Leading through and Confronting Imposter Syndrome

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.

Good morning, everybody, and welcome to today's episode of Beyond Leadership. I'm Brian Bolwell, your host. Today, I'm delighted to have Dr. Rebecca Starck, who's the President of Avon Hospital here in our Cleveland Clinic Healthcare System. Becky, welcome.

Rebecca Starck, MD: Thank you, Dr. Bolwell, for inviting me to this podcast. I look forward to our conversation this morning.

Brian Bolwell, MD: Becky and I have known each other for a long time, and obviously Brian is wonderful for today's conversation or really for forever. Tell us a little bit about your career.

Rebecca Starck, MD: Well, let me start with my life. I grew up in West Michigan, the daughter of a very, very forward-thinking nurse who traveled the world on mission trips and started a home healthcare agency. She wrote a book on death and dying and caring for hospice patients. My father was a builder, and I bring these up because they'll maybe come back later in our conversation. I always knew I wanted to do something in healthcare.

When I was an undergraduate, I began my medical career, I suppose I would say, as a phlebotomist, drawing blood, in my local hospital when I would come home in the summers and had a great time interacting with patients, some would refer to it, at the front lines and began my career thinking maybe I'll go into physical therapy. And expanded my opportunities and horizons and felt I should keep options open and eventually determined that I would go in medical school and continued on my career in medical school and began as I started my rotations thinking about what's the best fit for me.

I loved surgery, but I also loved the continuity of care that being an OBGYN provides me. I have become an OBGYN and love the ability to work with women and care for women and become healthcare partners with my patients throughout their entire lives. I find it truly rewarding to have patients who still see me 20 plus years into my career. Some I took care of as adolescents and teenagers and to their early 20s and through childbearing years and into perimenopause.

We shared a lot of stories. I feel like some days I should be paying them for their visits rather than them paying me for a visit because I think that it's a mutually beneficial relationship. It's extremely rewarding to care for women throughout their lives.

Brian Bolwell, MD: You've been president of Avon for how long?

Rebecca Starck, MD: Since 2014. Maybe I should pivot and talk a little bit about how my career as an OBGYN transitioned me into leadership.

You know, I think as physicians, we are just innate leaders. It's really about helping people find positivity in their lives, helping people live a better life, helping people find their passion. Again, that's what I think day-to-day healthcare is all about, especially as an OBGYN and preventative healthcare, helping women identify ways to live their lives better and fulfilled.

And in 2010, I had the opportunity to throw my name in to become the chair of our regional OBGYN department within the Women's Health Institute here at Cleveland Clinic. I thought immediately that was something that I was drawn to. I had been in practice here for over 10 years, so I felt I understood what that could look like from a leadership standpoint. And I felt that it would really allow me to help on a broader scale other providers lead better healthcare for a much larger population of women.

I, in fact, was given that opportunity and was elected as that chair of my regional OBGYN department in 2010 and found it to be extremely rewarding, because it wasn't necessarily me caring directly for women, but it was working with other physician providers. Eventually we worked with and built a very large nurse midwifery program and an advanced practice provider program. But it was about helping the physicians feel rewarded and valued in their jobs, but also helping lead our initiatives around quality, safety, increasing access to healthcare.

And I almost looked at it as working as a servant leader to support the providers, which then led to supporting more patients. I just had a wonderful experience and was able to connect with providers on a one-on-one personal level. Each year when we sit down at our annual review process, I was able to sit down with the providers. And whatever stage they were at in their profession, they could have a conversation about what would make their jobs more meaningful for them. Some years it was, I just need to go to work and go home because I have small kids. Some years it was, I'd really like to get involved in quality or maybe in compliance or in the business side of healthcare. Finding their interests and then opening doors for them.

But there were also, again, very meaningful ways to impact healthcare and quality of care by just sharing initiatives around whether it was our primary C-section rate, whether it was induction of labor, whether it was infant mortality, whether it was kicking off our opioid use disorders in pregnancy. These were big high-level initiatives that had a great impact on our community, and I found it very rewarding.

That was in 2010 that I started on that journey and continued until around 2017. During that process, however, I was invited to consider leading the opening of Avon Hospital. The planning for that began in 2013, and then 2014, there was a desire to identify a president or leader for that project. And so again, I was very honored to take on yet another leadership role, and I started in on the project in 2014. We opened the hospital in 2016. So, a very different from my leadership role in women's health and a very exciting leadership journey as well.

Brian Bolwell, MD: Talking about your role as chair of regional OBGYN, you mentioned a couple things. One is you talked about the importance of making your staff feel valued, which certainly I agree with. I think that's a very big deal. How did you do that?

