Put together a Team like a Puzzle

Podcast Transcript

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

Hello everybody and welcome to today's episode of Beyond Leadership. And today I'm delighted to have one of our leaders of Cleveland Clinic London, Dr. Jamanda Haddock, who's the Interim Chief of Staff and the Chair of Hospital Services at Cleveland Clinic London. Jamanda, welcome.

Jamanda Haddock, MA, MRCP, FRCR: Hello, Brian. Thank you and thanks for the opportunity to talk to you today.

Brian Bolwell, MD: Well, it's my pleasure. Tell us about you. Tell us about how you came to join the clinic and what your career was like before you did.

Jamanda Haddock, MA, MRCP, FRCR: I'm a radiologist, Brian and I had a consultant post at one of the London teaching hospitals for many years. I'm a cross sectional radiologist with an interest in chest disease. But along my journey, my clinical journey, I did a lot of management and leadership roles. I initially got involved in the training program for our trainees and later I ran the department in my NHS Trust and subsequently in the private hospital at which I worked.

I came across Cleveland Clinic by word of mouth. Cleveland Clinic started to explore the London market, doctors who might be interested in talking to them. It was a sort of bidirectional exchange of information whether doctors might be interested in coming to the Clinic, what the Clinic could learn about the UK healthcare system, which is so different. So, by word of mouth, I got involved in that. There were a lot of doctors initially and I suppose it was whittled down to 12 who formed what was called the Physician Advisory Committee, the pack and we had conversations with leadership from Cleveland about the UK and how Cleveland Clinic London would function. And after a couple of years of being on the pack, some of us went forward with a permanent post. Some of the people who didn't go forward were in specialties that we don't provide now and some of us were in the specialties that Cleveland Clinic had chosen for the London hospital.

Brian Bolwell, MD: So, you said that before the Physician Advisory Board you had leadership roles in your department at the NHS. Can you tell me a little bit about that and how that came to develop and what you were like as a new leader and any lessons learned along the way?

Jamanda Haddock, MA, MRCP, FRCR: Well, yes, in my department, in my NHS trust, people didn't really like leadership. Well, after so many years the job has changed and the next person had to do it for a couple of years, two or three years and actually just, we were a very small department, there were only seven of us and it came to be my turn. But actually, there were things that I didn't like about the system because from a very early stage of my career, I've understood that although ultimately patients want great clinical care, they want a surgeon with a low complication rate, they want a physician who understands the latest drugs. But around that, there is so much to the patient experience and in my hospital, I felt that patients got great treatment and sometimes it was a poor experience.

And in my leadership role there, I think I was able to influence the experience in a very positive way and I enjoyed doing that. I thought it made a very big difference for our patients and I'm talking about things like the patient journey through the department. If you're an inpatient, how that works, if you're an outpatient, how you're received, where you wait, where you get changed. These steps make a big difference. Who answers the phone? How quickly do you get your appointment made? I enjoyed doing that and I enjoyed also radiology as a support service, and I enjoyed working with my colleagues. I wanted my department to provide the best possible support for the clinicians and their patients. So, I found I enjoyed making a difference in that way in addition to the clinical work that I also love. I love being a doctor, always have done.

Brian Bolwell, MD: So that's an interesting story for me. Tell me a little more about how you figured out the patient journey. So, somebody needs an x-ray, and they may be an inpatient, they may be an outpatient. I remember, I mean I think if you've been a patient, there's an advantage in figuring all this stuff out because when you're a patient, you realize some of the less-than-ideal situations that you're frequently put in. I mean, I applaud you greatly for paying attention to it. So, how'd you do it?

Jamanda Haddock, MA, MRCP, FRCR: Well, I think the important thing is to understand that one person can't appreciate all the difficulties in that journey. So, it's a team process and it involves getting the stakeholders together, it involves working with the nurses on the ward, it involves working with the porters, with our... There's also a piece about this physical space, how somebody moves from A to B, how the lifts work, the waiting period. So, I think it's a team process to make that efficient and as painless as possible for the patient. And in fact, I think team working is such a big part of Cleveland Clinic, the collaborative approach. But I'm already understood, I've always believed that the collaborative approach is what we need to deliver the best possible healthcare. So, I didn't learn anything new in a way when I came to Cleveland Clinic, I just came to an organization which enforces what I believe in across the board.

