Fail early, Fail often: Learn to Fail to be a Better Leader

Podcast Transcript

Brian Bolwell, MD: This is your host, Dr. Brian Bolwell, with a message for our listeners. In the following episode of Beyond Leadership, you'll hear Dr. Robert Wyllie and I discussing information related to the COVID-19 pandemic, and how it has played out in the state of Ohio. As a disclaimer, this episode was recorded in mid-December 2021, prior to the surge of the Omicron variant. Any statistics and numbers referenced regarding COVID-19 were relevant at the time of the recording. Thank you very much.

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.

In today's episode of Beyond Leadership, we're discussing a lot of different leadership topics with our Chief of Medical Operations at the Cleveland Clinic, Dr. Robert Wyllie. Bob has had this role for quite a while, and has been instrumental in the response to COVID for the entire Cleveland Clinic Healthcare Organization. Bob, welcome.

Robert Wyllie, MD: Thank you, Brian. It's a pleasure to be here.

Brian Bolwell, MD: Bob, why don't you share with our listeners a little bit about your background and how you ultimately came to this role?

Robert Wyllie, MD: Sure. I joined the clinic a few years ago, in 1981, and was the first fellowship-trained pediatric gastroenterologist. I always had the ambition of starting a fellowship program and heading a department of pediatric gastroenterology, and eventually heading a children's hospital. That was through my experience through residency and fellowship, and what I thought the opportunities were and the type of leadership skills I thought I brought to the table.

I eventually did start a fellowship program. I started a department of pediatric gastroenterology. I was the first chair of the department. As chair and the only member, that was fairly easy. Subsequently, the department has grown to 15 staff at this point. Although, and I still participate clinically, I became an Institute Chair in 2006 and that lasted for five years. Then I was asked to become part of the administrative team by Toby Cosgrove in 2011, and I've been the Chief Medical Officer of the Cleveland Clinic since that time.

Brian Bolwell, MD: I didn't realize that you were the chairman of a department of one, which is yourself. That must have been highly challenging. But, I mean, what you've done in pediatrics has been very, very impressive. The Department of Pediatric Gastroenterology is certainly very well known, and very well respected. Then you jump to be the Chairman of all of pediatrics. What was that progression like for you? What tools did you need to develop to become an effective Institute Chairman?

Robert Wyllie, MD: The skillset for leading a department of 10 or 12 people is quite different from the skillset needed to lead a group, an organization, as large as an institute. So, at first I welcomed the opportunity, but I was a little bit like the deer in the headlights, in terms of the magnitude of the job. I tried to gain skills around HR skills, how to understand and lead difficult conversations, how to gain the trust of people, how to develop strategy and strategize around an institute's goals, and then how to work within the Cleveland Clinic with the other institute chairs, because it's a highly complex organization.

Most pediatric chairs, or the head of pediatrics hospitals work in relative isolation in a freestanding children's hospital. I saw, however, a significant advantage of being part of a larger unit. To give you an example, so a typical pediatric department of gastroenterology or children's hospital might have one or two people interested in hepatology, and maybe one or two in inflammatory bowel disease. When you come to the organization like the Clinic, you can lean on your adult colleagues, where you've got 20 hepatologists and 25 people interested in inflammatory bowel disease. You can have much richer discussions.

So, in terms of building the Department of Pediatric GI, as well as the Pediatric Institute, I tried to leverage that concept and build on that concept that really we had something special at the Cleveland Clinic. It wasn't a typical children's hospital structure, and to do that, I had to lean on and get to know institute chairs.

I want to tell this story, and I told Brian in the preview that I would tell it. That is, after getting named the Chairman of the Pediatric Institute, the first institute chair I went to talk to was the person I'm talking to now, Brian Bolwell. That was really because I'd seen him be successful. I'd seen him develop strategies in leadership, and I wanted to acquaint myself with him and understand what his thoughts were around institute leadership very early on, and I think that was very beneficial

Brian Bolwell, MD: Yes, for our listeners, Bob and I have been very good friends for quite a while, and I've deeply respected Bob's leadership for a long time. So, thank you for mentioning that Bob. Yes, I think that so much about leadership is building relationships, and I think that that all of the clinical leadership here, if they're effective, learns rather quickly, that they can't work in a silo. They have to know other clinical leaders, really, most all clinical leaders, and learn how to be transparent with them, and how to strategize together with them, and how to build trust. That's part of the true enjoyment about being in clinical leadership here in this organization.

