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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. I'm your host, Dr. Brian Bolwell, and today I'm joined by Dr. Richard Parker, who is President of Cleveland Clinic Hillcrest and Mentor Hospitals in northeast Ohio. Hillcrest is one of our most important and most successful regional hospitals. Dr. Parker, welcome.

Richard Parker, MD: Hello. Thank you.

Brian Bolwell, MD: I've known Rick for a long time. Rick was formerly chairman of our orthopedic department here at the Cleveland Clinic, and he's had a wonderful career. So, Rick, can you tell us a bit about how you started and a bit about your leadership journey?

Richard Parker, MD: Sure. What's really interesting is that I joined the Cleveland Clinic in 1993. Brian, I know you can recall that at that point in time, everything was on the main campus. That was the Cleveland Clinic. I joined after being at Mount Sinai Medical Center here in Cleveland where I trained, and then I went away and did a Sports Medicine Fellowship for a year. I came back and was there for five years, trying to start up a Sports Medicine program and had some success, but really saw the light and decided to join the Cleveland Clinic Sports Medicine and Department of Orthopedic Surgery. For those of you that don't know, Cleveland Clinic was one of the fathers of Sports Medicine with John Bergfeld and several others, so I had the opportunity to join them in 1993.

I recall when I joined, knowing that I wanted to do something more than just be a really good clinician surgeon. I wanted to be involved in professional team coverage and college team coverage, but I just knew that there was something else I wanted to do but really had no idea. I vividly recall when I was interviewed, being really interested in understanding how you could grow within the Cleveland Clinic from a leadership point of view. I had some really good mentors. Dr. John Bergfeld was one, but another one was Dr. Ken Marks, who was at the time the Chairman of Orthopedics, who I felt was very visionary. Indeed, it turned out that he was. Actually, I was part of a group that wandered off of main campus in 1994, I believe, to set up a little clinic down in Independence, which ultimately became the Independence Family Health Center. Then, we began acquiring hospitals and building family health centers, and now we have a huge Cleveland Clinic health system.

So, Brian, I always knew I was interested in doing something in leadership, but really didn't know what it would ultimately look like. I recall I got my first chance about a year in when we were looking at our rehabilitation in Orthopedics and Sports Medicine. And I remember saying that there are models out there in which you could really grow this into a very, very profitable entity as well as serving our patients extremely well. And in orthopedics, rehab is incredibly important. I remember Dr. Marks said, "Well, why don't you take a stab at it?" So, we brought in the right person, and we built a program, and then things started falling into place. I got more and more opportunities to lead.

Brian Bolwell, MD: It's fascinating that you pioneered the first regional footprint for the organization in Independence. That's something that I think few people are probably aware of. So, the rehab stuff you executed and that gave you more opportunity. So, what happened after that?

Richard Parker, MD: Yeah, well, it was interesting. I'm a firm believer of you need to work with people smarter than you and you need to get the right people in your position. I happen to know an extremely good physical therapy leader, Gary Calabrese, he's still here today. We actually had worked together at Mount Sinai and brought him over to lead the effort. It was really interesting because, like I said, we were in Independence and running a little orthopedic clinic, and then there was an appetite institutionally to build these family health centers. Cindy Deyling was incredibly important in that, as were other leaders, Rob Stall in particular.

I remember when there was an opportunity to bring physical therapy into a family health center and remember meeting with Rob and his team and really expressed a willingness to work and to grow with them. And they decided to work with us. There was another rehab, physical therapy through rehabilitation medicine arm at the Cleveland Clinic that was also looking at that opportunity, but they chose to work with us. If you look at the family health centers today, you see that each and every one of them has physical therapy as a key allied medical component of that facility.

Ultimately, that opportunity positioned me I think really well when we went to the institute structure and Joe Iannotti, the Chair of Orthopedics at the time, became the Chair of the Orthopedic Rheumatologic Institute. Then, there was a call for interested people to apply for the chairmanship of orthopedics. This was back in 2008. And I threw my hat in the ring and was interviewed by the committee and communicated what I thought would be my vision. And one of the key components of the vision was really to define the role of a chairman of a department within an institute. Because there was a lot of confusion and it was, okay, what's an institute leader versus, I was afforded the opportunity to be Chair of Ortho in late 2008, 2009, and remained in that role through 2015.