Brian Bolwell, MD: Okay. So, let's talk about that. How did you wind up being on the Physician Advisory Committee in the first place? Tell us about that. What was that?

Jamanda Haddock, MA, MRCP, FRCR: It was a group of doctors who were interested in the model. I mean, when the model gets explained in London, it is different to anything we have available to us now. Physician leadership, not-for-profit, research and education. These features until Cleveland Clinic came to London, didn't exist in our country in the private sector and not everybody liked them. Some people were very well established as sole traders in hospital, they had being working years and they weren't interested. But some of us were very interested and for me, what I liked about it was putting patients first, you know a team-based model. Our private sector is sole traders all working independently, contracting independently with the hospital until Cleveland Clinic London. So, I love that team working. I love the patients first and I also like the emphasis on empathy because I think it is the caring part of healthcare. And to have an organization that recognizes that can... Because it is like for me, I think of it as a sort of, well, before I came to Cleveland Clinic, I thought of it as the soft side of medicine.

But actually, it's the factor that makes such a big difference. If you can imagine how your patient is feeling and express to them that you can imagine how your patient is feeling, then we're in the business of healthcare as opposed to just treating patients so I like that. But not everybody wanted to change from what they were doing in the private sector but some of us were very enthusiastic about the model and went to and from Cleveland, meeting people, seeing more of the hospital, discussing what we could contribute. And it was an organic, it evolved organically from the people who came to the bigger meetings and then would start discussing with Brian and the Cleveland Clinic representatives who came from main campus and the conversation started and I suppose it was just a group of people who were most enthusiastic with the model.

Brian Bolwell, MD: So, you just did a great job of summarizing the Cleveland Clinic culture. Congratulations. [Jamanda laughs.] I'm struck with your common emphasis on empathy. I think that that's really important. I totally agree with you and walking in the shoes of a patient is very important. I remember when I was in charge of the cancer center, almost every day I'd tell somebody, or I'd be in a public speaking opportunity and say the universal emotion felt by anybody with a diagnosis of cancer is fear and they're scared and they're very anxious and their family's scared. One of our essential jobs is how are we going to address that? How are we going to manage that? It's not just a matter of taking care of the disease, taking care of everything. This emotional component is extraordinarily important and it's not just for the patient, it's also for the family. So, I love the phrase emphasis on empathy. Okay. So, you're on this physician advisory council and at some point, you signed up.

Jamanda Haddock, MA, MRCP, FRCR: 2018, I signed up.

Brian Bolwell, MD: In charge of hospital services. So, what was your first job? I assume you had to recruit.

Jamanda Haddock, MA, MRCP, FRCR: Yes, I think, well, the first job was deciding on the clinical specialties that Cleveland Clinic was going to provide and then appointing chairs. But as a chair, my job was to recruit the team and I think of that, and I've done this in previous roles, but I think of recruiting the team as doing a jigsaw. I have a clear vision in front of me, the picture of what I want to create and then I'm going to put all the pieces together and they are different sizes and shapes, and they are different sizes and shapes in terms of skill mix. So, I want the worker bees, I need the people who are outgoing and like to take meetings, those who sit in the corner and crunch the numbers. People who are interested in research and education, who are innovative with new ideas. You want all these different skill mixes to create the team.

And it sounds easy to do that, but I think it's more difficult than people appreciate because it's important to overcome our natural instinct. I think everyone has this instinct to like people like yourself and so part of that different shape and size is diversity of character and diversity of think so that you end up with a team who challenge you, who bring you new ideas because good as you might be, you don't think of everything. You don't have all the ideas; you certainly don't have all the solutions and shouldn't expect to have all the solutions. But the broader diversity in the team, the more likely you are to find them with the collaboration between your team members. So that's what I was really looking for.

But I think in terms of building a team in London, we had the added challenge of instilling the Cleveland Clinic culture because as I've already told you, it's different to anything that's been on offer in London before. And that's been a big part of the team building, getting people to work together, collaborative approach and their engagement because that's the thing about Cleveland, is I feel the engagement is huge in the organization. That's what struck me first when I went to main campus. I was just overwhelmed by the engagement of everybody in the organization. And that's what we've tried to do in the team.

So, my team is not just radiologists of course, although it involves 44 radiologists, most of them working part-time, but they're also the radiographers and the nurses we have in our department and trying to bring them together to work as a team to share their concerns, to problem solve together. That's also been a very big piece of the picture here and what makes it so different to the sole trader private practice and many other hospitals through London.

