Set the Tone with Positivity

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.

This is Dr. Brian Bolwell, your host of Beyond Leadership. Today, we're looking forward to our podcast with Dr. Tim Barnett, who is President of Lutheran Hospital here at the Cleveland Clinic. Tim, welcome.

Tim Barnett, MD: Thank you, Brian. I'm honored to be here with you today.

Brian Bolwell, MD: Tim, can you share with our listeners a little bit about your journey to becoming president of one of our regional hospitals here in the Cleveland Clinic health system?

Tim Barnett, MD: Yeah, absolutely, I'd be happy to. So, by clinical background, I've been a general surgeon and a trauma surgeon with the Cleveland Clinic for over 20 years, and my leadership journey was pretty organic. I was asked, about 12 years ago, to take over the Trauma program at one of our sister hospitals, so I became Trauma Medical Director for a few years. And then, after that, was asked to be the Chair of Surgery, and then evolved into hospital administration as Chief Medical Officer. And then, I came to Lutheran Hospital in February of 2021 to take over the president's role here.

Brian Bolwell, MD: Can you tell us a little bit about Lutheran Hospital, and tell us a little bit about what a hospital president does at a regional hospital?

Tim Barnett, MD: Yeah. Lutheran Hospital is a 200-bed community hospital. It has been here in the Ohio City neighborhood of Cleveland since 1896, so its roots in the community run very deep. A hospital president's job is basically, at a high level, to oversee day-to-day operations of the hospital itself, to set the vision and strategy, what service lines do we want to develop, what makes sense for the community. So, in that, probably one of the most important roles as a hospital president, and one that I enjoy the most, is being an ambassador to the local community. I see this role as facing outward as much as it is facing inward and leading teams. Based on the fact that we've been here for 130 years, having close connections with community leaders and stakeholders to be sure that we're appropriately caring for our local citizens is really important. So, I make a point of being involved in the community as much as possible and having regular meetings with local stakeholders.

Brian Bolwell, MD: That I think is a pretty big deal that I'm not sure everybody appreciates. I like the way you put it, that it's both inward facing and outward facing. I think many people involved in healthcare are well aware of all of the metrics that are very important to the practice of medicine right now, which is kind of an inward-looking thing and making sure that operations are going well, and quality and safety are going well. But the importance of a local hospital to the community is a pretty big deal.

Tim Barnett, MD: It is. And when you work with the stakeholders and you talk to our local citizens, what Lutheran Hospital means to its community, the fact that it has been a beacon in this neighborhood through changing times over the last century plus, this is where people come for their healthcare. As social determinants become more challenging, they're also accessing hospitals for other things like food insecurity, for medical needs, and for social needs. That's very important for us to really be connected to our local community to make sure that we're serving them the best way possible.

Brian Bolwell, MD: Give us an example of that.

Tim Barnett, MD: Sure. So, what we try and do here at Lutheran Hospital and other hospitals in our system that are deeply rooted in the community is we have annual community health fairs. This is a way for us to open our hospital doors and allow the community to come in and access areas of healthcare that they may not be able to do historically. So, when we do this, we can offer screening mammograms, blood screening work, and other exams, retinal exams to look for diabetes and skin changes. Just being able to offer that open door policy to our community and make sure that we're offering those types of screening opportunities for the patients is very important.

Brian Bolwell, MD: That sounds pretty cool. You stated that you were the Chief of Surgery and then a Chief Medical Officer. Those are two different roles. Can you tell us a little bit about your experiences with each and what you learned, especially from a leadership perspective, from both?

Tim Barnett, MD: Sure. As the Chief of Surgery, when I look at the journey of my personal leadership development, I draw a lot of parallels to being a physician and a surgeon and being a leader. This is why, and I always tell people that I'm involved in meetings, I think that physicians are natural leaders. So as Chief of Surgery, my job was to make sure that we ran surgical operations at the hospital and then also made sure that we maintained quality and safety metrics for our patients. But what is in parallel with the chief of surgery is that that's where I'm a content expert. So, when you're a leader in an area where you're content expert, it's a lot easier.

