Don't Be Afraid to Make a Decision

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. Hi, I'm your host, Dr. Brian Bolwell. And today I have the pleasure speaking with Corinne Ehretsman, Executive Director of Clinical Operations at the Cleveland Clinic. Welcome, Corinne.

Corinne Ehretsman: Hi. Thank you for having me.

Brian Bolwell, MD: Corinne, what does the executive director of clinical operations do?

Corinne Ehretsman: Well, I have the pleasure of supporting the chief of staff and the clinical service lines at the Cleveland Clinic. The way we're organized, as I know you know, Dr. Bolwell, is by institutes. Years ago, the clinic broke up departments and divisions and organized business units around patient care, and we call those institutes.

In those institutes we have physician leadership and then we have an administrative infrastructure or a business infrastructure that helps to carry forward the goals and objectives of those service lines. That business unit and those business leaders that report up through me. And I help to, I would say, implement and create the strategy to grow our service lines across Ohio, and really maximize our ability to provide access to patients throughout the enterprise. And I've been doing this particular job for just about three years. And every day is a new challenge, and I learn something new.

Brian Bolwell, MD: I've known Corinne quite a while, and I can tell our audience that she does a truly wonderful job in this role, as in all of her prior roles. But before I talk about your prior roles, Corinne, how does the Cleveland Clinic even approach growth within the clinical enterprise? I mean, you help manage everything we do clinically in northeast Ohio, which is certainly the majority of what the Cleveland Clinic does. And many years ago, we actually had a strategic retreat to think about the concept of growth. Should we continue to grow? If so, what does that look like? We made the decision to do so, but what does it look like now? And how do you help facilitate growth?

Corinne Ehretsman: It's always an interesting question. Because as any expert in strategy would tell you, strategy is as much about deciding what to do as it is about deciding what not to do. So, when we think about growth, we're always balancing where we think and what we think will best serve a patient. And understanding that against maybe some business objectives, is that also in the best interest of the overall business? So, I get to live in both those worlds.

The first thing we want to do is, how do we best serve a patient? And that helps have a very specific goal in mind. We can look at incidents of disease, we can just look to see where there may be gaps. And how are we going to touch and support each and every one of us, because we're all patients? And then where can the Cleveland Clinic make a clinical difference?

I then get to live in the intersection of understanding that and the business components of it to build a strategy that helps to support both. And from a business standpoint, sometimes it really is about knowing what not to do, as much as it is about creating the infrastructure to do more and enable that growth. Its most basic component, it's really about looking to understand patient needs, market needs, medical needs, how medicine is changing. And every time there's an innovation in medicine, it definitely changes the way we deliver care and how we think about our growth strategy. And then building those business bricks to enable that strategy and make sure we do more of what's going to benefit everyone and less of where it's going to just cause waste and work, you know, against that goal.

Brian Bolwell, MD: One of the things that I have found challenges some physician leaders is operations. I think sometimes physicians are very good at saying what we need to do, and sometimes they're less good at figuring out how to do it. And you're very good at the how. How do we do things? How do we actually get things done? Not only are you good at that, but you've also got to teach it to the other institute administrators and the other people who work for you. How do you approach operations? How do you in fact execute? How do you approach that?

Corinne Ehretsman: I've thought about this, because it sometimes feels somewhat intuitive to people who get their energy from operations, and I tend to be one of those people.

First and foremost, it's about understanding the problem you're trying to solve. I think continuous improvement teachings give us a framework to understand that. You can't always look and see exactly what's the problem we're trying to solve, what are the variables that are going to influence that? And then design an approach. That's a very academic answer. I've been here for a long time, as you alluded to in the beginning of our conversation. Not only is it about understanding the problem, but you really need to know your business. And the only way to know what you can control or how you can create an approach to help someone accomplish their goals is if you understand what is in that box of that problem.