Brian Bolwell, MD: So Jamanda, you're just dropping leadership roles right and left here. [Jamanda laughs.] So just to review a few, love the analogy of building a team like a jigsaw puzzle because I remember one of the leadership books I read said, not everybody does everything well. Some people are very good at X, not very good at Y. But then, you want somebody who's good at X, you want somebody who's good at Y and they're going to be different people. The point you made about diversity is obviously essential and I think the corollary to that of course is you've got to be receptive to diversity of thought by creating psychological safety. That's absolutely essential. You've got to invite diversity and it sounds like you totally embrace it and again, kudos to you. But to drive results, you need great teams. So, I'm curious, you talked about the importance of building teams. How exactly did you do it?

Jamanda Haddock, MA, MRCP, FRCR: Well, radiology is quite a small world. So, I know a lot of very top-notch radiologists in London. I also talked to some of the clinicians… because I've talked to you about the team in radiology. But we're all members of multiple teams. So, in the neurosciences for example, the interventional radiologists, the neuroradiologists are all part of the neurosciences team and they're part of my team as well. So, I talked to clinicians about people they worked with. We had this challenge in that the entire hospital was new build. Every single piece of equipment was new within it, so when we were building teams, it was good to have radiologists on the supportive structure who had worked with some of our clinicians before. So, I talked to the chair of neurosciences and said, "We need an interventional radiology team." I'm just using him as an example, and he had some ideas about who would provide the level of support he needed. And then I talked to other members of the team. So, we built up a team who perhaps didn't know each other all in radiology or some of them did, some didn't, but they knew somebody else in the hospital. So, we had this sort of weave, if you like, of people and some who were completely new to the team who were highly recommended or brought a particular skill that we wanted to offer.

And so it was, you know, we advertised the post. I saw every single person who expressed an interest in Cleveland Clinic and sometimes they were massively skillful, but their profile, their range of skills didn't suit what I needed and sometimes I came across people who were exactly what we needed, and we could build them into the team. So, it was a whole mix of roots really to find the people who would create our teams.

I think character was really important. You know, I wanted people who were as excited about the model as I am, who wanted to be collaborative, and I am actually very pleased with the team because the radiologists are divided into different subgroups. Musculoskeletal neuro, IR, et cetera but they all work very well together, support each other because again, in their fields they can't always be experts into everything, but they collaborate together to provide the best possible service for the clinician and his or her patient.

Brian Bolwell, MD: So, I'm curious, I totally agree with you that interviewing for character is really important. How do you interview for character?

Jamanda Haddock, MA, MRCP, FRCR: I think I talk to people about what matters to them, and I think it becomes obvious that people who like to be a personal star, because I think that's not what you want. We want people who want to be part of something, they want to be part of the organization, want to be part of our department, part of the DDSI Institute or whatever and that they enjoy that, who enjoy providing the best possible care, doing their job as well as possible and are not looking for personal glory. I'm not actually saying you can't have someone looking for personal glory in your team because sometimes you've got very, somebody who's outstanding in a particular field, you might actually want them in the team to give you a big national or international reputation, break down the frontiers of knowledge in an area. I mean, that would be exciting if someone had to help you. You have to recognize that is something completely different to the collaborative person that I needed initially. I knew in my mind that the biggest challenge for us, what the radiologists have to do here, what the support services have to do is be available, be receptive, say, "Can I help?" "Yes, I'll do that." If I can't do it, I'll find somebody who can. That's the type of character I knew I needed for my team to start with. In a year, two years, five years, maybe we can tinker at the edges with different things, but this is what we need now. Everyone's nervous, everyone's using new equipment in theater, they don't know the nurse, they've never been to PACU before. They don't know which floor the ICU is on. All these things they've got to find out, so they just need a very willing collaborative support services.

Brian Bolwell, MD: So again, another pearl for our audience. I mean simply saying yes goes a real long way.

Jamanda Haddock, MA, MRCP, FRCR: Yeah.

Brian Bolwell, MD: And the other thing that goes a really long way is, if you say you're going to do something to actually do it. That turns out to be a challenge frequently in the healthcare setting.

Jamanda Haddock, MA, MRCP, FRCR: Yeah.

Brian Bolwell, MD: So, you open and that was about a year ago and everything's new and nobody knows where the ICU is as you just said.