Rebecca Starck, MD: Little things. I felt it was extremely important to see them in person on a regular basis. The department was all over Northeast Ohio, down into Wooster. Those of you who know Cleveland know that it's a pretty expansive territory. I put a lot of miles on my car, but simply just going to see them in person showed them that I cared about them as individuals. Recognizing that, yes, we have basic initiatives and basic expectations for our practice model at the Cleveland Clinic. One of the doctors told me once she was going to make me a T-shirt with the letters F-U-T-R, FUTR.

I said, "Well, what does that stand for?" Fly Under the Radar. I would say to the providers, "Look, these are the basic expectations. If you can achieve this, whether it's quality, access, your RVUs, your productivity, whatever it is, these are the basics that I expect of you, you're going to fly under the radar. I'm not going to have to hound you about seeing more patients or seeing patients for longer hours. These are the basic expectations."

But I think that they really appreciated that I was able to, where possible, allow them some flexibility in their lives if they were still producing and they still had great patient experience scores, quality scores, involved in education of residents and students, potentially community engagement. That was how I addressed it that I think made the individuals feel valued and appreciated and just showed gratitude from time to time, wherever it was, whether it was publicly in a meeting or just privately sending them an email.

Brian Bolwell, MD: The other thing, you just mentioned flexibility, and part of that is a certain amount of autonomy. That's the antidote for burnout. When we think about burnout these days, there's a lot of drivers, but the solutions seem to be rather limited, but certainly front and center is a feeling of autonomy, a feeling of control of one's own destiny. That's pretty much what you're describing.

Rebecca Starck, MD: Completely agree with you. I think that when people feel that their lives and their work is micromanaged, they get extremely frustrated. They feel that they have no control. And I've heard of providers who have quit their jobs because they couldn't take an afternoon off to go to their six-year-old's play at school because obviously it was short notice. We all agree that patient care should come first. For my practitioners, the comment was, do everything you can to accommodate the patients and their schedule.

If there is a cancellation of an hour or two hours in an afternoon, if you can accommodate them, whether it's earlier in the day or the day prior, make it something that's mutually convenient for the patient. I think patients understand and are willing to accept that. It certainly helped, I think, because the providers felt that they could manage their practice in a way that was satisfactory to them.

Brian Bolwell, MD: The other thing you just mentioned was servant leadership, and that certainly is talked about many times in leadership books. We've talked about it a lot on this podcast. What does that mean to you?

Rebecca Starck, MD: I think first and foremost, leading by example. It's hard to ask people to do something when you're not going to put yourself out there as well. I think about the pandemic. Many people shied away from healthcare facilities. Some leaders would say, "We're all working from home because we need to stay safe." I could never ask my caregivers to put themselves at risk and to care for COVID patients if I wasn't willing to walk on the floors and thank them for their efforts myself in person.

I think it's also when you talk to your leaders or your fellow caregivers, it's asking them what you can do to better support them and help them. I don't see it as a top-down autocratic environment. I see it as a bottom-up. I'm really here working for them, helping them, again, be their best selves at work as leaders, as frontline caregivers. And that's what, to me, servant leadership looks like.

Brian Bolwell, MD: Yeah, I agree with all that. I think the other thing is that when people tell you what they need, you've actually got to deliver. It's not good enough just to go listen to folks and they say, "Gosh, I need help with X," whatever X is. You've got to try to help them and try to fix whatever the problem with X is and make it better. Otherwise, there's a certain hollowness to the whole exercise.

Rebecca Starck, MD: Responsiveness. Probably this is where I am very particular about responding to people. If I get an email from someone, I'm going to respond to it. Sometimes I get bogged down with emails, I think we all do, but I don't want people to feel that their email to me isn't valued and isn't important. Those are little things, but you're absolutely right. We can't always fix the problems. We can hear the concerns. We can express empathy, and we can suggest that we will do what we can to investigate and advocate to make things better. I think that goes a long way as well.

Brian Bolwell, MD: Yeah, I think that's well stated. You talked about getting the role and you implied, of course, something that we know, and our listeners probably don't, that when you were considered for that role, the hospital actually wasn't built yet. We had to build it. Actually, building a healthcare facility is something that we have in common, at least being involved in it. Well, obviously I didn't personally build the cancer center, but certainly I was involved in the design, as were you in the design and ultimately building Avon Hospital. For me, that was an awful lot of fun. Tell us about that from your perspective.