And as I thought through this, and I've never been the most talented student, but in understanding what it was that I needed to solve, you could really understand that there are ways to persevere without always having the right answer, or an academic answer. And I think that's what operations is about. It may not always be obvious, but if you can break it down to a simple conversation of, I know that I want to change this one thing and here's my real problem. And then within that, what can I actually control? And then just start. Even if it's wrong, you can then point at that elusive, I would say puzzle, and say, "I tried this and it was wrong." But I now can articulate that. And the team can come together and say, "We can all see it too. Let's now try something else."

I think the first step in all of this is not being afraid to make a decision. It can be the wrong decision. But at least it gives everybody something to look at so that we can design the next step together. And that's where I see people get stuck. It's the first step, it's being afraid it'll be wrong and the whole thing will fall apart. And as you know, Dr. Bolwell, we do a thousand things every single day that may not have been the right decision, but it's how we get to what's going to help us look forward ultimately.

Brian Bolwell, MD: For our audience, Corinne just talked about three very important parts. The first part is you need a team. And you've got to form a team, and hopefully as part of that you have to create psychologically safe space for people to feel free to talk about what they think is going to work and what they think isn't going to work. Secondly, which I think is really important, you talked about, try to figure out what the focus is. What is the real issue? What is the long jam, or what is the thing we've got to change? Because, boy, I think it's very prevalent in medicine when facing almost anything is to get so many different views on what's going on and. It becomes rather diffused; it becomes all the leaves on a big tree.

When really what you want to be focusing on is the trunk. And having an ability to focus on the core is very important. And I think, unfortunately, isn't all that common. And then as you said, which I really like, start. Do something. Try it. Pilot something. Boy, we tend to get paralyzed by analysis by paralysis. And I love the idea, let's just give it a try guys and let's see what happens. What happens when you do that? You give it a try, it works, great. But if it doesn't work, at least you can pivot.

Corinne Ehretsman: I think you can always pivot. There's a comfort in solving a problem that people don't know how to solve because it's not, and I think this is one of the fears. That somebody's going to show up and say, "Oh, you should have done it this way." You can always pivot, and now you can pivot more information. And there really is no such thing as that person that's going to come in and say, "You should have done it this way." Because if that were true, then we wouldn't have some of these very large complex problems that we have that they have absolutely no simple solution. And the one thing you said, Dr. Bolwell, that's really important, it is not an individual leadership game. At any point of running operations, it is very much about a team. And one of the things I've always grown to appreciate, again, going back to knowing your business, is everyone on that team is going to bring information to you that helps you understand how something can be mobilized. And the talent is taking all those diffused leads and boiling them into a trunk so you can start. But also, not limiting the information to gather all of those data points. That's really important. And as you said, there's two things you need to do. Understand and gather your data points or make a decision and at least move, and then know you're going to have more information to be able to pivot. And in my world, because it's not a patient care arena from a direct care standpoint, no one's going to get hurt as long as you know can continue to understand and grow and change. Again, we make different decisions every single day based on that. With, hopefully, some themes you pull through from things that you've learned, so you can always build upon those and do better.

Brian Bolwell, MD: Shortly after you were appointed this role, the pandemic hit. Talk about changing with information pretty much daily, if not even hourly in the beginning. How did you approach that? You're in charge of the Cleveland Clinic clinical enterprise administrative leadership for everything. And on the one hand, we had to figure out how to take care of a whole bunch of very ill patients with a disease that we didn't know much about. On the other hand, we had to figure out how to keep people safe, what services needed to not really be very prevalent anymore, and everything in between. Walk us through how you approached that.

Corinne Ehretsman: Well, we were really getting new information every single day. And I think one of the things that became frustrating for anyone is that you want answers, you want to know what to do next, and you want to know why. The first thing we did to approach it is to make sure that we had ways to communicate what we knew when we knew it, so that everyone was at least working with the same amount of information. I think we became very comfortable with being able to say, I don't know, here's my best decision based on the things I know right now. One component of that was being able to communicate to others from a leadership standpoint. Another piece of that was making sure that lines of communication were open into my office so that as we were all learning we could have that information and know what was important and valuable to people on the front line.