Jamanda Haddock, MA, MRCP, FRCR: Well, they did. I don't want to give the impression people are wandering around the hospital lost, but they've never worked there before.

Brian Bolwell, MD: Totally understand. So how exciting, I mean wow. Once in a career opportunity. How was that? I assume it was wonderful as well as filled with all sorts of challenges. Tell me about it. How it was initially and now that we're about almost a year into it, how it's going now.

Jamanda Haddock, MA, MRCP, FRCR: I think it was exciting. I mean I think Cleveland Clinic is the hottest ticket in town and people are very excited to be part of it and want it to be a success and work hard on their journey. It was challenging getting to grips with a lot of new IT. I think we have something like 184 new IT systems of which one of them is Epic, which gives you an idea of what people had to learn and take on board. And there was a bit of anxiety about getting it right, about doing the right thing for the patient. So initially there was all these conflicting emotions. I think a year on in, we've made tremendous strides. It's much, much the whole process and the interrelation between the clinicians and the support services. It's all much smoother. People have got to know each other more and develop a trust because trust is so important.

Well, as a leader with your team, but going back to my original point that we're all part of multiple teams, you know, for our clinicians to trust us takes a little bit of time. And that's based on, as you called out, saying yes, and sorting a problem. But it's also about being correct in your diagnosis and saying this patient has a perforation, this patient doesn't have a perforation, the tumor is bigger. So, it takes a while and I think all of that has built up over the last year. So, the processes have been smoothed out. We spent a long time on the project looking at process, but you know what it's like on the chart and then when you put it into practice, you've forgotten something, and all those little glitches needed to be ironed out. So, we spent a lot of time doing that. It's been a very interesting year, but I think that the major emotion is excitement, and our figures are all building up and we have... We still are not without problems still or delivery of our services, not without problems. We have a lot of patients who are very happy with the service they receive, and we have a lot of patients who are having treatments that they couldn't have elsewhere in the private sector in London. So that's also, I think everybody feels very excited to be part of what we offer.

Brian Bolwell, MD: So again, a couple follow up points. One is the importance of trust, that's universal leadership tenet, keeping your word, having other people's back to use our phrase over here. Well, all sorts of things go into that. But one of the things I wanted to follow up on, again, another thing, I was looking at recently is the author was saying that it's not an org chart that matters in an organization, it's not boxes and lines, it's all the synapses between the two or between eight or between the 20. And you were creating those synapses as you went along.

Jamanda Haddock, MA, MRCP, FRCR: Yes, we were.

Brian Bolwell, MD: Which is kind of cool. And anyway, so now the other thing you mentioned is that you're not a member of one team, especially at the Cleveland Clinic because we're such a teamwork-based environment. You are in fact a member of multiple teams and the importance of trusting each other in that setting is I think even more important.

Jamanda Haddock, MA, MRCP, FRCR: Yes, I agree. I agree. And it's about, I mean, I try very hard. You mentioned this before, but I try very hard to deliver what I say I'm going to do, come back to people in the way that I say I'm going to do. I call this leading from the front. I don't know if that's a phrase you would use, but just in small and large ways. So, the small ways would be being on time for a meeting and the larger ways would be delivering on a project, but in the timescale that was set.

And I don't know what you think about this, Brian. I also think, as part of that trust piece is the emotional tone. It's very important to set the emotional tone because people, if you're a leader, people watch you and they imitate you and so it's important to be aware that you control that. So, one of the things I do to create trust is when someone comes to you with a story, or a problem and they plunk it on you. And I always try and remember that that is their truth and it's a version of the truth, but there's always a bigger picture and there's always a backstory so I try never to react to that. Just to take it on board, accept it, and then explore, get to the bigger picture, and then come to a conclusion. I try never to react immediately, and I think that's all part of the trust picture so that people understand that you look at the bigger picture.

Brian Bolwell, MD: Another really good point and actually setting the emotional tone was one of my challenges earlier in my career.

Jamanda Haddock, MA, MRCP, FRCR: Yeah.

Brian Bolwell, MD: It's something that I had to learn, and it wasn't easy for me. I had to do things differently, but I think it is essential. I think it's very important. And now I think it even goes beyond that because I think that one of the roles of the leader is actually to try to create joy. And I think that leaders have, we're put on a pedestal, and we can favorably impact people pretty easily by being present, by acknowledging them, by listening.

Jamanda Haddock, MA, MRCP, FRCR: Definitely.

