Mindful Impact - Leading by Example

Podcast Transcript

Brian Bolwell, MD:Beyond Leadership, a Cleveland Clinic Podcast at the intersection of leadership and everything else. In this podcast, we will commingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership and management.

Brian Bolwell, MD:Hello everyone. I am your host, Dr. Brian Bolwell, and today I have the pleasure of speaking with Marna Borgstrom, former CEO of Yale New Haven Hospital and Yale New Haven Health. Welcome to Beyond Leadership, Marna.

Marna Borgstrom:Thank you so much for having me, Brian.

Brian Bolwell, MD:Marna, can you tell our listeners a little bit about yourself? You started as an administrative fellow, I see, in '79 at Yale, is that right?

Marna Borgstrom:That's correct. I'm the accidental CEO, is what I tell everybody, because I never said I want to be a CEO. I actually started my healthcare career as a unit secretary back in 1976 at Stanford University Hospital. I graduated from Stanford with a degree in Human Biology, which prepared me to do absolutely nothing, other than having loved studying human biology. So, to pay the bills, I had a part-time job at Macy's, and I worked as a unit secretary on the second shift at the Medical Center. And over the course of about two years, I just fell in love with, at that time, the inpatient environment. Went to graduate school, and when I got out, I promised my husband who I had just married and who was from the West Coast that we would stay in New Haven for two years, that was 1978, and we would go back to the Bay Area.

Marna Borgstrom:I keep most of my promises, that was one I did not keep. And I started and I've done a little bit of everything. I've done staff work. I've done operations. I've done strategy. And I've loved it all. I never sat down at one point and said, "Gee, this is exactly what I want to do."

Brian Bolwell, MD:So, I've got to ask when you were a secretary at the hospital, what was the ward?

Marna Borgstrom:It was the pediatrics unit. You know, because I think that you go back a while in healthcare too, I shudder to think of the number of medical errors to which I contributed. Because that was in the day when the unit secretary sat there and the attendings and the house officers, everybody would come, and they would plop orders on my desk. They were handwritten for a radiological procedure, for a lab test, for a drug order. And my role, in part, was to transcribe it manually onto Kardexes that would then go... I mean, you remember this... What did I know about reading the handwriting? What I knew about the nuances of clinical chemistry orders and pharmaceutical, I shudder to think about all the terrible things I may have contributed to.

Brian Bolwell, MD:I'm sure that's not accurate, [Marna laughs]. But anyway, it's a good story. So, in 2005 you became CEO, how'd that come about?

Marna Borgstrom:So, I was the Chief Operating Officer at the time, and the person I worked for was a great guy, great mentor, and he was fairly young, and I didn't expect him to retire at that point. But for a whole lot of reasons, he retired when he was 58. And we were not that far apart in age, and he said to me, "You're the insurance policy. Do you want this?" And I really had to think about it. I wasn't sure. But then I realized that if I didn't take the job, they would bring somebody else in who would likely require me to leave because somebody would want to build their own team, so, you know, I threw my hat in the ring. The President of Yale University at the time was pretty intent on having a physician in this role, and serendipity, the rest, as they say, is history. And three of the people with whom I competed for the job have become good friends and are all doing amazing things now. So, it's a small world.

Brian Bolwell, MD:So, when you first became CEO, a couple questions, number one, what were the challenges that you faced? This was in 2005. Number two, wonderful book, What Got You Here Won't Get You There. And so, you can't really be the same leader when you elevate to a role like that. In what way did you have to change?

Marna Borgstrom:It's a really good question, and I think in reality the reason that the President of Yale University was not enamored of my candidacy was less about me and more because he and my predecessor butted heads on a lot of things, and he assumed that because I had worked for this individual for a long time, that I was going to be a continuation of that. And while I was very loyal and still friends with my predecessor, we are very different people. We approach things very differently. And so, I think that was number one, is how do you maintain a commitment to the values and the strategy while executing in a way that says, "I think about things differently, how we get there, what success looks like." So that was a big one.