So, Toby asked you to join the executive team in 2011. Tell us about that.

Robert Wyllie, MD: Well, each time I've taken a significant jump in leadership, meaning in my case, the Institute Chair of Pediatrics, and then I've had the pleasure of serving as the Interim Chair of Digestive Disease Institute, as well as Path and Laboratory medicine. I've committed myself to a full year of kind of staying in place, getting to understand the job, and that, the major part of that is getting to understand the people, what they're interested in, what their abilities are, and how to form working administrative units that can lead that organization forward.

I did the same thing when I came to Medical Operations. So, when I came to Medical Operations, I looked at the scope of the job, realized that I was going to need several individuals to become involved in Medical Operations on a staff level. It gave me the opportunity to promote people into leadership positions within the organization at an enterprise level, and then to develop them, and part of what I enjoy greatly, and I've seen you do this as well Brian, is developing other people and watching them take off, and assume other roles were within the organization. It gives me great pleasure to help them develop their administrative skills, their leadership skills, their leadership styles, and work with them in terms of gaining those type of abilities.

Brian Bolwell, MD: Yeah. You said a couple things that I think are very important. One is, when you have a career transition, I totally agree that I think initially, it's very important to listen, to just kind of go on a listening tour, and get to know the folks, and get to know what people do, and not assume that you know anything, because until you're there and you're actually part of the team, you probably don't know nearly as much as you might think do. So, the importance of being calm and being measured and being thoughtful about listening and learning how things are operating is I think, really important.

Then of course, the whole idea about building relationships. Again, it's not just with peers, it's also with everybody who you work with and everybody on your team. Both are really key, fundamental leadership principles. Actually, the listening tour part is something I'm still doing. I've got a new role myself, and I'm still trying, I mean, rather than come up with a bunch of tactics and strategies, it's probably a better idea to take your time, and to learn the scope of what's going on within whatever you're doing.

So, you did that. Again, we're in a complicated place, but you're in charge of Medical Operations, and what were the key things that you did learn and that you tried to improve on?

Robert Wyllie, MD: So, let me drop back just a little bit and say, what's the difference between being an Institute Chair and the Chief of Medical Operations, because they're quite different jobs, and they actually involve a different leadership style. So, an Institute Chair, if I was going to use three adjectives, I'd say is, has to be motivational, inspirational, and highly organized. When I moved into medical operations, I did it for one, because I was asked to join the administrative team. But secondly, I wanted to learn the other side of the organization. But for Medical Operations, it's being quantitative, analytical and organized.

So, I think you have to be organized in both, but it's a little different emphasis, in terms of what's expected out of leadership being an Institute or Department Chair versus an operational unit at the clinic. That would involve hospital presidents, who have obviously, there's overlap between these two, because hospital presidents have to be motivational and inspirational, but they all still have to be those other things, quantitative and analytical and strategic as well. So, it's be being comfortable switching gears a little bit for me, in terms of medical operations, and then knowing what my job was.

To do that, I think you have to be kind of confident and comfortable first of all, in your own skin. I think trust is the heart of any leadership position. Then, you need to try to differentiate yourself on the basis of being authentic and being comfortable with yourself, and then not be afraid to take on challenges, particularly in an operational role. So, an operational role can be fraught with pitfalls. You may start up a project which doesn't work. But you've got to be quick to start a project, and you have to be quick to start to stop a project as well and say, and I encourage people to fail early and fail often, because you're going to learn every time you fail, and then you can tweak the process, and then you can move on again.

The other thing is to have confidence in what you're suggesting, and to have confidence you're going to need to build a consensus. That usually starts out with people who are, you work with that are fairly close, and then you go to people who are supporters. Then the last thing I typically do is go to people who I know probably aren't going to like the idea necessarily, and we're going to get pushback. You have to know about the timing of that, obviously, because they can also provide you valuable input, so they can help you anticipate where you're in front of a larger group, what the objections or the concerns are going to be, and to build that into your plan up front. So, as you're bringing plans forward, whether it's this is on an institute level or an institutional level in operations, you've got things pretty well lined up before you're ready to present.