Rebecca Starck, MD: Well, this goes back to my roots, right? My father was a builder. He built a hospital. He built a college. He built several large facilities. As a kid, I remember putting on a hard hat and walking with him through those big facilities and thinking about, wow, this is really cool. The steel, there were these little punch outs from where they would put in electric boxes. My sister and I would pick them up and then we'd pretend they were coins. We were really rich by the end of the tour. I had my father on one shoulder. My mother is a healthcare provider herself on the other shoulder.

What an amazing experience it was to be involved in the journey of building a hospital from the ground up. Not only a hospital and a structure, but a culture and building a team from the ground up. From the hospital standpoint, I would meet every single month with all the key individuals who were working in all the trades, the electricians, the general contractor. We would meet every single month through the project to talk about how things were going, were there any issues. It was the leaders who met. Again, a great experience.

I knew very little about actually building buildings, although I think it was in my blood from my father, but I could help provide a vision of who we were going to be and what was the purpose of this hospital in a community where we had a lot of Cleveland Clinic patients cared for by Cleveland Clinic providers, but they couldn't receive inpatient care close to their homes or workplaces. We were really changing healthcare in this community and bringing Cleveland Clinic care to a new county in Northeast Ohio. And many of the team members, the folks who put the structural steel up, live in this community.

It was an ability to connect with them and say, "When you drive by this building, just like when I was a kid, you're going to point to that building and tell your kids, 'I was part of building that hospital.'" That was a really cool time to get involved in a completely different aspect of healthcare. And then building the culture. I had a phenomenal team of leaders who joined, and our Chief Nursing Officer who had 40 years of experience here at Cleveland Clinic came to join and helped build the team. We had key operations folks helping us.

Again, we were very intentional about what our culture is going to be within the Cleveland Clinic Health System. Really the culture of, first and foremost, everyone deserves and expects to receive high quality, safe care when they come to a Cleveland Clinic facility. That is our North Star always. Culture of speaking up. Culture of teamwork. The culture of providing compassionate care where every single individual, whether it's a patient, whether it's their patient's family member, whether it's your fellow caregiver, they all feel like they're being treated like family.

We spent a lot of time on that cultural onboarding. The year before we opened the hospital, we started talking and meeting with our leaders who were going to be identified for the hospital, and they were mostly assigned about nine months prior to the hospital opening. We started with leadership retreats and really just talking about what does it means to be high reliability, that people will speak up if they see something no matter what their position, that everyone is respected.

It doesn't matter if you're walking through the halls, sweeping the floors, if you're bringing trays to the patient's room for their food, if you're patient transport, whoever you are, you matter. None of us can do our jobs in silos. It doesn't matter how smart you are, how talented you are, you cannot do it without the other team members to support our patients in what we're delivering on. We were concerned, we talked about that. Mary Sower was my Chief Nursing Officer, and actually, God bless her, just retired last week, in fact, after 47 years in nursing.

We talked a lot about how we are going to sustain this culture. We still have onboarding for individuals who come to Avon Hospital. Even if they're from somewhere else in our health system, we do this every single month in person. Unfortunately, during COVID, we went on to virtual platforms, but now we're back in person. We have generally maybe 20 caregivers in the room, and again, from all disciplines, and we just talk about who we are at Avon Hospital. They'll spend a morning with us. The executive team, we spend about a half hour with them.

We have other key leaders who just share what their roles are and how we can be unique and special and make Avon a great place to receive care and a great place to work.

Brian Bolwell, MD: Well, that's wonderful. Did anything not go well?

Rebecca Starck, MD: I would say it's been a huge success. I will tell you, as a leader, I really pushed myself out of my comfort zone. When I talked about my leadership and when I had my experiences becoming chair of regional OBGYN, it felt natural. It was my area of expertise. I had, I think, a good reputation as being a respected provider, a respected clinician. My colleagues respected me, so it kind of felt natural and easy. When I jumped into the role of President at Avon Hospital, there were times where I felt like I jumped off a cliff and I was waiting to land. I really didn't know what I had jumped into.

I think that's one thing as leaders, to trust yourself and to take chances. It's important to do that. And I will admit, it took me several years. I had a bit of imposter syndrome. What am I doing in this role? Do I know what I'm doing? I had never run a hospital, and here I was building a hospital. I had to get past that fear and that factor, “People must be looking at me thinking, how did they pick her and why did they pick her?”

But leadership can be applied in many different areas, and it took me several years to look back and say, "Wow, I did it." It was successful, and I now really truly understand what it means to run a hospital. I feel like if I hadn't taken that leap of faith, I would've continued to have a pretty narrow perspective on being a leader in women's health, which is great. It was my passion. It was what I did as a clinician, but now I have a much broader perspective on all sorts of specialties, cardiovascular health, pulmonary health, cancer care, what our community needs.