Marna Borgstrom:The other thing that was particularly challenging was Yale New Haven Hospital, the academic medical center at the time was in the fifth year of a national corporate campaign that was being promulgated by the Service Employees International Union. And their strategy at the time, because they're like any other business, they only do well if they grow membership. And so, they had decided that, because Yale University was wall to wall unions, that they wanted to organize the academic medical center and create what they call the Union City, so that all the major employers would be organized, and then they could influence the course of many things in the city.

Marna Borgstrom:And my values were, if the employees want a union, let them vote, but we are not going to roll over, accept card count. And so, I walked in in the middle of this. I think it's one of the reasons, frankly, that my predecessor retired when he did. We agreed on some rules of engagement, but that would end in a free and fair election for the employees. And when we got within about six weeks of that, I think the union knew that they were going to lose, and so they filed almost simultaneously about 50 unfair labor practices and created this image that then the press and politicians bought into that we had done something wrong in this.

Marna Borgstrom:It was an awful time because I would read about myself in the paper, how awful I was, but I knew the organization and I knew the employees. And anyway, long story short, after a really miserable time that nobody could have ever prepared me for, nobody wrote a case study on, we came through it. There was never an election held. The employees did not then when SEIU went away try and organize, so I think it wasn't their thing, and we moved forward.

Marna Borgstrom:But in the course of this, because of the political influence that they had, they held up the construction of a new cancer hospital for almost three years. And so that project at the time cost us over 40 million dollars more than it should have just in inflation cost. So, you look at it and say, nobody won in this. It was awful. But I learned a lot about myself, and the one thing I learned is that although I've always thought of myself as a pretty nice person, Brian, I'm a lot tougher than I thought I was.

Brian Bolwell, MD:Well, for our listeners, they've heard me say this many, many times, I think the single most important character trait you need to be an effective leader is courage. And it sounds like you've had to have an awful lot of courage to go through that.

Marna Borgstrom:It was tough. People sent my kids, who were in college and away at high school at the time articles about me that were just awful. I think it was the personal insult that was as hard as anything.

Brian Bolwell, MD:So how did you draw resilience during all that?

Marna Borgstrom:I think the way that I've drawn resilience from a 43-year career at the organization and as the health system grew, because I believe that I know the values and the soul of the organization, and organizations are only as good as the people who lead them and who we employ to do the work. And we are so fortunate, like many people in organizations in healthcare, to have amazing, amazing staff. And throughout it, they kept me strong more than anybody else.

Brian Bolwell, MD:Yeah, that makes sense to me and that resonates. I mean, at the end of it, on the other side, the way you managed that must have generated a lot of respect.

Marna Borgstrom:You'd have to ask other people, but I think that I had a great run, and you said courage is an important leadership attribute. The other one that I would add to that is humility. Because I think people can relate to people who they think are humble. And so that was another important trait I think that my late mother brought to me, and I brought to the job.

Brian Bolwell, MD:So once all that kind of settled down, it sounds like the growth of the system was pretty stunning over the next 15 years or so. Probably a lot of strategy involved, probably a lot of operations, a lot of executions. How did you do that? I mean, you mentioned that you have a background both in strategy and operations, it sounds like that served you well.

Marna Borgstrom:Thank you for saying that, and I think it did, because I think sometimes the challenges with strategy and strategists is that you can have great ideas, but they can't be executed effectively. I do think in the time that I was CEO and got to know so many of our colleagues around the country, when we would get together, we'd kind of laugh because everybody had pretty much the same strategy. I think the holy grail was execution. And what I'm more proud of than the actual growth of the health system, and it's still a work in progress, but was the work that was done to integrate so that we weren't just a collection of ambulatory sites and hospitals, and now home care agencies and things, but we really knitted together, not perfectly, and there's a long way to go, but I think that's important because you can be a system.