Brian Bolwell, MD: By being kind. There's all sorts of things that leaders have that's part of the title that I think are underappreciated and I like the phrase you used of emotional tone because it has many connotations, all of which I think are very important.

Jamanda Haddock, MA, MRCP, FRCR: Yes, I agree. And also listening is hugely important. I find that most people I work with in healthcare right across the range actually are rational. They are logical, they understand. So, if you listen to their point of view, I used to say to people, now I won't necessarily do what you would like me to do, make the decision in the way you would like it made, but tell me what you think. I need to hear what everyone and then if you listen to everyone and then come back and say, well actually we're going to do this, I find there's much better engagement with the decision making if people have been heard. It's really important.

Brian Bolwell, MD: Yes. Couldn't agree with you more. And actually, it kind of gets back to, you need a feedback loop as well. I mean, if you're going to ask people their opinion, it's important to get back to them even if you don't do what they think you should do.

Jamanda Haddock, MA, MRCP, FRCR: Yeah.

Brian Bolwell, MD: So, thank you for the opinion, I acknowledge that but we're going to do X and here's why we're going to do X. But it doesn't mean I didn't hear you.

Jamanda Haddock, MA, MRCP, FRCR: Yes, yes, yes. I remember actually, again in a previous leadership role a long time ago now introducing Saturday working. I mean it seems unbelievable. It was a long time ago, but very unpopular decision and exactly that. We had a meeting, everybody was able to express their points of view, go away. It's so important because sometimes people have thought of the point of view that you as a leader haven't considered. It's not just for the good of the person you're listening to, it's also very helpful as a leader because people bring you ideas that may not have occurred to you.

But anyway, then going back exactly as you say to the team, now this is why we're going to do it. We are going to start Saturday working. I'm sorry for all of those you thought we didn't. This is why we're doing it. And in fact, a couple of people came up to me afterwards and said, Jamanda, I don't agree with the decision, but I understand why it's made and I'm happy to support. And that's what you want because you don't want your team to do what you want them to do. You want them to want to do what you want them to do and that's listening, engagement, hearing the ideas, feedback is what enables you to get to that position.

Brian Bolwell, MD: Well, it also defines culture and one of the things I remember from an earlier podcast in the series was an organizational leader said, it's not that hard to hit metrics. The question is how are you going to do it? And you can be a dictatorial leader and you can probably get to the metrics at least a lot of them that you want to go, but it doesn't do much for morale, it doesn't do much for engagement, it doesn't do much for culture and doesn't make it a very fun place to work. It doesn't lead to retention; it doesn't lead to great experience for employees or patients. The how is incredibly important and everything you're describing is wonderful and I couldn't agree with more. So, as we're wrapping up any pearls that you'd like to leave our audience with that you've acquired as you've matured as a leader and you're still kind of in the prime of your career.

Jamanda Haddock, MA, MRCP, FRCR: Well, we've talked about a lot of things. Yes, transparency is very important we discuss, but there's one thing we haven't mentioned, which I am very keen on, is fairness. And that's another natural instinct that as a leader we have to fight against because it's not possible to like your entire team the same. Inevitably you have more in common with some than others, but no favorites. Everybody must be treated the same. They must know that if two people ask the same question, they get the same answer. If they ask it the following day, they get the same answers, so I am very keen on fairness in the team because I think there's nothing that destroys it quicker than, you know, having favorites.

Brian Bolwell, MD: Yeah, absolutely, I totally agree. Another thing is you talked about teams. The importance of having everybody give their opinion is also key and I mean, one phrase that a colleague of mine used is that, there's no passengers on the bus. Everybody has to contribute. I think if everybody contributes, that also helps to get to your point about fairness. They can't have one person dominating the conversation. Everybody's got to weigh in.

Jamanda Haddock, MA, MRCP, FRCR: But the contribution doesn't have to be in the same way. They contribute in different ways, but I agree. Yeah, everyone has to contribute. Yes.

Brian Bolwell, MD: Jamanda, this has been a brilliant episode of Beyond Leadership. Has been totally my pleasure talking to you. Thank you so much.

Jamanda Haddock, MA, MRCP, FRCR: Thank you very much for including me in your series, Brian. It's been a huge pleasure.

Brian Bolwell, MD: Thank you for that. For our listeners, I hope you enjoy this episode of Beyond Leadership and we look forward to sharing many more in 2023 and beyond.

Have a great day everybody.

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