What might have been important and valuable in that moment was, do you need a mask or not need a mask? Or it might have been, what door do I come into today? And everything was difficult, but I think we were able to rapidly disseminate information was one of the most important things in being able to keep everyone feeling like they had some element of control. Or at least enough information to make decisions that were going to be the right decisions in that moment. And that was the hardest piece was just really, am I going to do something that's wrong, hurt my colleagues, endanger my colleagues, possibly hurt a patient? It was a lot to do very, very quickly. And there was just a lot of amazing people that came together to share their best thinking for us to design and continue to just create an environment that took unbelievable care of patients and of all of our caregivers.

Brian Bolwell, MD: Yeah, I think it was one of our shining moments. I don't think there's any question about it. You talked about a couple things there. Obviously, the importance of communication is key. Again, our listeners who've listened to these podcasts have heard me say this more than once. And the value of saying, I don't know. I think that if you can say, "I don't know," it does many things. Number one, it totally generates authenticity, which I think is utterly crucial in effective communication through a crisis. Secondly, I think it makes people human. I think it almost becomes a glue if you are honest about what you know and what you don't know, your fears, your concerns, et cetera. And one of the things I've always really appreciated about you, Corinne, is your ability to be authentic. Do you think about that? Do you place value in that? How do you even approach that? How do you approach being authentic, or authenticity?

Corinne Ehretsman: I place a lot of value in integrity and authenticity. I don't know what more I really have to offer [Both laugh] when I'm thinking of myself as a leader. The one thing you can expect is that I'm going to show up, or the teams that I work with that support me, we are going to do our best to make sure that whatever we advise or however we make a decision, it's really just coming from the best thinking we know, or we have in the moment. It's about trust and relationships. And going back to, if I'm going to be a decisive leader, which I think is something that leaders should really put value in. Is the ability to make a decision but also to make the wrong decision at times. You need to build that through trust. And I don't know how to build trust unless people have authentic relationships. It doesn't mean they're perfect. Doesn't mean you like everything about me, or we'll start there. But it just means that we have a trust that is really going to be able to help us be successful together. And I think that's what really defines some of our work relationships. And we should hold dear is that when we show up every single day to a place that we probably spend more time at than we spend time with some of our families. They're real relationships that add value and really help others.

Brian Bolwell, MD: Well, I couldn't agree more. Two really profound points there. One is, so much of work is in fact about relationships. It's almost everything, actually. And secondly, the massive importance of trust, and how do you gain it? Yeah, I think that you're real, you're straight, you're authentic. You tell the truth. If you say you're going to do something, you do it. This doesn't sound complicated, and yet for reasons that sometimes escape me, it's somewhat rare. But boy, if you can build trust, everything gets better and you can accomplish a lot.

I'm going to switch gears a little bit. Corinne, tell us about how you came to the Clinic and what you started doing. And I think we first connected when you were the institute administrator for pediatrics, and I think I was running the space committee. And then you worked for medical operations. And ultimately now, for the chief of staff office, and you're basically in charge of the entire clinical enterprise. Walk us through that.

Corinne Ehretsman: As long as nobody promises to do math, I've been at the clinic for 22 years. Before I came to the clinic though, I started my career at GE. And really, I have a basic MBA. I do not have a master's in health administration and public health policy, and anything that would help you understand how I end up in hospitals. When I was at GE, we rotated through different, just areas of specialty for GE. It's something that they do. And I worked for their corporate benefits division for a little while, and healthcare was interesting and beautiful puzzle. A different language for me at the time. I was intrigued. I also really liked being able to influence and help people in a different way. This is the era of everybody leaving with MBAs to go be consultants and make lots of money and have a flashy lifestyle.