Marna Borgstrom:The argument that the Federal Trade Commission makes is that you end up just being more expensive and you become more costly in the market. And I've always thought that would be kind of a stupid reason to grow, because at least in the Northeast, 70%, almost of our revenue now is from the state and the federal government. And they don't negotiate with us. They kind of tell us what they're going to pay us and what they pay us is based more on what they can afford than what their insureds are using. And the commercial payers, with the exception of the real tertiary and quaternary care at the academic medical center, the commercial payers are saying we can't sell our product if the aggregate is outpacing anything that can be supported in the market. So, I think that the imperative for all of us is to get that value equation right. There is value when you have the largest kidney transplant program in New England and what you do, but it is hard to define value for a cholecystectomy that can be done in any of our organizations, define it in the same way I should say. Yeah.

Brian Bolwell, MD:So, I would agree with the importance of integration. We certainly have spent a lot of effort doing that here in Cleveland, at the clinic and throughout our hospital system. Again, from an execution perspective, how did you do that? One of the things that we've done is having a uniform electronic medical record. That's one of the ways to integrate. What tools or techniques did you use?

Marna Borgstrom:Well, you just pointed to the one that I think was the single most important decision we made. So, when we had a smaller system, we had every one of our organizations on a different EMR platform. We had Cerner, we had Meditech, we had Eclipses, the medical school back a little over a decade ago was still manual. Everything was, kind of, you know, Rube Goldberg and we had made the decision as we were growing that we would have to figure out how to adapt those, because it would be too expensive to throw them all out. Because the organization that had Cerner had just put in the newest version of it, and it wasn't appreciated and blah, blah, blah, and all these are arguments that can be made. But what became clear was that you can't maximize the value of the care. You can't integrate it. You can't produce good data if you can't get it in the same way and use it similarly throughout the system.

Marna Borgstrom:So, we came together, we got all of the original boards of the hospitals together. We interviewed all these firms and the then Dean of the medical school, Bob Alpern and I used to sit in the back row of these rooms, listening to these tech companies and we got most of our emails done during them because they were not very interesting. Then, this is going back 12 years ago or so, Judy Faulkner walked into the room. Bob and I both kind of sat up, and at the end of that, we were looking only for an ambulatory EMR at that time to knit across the system and for the medical school to go on to. And by the time we finished subsequent conversations with Judy, I said, "We got to do this for everything across the system." Now, Epic isn't perfect, as you know, but what it allows us to do, because it is a single system that you can integrate and grow with has been phenomenal.

Brian Bolwell, MD:Yeah. And it's really important to do that, to have one medical platform like EMR platform that everybody can connect with. Supply chain, that's another thing that we've done.

Marna Borgstrom:Yep. And you and I, we both share Vizient. As a matter of fact, I chaired the board of VHA, then when it brought in the University Health System Consortium, my term got reset. And then when we bought net assets and sort of evolved to Vizient, they couldn't get rid of me for whatever reasons, but it was really fascinating, Brian, to be part of that growth and that vision. And I remember a very innovative approach that the clinic brought to Vizient in order to move that and to create kind of a regional platform for integrated, not just Cleveland clinic organizations in that Vizient coalition. And what I know about what you all did, it was very impressive. And we've tried to emulate that because it's a part of getting a signature quality of care, and it also can be an effective way of leaning your costs a little bit.

Brian Bolwell, MD:Right. Has your leadership philosophy evolved over the past 20 years or so? How do you approach leadership, and do you continue to learn about leadership?

Marna Borgstrom:I think if you stop learning about leadership, you're no longer a leader. I took this job, I had a board chair who is still a very good friend, but he was just a humble bagel baker. He had his family make bagels and then they sold the company to General Mills or something and whatever. But anyway, Marvin, as a simple bagel baker, two different times gave me the two best pieces of advice I had for evolving my leadership style. One was when he told me that as a leader, I should be spending at least a quarter and ideally a third of my time on talent and talent development. And I thought he was crazy. How can you possibly spend that amount of time? And I certainly didn't at the beginning, but in the last several years I spent every bit of that and then some, because I think that it's not just identifying succession plans, but it's making sure that everybody has a growth and development plan and they know what that plan is, and they know what they need to do to become even stronger than they are and to make themselves ready for other positions.

