Managing Career Transitions: From Frontline to Leadership with Donald Malone, MD

Podcast Transcript

Introduction: 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 on leadership and management.

Brian Bolwell, MD: I am Brian Bolwell, your host. Today, I'm happy to introduce you to Don Malone, who joins us to talk about leadership and career transitions. Dr. Malone is president for Cleveland Clinic, Ohio Hospitals and Family Health Centers. In this role, he oversees Cleveland Clinic's main campus, all Ohio regional hospitals, family health centers, and ambulatory sites. He is also chair of the Department of Psychiatry and Psychology and is a practicing psychiatrist. He joined the Cleveland Clinic in 1989.

Brian Bolwell, MD: Fabulous to have you here with us today, Don.

Don Malone, MD: Thanks, Brian. Looking forward to it.

Brian Bolwell, MD: So can you tell our listeners a little bit about your leadership journey? As one of the major leadership roles in the organization, it should be obvious that he's in charge of all of the hospitals in Ohio, but he's also a world pronounced psychiatrist with a large academic career. So Don, will you walk us through it?

Don Malone, MD: Sure. I tell people I think it was accidental that I sort of bumbled and stumbled my way along over 32 years here at the clinic to get into this leadership position. But I found over time I would say yes to a lot of things, whether they were committees, whether they were smaller assignments, whether they were larger assignments. And I found that I had an ability to engage people, that I had the ability to bring people together around a specific task and accomplish it and get it done mostly due to all the other folks. But I was able to foster that in some way that that was a skill set that I had and I enjoyed it. I really found that I got the most gratification when it wasn't just me that accomplished something, but it was a team. And I think that, that enjoyment led me to different kinds of roles as I went along.

Brian Bolwell, MD: So when did you discover that? So the whole concept of working with teams and having teams drive results, is that something that you knew from the get-go? Is that something that evolved? How did all that work?

Don Malone, MD: Yeah, I don't think I did know it from the get-go. I've enjoyed interpersonal relationships so that's certainly something that comes relatively naturally to me. I enjoy that. But I started out when you do a lot of research, you start with your own ideas, but you realize very quickly that you don't get anything accomplished without a team. And when I took over the inpatient unit, you find that you don't accomplish anything without a team. And the more you engage that team and the more you allow others to succeed, the more success you have yourself, the more success the team has. And that just became more obvious to me overtime.

Brian Bolwell, MD: So you were chairman well, you ultimately, you didn't become chairman initially, right? I mean, so-

Don Malone, MD: No, I've been at the clinic 32 years. I became chair in 2009. So I was chair for about 11 years up until last November when I took over this role. And over the last seven and a half years of that, I was also president of Lutheran Hospital, which is a 200-bed hospital in inner-city Cleveland, not far from the main campus, which was a different kind of leadership journey. It wasn't always working with other professionals. It was working with a thousand employees that do everything from help prepare the food, to cleaning the rooms, to the docs that are in independent practice. And it's important that you speak openly, transparently and honestly with all of those groups. And it's important that all of those groups see you as a leader, and people are really good at seeing through people and their motivations.

Don Malone, MD: So if your motivation is self promotion, you're not going to fly amongst the environmental service staff. They know. And so engaging those teams is similar in my mind to engage in other teams, which is being open, transparent, honest, here's what we got to do together and to be part of that team, but there's different nuances that go along with that. And I found, I really enjoyed that. That when you get every level of the team functioning together with the same goals, it really does become a lot of fun and very effective.

Brian Bolwell, MD: So it seems to be a pretty big jump from chairman of psychiatry to running a relatively small regional hospital in inner-city Cleveland, why did you even apply for the job?

Don Malone, MD: I wish I could say I did, but I was kind of appointed. They said, you know, we need somebody. So it was sort of an application, but not really. And I thought about it and actually I had been talked to about it a number of years earlier, and didn't think it was the right time because we were really growing behavioral health in many ways. But I thought this was the right time. Lutheran is about half behavioral health so it was an obvious fit for me. But it also has half medical surgical with a strong orthopedic surgery presence so it wasn't just behavioral health. And that extra stuff that I hadn't done before was interesting to me and I thought would be valuable, not just in my development, but fun to do. And it was, very much so.

Brian Bolwell, MD: So you talked about the importance of transparency and authenticity and dealing with all levels of employees in the hospital. Are there differences between running an academic group, like the Department of Psychiatry at the Cleveland Clinic, one of the most prestigious academic organizations in the world versus leading a regional hospital?

