It Is Not About You - Brian Donley, MD, Cleveland Clinic London CEO

Podcast Transcript

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

Brian Bolwell, MD: In today's episode, I'm delighted to be joined by Brian Donley, CEO of our Cleveland Clinic London. And we'll talk about his leadership journey, as well as his philosophy about leadership. I know that Dr. Donley is a student of leadership, and has read an awful lot about the topic, and it's always fun to talk with him about it.

A bit of background on Brian. He joined the clinic in 1996 as an orthopedic surgeon, and has had a bunch of leadership positions subsequently, including being president of one of our regional hospitals, president of all of our regional hospitals, and ultimately, was chief of staff prior to becoming our CEO of Cleveland Clinic London. Brian, welcome.

Brian Donley, MD: Brian, thank you so much for having me. It's nice to be here.

Brian Bolwell, MD: Can you tell our listeners a little bit about what Cleveland Clinic London is?

Brian Donley, MD: Sure. Cleveland Clinic London, in many ways, is a story, I think, of the Cleveland Clinic. Most of us, hopefully know, the clinic this year, it's our 100-year anniversary, and I think what all of us are proud about as all of us reflect on that hundred years is all that we've accomplished for patients. And essentially, what I think Cleveland Clinic London represents is our desire to be actually great for another hundred years by continuing to do what led to our success over the first a hundred years. And I think that success has been around a passion to learn and be better for our patients, and a passion around innovation.

And so, what Cleveland Clinic London really at the core is, is our desire to want to learn, innovate, and be better for our patients. That's why we made this investment. I think the question is why London, and the reason we came to London is because there is a great healthcare ecosystem that's located in London. And when you think of the research capabilities here, which certainly, has been key to Cleveland Clinic's success for our patients, it's a great part of an ecosystem we can join. And so, it's our desire to be a part of that.

Now, that's the big picture of what we are and why we made this investment. Getting into the nuts and bolts of that, we're developing 184-bed hospital with 29 ICU rooms. And we're building this here behind Buckingham palace. As we know, we are focused on complex interventional care that we do in Cleveland, and that's what we're bringing to London. Back to that first part about learning and innovating, it's why, what we're doing here is we are not, and I'll repeat, we are not bringing the Cleveland Clinic to London, we're bringing the best of what we do, and we want to integrate with the best of UK healthcare. That learning and innovation brings together to the Cleveland Clinic London model, which then, we can spread back across our organization, back across our 70,000 caregivers that every day are focused on how we can help patients.

Brian Bolwell, MD: Say a little more about that. What makes the healthcare ecosystem in London and the UK distinct and different from what we're used to at the Cleveland Clinic here in northeast Ohio?

Brian Donley, MD: Yeah. I think there's a lot of differences, and whenever we see differences, whether it's actually in your team, whether it's in your organization, whether it's in your geographical area, those are opportunities to learn. So, the differences here or the big differences, it's a nationalized health system. It's free care at the point of delivery, for every citizen in this country. That actually is a different model than what we have in the US, but similarities to what the Cleveland Clinic has.

And the similarities are around a culture of research and education. It's also similarities about the fact that all the physicians in NHS are salaried, so their focus and effort, and that type of setup is purely around team care for the patient. And that matches well to us in the Cleveland Clinic.

Brian Bolwell, MD: Obviously, the UK is having challenges with the coronavirus, it has for, really, since last February. That's clearly affected what we're trying to accomplish there. Can you educate our listeners about what that has looked like, and what's going on right now?

Brian Donley, MD: Unfortunately, there's been a devastating effect of the virus here on the UK, and certainly, here in London. Over these past 10 months, we essentially on our third lockdown here in the UK. The other differences that you see in the UK compared to America is a centralized approach. And so, things are much more centralized. There's advantages and disadvantages to that, and the fact the whole country comes under lockdown, and that's quickly within a day, goes across. What we're seeing now is essentially all venues are closed, except for takeaway food restaurants, and a very small definition of essential stores, all in an effort to combat the effects of this COVID virus.