Marna Borgstrom:So that's something, because I think the single most important thing that a CEO can do is build and nurture leadership because that's how everything gets done. The second piece of advice Marvin Lender gave me at the time was he asked me if I had at least two and ideally more people on my senior team who I was confident would walk into my office, close the door, and tell me when I had been absolutely wrong or totally stupid about something. And he said, "And I want you to think about this."

Marna Borgstrom:So, I thought about it and thought about it, and about a month later when we met, I said, "You know, Marvin, I've been thinking about this. I have the answer." And Marvin had forgotten he'd ask me the question, by the way. When I told him who they were and that I was confident that they would, he said to me, "If you don't have people who you are confident will do that, I would tell you that you have a higher likelihood of not succeeding in this job." If you have them then the only thing that will impede your success is if you don't listen to them when they walk in. The translation of that is don't believe your own press clippings, because you're not nearly as good as other people say you are. And I think that was a very important piece of leadership advice that also gets into humility. Ask more questions. You have many more questions than you have answers.

Brian Bolwell, MD:Well, that's a really important point that I totally agree with. I mean, number one, obviously you want to create an environment of psychological safety where anybody can come into your office and say, "You didn't really do really well right there. That's a really dumb idea," or whatever. Secondly, having a couple people who kind of fill that role is a really good strategy and resonates with me in a big way. Before we started this podcast, we talked a little bit about a week ago about the value of 360s, which I think is another way to keep your humility at a fairly high level. At least it is for me, because my first 360 was pretty negative and it didn't feel very good. In fact, it felt terrible.

Brian Bolwell, MD:It really propelled me to try to study leadership and to try to get better, and to realize that no matter where I was, or no matter how good I thought, I had an awful long way to go. And I still think that. And I think that part of the keys to success is realizing that. That however good people may say you are, internally if you're self-reflective and you have self-insight, you know that you've got a long ways to go, no matter where you are in your career.

Marna Borgstrom:I absolutely agree. And one of the things that I did not do initially, but about seven or eight years ago, we started doing a 360. And the 360 tool that we used, what I really liked about it was that it was pretty straightforward and easy to use because that then makes it replicable. You can do it every couple of years and watch people's progress and really begin to look at some of this. And I think that the 360 has been incredibly important, not just to the individuals, but to the team. Because it really is about this being a big team sport ultimately. And when you have subordinates, superiors, peers, other people with whom you work providing input into who you are and how you do things, once again the only thing that's going to trip somebody up is if they don't pay attention to that, as you said.

Marna Borgstrom:And I have found it to be incredibly helpful, my first 360, one of the things that people said about me was that they wanted clear direction for me. They thought that I tried to build too much consensus. And so I took that to heart. I started being a little bit different than I had been. And our chief clinical officer walked into my office one day and he said, in more colorful language, "What the devil are you doing?" [Brian laughs]. And I said, "Well, I got the feedback, Tom," and he said, "Stop it, stop it, go back." So sometimes it's a little bit be careful what you wish for.

Brian Bolwell, MD:Yeah. So, one interesting thing about development plans, and for our listeners a development plan is basically something that's laid out on paper for individuals to look at what their strengths and opportunities for improvement are and to come up with specific plans and things for them to do to get better. Where I was just having conversation about this the other day is that development plans are very individualistic. And sometimes in a given group of individuals who have to work together, the individuals may individually be doing fine. But as a team, the team may not be doing so fine. How do you marry individual development plans within team dynamics and how well the works together in terms of collaboration, in terms of psych safety, in terms of all that stuff?