Brian Bolwell, MD: Those are all really good points, and certainly one of the most important I think is being willing to try things that are different. It's okay to fail. Google is referenced many, many times by stating that very fact, that if you're not trying different things and if you're not failing every now and then, you're probably not very effective, because you're not being willing to be innovative and different, and really inspired to change for the better.

But the other thing you said, it's not just about failure. It's also about admitting when it's time to pivot. One of the things that was taught to me when I was in training, back when I was a resident, I remember this line very well. Somebody told me in academic medicine, bad ideas die hard, and I have found that to be true.

A lot of times people come up with an idea, and they might take forever to come up with it. Maybe it's a good idea, and maybe it's a bad idea, but if it's a bad idea, they don't want to let go of it. They don't want to admit that it's a bad idea. So, they keep trying to squeeze this idea into something that it just won't fit into. I think having the confidence and the authenticity, as you mentioned, and the honesty to admit if the idea isn't working, and then to pivot out into something else is really important. I'm really glad you brought that up.

So, give us an example of one of the challenges that was a significant thing for you, and tell me about a success. You certainly have had very few failures, but if you can think of one, tell me about one of those too.

Robert Wyllie, MD: Oh, I've got lots of those, but let's start out with the good news. The good news is looking at hospital transfers and we, when I started Medical Operations, we were transferring about 200 to 250 patients a month from the free-standing EDs, from one hospital to another, and from outside the organization to inside the organization. We had a fairly complicated process to get transfers in. We didn't have a 24-hour line that could answer transfer calls. We didn't have physicians talking to physicians, in terms of selecting the transfers and making sure they got to the right people, and were quickly accepted. We had some challenges around financial clearance, when really we were taking everything, but some patients who were out-of-state Medicaid, for instance, where we would not get reimbursed if we didn't have prior authorization in Medicaid, and a few people who were thinking about transplants, but were really not transplant candidates.

They needed to be evaluated, so they didn't come and have it be a useless experience for them and their families. So, we began to change the financial clearance. We began to just say, yes. We put doctors on the phone 24 hours a day to receive those calls. We went up from 200 to 250 a month, and currently we were running about 3000 transfers a month. That took a long time, because obviously, it would be easy with 3000 transfers a month to fill the main campus. So, we had to develop the other hub hospitals in terms of getting them to take transfers and convince people, particularly from outside the institution, that if you transferred to Hillcrest or Akron or a Fairview hospital as a hub, it was the same thing, with the same quality of care as the main campus. So, first we had to get that messaging out.

Then we saw some resistance, and we had to talk through all those people who were thinking about gee, if I can't come to the main campus, maybe I'll go elsewhere, that it was okay, and then get back to them about the experience. So, that turned out very well, and we transferred into our medical hubs. During the COVID crisis, we transferred to all our hospitals, including the Critical Access Hospital in Lodi, to even of patients in.

In terms of a challenge, trying to get patients discharged earlier in the day. I have a whole diagram of all the projects that I've started and stopped, which didn't work, including the 10 by 10, which has gotten a significant reaction institutionally, if I ever mention it again by the doctors to get 10 patients out on the main campus before 10 o'clock.

Writing orders early. We hired a driver to take patients home, and found out that CMS didn't like that idea. We were going to put them in a limo for a ride home. Not a fancy limo, but one of the standard ones where it would be comfortable for a patient. They said that was inducing the patient to leave the hospital. So, we had to rent vans instead, but we put many things together. We even gave people lunch on the way out the door. So, we had many different ideas and processes. None of them worked particularly well to get people out earlier. We just started a brand new project in the last 10 days, where I'm always hopeful that it'll work. This is with an outside organization called Palantar, which has a computer model called Foundry, which can operationalize data.

This is all about trying to shorten the length of stay and get people out a little quicker. The reason for that is we have tremendous demand for our services, and if we believe as an organization that we provide the best care, it's our obligation, to some extent, then, to be able to open up care to everybody who wants to come. Right now, we're not quite there. So, it's pushing the system a little bit to move patients through quicker and a little bit more efficiently, so that we have the opportunity to touch more lives.