There've been record, unfortunately and sadly, record numbers of deaths have been occurring over these last several days. The admissions into the hospital are... The NHS trust, which is the hospitals, are packed, unfortunately, with patients. The encouraging news is in the last couple of days, the actual case rate is starting to dramatically come down from the effects of the lockdown. So, we are hoping that we will see the inpatients and the deaths follow that as you would expect.

Brian Bolwell, MD: I'm not sure when this is going to end. So, I guess one question is our hospitals due to open in, when exactly?

Brian Donley, MD: So, our hospital will open in... Not that we're counting, but 52 and one half weeks exactly.

Brian Bolwell, MD: So, about a year from now?

Brian Donley, MD: Yeah, about a year from now, January 31st of 2022. And our outpatient operations will open in September of 2021. About nine months.

Brian Bolwell, MD: One thing that's unanticipated, of course, is having to do COVID testing, and potentially, having to treat COVID patients. How do you gear up for that when, really, it wasn't part of any of the advanced planning?

Brian Donley, MD: Yeah. I will tell you, Brian, I think for all of us in all of the different roles that we play in healthcare, and even outside of healthcare, where we certainly learned, I think, the importance of flexibility. We learned, I think, the importance of having a growth mindset to your leadership group, opposed to a fixed mindset. And this is just one of many things that, obviously, we've had to pivot on, and bring this into the program as we are continually focused on this opening date.

You know, other things... Just for example, that we've had to be very flexible on is just as recent as late November, early December, we had had our plans in place for our recruitment. We need to add 800 people to the team in the next seven months. And certainly, when you recruit, it's critical you've got to culture, and it's critical that that has to be in person. Rapidly, over the holiday, we realized this cannot happen in person. And we've pivoted that recruitment to a complete virtual recruitment, and had to change the focus. So, instead of one person interviewing in person, now, we've had to bring two people from our team to have interviews with everyone.

Instead of having a group interview in-person, we've developed scenarios so that we can get to try to know that person better and make sure for their benefit, and our benefit, that it's a better match. And we had this focus of doing these big groups every other week. Now, we do them every week. So, a lot of flexibility. And I think all of us are familiar with that over this last year.

Brian Bolwell, MD: When you conduct your interviews, what are you looking for?

Brian Donley, MD: Well, that's the one thing that doesn't change. I think through this pandemic, and I don't think the principles of recruitment or leadership are different, they're just dramatically more important over these last seven months. We look for the same thing, and we concentrate hard on our values. And one thing that we've done here, we concentrate hard on our values, and we concentrate hard on our purpose, our meaning and purpose.

One thing we're really thankful for is, prior to the pandemic, we brought our leadership team together probably two years ago, and we've had a whole session about what is our purpose at Cleveland Clinic London? Why are we here? Is it to build this unbelievably dramatic 322,000-square foot structure and to look at it and touch it? And the answer to that is absolutely no. It's not about this building. It's incredibly impressive, it's right behind Buckingham Palace. That's not what we're here for. And we're here for nine words, we're compassionate caregivers transforming health and care for the world. That's what our purpose is.

And then, we talk about our seven priorities, and who do we do this for? And as an organization, we know we do this for our patients, for each other's, caregivers, for our community, and for our organization. And then, how do we do this work? All based on our value. It's our values of quality and safety, of empathy, of teamwork, of inclusion, of innovation and integrity.

Brian Bolwell, MD: One of the things you mentioned earlier, Brian, was a growth mindset of leadership, as opposed to a fixed mindset of leadership. How would you define that?

Brian Donley, MD: I think two words define it, for me, and those are curiosity and humility. I think both of those are critical words to leadership, having humility and curiosity. And I'll tell you, for our team, in coming over here and coming in to a different culture, a different country... And don't forget, we're very proud of the Cleveland Clinic, we're 100 years old. The Royal College of Physicians here started in about 1550. So, they got a little jump on us from there. So you better have some humility, and you better be curious because you can learn a ton from a place that has a nearly 500-year history. So, to me, it's humility and curiosity.