I think when I transition to the Chief Medical Officer role and the Hospital President role, what I learned and what I understood is that many times you're going into meetings or you're leading teams where you are no longer the content expert. So, you have to rely on getting the right people in the room, asking the right questions, listening and learning before you can help lead and make decisions. So, when I transitioned to Chief Medical Officer, that was a big step for me because now you're involved in hospital operations. And in many of those areas, you're learning about things for the first time, so you're no longer the content expert. In a way, you're a leader, but you're also a student.

Brian Bolwell, MD: Yeah, I think that's a really cool point. I mean, one thing's for sure, the bigger the role is, there's no way you can be an expert in everything that the role covers. I mean, certainly, when I took over the cancer center, I tried to be pretty knowledgeable about just about everything, but there was no way I was going to know more about radiation therapy than the people who were performing radiation therapy, because that's not my training. Nevertheless, I think some leadership principles kind of are uniform despite whatever role you're in.

So, why don't we go there? So, between Chief of Surgery, Chief Medical Officer, and now Hospital President, what are some of the things that have worked for you?

Tim Barnett, MD: Yeah. I agree with those points entirely, Brian, it is that you have to understand what your role is and what your responsibilities are. The one thing that I probably carried over from my role as a surgeon into my leadership career, and my journey more than anything, is realizing that whether you're in the operating room or the trauma bay or in a meeting room, that you're responsible for setting the tone of your team. People look to you as a leader, whether it be by title or by running a meeting or organizing a section meeting. People are looking at you to see what your behaviors are, and you are going to set the tone of what's going to happen. So, when I go into a meeting now as a hospital president, I'm thinking to myself, "There's going to be people watching you, so are you going to institute calm or are you going to institute chaos? Are you going to bring a positive vision or are you going to bring sarcasm and blaming and complaining?"

Because your team is going to adopt and reflect the efforts that you as a leader bring into that area. So as a trauma surgeon, I would remember many days walking into a level one trauma, which means that you have an unstable patient and the first 5 or 10 minutes of what you do is critical to whether or not that patient has an opportunity to survive. When you walk into that trauma bay, and if you incite chaos and you start yelling and you are demanding that people do their roles and responsibilities, you're not going to have a high functioning team. That team is going to struggle and it's going to affect patient outcomes.
Very similarly, in the meeting room or in a boardroom, how you act, how to enter that room, and what you ask of your team and how you ask it is going to impact the results that you're going to achieve, and then, obviously, the outcome of what you're trying to achieve.

Brian Bolwell, MD: There's a lot of really important points there, one of which is certainly positive. I do think that no matter what the challenge is, your teams are looking for you to provide clarity of how we're going to accomplish the task, and to have a vision and to transmit a message of, "We're going to figure this out and we're going to be okay." I think that's a pretty big deal. As healthcare gets more challenging, I think that's even more important. It sounds like that's something that you're pretty intentional about.

Tim Barnett, MD: For sure. We've heard about this a lot as we've all explored our leadership journey is that your team isn't going to always move at the same speed. You're going to have members that are early adopters, that might be the content experts like we referred to before. And you're going to have other team members that might be skeptics, might be late adopters, or even non-adopters. The challenge in leadership is figuring out how you connect with everybody.

So, to your point, that positive communication, the why about what you're doing or what you're looking to accomplish, and how you leverage everybody's skills and talents is going to matter, because the late adopters and the non-adopters can still be valuable assets to what you're trying to achieve. You might just have to have different conversations or handle them in different ways than the ones that might be fully on board or support your vision and where you're trying to go.