I remember, spent a lot of time particularly outside the Cleveland Clinic helping our colleagues understand what the difference between my role as Chairman of Ortho and Joe Iannotti's as the Chair of the Institute was. We grew during the time that I was Chair, and we have a successful Orthopedic residency. We have a lot of fellows, but we're a resident first department. The other thing that we did that I'm really proud of, and it was an interesting time because we, of course Southpoint was a part of the Cleveland Clinic when the Meridia system joined, but the education program of the Osteopathic residencies was kind of at an arm's length.

Well, we recruited and brought on the three faculty of that Orthopedic residency at Southpoint for a couple reasons. Number one, extremely good docs who wanted to join us, but we were also putting together our trauma support from an Orthopedic department for Hillcrest. And these three gentlemen were our really good surgeons, and we decided that we'd build the trauma program around them and then embrace the residency, the Orthopedic/Osteopathic residency to be a key part of that effort. But I was always of the opinion, why wouldn't we embrace that residency when those are the two pathways to becoming an Orthopedic surgeon, through the Osteopathic as well as our traditional program? By the way, did Osteopathic physicians historically come through the program because the Cleveland Clinic has always embraced Osteopathic medicine.

Anyway, that wasn't happening around Northeast Ohio. University, there's a program at Richmond Heights and they had acquired Richmond Heights, and they essentially let that residency go by the wayside and it ultimately fell apart. The same thing happened down in Akron. So, I'm proud to say that we embraced it. We actually increased the residency from two to three people per year, and now it's arguably the best Osteopathic residency in the country and they get a fantastic education.

Brian Bolwell, MD: Well, that's very cool. Congratulations.

Richard Parker, MD: Yeah, thank you.

Brian Bolwell, MD: There's two other components that we want to get into. One is your relationship with a professional basketball team, the Cleveland Cavaliers, and one is your decision to leave the chairmanship, which was a very prestigious role, and become a regional hospital president.

Why don't we talk about that? You were clearly thriving in your role as Department Chair of Ortho. Why did you even consider becoming a hospital president?

Richard Parker, MD: Well, Brian Donley and Steve Jones. Brian and I, Brian a prior leader here, great friend, orthopedic colleague. I remember before he went over to become President of Lutheran, he and I sat down and he talked about making that decision and whether or not he should do it, and wanted my feedback and I thought he would do great at it, and I thought it was a great opportunity for him. But Brian and Steve came to me with the vision of trying to bring in proven, what they said, proven leaders who they felt were good at communicating with many different groups of people, into hospital leadership.

I was enjoying immensely being the Chair of Ortho and could have stayed in that role. I have just gone through my five-year review, and it was very positive. But they were very compelling and convinced me to look at it and consider it. There was also the idea of developing centers of excellence, and I'm always careful with that word, center of excellence or words, center of excellence, because you have to approve it. But part of the vision was, well, maybe we could develop a, what I now call Centers of Focused Care at Marymount, particularly along the orthopedic line.

So, I thought long and hard. My wife thought I was crazy, but I never been one to turn down a challenge. After I accepted and it was announced, two things happened. Number one, about a week before I was going to start in that role, I got a phone call from Dr. Jones and he said, "We forgot. You need to make sure you meet the sisters, because Marymount's a Catholic hospital and they have the first right of refusal if they don't want the leader in that role." So, I went over, and I don't know if anybody's ever met Sister Mary Alice, [she’s] is an incredible human being, but she was the sister in charge and she and I luckily hit it off. We have become close friends, and the rest is history because she gave a thumbs up and I was able to go over there and lead.

The other thing that happened was my first day, my first day in the role. I walk in and I'm meeting the team and CMS is at the hospital, CLIA they're called. They're there to come back to look at the laboratory, because they had been there in, I think January or something like that, and they were just coming back to check a few things. That's what I was told. Well, by the end of the afternoon we were in immediate jeopardy, [Brian laughs.] and I knew what jeopardy was, but I didn't know what immediate jeopardy was. Only to find out that basically we were going to need to shut the lab down and rebuild the lab really from ground up. Knowing nothing about the laboratory, I learned very quickly how important it is for a regional hospital to be part of a healthcare system.

I actually ended up using it to my advantage or to our advantage, if you will, because what I encountered when I came to Marymount was that it was an incredibly good culture who really cared about patients and each other. But there was a little bit of resistance, if you will, to being part of a bigger entity. And what I found was, and it was very clear, that if we were not part of the Cleveland Clinic health system, that hospital would have closed because we would not have survived without a lab.

