Keep it Real, Keep it Simple

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 and welcome to our podcast. I am your host, Dr. Brian Bolwell and today I have the enormous pleasure of speaking with Dr. Miguel Regueiro, Chair of the Cleveland Clinic's Digestive Disease and Surgery Institute, which is one of our largest and certainly one of our most important. Welcome to the podcast, Miguel.

Miguel Regueiro, MD: Great. Thank you, Brian.

Brian Bolwell, MD: Miguel, can you tell our listeners a little bit about your background and when you joined the Cleveland Clinic and how you got to be here?

Miguel Regueiro, MD: Yeah. No, so I joined Cleveland Clinic in 2018 as the Department Chair for Gastroenterology, Hepatology and Nutrition. Prior to that, I'd been in Pittsburgh since 1997, UPMC and originally in the Inflammatory Bowel Disease Program and then worked in the division of GI, was the Clinical Director there. And then prior to that, was in Boston for about seven or eight years in training and junior faculty and then I grew up in Philadelphia. So, I guess that takes me back to my true roots, but Pittsburgh before Cleveland Clinic.

Brian Bolwell, MD: And when you came and became Chairman of the Gastroenterology Department, if I recall, there were some challenges. It was a department that wasn't a very happy one. So, what did you find and how did you approach it?

Miguel Regueiro, MD: I knew coming in, in 2018 that there had been challenges. And I guess I've gone through my life not shying away from challenges and looking at what I consider high risk, high reward. And I'm happy to sit here today and say it was a high reward, but there was some risk, that's definitely true.

I think it was a, it's a wonderful department and had been for years, but there had been a lot of turnover. So, people had left, leadership changes and with that, the morale was quite low. And I think the feeling at the time was that the Gastroenterology Department wasn't being heard, "Why should we stay?" And this really led to a mass exodus. So that's what I walked into, and I knew that coming in eyes wide open. And really, the first few months, and we can get more into this I guess, but was really just listening, that's probably what I did more than anything, in the interviews and leading up to the job and then when I took the job, is just to really hear everybody's voice.

Brian Bolwell, MD: Yeah, I think that's incredibly important as you start. What did you find out when you listened?

Miguel Regueiro, MD: I found out when I listened that people felt that they had lost individual controls of their lives, their professional lives, their schedules. The second thing I found out was that, really that people felt, or the staff felt that there was a de-emphasis on academics, so that they were widgets in a machine to see patients and generate revenue, but really that was it. And without any control, that was quite demoralizing. And so, those are probably the two largest. And through that then led to a lot of negative emotions and negative feelings, but at least it was a starting point. And one of the things that was refreshing to me, which I was worried about originally, is that people wouldn't tell me anything. And it was quite the opposite. [Laughs.] If anything, I think people were just ready to unload. So, that was quite good.

Brian Bolwell, MD: So, from a leadership perspective, how did you think you needed to approach this? How were you going to go forward and make things better?

Miguel Regueiro, MD: I came in with my own set of thoughts as far as what I wanted to do, build back academics, build back the clinical programs, do a lot of recruitment, that was going to be a key piece of this. And to do that though really was, not to ignore the past and the people that were here, but really to work with them. And one thing I wanted to make clear when I came in was, it wasn't really my role or job or interest to come in and clean house and start all over again, I think we had a lot of strengths and it's to build on those, do it together.

Did some hard changes need to be made? Absolutely. And there were some challenges in the first year, year and a half. But I would say for the most part, it was really building up the team, growing upon that and setting a vision. And I think the lack of vision prior to me coming was palpable. And I think the vision statements, and again, the shared vision that we ultimately had really is what led to the first few years of what I think was success.

Brian Bolwell, MD: So, a couple key points there. One is obviously the importance of a vision for a leader, especially a new leader. And secondly, building up the team. A lot of ways to do that, what did you find worked for you?

Miguel Regueiro, MD: I think, again, the first and foremost were really one on one and what I called no agenda meetings, where I didn't come in with an agenda, it was just for me to listen. And what I actually found was that the 45 minutes or whatever time allotted quickly went, so I actually re-met with a number of the staff very early. And I think what worked well was to start to piece together, because again, this was, it's a large place, I didn't know it, I hadn't done any of my training, I really hadn't been here. So, just really being able to connect and understand and then through these connections, listening to people, knowing what I wanted to do, finding common ground, were some early quick wins that we all agreed upon. So, for example, the way clinical schedules were set, and these may sound simple, but the fact of getting more support staff as far as nursing. These types of things that resonated and were commonly shared with everybody to me was so important early.