Brian Bolwell, MD: The other point that you raised, which I think is really important, you talked about being a trauma surgeon, in the first 5 to 10 minutes, being really important and trying to set the right tone. Part of that is to allow your team to be at their best, and that involves several things. I think, number one, it involves trusting that they need to know that you're not going to micromanage them, that you're going to let them do their thing, whatever it is, and you trust that they're going to do it at a very high level.

It's something that I said over and over again when I was running the cancer center, is we do what we do. People sometimes ask me, "How do you manage this situation or that situation, or how do you manage somebody with a challenge X?" And I would always say, "Guys, we've got great people here. I don't care who the patient is, we deliver great care and just be yourself. Do what you do. We do what we do." And when you do that and when the leader doesn't get in the way, usually things turn out okay.

Tim Barnett, MD: Yes, I completely agree with you. I liken whether you are leading a team in a meeting or in the trauma bay, it's very similar to going to the Cleveland Orchestra and watching the expert's work. And when you see the conductor, there is a center position there and everybody is trained on the conductor, but the conductor is a passive guide. He doesn't go to the section and play an instrument, he's not directly involved, but his job is to make sure that everybody is working in unison and that the piece of music is unfolding as it should and kind of keeps everybody on time and on track. As a leader, I try and do that too, to just make sure that we are clear with our vision, the purpose, and the why, but then you let the experts give their input and guide their teams on how to do the work.

Brian Bolwell, MD: So, it's a pretty uniform tenet in leadership, that you lead through teams. How do you do that, Tim? How do you form teams? How do you make sure they're functional? How do you keep everybody engaged? What are some of the things that work for you?

Tim Barnett, MD: Yeah, I continue to learn. It's interesting to me that sometimes you'll get a team together, you'll hear about a problem, say, "Okay. Well, let's get people in a room and let's talk about it." I've made mistakes where I've had some people that needed to be in the room that I didn't think about. That's a big oversight because when you start that meeting or you're down that road and there's key people that you did not bring in, that can show a level of disenfranchisement or could even jeopardize trust. So now, what I try and do is ask people, "Who do you think we need to be in the room? Who should we invite? Who should we consider?" Sometimes, the team might be a little bit bigger than it needs to be, but I would rather have more people included to set direction. Most of your leaders realize they'll come to you and say, "Hey, look, I think that maybe I don't have a big role in this area here. But if it's okay with you, I'll step out and then pull me in later if you need me."

So, when I organize a team now, I'm really conscientious or at least I try and be on every occasion about asking around to say, "Who needs to be here? Who am I missing? And who has an important role in this?" And then, I think once you kind of get the team in the room... I think, again, it's important to guide and learn and ask the right questions. So, when I go into a room, you don't oftentimes know what you don't know. But if you're not listening and you're not asking questions, and asking the right questions, you can potentially miss something. And then, I think it's important that once you have a plan, once there's that call to action or you're heading to the execution phase, that you step back, and you show confidence in your leaders and in your teams to do what they need to do. And then, you are there for resources, for support and guidance, or to give them more tools to be able to effectively execute their job.

Brian Bolwell, MD: A lot of good stuff there. I mean, one of the keys to, first off, I love the fact that you asked people who should be at the meeting. I think that's really important.

Secondly, this brings up the concept of psychological safety, something we talk a lot about on this podcast. I don't think it can be overstated how important it is. I think that making sure that everybody participates, and everybody participates in a non-judgmental way and people are encouraged, in fact, to disagree, is vital to really having a team thrive. I think it's very engaging to a team when a leader asks for a disagreement or admits they don't know things. And you've brought that up several times, is asking them to be part of an educational process. Have you found those things to work for you?

Tim Barnett, MD: Yes. I'm really glad that you and I are going here in this podcast because I think that that is a critical piece of a high-functioning team that's going to get good results for you. I remember when I first heard the term psychological safety, you kind of take a step back and you're thinking, "Well, what does that really mean? And what is psychological safety?" As I came up through my leadership journey, as Chair of Surgery, it's our job to review adverse outcomes, whether that be postoperative bleeding, postoperative mortality, or a serious safety event. I really learned a lot about psychological safety because when you have these events, we do a very detailed after-action review, as you know, Brian, called either a critical incident review or a root cause analysis.