Brian Bolwell, MD: Well, I think the transfer project that you talked about has been an enormous success, and kudos to you. Actually, Bob has a huge number of successes throughout, and hopefully this new project about early discharge will yield some benefits. It's, so complex and there's so many challenges to it. I know it sounds simple to somebody who's not actively participating in inpatient healthcare, but we're going to stay optimistic.

Bob, you've been in charge of the organization's response COVID, and when I think about this pandemic, I think about it in several stages. I think that, early in 2020, we had a couple really big challenges.

One, was we didn't understand the virus very well, and one was just supply chain stuff. Did we have enough PPE? We really didn't have testing initially, and we had to kind of craft that ourselves. Certainly, one of the initial challenges is we didn't have any idea about the scope, and we were worried that we would be totally overwhelmed by patients with COVID, and you coordinated in all of that. Then, subsequently, when we had a little better handle on the virus, a little better handle on supply chain, we've had obviously waves of COVID. Can you walk us through the different stages, because I think the organization's response has been exemplary, and that's been led by you.

Robert Wyllie, MD: Thanks, Brian. Obviously, in wearing that hat being led by me, I'm representing a whole bunch of people, hundreds of thousands of people, who have participated heavily in terms of a response. We became concerned in terms of looking at the television pictures and the news media coming out of Asia, particularly China, and Wuhan early on in December of 2019. I actually canceled a meeting I had in the early part of January, because we were prepping, the clinic was prepping to get ready for the possible first case, and then a significant pandemic, which we thought there was at least a significant possibility of with our early modeling. So, one of the things we did first was began to, we began to hold on to expired medical supplies, and you may say, well, why would you do that? Well, it was masks and gloves and everything else.

I met with Bill Peacock in Operations, and we began to pull back on sending those because we thought, we sterilize them. We did that very early on to try to preserve our PPE, because China makes over half the PPE we typically use, and they weren't sending anything, because of their own challenges with the pandemic. So, we knew we were going to be in short supply. The other thing was to develop supply lines, which are independent of our typical suppliers Amerisource Bergen for drugs and Cardinal for medical supplies and look outside and see where we could contract ourselves. Now, that did work early in the pandemic. Later on, when everybody became stretched to provide their personnel with gloves and masks and gowns, everybody was trying to do the same thing.

So, as an organization, we were competing with other organizations, not only healthcare delivery systems, but also cities and state governments and the national government for supplies. So, that, looking towards what we're going to do in the future, we're currently working with Washington DC to develop a national response, as opposed to everybody internally competing for limited supplies.

We also went down and was invited down by a Governor DeWine with a couple other healthcare delivery systems, and asked how to manage the pandemic. We actually suggested that we divide the state into zones, as opposed to eight emergency regions, because the emergency regions didn't really follow the lines of referral. So, the lines of referral in Ohio are obviously Cleveland, Columbus, and Cincinnati.

That's where the beds are. That's where the medical expertise is, in general for tertiary care and above. We knew that there were going to be a lot of ventilated patients. So, how did we divide the state?

The second thing we began to look at and suggested on the state level and we did after I was appointed head of the Zone One, which is the northern part of the state about five million of the 11 million people in Ohio reside there was what's the coordination between the local county health department and the local hospital, and then the long term care facilities, whether they're rehab hospitals or LTACs or nursing homes, where people just live and have residents, and who could they rely on?

So, we started to create a triad of those three. As part of that triad, we listed all the nursing homes. We listed all the employees. We listed all the residents. We put them on spreadsheets. We listed their PPE and along with the state, then we created a virtual stockpile of equipment. The Cleveland Clinic sent PPE and ventilators to other hospitals, rather than sending all the patients. If they were short of a ventilator, we would send them a ventilator. Later on, as the, we learned that the national supply of ventilators was gone, and over time, there was production of more ventilators and the state does have a supply. So, now we use the state to do that, but it was coordinating all the activities around the state, and then load-balancing, because sure, the Cleveland Clinic had a lot of capacity, but not enough capacity for thousands and thousands of new patients.

So, we peaked in Ohio at about 5,300 COVID admissions. This last surge we've had nearly 3,800 COVID admissions. We still have 315 this morning at the Cleveland Clinic, in terms of inpatients. So, still a significant burden. But we couldn't take all the patients, so we developed a zone call where every hospital in northern Ohio would participate in a call initially, three times a week. Now it's down to one time per week, where we talk about our patient status, the patient positivity, how much PPE we have, and do we need any help? Do we need help with equipment?