The partnership with Path Lab Medicine Institute and their leaders was incredible, and the number of hours that they put in to rebuild that lab. We literally had couriers taking specimens down to the main campus or over to Hillcrest to be able to get the results back to the Emergency Department, the hospital, the operating rooms. It took us the better part of a year to reopen the lab. And so, I remember sharing with particularly the medical staff, the importance of being part of a healthcare system. I really believe it helped turn the culture there a little bit to be much more receptive about being a key component of the Cleveland Clinic health system.

So, I was there for two years, then Steve Jones came back to me and said, "You know, Rick? I'd like you to consider going over to Hillcrest." So, I said, "Okay," once again, and I've been at Hillcrest since 2017. Loved it at Marymount, absolutely love it here at Hillcrest. We accomplished and have accomplished the things that we were set on, and a lot of it was around medical staff bylaws and really partnering with community physicians and developing relationships in what I like to call aligning incentives or aligning goals and having them converge instead of diverging.

Then, we fell into COVID, which actually I think was something that really brought the medical staff together, particularly the community and the Cleveland Clinic employed physicians, and once again, converging goals instead of diverging goals. And here we are, 2023. Yeah, it's been an interesting journey.

Brian Bolwell, MD: You touched on the challenge of local culture, Marymount and at Hillcrest. So, certainly, one of the reputations that some of our regional hospitals have been that the private docs didn't really identify with the Clinic, they identified the community hospital that they were working with. And you've overcome that, or at least you certainly improved it dramatically. How? What was your approach?

Richard Parker, MD: Number one, being really agnostic to whether or not you were a community doc or a Cleveland Clinic doc. The other is leading with quality and safety and patient experience, and having it be non-negotiable. I think those two things really helped us come together and rally around that. COVID did help, literally, because particularly community docs saw how we as an organization stood behind our caregivers and our providers. When they were watching what was happening in other healthcare systems where people were either being terminated, laid off, or hours cut, they saw the way in which we were able, as an organization, Hillcrest being part of it, but to support the community docs in trying to keep their practices going during a very difficult time. I think they've remembered that, and they value that. I think our ACO or Accountable Care Organization, which we're all part of it, but so are a lot of the community docs, they have I think been very good partnering and helping give the community physicians the tools that we can provide them to provide great care for their patients.

So, I think it was a sign of the times. It's evolution but also taking advantage of a pandemic and then connecting the dots.

I know you wanted to talk a bit about my role as the team physician for the Cleveland Cavaliers, but I think I told you before and I told others that being a good hospital president is like being a good team physician. You need to always do what's right. The patient comes first, and so in team care, it's the athlete who comes first, and you don't deviate from that.

But there are several different groups of individuals that have different interests and different abilities to understand what's really going on with an athlete. In a professional team, you have the owner, you have the general manager, you have the coaches, you have the agents, you have the public, and then first and foremost you have the player. So, every player's different.

What's good about the public is, as a team physician, you don't worry about that. But you have to understand how to talk to the general manager in a way that he or she, I took care of the women's basketball team as well, but you need to understand how to talk to each of them so that they understand. The head coach, because he wants to understand when the athlete can play again and how long they will be out, because he's trying to win games. You have the athletic trainer, who's trying to take care of the patient from day to day. You have a group of consultants, who give you information, and then of course you have the agent, who is trying to show his value to the player and they're all competing. But at the end of the day, as a team physician, you have to learn how to communicate with each of those groups so that you all stay laser-focused on the well-being and particularly the career of the player.

So, in the hospital, you have the medical staff, you have the nursing staff, you have operations, you have finance. You have all these other entities and you're trying to make sure that everybody stays focused on the patient and really understands how all of these roles overlap and how our optics can all be different even though we're focused on the same thing. So, a lot of similarities.

Brian Bolwell, MD: Well, that's fascinating, but one of the things you've got to do to satisfy the different constituents is develop trust. You develop trust by building relationships and by keeping your word and being straight and being consistent, and all of these things are things that you're known for, Rick. And so, it's very interesting that the parallels of being the team physician for the Cavaliers are not unlike how you run a regional hospital. It's an interesting story.

Well, tell us a little bit more about the Cavs. When did you become their team physician and go to every single game? Ultimately, I wouldn't mind hearing a little bit about when they won the championship in '16.