That's a way for the team to be in a protected environment where we can share information about what might not have been optimal, what we could have done differently, or what we could have done better. And when you do these reviews, a lot of times it comes down to the common denominator of, what was the psychological safety in a group? And you might hear a scrub tech say, "I thought that our counts weren't right, but I was just afraid to speak up and say something," or a nurse say, "I mentioned something, but I didn't know if I was heard, and I didn't want to speak up again." And if your team truly has psychological safety where somebody could say, "Can you just pause for one minute and let me make sure my counts are correct? Or Dr. Barnett, did you hear me when I stated this? Can you repeat back to me that you heard it, and you understand it?" A lot of these events can be avoided.

So, when you take that into your executive team and in the administration as well, everybody has blind spots. In a high-functioning team that has psychological safety, your team, everybody is motivated to come into work and do the best they can. Your team will help you see what you can't see or say, "Should we consider this?", or "Wait a minute, I have a concern if we do A, this can result in B. Let's talk about that." So, if you don't have psychological safety, either in the clinical setting or the administrative setting, you are going to fail more than you're going to succeed.

Brian Bolwell, MD: Yeah, I think you're right. I think it's really important, and I think that it's interesting that we talk about this so much. I think one of the reasons why we talk about it a lot is that it's frequently not present. People might think that they create an environment of psychological safety, but if you're defensive about what you're saying, if you're defensive about the plan, then it's really not a psychologically safe environment because nobody's going to want to annoy the boss. I think you've got to be willing to hear criticism, you've got to be willing to hear people question. In fact, you've got to welcome that.

I think that's part of one of the central tenets of serving leadership is the ability to receive honest feedback. That's true at a micro level when you're having a meeting about how to get something done, which leads me to the other point. A lot of times, psychological safety is important because why we're doing something is frequently pretty well understood but how to get it done frequently isn't. And listening to people who actually know how to do things is I think very, very important to actually execute on a vision. There are all sorts of layers of psychological safety that I think are crucial.

Tim Barnett, MD: I agree with that. I think that as a leader, you really need to focus on developing that psychological safety. Because to your point, they're going to look to you, and these aren't words that you can just speak. There are a lot of ways that you can bring out psychological safety in an environment. It could be words, but it could also be walking the walk, stopping and saying, "You know what? We're getting ready to close in surgery here. Why don't we take two minutes? Let's let everybody catch up. Does anybody have any issues or concerns? Does anybody want to say anything or contribute anything?" You could take that into the boardroom as well.

Regarding your point about being a leader, this is where I think humility is one of the best traits of a good and effective leader. Because to your point, if you don't admit what you don't know or that you made a mistake, everybody appreciates that even the best leaders may be off course or may make a mistake. But if you don't have the openness to admit that in front of your team, or to say, "I might have missed this, or am I on the right track, or I want some honest feedback," you're going to miss a lot.

Brian Bolwell, MD: I totally agree with that. That's really, really important. As I said, more than once on this podcast, I have a lot of opportunities to do that because I have a PhD in making mistakes.

Tim Barnett, MD: All good leaders do.

Brian Bolwell, MD: Well, what would you like to share one or two of the mistakes that you've made that you learned from?

Tim Barnett, MD: Yeah. I think I shared one about not getting the right people in the room, and I've learned a lot from that. The other thing that I learned as a leader is I spent the first 20 years of my career at another Cleveland Clinic hospital. Over time, you build a reputation. People come to know you, they know your strengths and weaknesses, and they know who you are genuinely as a person. And when I transitioned over here to Lutheran Hospital, two years ago, you think that you bring a lot of that credit with you, that you bring those assets of leadership development and relationship building with you. That's not the case.