Brian Bolwell, MD: Well yeah. It's interesting, when you go on a listening tour, getting the information is useful, without question, and getting to know people is extremely useful. But then you've kind of got to act on what you hear. Some would say, if you don't act on what you hear, then it kind of destroys the value of the listening part. So, hearing the challenges, but then actually trying to do something about it and implementing some things, even if it's just more support staff is actually a pretty big deal.

Miguel Regueiro, MD: Yeah. No, I agree. And obviously then, when it gets into larger challenges, how do you provide more potentially protected time in an era when we are being asked to do more clinically. And probably the biggest challenge was seeing some of the leaders that needed to be moved on and whether it's finding a different position for them within the department and inevitably in a few cases, having them actually migrate away from Cleveland Clinic. To your point, listening alone doesn't get you there, it's listening with action and I think a shared goal and a vision is critically important.

Brian Bolwell, MD: But then of course, when you do deliver and you have their back and you actually have some tangible things that are in place, that of course leads to trust and trust is essential if you're going to go from point A to point B.

Miguel Regueiro, MD: I think the trust is absolutely essential. The one thing I found early was that this was a group that really yearned to trust their leader. And it didn't come overnight. And I think to your point, that takes time and sometimes it takes years, it's not even months. But early trust. But once the trust is in place and the team is really working in the same direction, working to the same goal, then the allies become palpable and then all of a sudden exponentially, it's not just one person doing, it's a team doing. And obviously, the team can do much more than one individual leader.

Brian Bolwell, MD: How did you turn it around so quickly? What is the current state? The current state is very different than the one you showed up at.

Miguel Regueiro, MD: I think there are probably two or three things. So, one, just to restate what I said before is, setting a vision that changes the culture. And that was probably three to four years, I'm just entering my fifth year, so that takes time. And what I mean by that is, not just clocking in every morning, clocking out every night, seeing patients all day, but what is it we want to do in innovation, education, research, really making that part of the fabric of our lives? I think that was one big one. Probably in the first year to 18 months was rebuilding. So, we just, well just recently hired our 45th gastroenterologist over about a three-year span. So, we essentially hired an entire division in most places in the country in a very short period of time.

And I think having new people come in, fresh ideas, that gives a lot of motivation. And having our staff that were in place help with that recruitment, that alone is just incredibly inspiring. I think the staff wanted to hire, saw the new people, some of them they would actually mentor, which is even more fulfilling to me, so it's really setting up a legacy and a program. That overnight turned things around. And then finally, there were some leaders that were in place that probably weren't the right people and making those changes which needed to happen over the first couple of years was important as well.

Brian Bolwell, MD: 45 docs in three years is an awful lot. So, what do you look for when you recruit? Obviously, you're good at it. Do you look for how big somebody's CV is? Do you look for other things? How do you approach recruiting?

Miguel Regueiro, MD: I would say, to me that the number one most important part of recruiting is their emotional intelligence and their personality. Obviously, there's the CV, there's the academics, there are the letters of reference, there are personal references. Unfortunately, within gastroenterology, it's a big community, but it's small enough that we know each other so I can pick up the phone. Those are the easy parts. And I think most people who are applying or interested in Cleveland Clinic have checked off the CV and academic boxes. It's really the person themselves. How do they fit into the team? Where do they see their direction? How do they deal with difficult times? Resilience, I know we say that a lot. I think the most successful recruits are those that have really failed a couple times, picked themselves up, succeed. And then, bringing them into that culture has been really rewarding. So that's not all the CV, I'd say there's certainly a lot of emotional intelligence and personality.

Brian Bolwell, MD: Well, I couldn't agree more. When I was recruiting, and I recruited a huge amount for the Cancer Center. I think actually I've got 45 beats, but that was over 10 years. So, in terms of the short period of time, that's really impressive. But emotional intelligence is front and center. And it was interesting, when I was recruiting, frequently applicants would tell me at the end of the interview, "Boy, you asked different questions than anybody else.", because I actually tried to probe for emotional intelligence. And then the other thing you mentioned was resilience. And Angela Duckworth is a wonderful book called Grit, which tries to predict success. And essentially, it's a combination of passion for what you're doing as well as perseverance, which gets to the resilience part. Everybody gets knocked down, but the people who get up and keep at it, boy, those are the people you want on your team. And then finally, academic medicine tends to focus people on themselves. And increasingly I think today, you've got to have people who can work as teams and not just with docs, with all the other people in the healthcare delivery system. And I think all those are incredibly important as you, when you think about who you want to recruit from a physician perspective to your organization.

