen. Most of them are essential services, like banks, if you will, that have to stay open. It's worked tremendously well where not only are we providing direct patient care to these organizations, not only are we writing strategies to these organizations, but during COVID they've relied on us to not just provide ... but they say, "Hey, return to work strategies, can you execute as well?"

That's where our fabulous team has shined. We're doing thousands of thousands of tests each month for these organizations to help them and help the community.

Brian Bolwell, MD: Mike, when COVID hit here one of the things that I thought was essential was managing the fear that existed of our employees and our patients. That kind of became my primary job for months. How did you manage that with your employees?

Mike Kessel: Yeah, that's a great question. Thanks for asking it. We found the same thing. No different. I can tell you our quality committee, which was headed up by our fabulous Medical Director, Dr. Khalil Sivjee, and our head of our Patient Experience and Clinical Ops, Dawn Lunan, both of them led the way, and they did an absolutely incredible job. They also relied heavily on the unbelievable knowledge of main campus and staying connected and aligned with everything going on in main campus.

That has resulted in honestly, shockingly, we've only had for 250 people here in Canada, caregivers, we've only had two or three caregivers test positive in 12 months in the community setting, which I was shocked. Everyone did an incredible job putting the team ahead of the individual and following all the rules. I have to also give incredible credit to our head of Marketing and Communications, Meegan Guest, who just like [Cleveland Clinic CEO and President] Tom [Mihaljevic] on main campus did. We learned from main campus and we will continue to learn from main campus. We over-communicated, and there really is no such thing as over communication. We were constantly communicating with all of our people. And that I felt, between the quality standards, that we set and the constant communication, I think people felt as though, I'm hoping they did, we were taking care of them.

I also have to give credit to the incredible Supply Chain team and Operations team in Cleveland, because if we needed, for example, a rapid testing device for our people, knowing that we don't have a lab here, they would say, "No problem. We got it." If we needed certain PPE, they would say, "No problem. We got your back." So to work in a system where main campus will support us like that, I mean, it's unbelievable.

Brian Bolwell, MD: Let's go back to some of the things you talked about earlier that you believe are essential to your leadership success. You talked about getting the right people. You said that you've become very active, I guess, maybe you always were, in recruiting, I assume at all levels. What did you learn? How did you get to be a better recruiter? Did you ask different questions? You mentioned taking people out for an extra cup of coffee. Was it a social environment? I'm sure not everybody who you've hired has played team sports. What have you learned about just how to pick people?

Mike Kessel: Number one, find a good-hearted person. The only way to figure out if they're a good-hearted authentic person is to spend a lot of time with that person in advance of making a decision and doing that in alternative environment. One of the things we would do, and of course I would do is I would step outside our facilities and I would meet that person in a park, take in a walking meeting. I would meet that person in a coffee shop. I would meet that person outside of a normal interviewing environment. I would get them to loosen up and talk about anything that we believe is important to fitting in and knowing that that is a good-hearted person. And instead of a few encounters with that person previously, we learned it would take probably six or seven encounters to determine if that's a good-hearted person. That's number one.

Number two is I realize where I'm strong and where I'm weak. As our team grew, we were able to complement the small team with people here that are way stronger than me in a lot of areas. I would get those people involved in interviewing those candidates, not just myself.

There's one other thing that I did that I encourage all of our people to do, the third thing. It really is a small world, generally speaking, most of these candidates you are connected to them somehow. You have to find it though. So what we encouraged, and I did, was I knew someone that knew someone that knew their candidate. Behind the scenes, I would call up and try to triangulate. Find three people that knew that person, that worked with that person, that maybe knew that person personally and I would ask them, "Is this a good-hearted person?" That proved to be a lesson well learned. You get the real truth, if you will, doing those three things.

Brian Bolwell, MD: Mike, the other thing that's been thematic this morning has been the importance of authentic relationships. Why do you think that's so important?

Mike Kessel: Geez. All that matters in life is being real. Something could be perceived as great, as real, but it has to truly be real. You have to care about that person as a person, whether it's family, the person of themselves, and the working relationship. That's what it's about. That's what's going to keep people working together for a long time in order to benefit the patient. It is that simple. I don't exist without these fabulous people. My job is to grow our team and to protect that team so there can be continuity and consistency in the future. That's my job.

People are all that matter. That's it. It has to be real. It cannot be fake. No one wants to leave this world with a legacy. You're only on this earth 30- to 35,000 days. I don't want to leave this world saying ... "Oh, that Mike character, he wasn't real." That's no way to leave your mark.

Brian Bolwell, MD: One of the things I've found is that great teams are a magnet for great talent, and once you construct teams, other people want to join it. Have you found that to be true?

Mike Kessel: Oh, absolutely. That's brilliant. I'm going to steal that from you, Brian.

Absolutely. The medical directorship program that we started five, six years ago, we now have close to 30 physician leaders that have both a clinical and consulting background or MBA, MPH, and they practice. These are, I would call, the medical elite warriors. And now more and more people want to join. I think scarcity sells. And because of that I completely agree with you. The talent we're getting now over the last three to four years, I humbly say this, is 10 X more of a fit and talented than what it was 10 years ago.

Brian Bolwell, MD: As we conclude, Mike, what would you like our listeners to know from somebody who's successfully started up something in a different country and is achieving wonderful success and growth.

Mike Kessel: That's kind of you to say. Thank you. I would say the biggest thing that I'm always thinking about every minute of the day is other people and how to be kind and help other people. The old proverb, I think it's, "you scratch my back, I scratch yours." I actually don't think that's right. I think, just focus on scratching everyone else's back and everything will be fine in your life. That's the most important thing; helping as many people as you possibly can.

Brian Bolwell, MD: Yeah. I think that's pretty profound, Mike. I mean, at the end of the day, much of the whole literature about serving leadership is talking about the importance of relationships, both at work and at home. So I think that's a wonderful way to conclude.

Conclusion: Thank you for joining us for this episode of Beyond Leadership. We welcome any topic ideas, comments, or questions about this, or any past episodes. Email us at executiveeducation@ccf.org or by clicking on the link in the show notes.