I didn't have any connection to really a healthcare organization. A mentor of mine suggested that I do a fellowship. My roommate left for New York City with an incredible package and salary to go work at a consulting firm, and I came to be an administrative fellow. Which really is like an intern. The good news is, at the end of the day we both had the same spending money because I was coming to Cleveland, she was going to New York. I came here really for a year and was just interested in getting close to the delivery side of healthcare. For some reason was chosen to be at the Cleveland Clinic. And I think what I loved the most from the day I walked in the door here was the people I met, and the amount of intelligence and fascination that I had with these just incredible scientists and professionals that were really changing healthcare.

There's a saying that you come to the Cleveland Clinic if you want to cure cancer, you may go to a community hospital if you want to take care of somebody with cancer. And that's what I felt walking in the door. I was a fellow. Then, this is back in the day, we didn't have project managers. But I'll say I was then a project manager and analyst, and I worked for Gene Altus, who then worked for the CEO, Dr. Loop. After a career doing project management and really understanding how this organization worked in a multitude of different ways, we called it managed care operations, and today it's market and network services. But it was understanding the different contracts we had. This is the HMO era, so we had a lot of referrals that needed to be put in place to be able to deliver care at a tertiary entity such as ourselves. This is prior to us having such a primary care workforce, it's something we delve into after understanding HMOs and the referral patterns. I worked there for a couple years, and then I was recruited to pediatricians to be a department administrator. After a couple years as a department administrator, this is where I think I met you, Dr. Bolwell. I was asked to be the division administrator and then transitioned to an institute administrator, as the Clinic transitions institutes. And then in working for a couple of different cost projects and things that represented large problems for the overall organization, I was asked to work in medical and surgical operations.

I was in medical and surgical operations for six years, and that's an entity that's changed a couple different times. I touched some services that are no longer in that space. I was recruited really to work for Dr. Wiedemann as the chief of staff. And then I had the opportunity, with his retirement, to support Dr. Beri Ridgeway. And it's just been an amazing journey. And I love it still, the same way I did from the first day I walked through the doors 20 years ago. I don't know how many people can say that about their job.

Brian Bolwell, MD: Congratulations, that's quite the success story. What two or three things have you learned along the way that have stuck? Clearly, we talked about the importance of trusting relationships. Can you think of another one or two things that you learned from pediatricians, or you learned from med ops, or anything? From being an administrative intern?

Corinne Ehretsman: I think the thing that sticks with me the most is building teams. Having highly integrated... People say high performing teams to me comes with integration. But through all of those roles, I appreciate you saying that it's a success story. I think any leader who's successful is only successful because they have an incredible team. I think a good leader puts together a good team, if the leader's bad, it's the team's fault, is not what I'm saying.

First and foremost, there's a responsibility to create the right environment, understand talent, and bring people together to support that leadership office. And that's really the linchpin of any success that I've had in any of these roles, is the incredible people who have wanted to work with me and helped really facilitate the success story. So, that's one of the biggest things that I always take with me. And every time somebody's promoted or recruited out of my particular team, it's always a little bit bittersweet. But there's the opportunities that when you find new in other talent too. I think you also have to just embrace that ability to recruit, retain, and promote. And live through all those cycles, and ups and downs. Because it all, at the end of the day, every team's always stronger in that next cycle. Sometimes those things are a little bit, unknown is a little bit scary.

Brian Bolwell, MD: Why do some teams excel and why do some teams really not? What's the difference?

Corinne Ehretsman: Because this podcast is a lot about leadership, I'll go there. And I do think if the leader isn't able to articulate a clear vision, it really is about clarity for the work at hand. I think it's hard for teams to function well. We talk a lot in the Clinic about team of teams. And it's interesting, there's different I'm sure interpretations of it. But first, my interpretation and my understanding of McChrystal, a team of teams is when a team can be far more agile and make a decision faster because the goal is crystal clear. It's not necessarily better sometimes than a hierarchical infrastructure. It's faster, and it might be needed for a certain situation. That more traditional structure sometimes is slower and heavy, and not always the right structure in certain situations. But you can see, depending on the problem you're trying to solve, sometimes you might need to leverage a different hierarchy.