Marna Borgstrom:That is another great question. And I'm not sure that I have an answer. Because I think that a lot of it, you intuit along the way as you look at the information that's coming in. One of our presidents of one of our community hospitals, one of the things that became clear when we did the 360 was that he had a bunch of really great individual contributors, but they did not operate as a team. And he was like the sun, and they were rays coming off the sun. And if he weren't in the room, I'm not sure that they could have come together and continued to move forward. That's a problem.

Marna Borgstrom:So, I think the reason the 360, well, a reason the 360 is so helpful is because it is about developing an entire team of people, not just individual development plans, so that the development plans that I've done with some of our senior executives, some of them have addressed their interactions with other people. It's interesting, when I started working with my current coach in 2016, and he said to me, "What do you want to get out of this coaching session?" Which was the right question. I sort of wanted to improve my self-awareness and my skills and everything. And he kept saying, "That's not good enough. That's not good enough." And finally, he just kept pushing me and pushing me. And I said, "All right, what I want is to develop a talent development and succession plan, where when I leave, this is a succession with no drama."

Marna Borgstrom:Which means the sun did not set and walk out. It means the queen is dead, long live the team and the king afterwards. I think my opinion is that we accomplished that. Nobody was surprised, there was no great gnashing of teeth. I have a lot of people who said wonderful things, but I actually listened to a town hall, system wide town hall that my successor and a couple of the members, senior members of the team did this morning just because I wanted to. They didn't miss a beat. And that's pretty cool.

Brian Bolwell, MD:That is. I mean, huge congratulations to you for accomplishing that. I'm a big believer in executive coaching. Sounds like you are too.

Marna Borgstrom:Yes. I wish I had gotten the right executive coach earlier in my career because I think I could have done a lot of things better, but yeah. It's finding the right person. I had a coach at one point, I loved her and I would love to go out to dinner and have a bottle of wine with her, but it got to the point when I'd look and see her on my calendar, I'd think I have so many other things to do. The right executive coach is the one where you're actually reaching out to them. So, like everything else, relationships matter there.

Brian Bolwell, MD:I agree. So, making a couple pivots here. In 2020 COVID came along and that was hard for every healthcare system, obviously. And the Governor of Connecticut named you co-chair of the state's response to the pandemic. Can you share a little bit about that with our listeners?

Marna Borgstrom:Yeah. You know, you're absolutely right. That was the game changer for all of us. And for us in the little Connecticut Westchester County and part of Rhode Island, a fairly small geography. The interesting thing was after this initial Seattle cases, the first major outbreak was in Westchester County. Our hospital in Greenwich, Connecticut, which is only a little over 200 beds, is a stone's throw. Most of its patients come from Westchester county. So, within a very short period of time, they literally were a COVID hospital and then they did some maternity. And that was it. And the cases came up the I95 corridor.

Marna Borgstrom:So, if you think back, I remember landing from a Vizient board meeting at the end of the first week in March of 2020. We were kind of gearing up to do a command system and to look at what was happening with this. But none of us really knew. I remember that we did our first town hall the second week in March because people were so anxious, and we were all sitting at a long table. We were not socially distanced. Nobody was wearing a mask because the CDC wasn't recommending it at the time. And we had at one time over 8,000 people in the system on that town hall. It just showed you how frightened people were. And as we were getting questions, either clinicians particularly knew how little we knew about how this was transmitted, how we were going to treat it. And it was a really scary time. And by the third week in April, we had over 820 COVID positive inpatients. The daily reports, safety reports were how many vents were not in use because that's when ventilation was a default rather than high flow nasal oxygen and then subsequent treatments. And the staff were terrified because people who worked didn't want to go home, and they took off their clothes in the garage and they were afraid of getting their families sick.