Miguel Regueiro, MD: Yeah. One thing I want to add, it's interesting when you were saying that, I think you and I have a very similar style. In my recruitment, the interviews, I would include non-physicians, so nurses, even a couple times secretaries, my administrator, coordinators. And it was interesting the effect it had when I asked these people to be involved in the interviews, they thought I was joking, or they never heard of that. But then they took it so seriously, that actually improved morale here. But then for the candidates on the outside, there were probably one or two that I did not hire because they did not interact well with the other team members. I think they felt at a physician level, they turned it on, they did a great job, but it wasn't a physician, they were a different person. And to me, that's the reason, probably one or two people I didn't hire.

Brian Bolwell, MD: I think that's great and I think that's a wonderful take home point for all of our audience. I wish I had done that more. The one thing I did do, was when it came to picking our fellows, the first person I asked was our fellowship coordinator who had to deal with all of these folks. And we had a bunch of docs interviewing these folks, but the fellowship coordinator had the best handle on all the applicants. And really, I relied on her more than anybody.

Miguel Regueiro, MD: I agree. I completely agree with that.

Brian Bolwell, MD: So, you come here, you have great success to your eternal credit. And shortly thereafter, the chairmanship for the institute opens up. And just to orient our listeners, the Digestive Disease Institute here at the Clinic is composed both of surgeons and non-surgeons. So, Miguel was Chairman of the Gastroenterology Department and Hepatology and Nutrition, and that's a non-surgical division. But we also have in the institute colorectal surgery, general surgery, breast surgery, much of the day-to-day surgery that goes on at the Cleveland Clinic. And historically, this has been an organization that has chosen surgical leaders. And so, what made you throw your hat into the ring and how did your initial approach to the opportunity evolve?

Miguel Regueiro, MD: Yeah, that's a good question. So initially, to be very transparent and honest for everything you just said, I did not throw my hat in the ring and really hadn't even considered it. One, I had been here, still relatively short period of probably about three years at that point. And secondly to what you said, the two thirds, well now with so many gastroenterologists, but still the majority of the institute are surgeons, not non-surgeons. And I just figured the history was it had to be a surgeon. And I know you had actually helped me through that process because I sought your advice, so thank you again.

But I think it was a combination of two things interestingly. One is my wife who said, "Why aren't you applying for this?" And I said, "Well, because it's always a surgeon." And it was interesting, just over dinner we had a conversation and she said, "You've done great things and it looks like the teams are taking to you." And a lot of the research I had done was actually with surgeons more than non-surgeons, so I'm very comfortable nationally in that realm. And then the second is, I did get a call from an executive leadership standpoint saying, "We noticed you didn't throw your hat in the ring." And this was probably three weeks in and I had a nice discussion and then I threw it in. So quite honestly, it wasn't something I was looking for or thinking I was going to do. And I'm thrilled to this day that I did it, but that's the honest truth as far as how it started.

Brian Bolwell, MD: It's always nice to be invited. That's a good thing, that's cool. So, you wind up getting the role and you've been at it a little over a year, a year and a half, something like that?

Miguel Regueiro, MD: Actually, believe it or not, just coming up to a year. It was May, so almost a year.

Brian Bolwell, MD: And tell us about the first six months. Tell us about how you've approached it. Was it identical to how you approached the gastroenterology opportunity, was it different and what's happened?

Miguel Regueiro, MD: So, it's interesting from a leadership standpoint, the same principles really applied. And I almost used the same blueprint. And there were some things I learned early in my tenure here in 2018 that I probably didn't do as well and since that was fresh enough in my mind, I could avoid those or enhance upon those.But really the first, so again, you're talking even larger numbers of people to meet with. But I did meet with everybody in the institute, so all the surgeons, different regions, different locations. And I tried to meet with as many of the nonphysician leaders within different areas, in the ORs, in the hospital. And again, it was the same exact thing. Just listening to what they were interested in. Understanding too as a non-surgeon, that I wasn't looking to disrupt the surgical presence, if anything, just looking to enhance.

And what I learned was similar to what I found when I came here, we're all people. So, it doesn't really matter what your name or the name of your title is, there are common goals. People wanting more time, more academics, trying to figure out what their careers, how that's going to look. And what I've really loved about this and probably didn't foresee, but I do these, like I said, no agenda meetings that I've done with GI, especially those within 10 years of fellowship. I actually now do that with surgeons. I have a number of surgeons, I don't know if they're coaching or mentoring, but just we have one-on-one meetings and whether it's in breast surgery, trauma surgery, main campus, just talking about career and focus and if they want to talk about just personal, that's fine. And that to me hasn't changed and that's something I'll always value as far as a leader.