Don Malone, MD: Absolutely. Yeah. I think, again, there are similarities in that you have goals and objectives that you have to meet and as a team, you have to get there, but the leading in academic department involves probably more one-on-one mentoring and guidance of folks who are interested in their academic career. Folks who are interested in leadership opportunities. Folks who are interested in fostering research and getting grants. So there are different motivations from the professional staff within an academic department, whereas the motivations for somebody at a hospital arranged from pretty similar, wanting to get academic at one end and just simply maintaining their paycheck at another. And I think being able to engage all of those folks with very different motivations around a concept of success as a team is different. Absolutely, it's different. And I think it taught me a lot about how important it is to act as a leader, be an authentic leader, and to engage folks and let them succeed in the ways that they view success.

Brian Bolwell, MD: So when you say, be an authentic leader, can you give us an example of what you mean by that?

Don Malone, MD: Oh, I think, it's inviting input and meaning it. Oftentimes we say, ah, happy to hear anything, any comments and the person that just said that doesn't really mean what they want to hear is silence. And when I got there, I had an open door policy in the president's office, literally my door was up. And initially, there was some reluctance obviously, but eventually a couple people came and sat down and said, I do want to talk to you about something. I said, absolutely. And you know what they had to talk to me about varied in significance to me, but not to them. And being able to address what it is, not all expected, but certainly saying, that's not something I can do anything about, but I hear you. And to actually hear them and to want to hear what they have to say, I can tell you, I avoided many many pitfalls by listening to whoever it was.

And I spent an hour every day while at the hospital and I'm not great with names I wasn't, but I got to know everybody's name and for the most part, and that took a while because it's not easy for me. I can remember everything about you, but I don't always remember you. And I got better at that, but I asked, how are you doing? And they began to realize that I meant, I really wanted them to know I cared because they were important part, whatever they did, they were important part of the team.

Brian Bolwell, MD: So all of this is sort of about psychological safety as well, right? I mean, you know-

Don Malone, MD: Completely, completely. I knew we had success when we were... We had a hand hygiene this year, really throughout the enterprise, which means you have to foam, sterilize your hands on the way into a room, sterilizing your hands on the way out of a room. And we developed this thing called snap with this scrub now and protect. And one of our infection prevention person ran a contest and we named it. And you could snap your fingers to remind somebody to wash your hands.

And I knew when a housekeeper in the intensive care unit snapped her fingers at our intensive care physician who didn't foam in and he just smiled. And said thank you. I knew that is when you have success, that is when there's psychological safety. And of course that story, we want to ramp it around the hospital. And everybody had a great time with it, including the intensivist who said, "Hey, you know what, I'm okay with that." And so that's when you know, you have it, but you can't just rest on that because it's something that has to be fed. It's something that you have to foster every day, or it goes away.

Brian Bolwell, MD: But also kudos to the intensivist who said, thank you. I mean, that's-

Don Malone, MD: Being awesome. No, it was. Yeah. And I think his response was because he knew what my response will be and he knew what the chief of staff's response would be. And the chief medical officer's response would be, it would be very much the same. Absolutely, that's awesome. But that engages the team, when everybody feels important. In a successful organization, everybody is, that makes a difference.

Brian Bolwell, MD: That's a really cool story. And just the idea of everybody feeling important. I mean, many people say that, folks, whatever they do just want to feel valued and worthwhile and meaningful. Easier said than done, but it sounds like you achieved that and quite significantly, and still do at that particular hospital.

Don Malone, MD: Yeah. I think you're always going to have 10% of the people that are unbelievably engaged, no matter what you do. You're always going to have 10% of a team that is not so engaged, no matter what you do. It's that 80% that if they're engaged and they're all engaged, then you're going to foster that attitude. You're going to foster that feeling of teamwork. And frankly, the bottom 10% probably will vote with their feet and you get the different 10% and gradually you hopefully get it to a higher level. At least that's what I thought.

Brian Bolwell, MD: You were still leading a Lutheran Hospital last year, when the COVID pandemic hit, how did that affect your workforce? How did that affect your leadership as well as behavioral health? What did you do if anything differently and what did you learn?

Don Malone, MD: Well, we had to do a few things. On a behavioral health unit, the odds of all the patients continuing to wear a mask and social distance are just... are zero. It's just reality for the patient population. And they eat together on the unit and it's a locked unit and they can't go off. So we immediately started testing all patients before they came onto the unit. And we didn't allow visitors, which was... That's a challenge. You know, people when they're at their most vulnerable and they're hospitalized often need their significant others and family to help them through it. So that was a challenge and something very different and also something different than we did everywhere else, because we had unmasked patients on a unit, but our... And then we had our caregivers wearing shields and masks like everywhere else, which was very impersonal and almost scary.