Marna Borgstrom:You remember, it's almost hard for me to remember how terrifying and all absorbing that was. When everybody else was hunkered down at home, healthcare people and not just physicians and nurses and respiratory therapists, but food service workers and environmental service, they were coming in. I think it was the hardest time bar none that I'd had in healthcare. But again, it's kind of like the union thing. What came out of it were a couple of really good things. One, the team never performed better as a team. The incident command structure in the system, we broke down all of the this is my delivery network, this is my, you know... It was load balancing. We wanted to make sure that nobody had too many really sick patients, that everybody had staff, and that everybody had the right equipment in pharma and IT equipment that they needed.

Marna Borgstrom:The team performed as perfectly as I could have possibly imagined. And the best thing that came out of it was that one town hall that we did thinking it was a one off, is what the men and women were still doing this morning, and it has become an incredibly effective way of connecting us for COVID and all kinds of other issues now with a pretty large and diverse workforce. So as hard as COVID was, we got some pretty good gifts out of it too.

Brian Bolwell, MD:Yeah, I totally agree with that. I think that number one, people outside of healthcare do not understand what it was like in March and April of 2020. And I think you articulated it very well and very accurately, the amount of fear was overwhelming, but people came through, and they were heroic. And it's something that I think all of our... Well, most of us who have leadership roles in healthcare are extremely proud of. One of the things that was key for me was communication. You know, constant communication. I mean, multiple times a day sometimes, but especially being authentic. And again, talking about humility, Marna, I mean, sharing what you didn't know, sharing what you were concerned about. And even on a personal level, that turned out to be very useful for me. I'm sure that you communicated constantly when you managed through this as well.

Marna Borgstrom:Well, and the one thing, you were talking about it, our chief clinical officer in a fashion that almost got him a right hook said to me very early on during the pandemic, "Marna, I don't think you should be out rounding because you are in that age group that's at higher risk." Which is a code for you're over 65. I said to him, "Come closer and I'll smack you for that." But I stayed in my office and tried to do things remotely for about three days. And then I said, "Well, this is crazy. If these people are in, I'm going to be in." It was interesting because remember all the local restaurants were sending in food and people were doing drive by toots in their police cars and fire trucks. But I remember in the COVID ICU and the academic medical center, we'd always go through and say, "What do you need? What can we do for you?"

Marna Borgstrom:Sometimes it was, "We need better gowns," because we couldn't get enough gowns. And these things were breaking. It was some of that. But one really poignant moment was when a nurse said, "Don't forget about us." It just struck me and I said, "What do you mean?" And she said, "After the food's gone and the hero stuff is gone, we're going to be living with this." She had just told me about a 32-year-old patient she had been caring for for the last three days who they'd done everything for and who she didn't think was going to survive. And I think that what those staff went through is the real definition of heroics.

Brian Bolwell, MD:I totally agree. 100 percent. You have been one of the leading female executive leaders in healthcare for quite a while now, thoughts about women in leadership, how far we have to go where we are today, anything?

Marna Borgstrom:You know, we've made a lot of progress in the time that I've been in this field. When I first started even 16 years ago, very often I was the only woman CEO in the room. That is certainly not true now. And there are a number of really talented women leading firms, leading systems right now. But we always have more to do and farther to go in all levels of diversity, equity, inclusion, belonging among our teams. As the mother of two Caucasian males in their thirties working, I like Caucasian men too. I try not to be overtly feminist about this, but I will tell you, I love working with women. And when I joined one of my favorite national groups, The Healthcare Institute, which is made up of about 35 system CEOs around the country, I was the only woman on the board. And then I chaired it, and when I retired from that position last November, the board of The Healthcare Institute was 50% women. And I used to joke with some of the guys, it was because the women did the work. [Brian and Marna laugh].

Brian Bolwell, MD:Outstanding. I'd like to ask you about something that just happened in the current events this week, because we started this podcast with you talking about being a secretary on an inpatient ward unit and you're worried about the errors you made. And this week a nurse was found guilty of criminal negligence for a medical error. What do you think the ramifications of that are?