Brian Bolwell, MD: Yeah, I think there's a huge value in that, in one-on-one meetings and just kind of leaving an open conversation, I think that's fabulous. So, you had a vision, and it must have resonated. One of the things about having a vision that I read a while ago and I didn't really appreciate it until I became Chairman of the Cancer Center was, to execute a vision, you've got to talk about it all the time and you've almost got to preach it. It can almost be evangelical, at least it was for me when I finally figured out what exactly my vision was. Have you experienced that? Do you think that that's valid?

Miguel Regueiro, MD: Absolutely. I think, repetition and simplicity. The theme, I have this pyramid that I created, which is very easy to see, where at the base is clinical, education, research, innovation. And it's just visually, it's simple, it sounds silly. But it became almost the preaching point, if you will, for the first few months. So, the town hall, individual meetings, we restructured our meetings and really every meeting almost started with that over and over. The newsletters, the inclusion of what we did. And I think the thing that I think has taken off is now, the teams are really, as you say, preaching this. I can hear people give talks or when they don't know I'm around or listening say the same thing. And I think that's the common thread. So, I do think that's important and I think having the vision also has to be simple enough. If it's too complicated, too many moving parts, then it's hard to be tangible and to repeat.

Brian Bolwell, MD: Yeah, I agree with that. How much is the institute involved in Cleveland Clinic London or Cleveland Clinic Abu Dhabi?

Miguel Regueiro, MD: So fair amount. I wouldn't say that's the majority of my time, but certainly a fair amount. We have great connections with both. And one of the vision, as I mentioned before, is building research. So, one of the areas we're looking at is this international research core in DDSI with Abu Dhabi and London. And we actually now have these global meetings set up and those are going very well. So, having those counterparts to work together, that's one thing that is special about this place, Cleveland Clinic, is having that international family that's built in that you can do a lot of neat educational research, clinical. So, it's a part, but they don't report to me specifically, although there's a lot of shared goals, visions and discussions as far as leadership.

Brian Bolwell, MD: And Cleveland Clinical London, probably by the time this podcast airs will have just opened its hospital. And I know that general surgery and much of what's in DDSI is a big part of that. How involved have you been in that? Now again, for our listeners, London has an institute model and they've got institute chairs over there. And so, there's a chair of DDSI at Cleveland Clinic London. I've actually met all the institute chairs. It's a fabulous group, very engaging, very intelligent, just wonderful to interact with. But do you have much, given that there's a lot of excitement about the opening, have you been involved with that?

Miguel Regueiro, MD: Not as much the opening per se. Just to be transparent, I'm not as much boots on the ground or making decisions even from this end. I think the interactions have been with the DDI Chair and the GI Chair who I've kind of known even before all of this. And again, this comes back to the GI is small enough, we get to know each other and he's wonderful, Dr. Charlie Murray. Really has been nice in terms of, as we evolve in our educational and research programs to include them and have these programs jointly. And with the world being virtual, it's so easy to link people in. But to be clear, the day in, day out operational decision and logistics, I've not been overseen or involved in so far as going forward, but there was a lot of, "How did you do this," shared ideas. Obviously, different systems, so that's also something to take into account.

Brian Bolwell, MD: Tell me about your early leadership experiences, I presume they were UPMC. What were they like and how have you learned and developed leadership?

Miguel Regueiro, MD: Yeah, that's a great question. You are correct, they were UPMC as the, at first was the Clinical Director of the Inflammatory Bowel Disease Program, that's probably 1999, 2000, so we're going back a ways. It's funny, looking back on me then, I was a very different leader just because I think it was maturity and not knowing. So, I think then it was the feeling of, "We have to drive this forward, which meant, "I have to drive this forward and everybody come along for the ride." Which in hindsight was a mistake and I learned from that very quickly. But those were my earlier days. And then, once, I did get the bug for leadership earlier, I liked building and then it became about the team. I liked building the team, seeing the team succeed more than me independently and we grew. And then, kind of each successive few years I was promoted or had a new position and that was very rewarding to me.