Brian Bolwell, MD: One of the challenges in a variety of specialties for the NIH is access. Access is certainly a big deal to us, and to the whole Cleveland Clinic. How are you planning to manage access over at Cleveland Clinic London?

Brian Donley, MD: Yeah. And certainly isn't access... We know that's a worldwide challenge. I don't have the golden ticket to solving access. I'll tell you one thing, one tip maybe that we try to use, and actually, to be honest with you, Brian, I learned this from you, because you have always been about time to treat. For us, it's more than just cancer as a full service hospital that we'll have, but the two words I think about is time matters, and use that kind of an orientation of what's important, and whether it's access, whether it's why are we taking longer to get someone the results from their tests, why they have to sit there for three days and wonder whether there's a nodule on their chest x-ray, time matters.

I think, in my leadership, I never... I mean, I know for sure, I don't have the answers, and I'm not saying that with humility, that's just with all honesty, but it's what you can do to allow these wonderful people in our organization to achieve all that they can achieve. And so, if you ask me about solving access, I don't really have the execution to that, but hopefully, set the parameters to allow these wonderful people to achieve that.

Brian Bolwell, MD: Yeah. I really like the concept of time matters, because it does. I remember 20 years ago, when I first started to read about leadership, there was a quote from a cancer patient who said, "You know, if I only have five months to live, then, waiting six hours to get my chemotherapy is a really big deal to me." I'll never forget that. But I think it's true, as you said, in all specialties.

To pivot, one thing I learned from you, and I increasingly think it's a core leadership principle in healthcare is... The Cleveland Clinic is somewhat unique in our total passion for patient care and patients first, but you always said the employees are just as important. And I really think that's true. I think if you hire really good people and you support them, it's kind of the concept of serving leadership, and they're engaged, then, a lot of good things happen as a result.

How are you going to try to generate that kind of philosophic approach to Cleveland Clinic London?

Brian Donley, MD: A couple of things, and I'm really passionate about this, as you know, so please, feel free to cut me off if I go too long.

I remember hearing a statement, I'm not sure how eloquently it was stated, but the general statement is customers won't love your company unless your employees love it first. I think that's what you're saying when you say that. Here's how I think about it, is what does every person who works want; and what do they need out of their work. There's a lot written about this. The person I like is a gentleman named Daniel Pink who writes about this. He talks about three things, mastery, autonomy, and meaning and purpose. Autonomy is around delegation, and as a leader, I think a lot of people, I do, constantly struggle with being a better delegator and accountable.

Mastery and meaning and purpose are the two I really, really concentrate on. Mastery is about providing people opportunities to learn and grow, and meaning and purpose is -- every person wants meaning and purpose in the work they do. And I have seen that time and time again at every single level of the organization. And you name any level, from the chief exec to the absolute frontline person there, everyone wants meaning and purpose. So I think the way you get employees to be engaged and love their job is make sure you can connect meaning and purpose.

We try to do it here in Cleveland Clinic London through those nine words. Every person sees if I do my job, I'm helping this organization achieve that priority. That's me, the work I do today. It sounds maybe fluffy, Brian, but for me, it's about driving meaning and purpose, and it's about opportunities to learn and grow.

Brian Bolwell, MD: I don't think it's fluffy at all. I absolutely believe that it is essential, and it's essential in healthcare, and I think it's essential in every industry. I think that this is the problem with level-one leaders who are kind of command and control people, is that they don't engage their employees. And the whole concept of meaning and purpose, I think, is hard to achieve if you're going to basically give orders all the time.

Brian Bolwell, MD: I mean, you've got to have core values as you have discussed, but the man, you've got to connect. You've got to communicate and connect, and you've got to get great teams. We talk about team of teams here. One of my favorite quotes is great teams are a magnet for great talent, and I truly believe that to be true.

I guess that leads to the question, in the past two years, how have you communicated to your team?