So it did change the dynamic quite a bit. I'm incredibly proud of the caregivers that just were able to do this. And we did have people seroconvert COVID positive at a time early in their stay. And then we'd have to isolate and shut down the unit and open back up. Fortunately, well, unfortunately the number of admissions went down significantly as people isolated and stayed home, mental illness didn't go away. It actually got worse. And we're seeing that now, while we're at where we're having huge, huge numbers of patients.

Brian Bolwell, MD: About five years ago, you applied to be chairman of the Neurological Institute, and that's a role that went to another individual. How did you react to that? And what did you do going forward from that?

Don Malone, MD: I was disappointed. I intellectually told myself that there were plenty of people that could do the job and their work. There's a lot of people that could do the job, but I'd be lying if I wasn't... Didn't say I was disappointed. But I also had a really good career and I liked what I was doing. It interestingly did have me look outside for the first time, 30 years, or almost 30 years at a CEO position elsewhere. And it caused me to look inside and say, what is it I want to do? Where is it I want to be?

And that was healthy for me. It actually was. I was offered the position and turned it down. It was very healthy for me because it, it allowed me to look inside and what's important. And frankly, the Cleveland Clinic was important. It's where I'd spent, at that point 29 years of my career to... And really is responsible for my leadership development. I don't think there's any question. I don't think I could have done this in many other institutions, but the opportunities that were offered to me were significant and I didn't do it because I thought I'd get this job. I didn't, but I did it because I enjoyed the jobs that I had and really enjoyed what I was doing and the people I worked with and I enjoyed the city and the geography and everything was just was the right fit.

And ultimately it's obviously worked out very, very well. And that's not always going to happen, and that's not always going to happen. There's not a lot of high level leadership positions and it could easily have not... Somebody else could have easily been chosen for this position and done just the same or better than I would. And I realized that, so I'm very fortunate, luck goes into this a little bit, too. You know, over time, there were times I was in the right place at the right time. And I took advantage of that. And I think that's important. Often I tell younger folks, then when you're asked, hey, can you help out with this? Or, hey, do you want to try your hand at this? Say, yes. You know, even if it's something you think, I don't know.

Sure. That's really what I want to do. You learn from it. You really learn from it and pay attention to leaders that your leaders and other leaders and how they act and how they behave and how they lead. Obviously, taking the good things from the good leaders. But I think just as importantly, make sure you pay attention to what's not working because there are leaders that aren't so great and every or any good leaders that do things. I mean, you and I, I'm sure they pump loads of mistakes as leaders over the years. And it's how you recover from those and how you deal with those that's important. But you can take a lot from examples of leadership that is not successful and learn from that.

Brian Bolwell, MD: Well, for those of you who are listening to this podcast have heard me say many times I have a PhD in making mistakes. And then I seem to continue to get that degree going on. So, yeah, but I think the key as, as you're suggesting Don, is to reflect and to try to generate self-awareness and to try to learn from mistakes and to try to improve. And if you want to improve, it means you have to change because if you don't change the status quo, then you won't improve. It's a pretty logical train of thought yet is very difficult for many, many, many people to do. I think that that's kind of essential as we talk about how to develop leaders. So it's not just a matter of, watching, it's also a matter of kind of internalizing and be willing to do the work, to change.

Don Malone, MD: Yeah. And to be comfortable with the fact that it's okay to be wrong.

Brian Bolwell, MD: Right.

Don Malone, MD: There's many times I've walked into a meeting where the group, and I said, sorry, I didn't get this one right. We got to change yourself a little bit. And some people take that as a sign of weakness that you admit your failings, but I can tell you that your team doesn't. Your team absolutely doesn't. They take that as a sign of strength and leadership. And I think you make the biggest impact on that team when you say, yeah, no, we, I didn't get that one right or we didn't get that one right or whatever it happens to be. And also too... if somebody else has tried something that didn't work to say, Hey, you know what, that's okay. There's nothing wrong with that. We learn just as much from the things that we don't do well, as the things we do well. So don't worry about that. We will be just fine. We're moving on.