Brian Bolwell, MD: For me, the epiphany was when I had my first 360, which was a little over 20 years ago now and I assumed it was going to be glowing and I was very wrong. And it wasn't glowing at all, it was largely negative. And that actually stung, that hurt a lot. And so, I decided that I wanted to learn a lot more about the topic and I didn't know that the whole field of research was involved and there was literature about this. And I started to read voraciously, but that 360 was a big deal for me. Have you had 360s? Have you learned from them?

Miguel Regueiro, MD: I've learned a lot. And to your point, probably my first 360 is, again, this is going back to UPMC, were not very good. And I remember to your point, probably the first two were, "You need to do less for yourself and more for others because that's not a good leader." And I do remember, I think it was the second 360 that started to get me involved in, as you alluded to, these coaching and the concept that leadership is actually almost an entity into itself within medicine. And I think those around the time that was becoming realized, I think before then it was more an individual making decisions, which is what I was trying to emulate, and I was terrible, I wasn't doing a very good job. So those did sting. Those still stick with me. I've actually kept them, and I refer to them. And it's interesting how I've learned a lot. I actually feel, and I say this even today, I learn a lot more from all the failures and I've had many more failures than I've had successes, but those are really what have shaped the next step.

Brian Bolwell, MD: I couldn't agree more, Miguel. I think that my multiple failures, which have occurred with massive frequency over the years are how you learn and how hopefully how you evolve in a positive way. Golly gee, I couldn't agree more. Anything specific you'd like to share about one of your failures that you've bounced back from?

Miguel Regueiro, MD: Yeah, I'd say one... Well, I would even bring it closer to here. One of my early failures when I got here, even though I thought I had learned a lot in my UPMC days, was realizing that there needed to be an individual change in leadership and making that as a year out and me assigning a new person and doing that without enough time to do due diligence of process and enough listening, which I said I did a lot of and although I think the decision at the end of the day was probably correct, the way I went about it was a failure because it disengaged a lot of people. I think early that was bad because that showed, "Hey, is this person really going to come in and saying they're not going to clean house, but they are?" And from that I learned, I slowed down. I kind of almost, "To go fast you have to slow down."

So, I became much more methodical, much more team, due diligence of process, putting bigger decisions through a process. At the end of the day as a leader, I acknowledge I have to make those decisions, but I did that, that was too quick, that was a fumble that I made early here. And I told myself, I remember that day I said, "I can't do this again. This is something we need to correct." And so, I think people joke about how much process I do now around leadership and when we make decisions, but I think that that's been helpful to me.

Brian Bolwell, MD: That's a really good story. And actually, it resonates with me because I pretty much did the same thing when I first became Chair of the Cancer Center. I thought it was important to make some changes quickly and in fact, the opposite was true. It's incredibly important to take your time and to do the due diligence and to not react quickly. People give you the benefit of the doubt when you have a new job and nobody really expects you to jump up and down immediately. So, I think that's a great point for our listeners.

One thing that clearly has been thematic in what you've described is the importance of teamwork. And there's pretty much two fundamentals to leadership. There's a lot of skills that people teach, like how to have crucial conversations and how to have learning agility. But the two fundamental skills are about supporting your team, developing your team, having their back, giving them credit for success. And then the second one being, improving yourself and having self-insight. I think that it's clear that you excel at both, and it sounds like, well, I won't project, for me, after the couple 360s, I wasn't placing enough emphasis on the team and I also didn't have enough self-insight about my behavior and my actions. So, they actually kind of occurred for me in a kind of similar timeframe. How about you?

Miguel Regueiro, MD: I would say that's true. And I think early on the realization was the team was more important, but also the feedback. One thing as you were talking, I was thinking about. Even till today, whether to coach or 360 other team members, all of us like to get positive feedback, I understand that. But for me, I'd rather almost hear, what are the opportunities for improvement? And I still will want that and listen to that much more critically than, "You're doing a great job, everything's positive." Because we can't get better unless we're really getting the honest feedback. And to your point earlier, if the team trusts you and there's the trust and you have a team, the feedback will be more credible and more transparent. And then I think we can continue as leaders to continue to make these small changes towards success.

Brian Bolwell, MD: Do you give honest feedback?

Miguel Regueiro, MD: I do. So, I think one other part that I've always tried to do, and I certainly would say the latter part of UPMC and certainly here from day one is transparency. We're actually going through another process where our section head is stepping down and we're having somebody else come in and there are a few people interested, is transparency and fair. And I'll be very honest with people, I'll tell them what I think their opportunities are for improvement. They may not always like to hear it and I tell them it's my opinion, but this is what we can do to get better and also do it in a professional way. I think if you do it in a berating way, it's not effective. But I think from what I've heard from my own team, people really appreciate that. I think before there was always this murky, "We're not really sure what the person's saying, my leader's saying." Now, it's pretty crystal clear what I'm thinking.