And one of the things I see is it's hard for people to switch. If you made up your mind on the team of team structure versus the maybe traditional structure, it's hard to switch even if it's not working because you don't entirely understand the environment. I hope that makes sense. But that's where I see teams sometimes fall apart. My environment changed; my problem's a little bit different. The level of clarity I need to be successful, it has to maybe come from a slightly different model. And having permission to change that model to have clear decision rights can take time. And in that gap of time, sometimes that team can flounder a bit.

Brian Bolwell, MD: Well, I certainly agree with clarity of purpose. And the other thing, it's interesting, one of my favorite books by Covey is, Speed of Trust. And there's two keywords. One is trust, of course. But the other one is speed. And I do think that the more agile the team, whether it's a team of teams approach or not, speed becomes important. But the only way to execute upon speed is to have trust, psychological safety, have a cohesive team that feels good about being part of that team. A lot of this is the psychological benefit of being part of a high functioning team. I always like to say that a great team is a magnet for great talent. People want to join teams that are doing well and functioning well. You lead a bunch of other institute administrators who are all very important to service line success. How do you mentor them?

Corinne Ehretsman: I think the first thing is to understand that we're all integrated. And we're highly integrated, we're medicine. So really, it's rare that one service line or administrator's going to make a decision in a silo, that it's not going to impact other decisions, goals, people. That constant awareness and bringing people together to talk through and leverage each other and going back to the principles and practices of servant leader, you're never going to know it all. And really, creating an environment where we work together to solve the problems and have thought partnership, I think is one of the most valuable things that the administrators do. And they do that extremely well.

The other piece is going back to what we talked about earlier, is that authenticity and that trust and that integrity, and making sure they have the opportunities really to build that within their own teams. And how do I best support them on their journey? And the thing that keeps me up at night always is, how do I best support those individuals who rely upon me in this leadership role? What do I need to provide for them, invest in, do differently? Make sure that they support themselves in their own offices. The one thing about administrators is they tend to think of themselves less, because they're so used to solving everybody else's problems. That they'll be up all night working to make sure that everything else works. And there's a little bit of investment I can do to help them invest in their own offices so that they can have sustainability and work-life balance, and make sure that we don't run into issues with burnout. And just keeping that top of mind, because I think that is part of my role.

Brian Bolwell, MD: Yeah, I think that's really important, and I fully agree with that. Your position is one of the most important in the entire clinical enterprise. Tons of success in a relatively short period of time. Where do you see yourself five, 10 years from now? If you ever think about that?

Corinne Ehretsman: We talked about, working for the Cleveland Clinic, from the day I started I still very much get a lot of energy and joy out of my role and being part of this organization. I think the Clinic has challenged me to answer that question with, I'd like to continue to impact healthcare beyond the walls of the Clinic. If there's an opportunity after the clinic for me, it would only be one that would really change and influence healthcare on a more global platform. And just to see really what happens next. I can't imagine working for another healthcare organization.

Brian Bolwell, MD: As we're winding down, Corinne, I always ask, do you have any closing thoughts about your own career or your own views on leadership that you'd like to share?

Corinne Ehretsman: We talk a lot about it today. And I think being a leader, I think the success of your leadership comes from being able to really build those relationships and trust. And I don't entirely understand my success story, and I appreciate all the things that you have said. I've been given unbelievable opportunities, and hopefully I've done those who have afforded me those opportunities proud. And I just work hard every day to just continue to give back in that.

Brian Bolwell, MD: Well, I think you certainly have made all of those people who gave you opportunities quite proud, Corinne, because your success is totally deserved. And as I said, it's always been pretty cool for me to work with somebody with such integrity and talent. Thank you for joining us. To our audience, I hope you enjoyed today's conversation, and I look forward to our next podcast. Have a good day everybody.

This concludes this episode of Beyond Leadership. You can find additional podcast episodes on our website, clevelandclinic.org/beyondleadership, or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcasts. We welcome any topic ideas you may have for future episodes, comments, and questions about this or any past episode. You can let us know by emailing us at executiveeducation@ccf.org.