Brian Bolwell, MD: I really agree with that. I mean, that's fascinating how sometimes it takes a team a very long time to arrive at a decision. And when they do, they're married to that decision for life. And I think that's derailing, and I think it's frequently leads to bad outcomes because it's fine to course correct. It's fine to say, Hey, there's new information. We need to make a change here, or as you say, say, Hey, you know what, that, wasn't the best decision after all, we need to try something else. And I think if you do that, it shows strength. It shows courage. It's analogous to saying, I don't know. I like to say, I don't know. I actually think it's something team members like to hear. They want to try to help. And I think it adds to authenticity, which the more I'm exposed to leaders down, the more I think authenticity is absolutely essential. Just to show that you're human, you're fallible, you're vulnerable, but you're also well motivated.

Don Malone, MD: No, I mean, I agree with you. I think that I don't know is one of the most important things I say. Even on the executive team now, if I get a question from the CEO, I'm not going to fudge an answer. It's just not me. And, and it also, isn't helpful to anyone I'm going to say, I don't know, I'll find out. And maybe I should have known maybe, but it doesn't really matter because I'm... I'll find out and we'll work on it and I'll get back to it. And that's okay. I think people really do. Not everybody likes that answer, but I mean, good leaders do. They appreciate that. And when people tell me that I say, Yeah, don't worry about it. Just let me know. And that works out pretty well.

Brian Bolwell, MD: I think a corollary to that is the concept of forgiveness. I think that within a team environment, it's inevitable that people will let other people down, especially you as the leader. I mean, you will make mistakes and you will, sometimes your words will be taken in a direction that you didn't mean. And there will be individuals who miss a deadline or whatever. And I think that, well, not a substitute for accountability. Forgiveness is actually quite empowering to a team. It generates psychological safety and it takes courage to forgive other people. But ultimately if you do, I think it really drives team cohesion.

Don Malone, MD: Oh, I agree with that. I think, I mean, especially a good faith errors. I mean, those happen all the time and yeah. I mean, those are different than things that are done, not in good faith, which have to be very directly addressed, but I mean, good faith errors and mistakes, and inaccurate projections happen all the time and that's okay. I think you learn just as much from those as you do from successes. Just a great, one of my favorite quotes of all time is bill gates and said, "Success is a lousy teacher. It seduces smart people into thinking they can't lose." I think that that says it all. If all you do is get rosy results, you're probably getting off track a little bit. Whereas if you're... If you have a mixture, that's a good thing because you learn, I think we learn more actually from your failures than you do your successes.

Brian Bolwell, MD: Yeah. I agree with that. Yeah, one of my personal favorite quotes is knowledge is the enemy of learning. I think sometimes people think they know it all and therefore they're unwilling to learn. And boy, I think you can keep learning about almost any topic under the sun and certainly about leadership. I think that's-

Don Malone, MD: Yeah. And I think, some leaders think they do have to have all the answers.

Brian Bolwell, MD: Right.

Don Malone, MD: I mean, certain personality styles feel that they do have all the answers, which is even more of a problem. But I think that a lot of leaders feel that they should have all the answers. And even if they're not overly committed to what they're saying, they say, then I think that's a mistake. I think being transparent about... I'm kind of thinking about it this way, but I don't know. I'm looking for input let's... Here's how we'll get to that answer. Let's do this. I think that that openness means a lot to people. They need to see some humility. They need to see some humanness, otherwise they don't connect as well.

Brian Bolwell, MD: So in your new role, your scope is much larger. You have one of the largest jobs in the organization. Has that changed how you lead? I mean, it's a little difficult to take an hour and walk every hospital that's under your purview and meet everybody and know everybody's name. It's a different role. What are the differences in, how are you addressing them?

Don Malone, MD: Well, that's a really good question. There are times during the day and I'm going to meet for, go from meeting to meeting oftentimes. And I think, what am I doing? I'm not really doing anything. I'm kind of watching everybody else work and it's kind of what I'm doing. And I have to set the vision. I have to set example, but it... You better be good at delegating. You better be really good at identifying people who are able to do the task at hand. Sometimes make hard decisions about those that care, because you're going to be completely dependent on them to do their jobs, whether it's medical operations, surgical operations, pharmacy, hospital presidents, whatever it happens to be. I mean, there are areas under my purview, such as pharmacy that I know absolutely nothing and yet I'm responsible.

So it's, it's completely incumbent on me to make sure we have a great leader in that area. And we do, we do. And so I have to let them intervene when I have to, as far as helping them succeed. But other than that, I'm delegating.