Do we need help caring for patients? We got our ICU people to look and do telehealth kind of consults to other people in ICU, so that they could manage COVID patients, and we wouldn't have to take them. But essentially, it was load- balancing. I'll give you an example. So, the Elkton Federal Penitentiary in Columbiana County, on the eastern part of the state, has about 2,400 inmates and 300, 350 employees. Just after we had our first patient in March, in Ohio, they had an outbreak over six or eight weeks with 1,200 people becoming infected, because you can't socially distance, and there was not adequate PPE. We really didn't even understand the transmission at that point. So, you've got two small hospitals Salem and East Liverpool in that county. They quickly became overwhelmed, but just telling them, we're not going to let you become overwhelmed. If necessary, we're going to transfer to Akron. If Akron becomes full, with Cleveland, the Akron City Hospital, as part of the Summa system and Akron General Hospital's part of us, we're going to transfer you to Cleveland, and we're going to divide the patients between University Hospital, Cleveland Clinic and we're going to have some go to Metro as necessary, and even St Vincent's was involved.

So, that's what we've done since the pandemic, is try to help people manage patients where they are, provide them with appropriate supplies, or make sure they get them, make sure that we can handle outbreaks among the elderly, where they're living in skilled nursing or long term care facilities, and then load-balance across the system.

We're still doing that today. On a call with the Governor's office and the Ohio Department of Health this morning, we talk about what are we going to do with this structure, because it worked so well and better than almost any of the structure statewide in the States, the United States. We want to preserve that capacity moving forward. So, how are we going to do that? So, more to come on that.

Brian Bolwell, MD: That's truly fascinating. So, let's expand upon a couple points. Back in early 2020, our projections were that we weren't going to peak in the hundreds. We were going to peak in the thousands.

Robert Wyllie, MD: Correct.

Brian Bolwell, MD: So, we actually, we built an emergency hospital. So, tell us a little bit about that.

Robert Wyllie, MD: The initial projection came from a model built by the University of Pennsylvania. We actually tweaked the model and sent it back to them to get more accurate projections. But those initial projections were based on the infectivity of the virus, the population that was susceptible. Essentially, no nobody was removed from the population at that time, because nobody was post-infectious, and there were no vaccines.

So, we had a model which suggested that we might be, have as many as 8,000 patients potentially, if things really didn't go well, and we didn't do anything at all. We actually presented that to the Governor, and that led to the Governor being comfortable with the idea or assisted in becoming comfortable with the idea that, gee, there may be a lot of patients in Ohio, and that things needed to be done.

So, within quick succession of the first patient in Ohio, he did three things which altered that projection. So, one was, he put an emergency order in that essentially closed the schools so to stop limited transmission. He had, travel was restricted to essential travel, including going to the store to get food, and essential workers and those type of things. But, those came out fairly quickly, and that actually mitigated the worst-case situation. It's hard to explain that sometimes to that to people. Well, you said there were going to be 8,000, but they weren't. Well, fortunately there weren't. That's, we didn't want to get to 8,000. 8,000 is if we didn't do anything at all to mitigate the virus. He also put a mask order into effect, which is the third thing he did. Those three things in Ohio, dropped our infection rate early in the pandemic to much lower than the other states.

We weren't like New York, which blew up and was in a crisis medical situation, trying to manage their patients. We weren't like California and Washington and Oregon, which had a huge problems, because that early intervention by the state government. So, I think that was very helpful. Moving on, then, they relaxed those orders, and then we saw second peak. Then, new orders kind of had to come into place. But over time, it became a political issue, which has made it more difficult to manage as well, as people have lined up on one side of the political spectrum or the other around masking, and I think we're all aware of that. Certainly, whether we should mask in school or whether we need the mask in public or whether we're indoors or not. Obviously, with vaccinations, there's still about a quarter of the nation, which is pretty adamant about not getting the vaccine.

Brian Bolwell, MD: Yes. Well, that's very true. So, just to give some perspective in northeast Ohio, what is our total bed capacity in the Cleveland Clinic enterprise?