It's something that had I not pushed myself way out of my comfort zone, I never would've had that personal growth, but also, I think an ability to have a much larger impact on a larger scale. Did it go wrong? No. Was it scary at times? Absolutely. Were there sleepless nights? Absolutely.

Brian Bolwell, MD: You've mentioned a bunch of things that just for our audience I want to highlight. Number one, you talked about during COVID the importance of being present, and I couldn't agree more. I think that COVID was a great test of leadership. I think that one of the things that successful leader did, number one, was that they were present. Number two, they were visible. Number three, they communicated to the best of their ability. And number four, over and over and over again, they were grateful and expressed appreciation. It sounds like you did that every single day.

When we built the cancer center, there was one thing that we didn't do right. And that was, in my opinion, entirely my fault because of the one part of the cancer center that I didn't pay enough attention to. I'm not going to go into specifics, but it sounds like you paid attention to everything, and the building itself went just fine.

Rebecca Starck, MD: Well, there were some decisions I wasn't able to make myself. Not sure everything's perfect, but I will say it's a success.

Brian Bolwell, MD: Well, congratulations.

Rebecca Starck, MD: Thank you.

Brian Bolwell, MD: Then you talked about taking a leap of faith to even try to be a hospital president, and then you got the job. And gosh, it was going to be uncharted water for you. I think that that's thematic of a lot of leaders is that at some point in their journey, they just take a chance, and they say yes, and then they give it a try. There's a huge value in that, I think. I think there's a huge value in stepping out of your comfort zone if you want to continue to grow in your career as a leader and probably as a person.

And you know, the corollary to that is, of course, when you're doing it initially, you talked about the imposter syndrome, and I'd like to follow up on that because I think it's something we don't talk about enough. I think everybody in a new role, certainly in a new leadership role, is insecure and has anxieties. And then the question is, how do you deal with that and how do you overcome it? Tell us a little bit more about that.

Gosh, you're running a hospital. It's built. You've got all these specialties. You've got to pay attention to your community and the community leaders, and you’ve got to listen. How did you do it? One step at a time? What was your approach?

Rebecca Starck, MD: So, I think the most important thing was to find key trusted individuals that I could lean on, whether they cheer you along the way, behind closed doors, the person to reach out to. And you know, four or five people is probably all you need, right? If you get too much broader than that, then it becomes the panel discussion, and it can be one-on-one along the way. Trusted individuals to provide that support and encouragement is critical. Some folks, I don't know that I would even have recognized them as being those individuals.

I think the other piece of it was going back to the basics of trusting myself innately and digging down into the recognition that people want a leader. People are looking for someone's vision and someone to follow and somebody to help them see. Even, again, as our community had to deal with the uncharted waters of the COVID pandemic, I began hosting weekly meetings with the local municipal leaders, the mayors, the school superintendents. Each week I would first hear information from our specialists here at the Cleveland Clinic, the infectious disease specialist. I would then turn around and share that information on a broader level. We were all in uncharted water, but they were just desperate for information. That went on for a couple of years. It was just the basics and bringing it down, instead of getting overwhelmed of the what ifs and the future and where are we going, it was, okay, let's take a step back and say, what are the basics that people need to hear and think about?

I feel like the imposter syndrome is not an uncommon thing, you're absolutely right, for new leaders. Finding those trusted individuals and then bringing it back down to what do I know and what do I believe is the trusted right path forward to trust, and how I can set that vision for others. And also recognizing that I don't know everything and stating that, and then bringing in individuals who can be the content experts in certain areas. And that's critical too. Building that team who can support you.

Because as I've gotten into higher leadership roles, clearly there's far more that's out of my comfort zone because it's not my clinical area of expertise. But finding the right leaders who can complement you and then also lead their teams is critical.

Brian Bolwell, MD: Yeah, I think that's very well stated. I think it's pretty cool that you met with community leaders as frequently as you did during COVID. That's probably something that few people recognize, is that we tried very hard to communicate internally. Certainly, I did. But I think one of the roles of a hospital president out in the community is to realize that they've got a constituency that goes beyond the employees and the patients. Paying attention to that is a big part of your job. It sounds like it was very successful.

Rebecca Starck, MD: It is one of the most rewarding things about the job. When I look at my role as a hospital president, setting the tone internally on our campus, again, for high quality, safe care. We're caregivers. People want to work. That's job number one. Job number two is working within the enterprise. How do we collaborate to bring more services, support our community better, support the enterprise better? But then the third and I think is extremely rewarding is that community outreach.