Richard Parker, MD: Yeah. Yeah. So, I started working with them in 1994, '95, and I backed up John Bergfeld, who was the head team physician. I remember in 1996 they said we're going to have a WNBA team, The Rockers. I remember at a staff meeting, Bergy asked if anybody wanted to take care of them, and I said, "I'd be happy to." I jumped at the opportunity and took care of them for the five years or six years until they dissolved, and it was great. Incredible group of women and experienced some winning seasons and some great people.

In 2000, Dr. Bergfeld came to me and said, "You know, Rick, I want to stay focused on the Browns. I want you to be focused on the Cavs. Would you be the team physician? They really like you." So, I started in 2000 and stayed in that role until 2000, I think it was about '18 going into '19. There are 41 home games, went through some really bad years and covered probably in the neighborhood of at first 38 to 40 games. Then as the years went on, we got better. LeBron James came with us, and we kept getting better and better.

Anyway, we ultimately got really good and went to the finals several times. I remember thinking I really need to bring in a junior associate and teach him the ropes, so that when my time came to an end that I could turn it over and it would be just an easy transition. So, for seven years, Jim Rasnick was my assistant. I began having him cover more and more games but would always cover over 30 games a year because you have to be visible, and you have to be there. So, he was part of when we won the whole thing.

But in 2016, what you read is really true. We were down three to one, the general manager really united everybody as did the players and the coaches. We won one game at a time and all at once it was 3-3. We're back, we were staying in San Francisco, but the game was in Oakland and we're back there. I remember Sunday, the day of the game, and I got up and I'd read enough, just enough talking about it. So, I literally went out, and if you know downtown San Francisco, I walked from downtown San Francisco all the way to the other side of the Golden State Bridge, turned around, came all the way back in time to get cleaned up, get my stuff together and take the bus over. But I ended up having over 40,000 steps that day. Yeah, it was crazy. And we ended up winning the game.

But I spent the entire second half in the locker room because my primary care partner, Dr. Sam Flocker and I, were sitting next to some really rude fans, and we just couldn't take it anymore. So, we literally went in the locker room, and we saw it and we watched it live and we saw the whole thing unfold. To this day, it still runs shivers up your spine when you watched everything happen and how it all fell together. I remember thinking, if we ever had a game-winning shot, it would be Kyrie that would make it, and he ended up doing it.

The other interesting thing is when, if you remember during the game when we were up by three, LeBron charged the basket, he got knocked and he fell down and people thought he was hurt badly. Well, the athletic trainer and I, we had hand signals. I would know he would signal to me if there was really a problem or if the player just needed to get his breath. So, I come running out of the locker room and Mike Mancias is his name, and I go, "Hey, Mike," and he just gives me the signal that he's okay, he's just trying to get his breath and his emotions together. Then he stood up, and if you remember, he missed the first foul shot and then he made the second and we were up by four and we ended up winning.

It was really an incredible thing because as a team physician, you try not to be emotional. You cannot be a fan if you're a team physician because the word fan came from fanatic, not somebody who's impartial. But you really want to see these guys win and you want to be part of that, and we were. We got home and I remember several days later when we did the parade, they invited us to be part of it. They said, "Hey, make sure you bring your wife," so my wife got to be part of it, and it was really cool. So, great memory. Yeah.

Brian Bolwell, MD: You once showed me a picture from the locker room standing next to the trophy, which is a really cool picture. For all of those of you listening on this podcast who are not from Northeast Ohio, Cleveland had not had a winning sports team, a champion sports team in 50 years and the emotional reaction to that time and to that event is hard to describe. Anybody who's a sports fan in this area will remember it forever because we all have stories. I've got mine, but I know that there's thousands and thousands and thousands of them, and that was really cool. This is a little off topic, but nevertheless, it's pretty cool.

Actually, from a leadership perspective, you did touch on one very important thing. So, we're down 3-1 and everybody banded together with a common purpose, and I think a sense of optimism. I think one of the things that's important for people in healthcare today to remember is that even if things are tough, and right now a lot of healthcare systems are going through challenging times. One of the tenets of leadership is that you've got to be the person to stay optimistic and say that there’s a way forward. You can't be disingenuous about this. You've actually got to have ideas about how to get it done. Negativity doesn't get you to where you want to go. As a leader, you've got to uplift a lot of people sometimes when it's not easy to do, but it also becomes one of the more rewarding parts of the job. Do you agree with that?