Robert Wyllie, MD: It's about 3,500 beds, 3,700 beds. That got into your thing about why did we build the Hope Hospital, is we were afraid that we would be, simply run out of rooms. The first thing we did was to look at every spare space within our current chassis, inpatient, outpatient. How many beds could we stuff in corners? University did the same thing, as did Metro. We essentially almost doubled the number of beds that we could offer. We went up, so that we could put people in about 7,000 to 8,000 bed spaces. University doubled their number of potential beds, and Metro increased it as well. That was all in preparation. So, fortunately we didn't have to activate the Hope Hospital, although the piping inside with the oxygen lines and the rest of it remains intact. It's all behind the scenes right now, but it's a great space, and if we ever get to the unfortunate situation of a huge emergency, that we could reactivate within several weeks.

Brian Bolwell, MD: The Hope Hospital, for our listeners, was constructed where I'm sitting, which is our big education building here on campus, the Health Education Center. It was a astounding, rapid construction of a inpatient hospital facility, and basically an educational chassis. Fortunately, we didn't have to use it, as Bob mentioned. I think that the coordination with the State of Ohio is a fascinating story, and certainly, the Governor's initial response was extremely important, as you said, to mitigate a lot of the stuff that we didn't see that happened in other states. Where are we today?

Robert Wyllie, MD: Today, we're coming off a peak, just one month ago of 3,742 patients hospitalized in the State of Ohio. This morning, we're down to about 2,600, so a significant drop by about a third. The Clinic has dropped from peaking at just under 500, and our projection was actually 500. We peaked at 498. So, pretty close on that one. We're down to about 315 this morning. The models at the CDC and our own modeling show that we're going to continue to drop. We're a little concerned by the surge in the United Kingdom, and I've talked to Brian Donley, our colleague in London about that, because they're seeing a significant rise, one of the fastest in the world right now, in terms of the number of cases diagnosed. Now, they do have a robust monitoring, and testing, which we don't do. So, they test about 4 million.

They give about 4 million people tests a day. In the United States, we give about 1 million, and they're about a quarter to a fifth of our size, so you can put the relative numbers together. They're starting to lead to some increase in hospitalizations. The reason we're concerned is because they have a higher vaccination rate than we do. So, we're, I'm very glad that the government is, has approved boosters, because I think that'll help mitigate the waning immunity, which looks like it's there for the Pfizer, and to a little, probably, a lesser extent, the Moderna vaccine, but present in all three. So, we're moving ahead with that. Over 11, 12 million Americans, as of this morning, have had the booster.

Robert Wyllie, MD: We have a long way to go, but we'll get there over time, because we want to prevent another surge. So, what's going to happen in the future, whether this is going to become a chronic, recurrent disease like influenza or something else, it's not clear. I'm pretty sure we don't understand the full biology of this virus, because we can't explain why surges go up, why they plateau and why they go down. It doesn't appear to be seasonal, because in July and January, we've seen the South have a surge. This one is a little bit clearer, because it went from the Southern coastal states, up through Tennessee and Kentucky into Ohio.

Now, it's passing out of Ohio, and moving into the Northeast, which is seeing a less effect because of the higher vaccination rate, but certainly Michigan is starting to light up. So, we've seen it travel this time, also going from the West, from the Washington and Oregon, Eastern across the Plains States as well. So, it's clearly going down nationally. It's going down in Ohio, which is good news, but we have to continue to pursue vaccinating people, and make sure we take care of the kids in school. I anticipate the pediatric vaccine for ages five to 11 will be approved by the CDC next week.

Right now, we're holding slots for immunizations, for pediatric cases, and we're going to give it in 80 of the primary care sites, as well as all our mass vaxx sites, will be open to vaccinating kids from five to 11. What we anticipated, if the CDC makes a decision on Friday night, we'll start vaccinating either Saturday or Monday.

Brian Bolwell, MD: Which, in itself is a very impressive feat. What do you think things will be like next year? I mean, everybody wants to know when will things be normal? Will we ever be normal again? Will we ever not be dealing with this? I mean, influenza's something that we take a shot every year around this time, and that's pretty much it. Hopefully, we don't get the flu. This is a more deadly virus obviously, and the stakes are higher. What do you think, how is this going to play out?