Especially being the new hospital in our county, in Lorain County, it's been extremely exciting to really connect with the community at a different level. I think that has been probably one of the most rewarding parts of the job, because I think we've really truly made a difference in a very short time. We've only been open six and a half years, but they see us.

I say all the time, it's not just the healthcare we deliver on our campus and in our buildings, it's who we are in supporting the community beyond our walls. Our caregivers see that too. We've got a very robust, it's called caregivers in our community, a team of caregivers who go out and they'll volunteer at the Second Harvest Food Bank, or they'll go build beds for children who don't have beds with the Good Knights of Lorain County. Those are the things that I think we're impacting. And to your point, just communicating. Our Community Advisory Council meets quarterly, and we bring all these municipal leaders here to give them updates and hear from them what their agencies are doing to support the community. It's an exciting experience.

Brian Bolwell, MD: Yeah, it's really cool. It's 2023. We have all sorts of new healthcare challenges right now. What are your one or two biggest and how are you approaching them?

Rebecca Starck, MD: Workforce. Workforce. The big resignation of the post-pandemic is how do we recruit and inspire the future generation of healthcare workers? What we've done at Avon Hospital with our community outreach program managers, we've invited students from every single high school in Lorain County into our hospital to walk through the hospital, meet with the managers of every area so they can really be inspired by what a career in healthcare can be.

Again, all of those jobs that are important, respiratory therapy, working in the cafeteria, working in patient transport, working in the lab as a phlebotomist, all of these are important jobs, and we need individuals to want to go into healthcare. That's our priority here at Avon Hospital. And then when we have new caregivers, we talked about that onboarding, but how can we make that first-year experience meaningful and how can we retain caregivers into the future?

Those are the things that I think we have to really continue to focus on as healthcare providers today, inspiring the future healthcare providers of tomorrow. We also have to recognize that we won't be able to do things the way we've always done things. We have to constantly be thinking of what are the new challenges? How can we use technology to support us? What can innovation look like that care delivery can really embrace for the future?

We figured out how to do virtual consults. We figured out how to do telehealth. We have to embrace that and move forward with that in a new way. I think we have to change expectations from people. The immediacy of the past isn't present today in healthcare, and so helping prioritize where the needs are and the critical needs are, but being able to then still deliver safe care today is going to be critical. Those are the things that I think we focus mostly on in these last six to 12 months.

Brian Bolwell, MD: Yeah, I agree with that. One of the things I do these days is, I coach and mentor an awful lot of clinical leaders around here, and sometimes people come from a challenging space. But I always pivot back to one key point, and that is, how can you make your world wonderful and wonderful for the people around you? I think that more than ever, we have to think about retention. We have to think about culture, as you have emphasized in this talk. But it also goes back to things that we briefly touched on, such as autonomy, such as appreciation.

If you have high functioning teams and people really enjoy being part of a team, it's difficult for them to leave because it's their second family. If you have a great culture, it's difficult for people to leave. Every single one of us, everybody who's listening to this podcast, everybody involved in healthcare can help create that, can help make their world a little better for everybody else that we touch.

Every day, if you're present and you're willing to express appreciation or simply just interact with somebody and say, how you are doing, and actually stop for 30 seconds and listen to them, and if you do that repeatedly, these little things matter, and they differentiate cultures. I think thinking about the workforce and thinking about our colleagues at all levels has got to be one of our major priorities as leaders in healthcare and in other industries as well.

Rebecca Starck, MD: Yep, I agree. People are watching us. If we express dismay and burnout, we're going to turn everyone off from wanting to go into healthcare. It's very rewarding to be able to help people in their life journey, whether it's in a hospital or in my office. I think if we can continue to show that and turn that around, we'll all be better off for it. I agree.

Brian Bolwell, MD: A long time ago, somebody told me about the value of a handwritten thank you note. If you hand write a thank you note to somebody who works alongside you or with you, odds are they'll keep that forever. These little things are just very, very powerful. So, as we're wrapping up, Becky, I always ask, are there any other leadership philosophies that you would like to share?

Rebecca Starck, MD: I think we covered a lot. I think setting a vision, leading by example, celebrating successes along the way, and trusting yourself as you embark on a leadership journey is important.

Brian Bolwell, MD: Well, and as you mentioned, having a handful of individuals who are your team, the people to course correct you if you're getting a little off track and people to also help you along the way. Developing that high functioning team of key advisors is I think really important. A lot of great points were raised today, Becky. Congratulations on our massive success. This has been a wonderful podcast. Thank you to our listeners. Thanks for listening, and we look forward to meeting you again on our next podcast. I'm wishing everybody a wonderful day.

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.