And also the other thing I recognize is how important even 15 minutes of facetime with me is. And my wife will tell you, you get way too much facetime with me. Right. I mean, it's, yeah... It's not necessarily positive for everybody, but for those that you lead, I stopped by medical staff get together last night from one of our regional hospitals. And on my way, home, the hospital president called me and says, you don't know how big an impact that had, and I'm thinking, really? Didn't do anything. I stopped by and said hello to everybody. It was, I need to remember that I'm learning that a little bit more every day, about how impactful that is, because to me, it just doesn't feel like it should but it is. And I have to remember that and I have to take advantage of those opportunities to make sure that folks know that they're valued.

Brian Bolwell, MD: So do you have, especially in your new role, has your philosophy of leadership changed and either way yes or no. Can you kind of summarize it for our audience?

Don Malone, MD: It hasn't. I am who I am. It's worked reasonably well for me so far. It's who I am. You have to be true to who you are. You can't be... You can't pretend you're somebody else in a leadership position. People see through that, it's transparent, it doesn't work. So truthfully, I don't think my style has changed at all. I think that I'm less able to get into the weeds on certain, in certain things obviously. And I'm okay with that. I'm pretty comfortable with that. But yeah, overall, I would actually say, no, it hasn't changed.

Brian Bolwell, MD: I mean, if you would advise for an upcoming leader, what would it be?

Don Malone, MD: Become comfortable with who you are. And I think again, I encourage people to have as many different experiences as they can. It makes a difference. I learned something from everything I did over the years, whether it's pharmacy and therapeutics, whether it's space, whether it's all these different things that committees that I was on, or did. People I engaged with, I tried to learn from everybody and every experience and it all comes together, in a good leader. I think it all comes together to where they are confident in who they are and what they're doing.

And that doesn't mean cocky, but confident that you know a lot about the direction and that you can help people achieve their best results too. And I also found that mentoring others taught me a lot addressing leadership issues with others as either positive or negative. That taught me a lot too. And I grew a lot from that because hard conversations are hard. I think I'm a relatively nice guy. So I don't like making people feel bad. That's not, not something that comes naturally to me, but I've over time become very comfortable with hard conversations. And in fact probably have them far earlier than I ever did because they are highly productive. And then they don't always resolve in anger and separation. They often result in this has been really helpful. So I would encourage people to do that as well.

Brian Bolwell, MD: And as he said, at the introduction of this podcast, a primary role of a leader is supporting their team and engaging their team. And with the team tends to be the folks who are driving the results.

Don Malone, MD: Yeah. I mean, they do it all. They do it all, especially where I am right now. I mean, they clearly do it all. And it's important that you give them credit for that. It's important that you recognize that both verbally and non-verbally, I think you have to do that to be effective as a leader, because if you don't, they're not going to go the extra mile the next time, what's the incentive? Or they're going to try harder to get recognized. And in other ways that that may not be a good for the team. So it's important that you recognize folks for all that they do because people do work with, I mean, I got a lot of people on my team that work a lot harder than I and that just they do. And it's amazing the amount that they accomplish and, and you have to tell them, yeah.

Brian Bolwell, MD: Yeah. One of the things I like to say is that a leader, when credit's going to be given the leadership, sit in the back row and make sure that everybody else gets the credit, because the credit is back, go to the leader, it goes to the team, it goes to, the people are actually doing the work.

Don Malone, MD: And the corollary to that is you better be in the front row when the blame comes.

Brian Bolwell, MD: Well, I agree with that too. You've got to shield the arrows and you've got to field them and you've got to have the courage, which many say is the most important virtue in leadership to deal with the bad stuff and the hard stuff. But I think if you can do that, it just adds to your credibility, to your authenticity and it helps generate trust.

Don Malone, MD: Yeah. I think we all have times we need to deal with frustration, whether it's our failures or whether it's something maybe have been out of our control that we're getting criticized board anyway. It's important to not dump that on your team. It's easy to do. It's tempting to do sometimes, sometimes some of it's deserved, but you can't do it. It doesn't help. And I can tell you, they will, they'll run through a wall for you if you take those arrows and say, okay, my bad, got it. All right. Here's what we got to do next. It really makes a difference.

Brian Bolwell, MD: So I think that's a good way to wrap up. I think that these are very important leadership ideas and philosophies that I think are applicable to all of you listening to us. And we certainly thank you for listening and Don, thanks for joining us today.

Don Malone, MD: It's been fun.

Brian Bolwell, MD: As did I, as always, when I get to hang out with you.

Conclusion: 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 executiveeducation@ccf.org or by clicking on the link in the show notes.