Robert Wyllie, MD: I don't know. My crystal ball has some mud on it. I can't see quite clearly through this one, but certainly the, certainly the vaccines are going to help. Are they going to totally mitigate it? It's unclear. About a third of the world's population has received at least one vaccination at this point. Two-thirds haven't. As we all know, when the virus replicates, that's when it can produce variation. We're all kind of crossing our fingers that, in a good luck sign, that we don't get a variant of concern that starts to escape the vaccine, and is no longer susceptible to the antibodies produced by the vaccine.

But, when we have this much virus replicating in people around the world, it's always going to a possibility, which is why this is more than an Ohio problem or a US problem. If you get people vaccinated, then they, particularly with the booster doses, your chance to getting infected goes down by tenfold. Your chance of getting hospitalized goes down by twentyfold. But if you're not infected, the virus is not going to be replicating, and we'll have fewer variants. So, it's going to depend on that race, and how effective the virus is in producing a variant that starts to evade our vaccine.

Brian Bolwell, MD: You mentioned that the State of Ohio was very pleased with the whole organizational structure of how the hospital systems have worked collaboratively to try to manage the pandemic, and that they'd like to continue this going forward. Will this sort of cooperation extend to other diseases, or it's strictly kind of a response to this particular, unique situation?

Robert Wyllie, MD: I think it'll extend to hospital capacity, at least in the near term. So, I think we're all aware right now that the United States and certainly Cleveland Clinic is challenged by the lack of nurses, as well as respiratory therapists, other professionals, and even people in environmental services and security. We've heard in the news that a lot of people are changing jobs and staying home to care for their children. There's not necessarily the same level of daycare or the same volume of daycare operations that there were in the past, because people are also reassessing kind of their life and their work life balance.

So, this morning's discussion really centered around, do we need to rebalance hospitals period, not in terms of saying you have this many beds and you have that many beds, but saying, look, if everybody is constrained because of staffing issues, and we have somebody who really needs to be transferred and can't wait ... And they're in an auto accident and somebody simply doesn't have the ability to care for them, can we use this system for that? Actually, we're already doing that, because we're not only load-balancing COVID patients.

A lot of the patients who we load-balance are actually not the COVIDs. The COVID patients are staying in the hospitals. Most of the time, we're transferring typical medical-surgical patients to load-balance. That way, nobody feels like they're being put upon by taking "all the COVID patients," and all the PPE requirements and everything else, which goes along with that, as opposed to leaving the COVID patients where they are. Except, if we can do things that that outside hospital can't do. ECMO being an example of that, but just routine ventilation and those type of things, patients can typically stay in their local hospitals, and if they get overwhelmed, we can start to move other medical-surgical patients. That's what we've done throughout the last 18 months now.

Brian Bolwell, MD: It's a truly fascinating story, Bob, and again, kudos to you and your team with how well we've handled this response collectively, but it's certainly been led by you. Wish we had longer to talk about it, but as we wrap up, can you think about a few key leadership points that have been very important to you, and helped you navigate all of these challenges so successfully?

Robert Wyllie, MD: I think as I started out with, I think being authentic, looking at what you know, and what you don't know. Listen to other people. Get opinions. Develop trust. I think all working relationships that work well within an organization are based on trust between the people who are working together. I think, don't have fear in trying new things, and don't have fear of speaking out. The only way to make progress in an organization like the Clinic, or most other organizations, is to put yourself out there. Have confidence in your own abilities, but say what's on your mind, even if it's sometimes not what people want to hear, because that's, if you want to rise in leadership, I think that's what people are looking for. Is looking for people who will be honest, not try to undermine, but be honest in terms of their perception of what's going on and how things could be made better.

Brian Bolwell, MD: I totally agree with that. It's often very difficult to say something that might go a little bit against the mainstream or the collective wisdom, but I do agree with you. I think that's what executive leadership is actually looking for, and will generate respect, and as part of the authenticity that you speak of. This has been a truly wonderful podcast. I wish we had longer. It's a fascinating topic, and always a pleasure to spend time with the wonderful Dr. Robert Wyllie. So, thank you very much.

Robert Wyllie, MD: Brian, that's mutual. Thank you.

Brian Bolwell, MD: Thanks everybody for listening, and we look forward to our next podcast with all of you present. Have a great day.

This concludes this episode of Beyond Leadership. You can find additional podcast episodes on our website, 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.