Richard Parker, MD: Oh, absolutely. Yeah. You need to lead by example, and you have to be a cup half full, not half empty.

Brian Bolwell, MD: Yeah.

Richard Parker, MD: I'll give you one little other tidbit about what happened there is we get home and we're in the ensuing weeks. I remember I got a phone call from the General Manager, and he said, "Rick, would you like to take the trophy of the day? You can have it for the day." I said, "Really?" He goes, "Yeah." I thought about it long and hard, and the first place I took it was to Marymount Hospital where I was the president. We sent out an email and the word got out, if you wanted to get a picture with the trophy and to touch the trophy and everything like that, come on down to the auditorium.

I can't tell you the number of people that wanted to be part of that. It probably helped build trust and also helped build the idea that I probably could have taken it anywhere. I thought about taking it down to Cosgrove and taking it to the main campus, but I really wanted to take it to Marymount, and that's what we did. Then, I took it over to Sports Health. But yeah, it was pretty cool to get the trophy for the day.

Brian Bolwell, MD: Yeah, that is very cool.

Richard Parker, MD: Yeah.

Brian Bolwell, MD: Just a couple other points before we wrap up. A year and a half ago, we both had the opportunity to visit Wharton Business School and have a weeklong course about leadership development. What are one or two things you remember from that week?

Richard Parker, MD: Sure. Probably it brought us all together, institute leaders and hospital presidents, and the classes were great, the professors were really good. They understood healthcare and they made meaningful connections. But when we broke out into work groups and we were working side by side, I think it brought us together. Maybe improved the culture of physician leadership at the Clinic. But yeah, because if you recall, they came to us for a bit and then we went there for that week. But I really think getting out of Cleveland and being there together with each other was key. I still have the picture, I don't know if you do too, that they took at the very end, and it really showed you the team together. As we enter into this new operating model, I think that experience will probably help as we try to continue and build those relationships and new relationships.

Brian Bolwell, MD: Well, I certainly think that one of the best parts about it was that. For our listeners, again, you have to understand the timing because COVID was a big, big deal for healthcare. It was a big deal for the whole world, obviously, and we haven't really been through anything quite like it. One of the things Dr. Parker said earlier was that in a way, when he was at Hillcrest, COVID helped unite people. I was in charge of the cancer center at the time, and it certainly united us because we showed up. We showed up every day. I thought it was very important that I was visible and present, and we took care of people in very uncertain times.

But it also meant that we didn't have very many in-person meetings and we went to a virtual environment. And so, when the institute leaders and the hospital presidents of the Clinic went to Philadelphia for a week, that was one of the first times that we had a chance to be in-person. One of the first times we had a chance to be connected again in real time with our colleagues and there is a real power in that. You can do a lot of things with virtual meetings, but some of the things you can't. I think that leadership books always talk about relationship building and how important that is, and the best way to do that is in-person.

To Rick's point, some of the things that I remember the best are the conversations I had in between the classes or after the classes were over. I remember the first night we had a fire alarm go off and I wound up having an hour-long conversation on a sidewalk in Philadelphia with one of my colleagues. It was a wonderful conversation. Those are the things you can't really mimic unless you're in-person.

So, Rick, fascinating stuff. For our listeners, are there any final leadership pearls you'd like to leave them?

Richard Parker, MD: I think you summarized it well. I think leadership is about being present. It's learning how to communicate in the manner in which someone needs to hear communication. You need to lead by example, and you need to be an active listener. You need to know when to escalate something and when to manage it at the level at which you are at. What I find is, it's easiest if you just are transparent and honest because it's so much easier to remember things by how they really are instead of sugarcoating it or making up a story. So, I thank you for having me and this was fun.

Brian Bolwell, MD: Well, thank you so much. These are great pearls that you're leaving with us. I'd actually like to just emphasize the last point you made. I think that being honest is ultimately the right thing to do for so many reasons, but not the least of which is sugarcoating things or spinning the truth. It's hard to remember. It's hard to remember what, just be straight. You can't really solve problems unless you're honest about them, so I really agree with that. 

So, thank you so much. Wonderful stuff. To our listeners, thank you so much for listening to Beyond Leadership with us again today. I hope you have a wonderful day, and we look forward to having you join us on future episodes. Have a great 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.