Brian Donley, MD: Yeah. That's a good question, too. Brian, maybe I can just make one comment on that. Just wrapping up that last...

Brian Bolwell, MD: Yeah, of course. Please. Yes.

Brian Donley, MD: Google did a study where they looked at teams and trying to figure out what are the predictors of success. And I always remember the results of that study. And the predictor of success for teams was about how well the people on the team treat each other. It was not about how talented the individual members are on the team. To your point, it is about the leader caring for each other, and these words that go on for, I say, thousands of years, there's a reason. There's a reason why trust, courage, compassion... There's a reason why Socrates and Aristotle talk about those words, because those are the leadership articles that have stood the test of time for 2,500 years. These powerful words are around for a reason. They've been tested for a long time. Around community.

Brian Bolwell, MD: Just to follow up on that, because I think you're right to amplify the point. That Google study is quoted by a lot of different people. Adam Grant is a great writer who talks about how being altruistic, and if you've got members of a team who are givers as opposed to takers, how the whole team can get elevated, and people who might be somewhat self-centered will actually improve their ability to work with other people.

And then, of course, there's the issue of psychological safety. A high functioning team has to have an environment in which people feel empowered and it's okay to speak their mind and to disagree and to make mistakes. I think that's very powerful stuff. I think it's very powerful for leaders to say they don't know. I think it's very powerful for leaders to admit when they're wrong. Again, I'm increasingly saying to people, I have a PhD in mistakes, pretty easy to say.

Brian Donley, MD: Yeah. I agree with you completely about that. I think sometimes, especially in healthcare... I'm a huge psychological safety fan, and Amy Edmondson, all the work she's done is fantastic. Some people though would think in healthcare that psychological safety is an excuse for accountability. I think it's just really important that... Actually, you need heavy accountability with psychological safety, that's when you're in the learning zone, and great things happen at that point. You need them both together, and only as a leader can you create that environment for your team, by doing exactly what you said, showing your vulnerabilities.

Brian Bolwell, MD: Yeah. The accountability is really important, I agree with that. Colin Powell has a great quote that if you procrastinate on accountability, the only people you're going to hurt are the good people on your team, because they're the ones who are going to have to pull the weight. At the end of the day, you're going to have to deal with a bad situation sooner or later, and you're just better off dealing with it. Anyway, communication! You're not in person, you're doing all these things virtually, you've had three different lockdowns, what a challenging situation.

Brian Donley, MD: I think there's so many things that are uncontrollable, and the pandemic has just shown that in a very heightened focus. But it's all the time, pre-pandemic, it also was there. I think a couple of important principles are to focus on what you can control, and actually, drop out the things that are out of your control. And that's a first thing that we did on March 12th, when we made the decision to go remote, and we made that decision 10 days before the government did. Which was based on our values, and we're really proud of that decision to protect people's safety.

I think focus on what you can control. People talk about how important it is to communicate. In a virtual environment, it's 10 times more important. We used to have an all caregiver meeting with everyone once a month. Ever since March 12th, we went to once a week, and doing it virtual. And I will tell you, we have about 240 people on our team, and for the last nine months, every week, we've never had less than 237 on that call. And it's been a really, really important thing for us.

The other thing we did is, with the one-on-ones that we have, that I have with my team, and my team has with their teams, we moved that to twice a week. And then, I started having skip meetings where I had once every two months--there's 40 direct reports to my direct reports--I have one-on-ones with them because usually, I'd see them in the office, and I wasn't able to do that. I think though, the important thing in all those meetings, have a constant theme of hope, inspiration, but realistic optimism.

We make sure that we confront the brutal facts of what the reality are. And then, gratitude and empathy. Those are the five things that we drive through our messaging. We never sugar coat. We're very honest with it, but we always drive a message of hope and inspiration. And I think the empathy and gratitude is very important. And the last thing I just say is the empathy, you can't read that in a book, and go see how do I communicate empathetically. It has to come from the inside of your heart. You have to have it in you.