Marna Borgstrom:You know, it's interesting that you're raising it, Brian, because as I was listening to my former team's town hall today, that was a big part of the question. That was a big topic of discussion that a couple of nurses raised. One, it's hard to comment because I don't know all the facts, I've read what everybody else has read, but I have not talked to my colleagues at Vanderbilt to say, "What can you share beyond that?" There's some holes in the information we have. I mean, people were writing into the chat in our town hall today, "Should I be getting personal liability insurance?" Things like that. And we're going, "Absolutely not."

Marna Borgstrom:I think the standard and when we find out more information is the allegation there was that there was criminal negligence. That this person did something that was fully inconsistent with policy guidelines, whatever. If that's true, you can explain and understand that differently. But what we've said to our team is everybody makes mistakes. And if you are working within the context of the policies, procedures, pathways that we have in place, and if you make an error, we will support you in that. Because human beings make errors. You know? So, it's hard to comment on that case without knowing more. But I think that we have policies, procedures, and standards for a reason, and people sometimes follow them, and they still make mistakes. And that's being a human being.

Brian Bolwell, MD:Yes. I agree with that. Career transition. So, you decided to retire from being an extremely successful CEO last year and you just made that transition a few weeks ago. What led you to the decision and how does it feel?

Marna Borgstrom:You know, I knew that you never know when it's time to go. So, this has been part of intentional planning, as I mentioned earlier for the last six years. And we moved the date a little bit because of COVID, because I didn't want to walk out at the beginning of COVID. But the former President of Yale University who served as an Ivy Leagues President for 20 years, when he told me he was leaving, I said, "Why, you are arguably the most successful president Yale ever had." And he said, "You need to know when to walk off the field, because you don't want to be carried off after the fact." So, I don't think that I was ready. It was a very hard transition, but I was ready because I had done the planning. That's all a personal thing.

Marna Borgstrom:My husband is terrified because he thinks he's going to be my new project. Maybe he should be a little bit, [Brian laughs] but I'm going to do other things. I'm working with a couple of colleagues across the country on two different projects, and I am looking forward when I finally exhale, this is my third day of retirement, to getting into a routine that's a little less frenetic than what I've been in for the last 45 years.

Brian Bolwell, MD:So, as we wrap up, what are your final thoughts about leadership, about leadership development, about what makes a good leader? What makes a leader who's not as good? What do you think?

Marna Borgstrom:You know, I would say that... I come back to something we talked about, humility, courage, the focus on building alignment and collaboration, because this is a team sport. Supporting innovation and creativity and modeling diversity, equity, and inclusion. Not just saying it's important, but modeling it are critical to any leader, in my opinion. And in the final analysis, it is just as important how we do what we do as what we do.

Brian Bolwell, MD:Say more about that.

Marna Borgstrom:I think successful people are very good at hitting metrics. If we give people metrics and it's part of an annual set of goals, successful people are going to move heaven and earth to hit those metrics. But you can do that and leave a lot of bodies in your wake, and a lot of work for people to clean up. And one of the things I love about being a not-for-profit healthcare is we don't have to live quarter to quarter. We can take a longer view of things and therefore I think doing the work and doing it well but being always mindful about the impact that it is having on the organization and other people is critical.

Brian Bolwell, MD:I think that's totally profound. I actually think the most important things leaders can do is hire really good people and support them. When you talk about achieving results, how it affects the team and the individuals who are participating is essential. Because you're right, there's a lot of ways to execute things. There's a lot of ways to hit metrics. There's a lot of ways to reach a certain financial target or whatever. And people execute in many different ways in real life. But the leaders who are level five leaders who are admired and respected and ultimately, I think do the best job are those who realize how important their people are.

Brian Bolwell, MD:This has been a superb podcast, Marna, thank you so much for taking your time and being generous with all of your thoughts. For our listeners, I hope you enjoyed today's conversation. Thank you so much for tuning in, and we look forward to our next podcast of Beyond Leadership. Have a good day.

Brian Bolwell, MD: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 podcast. 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.