Brian Bolwell, MD: Yeah, I think that's very important. And one of the things that allows you to do that, of course, is creating psychological safety, which again, for our listeners, Amy Edmondson has a wonderful book about this called The Fearless Organization. But if you have a psychologically safe environment with teams such that people, feel comfortable and are not afraid to share ideas, to share opinions, I think it also makes the ability to give honest feedback a bit easier. So clearly, you must practice a lot of psychological safety.

Miguel Regueiro, MD: Probably without knowing, yes. Yeah. No, and I think all joking aside, I realize that the other day when one of my more senior staff came and said, "Hey, do you realize this is happening, you may not be aware? And the other thing I always say is, I don't like blind spots and I always try to avoid my own blind spots. And I wasn't aware of this. And this was something that I think if they didn't feel safe in telling me, because it wasn't the most positive thing, not directly about me, but about a process, that helped me immensely and I think that took a lot of courage on their part to do it and it helped me a lot. So, absolutely, psychological safety I think is important.

Brian Bolwell, MD: So, since you took over last May, we've had a couple COVID surges, probably the biggest one was December and January of this year, which is 2022. What did you think was essential as the leader of a very large institute to get your group through that?

Miguel Regueiro, MD: I think that to me became more about the human being and the personal part than the professional. Maybe to explain that very briefly. Again, as you alluded to, this was a time where burnout was high from COVID to begin with and, "Oh no, here we go through another surge." So rather than say we need to do more focus on something clinical, it became more, "How's your family impacted? What do you need?" People are getting sick. Again, a lot of our own staff had COVID. And I think that, taking more of the personal touch first, the human part first helped the clinical and what we needed to get through. And so, it really flipped from where we were about six months ago. And I think that I wouldn't do it any differently, I think that helped and I think that really got us through that last surge.

Brian Bolwell, MD: When COVID started back in 2020, communication was so important. And I think all of us tried very hard to communicate extensively and I think our organization did a very good job of that. But as we went forward, being able to connect with people on that level, you talked about the humanistic level, I think certainly was a winning formula for me. And I think it kind of gets to authenticity as well as empathy. And I have found that, especially in tough times, the more open and honest and willing to be vulnerable, one is, a leader is, the easier it is to connect with the team, to your constituents, to whoever you're interfacing with. And I'm even more convinced than ever about the value of authenticity, about just being real and not saying standard jargon, but being very plain speaking and very, you don't know something you say you don't know. That has worked very well for me. Have you found that to be true for you?

Miguel Regueiro, MD: Absolutely. And I think the way that this came, is you were talking about the second surge, I realized I had done this and actually hearing what you're saying, I'm learning [laughs] because I didn't realize it at the time. But as the second surge started, I restructured our leadership meetings, which used to be just the administrative leaders and the chairs in a room, it was somewhat depersonalizing. And I think I switched it to, half of it was a core leadership meeting about the first 30 minutes and then the other half, opened it up to the entire Northeast Ohio DDSI leadership teams, from administrators to nurses to APPs to physicians, regionally, main campus. And it was about 70, 75.

I remember telling my administrator, I said, "You'll know if this is failing, if you see 75 people the first week, 60, 50, 20, 10 logging on," because these were virtual because of COVID, we've kept them that way. But to your point, one of the connection points and I think was successful, not just with me but with the others, were just the real plain speak of, "This is what it is. None of us have an answer, we don't know where it's headed." Just saying that honestly up front and then opening it for discussion was incredibly powerful. So, I think the way you stated it was great.

Brian Bolwell, MD: This has been wonderful, Miguel. You've done a stunningly superb job. So, congratulations. As we wrap up, do you have any closing pearls of leadership wisdom that you'd like to share with our audience that kind of summarizes your philosophy?

Miguel Regueiro, MD: I guess couple. Listen, keep it real, keep it simple and share your vision with your team because the team is going to be your success.

Brian Bolwell, MD: Those are wonderful, wonderful ways to wrap this up. And to our listeners, this has been one of our best podcasts with a really wonderful leader here at the Clinic. So, Miguel, thank you so much.

Miguel Regueiro, MD: Thank you.

Brian Bolwell, MD: To our listeners, I hope you've enjoyed today's conversation and we thank you for tuning in and we look forward to sharing future podcasts with you. Have a wonderful 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.