Brian Bolwell, MD: Give me an example of that. How do you do that specifically.

Brian Donley, MD: You can imagine, we have a lot of people that are locked down, you can only go out once a day for exercise. And London is a really big city. We have people that live in very small flats, and they're locked into that. That's a really challenging situation, and they're living alone. I will personally acknowledge the challenges that all of us have, and somewhat, going to your earlier point, expose your vulnerabilities.

Impending, within the next hour or two is going to be a hotel quarantine put into place in London. It could be for every country, and no one can fly in here. That's going to affect my family, and that's going to affect us. I'm scared and worried about that.

And I'll happily discuss that with everyone, to know that it's okay to have worries and fears, but together, we are going to get through this, and together, we will be successful, and we will open this hospital with the hard work and effort that we combine.

Brian Bolwell, MD: Yeah. I think that showing a bit of yourself, your personal life as a leader, actually, during the pandemic, has been very, very useful. Hard for people to do, but I think if you can do it, you do form a connection and a bond with your team that is strikingly powerful.

Brian Donley, MD: Something with empathy is honesty. And as a leader, there's times where you have to maybe be more optimistic than you really are inside. I always say one of the jobs of a leader is absorb the fears of others, but you also have to have that balance of when you're completely honest, and lay it out there on the line.

Brian Bolwell, MD: Yeah, absolutely. I've been incredibly transparent throughout. In the first few months, I read voraciously, and I tried to communicate everything that I learned about the virus to everybody. But I also talked about my own personal challenges, which I think were shared by people. I mean, I just said my hands are getting raw from all the hand-washing. And immediately, I sent that to an email to a thousand employees, and within six hours, I got recommendations for 55 different hand moisturizers. So, there is an upside to it.

But the other thing I always close with, at least, once a week is saying, I can't stand the pandemic, but if I have to be facing it, this is where I want to be. I want to be with you guys. I want to be with these people in this cancer center, and doing it together. And that's the optimism, but it's also the truth. These are the people that you trust, that you can count on. And I think that if you can show that almost raw honesty, boy, that connection is a very, very important thing.

Brian Donley, MD: Brian, can I just emphasize the word that you said, which hasn't come up yet in our conversation, but I think is so important is transparency. I'm glad you said that because it wouldn't be right to have a conversation like this without talking about that, because that is a critical part. And especially during this pandemic, that's probably even a better word than honesty, is transparency.

Brian Bolwell, MD: Yeah. I mean, increasingly, I think, over the past 15 years, I have found that to be essential, but certainly, in the past 10 months. What's going on in northeast Ohio, what's going on in the country, what's going on in the world, and now, what's going on with the vaccine. Wish I knew more about that, but you communicate what you can.

Brian Donley, MD: And I think, Brian, to that point, I think what's comforting is, you're right, with the vaccine, we're faced with this whole challenge here. It's a tremendous number of circumstances about the vaccine for employees, because we're not open, so no way should we be going in front of people for that because we're not frontline health caregivers here.

For me, whenever this complexity comes in, I just go back to some fundamentals to help guide decision-making. And it's about who we here for-- patients, caregivers, community, organization -- and what are our values. That's a pretty solid foundation, and how can I use that to help me make decisions. We just had this conversation 60 minutes ago in our executive team.

Brian Bolwell, MD: Yeah. This is all very, very important stuff. One of the things that we've been talking about internally, people have asked me, what's your leadership philosophy? And there's a lot of different components to it. But one of the things that I'm increasingly saying is it's a blend of it's all about you and it's not about you. It's all about you means the whole concept that leadership development and character development are one and the same. It's about being straight and honest and authentic and transparent.

But equally, if not more importantly, it's not about you, because again, it's about your team, it's about your employees, it's about hiring great people and supporting them. And again, I think what you're describing is a continual focus on that, on not focusing on self, but focusing on the team.

Brian Donley, MD: I never thought about that, Brian. But as you said, I think about something through the years that was explained to me. And I always repeat it to my children, I repeat it to my wife, is about having your cup full and that all of us are an empty cup. And boy, not until your cup is full can you start filling other people's cup. And leadership is about your cup has to be full, and you're content with that because you need to start spending your life filling in someone else's cup.

Brian Bolwell, MD: Yeah. I think that's actually a really good analogy. But it's critical. I mean, these jobs, I totally believe are not about you. It's never about you. It's about your ability to mold a group of individuals towards a common goal. That's a noble goal, that's got purpose and meaning. And in healthcare, that's pretty easy for us to set those kinds of goals, because I think that one of the nice things about being at the Clinic is that we have high aspirations. And if we're going to be leaders in clinical medicine, we actually want to be the best leader in clinical medicine.

So, how do you open an outpatient clinic in nine months if you're on lockdown?

Brian Donley, MD: Yeah. I will tell you, I've just talked about hope and inspiration. Where I get mine is by listening to these teams of ours here at Cleveland Clinic London and what they're doing and the work they're accomplishing. The challenge I have found with the virtual is what I think you need in person for is you clearly needed to recruit and retain your teams. You need it for cross-functional team problem-solving in a project like this. There's a lot of problems that come up every day, and then, you need it for culture. So, it's how do we get that recruitment, how do we get that problem solving. So, how do we have more interactions.

And so, we try to do that virtually. I think on leadership, whether you're virtual or not, it's a constant fight as a leader for discretionary effort, and what are you doing to get more discretionary effort out of your caregivers. And that's by having them feel purpose because the more purpose they have, the more passion. Purpose will drive passion and passion will drive work effort.

For me, it's just a continuation. And I'll tell you, the answer to your question is, how you do it, is I don't know. But I'll just tell you, it's an incredible group of 250 that we have over here that are accomplishing this, and right on target right now.

We end up with a massive increase in COVID that starts in late December here. Most of the country slows down for the two weeks around Christmas including the construction site. Our team works through that, puts in a complete COVID testing program. So, the day we started, January 4th, we have a full testing program for construction workers to continue to maximize their safety, and what that has allowed with that focus, and we essentially have developed probably the safest and gold standard for construction projects here in London, is today, there's 515 people in that building working on our construction because they want to increase healthcare capacity here in London.

This group of our team works over the holiday; gets us in place. I could spend the next four hours telling you about some unbelievable efforts and results out of this team here.

Brian Bolwell, MD: That's a really, really good story. And I really liked the phrase discretionary effort. We've touched on a lot of topics. If you wanted to leave our listeners with a few key take home points about everything you've learned about leadership, especially over the past few years as CEO of Cleveland Clinic London, what would they be?

Brian Donley, MD: I guess it's an incredible privilege to have the opportunity in your life to lead others, and to allow them to be their best. And I think of it not just at work. When you lead a group, you actually lead their lives. And hopefully, you're not just driving work and discretionary effort, but you're driving meaning and purpose, opportunities to learn and grow, and actually, enriching their entire life. And that's an amazing privilege. And I rarely go a day where I'm not thankful for all the opportunities that the Cleveland Clinic has given to me to grow to a position, to have this opportunity in my life to impact others.

I have a picture that I show leadership of a boat going down a big body of water with a big wake behind the boat. And I guess the one thing to leave is I think leadership is about what wake you're creating. And earlier, you talked about command and control. I think a lot of those leaders are looking out the front of the boat and they love being on a big boat, and it's awesome. And the sunsets out there, and how great. But as a leader, you should be looking behind you and figuring out what wake you're leaving. And the larger your leadership, the bigger the boat, the bigger the wake.

And is that a nourishing wake that people want to jump into and be a part of, or is it a destructive wake that everyone's trying to get out of their way? And please, take advantage of the incredible privilege that you have to create a nourishing wake to impact people in their professional and personal lives.

Brian Bolwell, MD: I really, really like that, Brian. Thank you so much. It's been my distinct pleasure. To our audience, thank you for your time today. And we look forward to sharing more healthcare leadership stories with you.

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