Probably, my biggest learning journey in the last two years as I accepted this role, even though a lot of people here at Lutheran knew me... I took surgery call here and I would come down and help out and go to medical staff events. As a new leader at a new place, you're starting from square one, and everything that you've accumulated in the bank of trust and relationship building starts over again. I learned that the hard way, and that's something that I'll take with me for the remainder of my career.

Brian Bolwell, MD: How do you build it? How do you build trust?

Tim Barnett, MD: Yeah, it's day by day, block by block. It's developing relationships, it's listening. It's being honest when you may not be able to deliver on something and saying why. It's showing support and delivering when you can. I think, over time, just as you did at every other location, you can build that trust. I had some rocky relationships when I started just because I had some gaps to fill, and I was able to do that. But as a young leader at a new place, the first 6 to 12 months were a steep learning curve for me. I take that within my journey moving forward.

Brian Bolwell, MD: Well, I think two of the keys that you just talked about are, number one, building relationships, and I think that work is all about building relationships. I think it's just everything. And then, the importance of listing, it can't be understated, I mean, overstated, how important it's to actually get feedback to listen to people. As you said earlier, having the humility to admit that you don't know everything, I think all these things are critical. It's an interesting perspective. I think you're correct that you'd like to think that all of your gravitas will carry over from one position to another, but it really does not. And that's okay, you have an opportunity to form new relationships. One of the keys I think is just keeping your word. If you say you're going to do something, you actually do it. Sometimes, that's a bit of a surprise to people.

Tim Barnett, MD: Absolutely, you're right. I think that you have to be careful about what you promise, and so that's a learning piece unto itself. But people are going to be okay if you are honest with them and say, "I'm not the final decision maker on that, but I could support this," or "The budget's tight this year, but I'll make sure it's a high priority in a future year." So just having people understand where you are and being open and transparent with them really carries a lot of weight in that relationship development. People are going to understand that every time you step up to the plate, you're not going to get a hit. But how you approach it and how you communicate that is really where the work is done.

Brian Bolwell, MD: We're taping this in May of '23. And almost exactly a year ago, Tim, you and I had an opportunity to go to Philadelphia with some of our colleagues and spend a week with Wharton Business School talking about a lot of things, among them leadership. I thought it was fabulous. I had a great time, and I learned a lot. Can you share a couple of things that kind of stuck with you?

Tim Barnett, MD: Sure. I agree with you, Brian. That week that we spent in Philadelphia at Wharton a year ago was very impactful and informative on my career. First of all, we got to network as leaders at the Cleveland Clinic with each other and realized that we have a lot of the same struggles and the same issues that face us throughout institutes and hospitals in a large healthcare system. What's also interesting is when you talk to the leading healthcare economic experts in the world, that we have a lot of challenges and headwinds in healthcare coming up. There's a lot of unknowns. I think there's going to be a lot of changes and differences in healthcare in the next couple of decades.

But again, back to the positivity of leadership and change, we have a lot of opportunities here to do better, to do better for our patients, to provide more cost-effective care, to keep focused on quality and what patients want and how they want to access the healthcare system. I'm so confident at the Cleveland Clinic that we are in a position to do that, and that everybody is in the same situation. It's how we listen and how we learn and how we adapt to what patients want that's going to translate to our success in the future. We have a lot of assets here. We have a great brand. We do really provide world-class, high-quality care, we're a leading research institution, and those will all serve us well as we move forward into the future.

Brian Bolwell, MD: Yeah, I agree with all that. We're very fortunate to be here. One of the things that stuck with me was the idea of trying things, doing pilots, and I think that sometimes, sometimes we don't do that enough. There's a lot of ways to approach problems and having the creativity and the courage actually to try to do things in newer, novel ways…One of the nice things about working here is that we encourage that, but you always learn, and you rarely get things perfect the first time around. So just doing pilots I think is, number one, very educational and, number two, is pretty engaging for your team. For our listeners, I certainly would encourage you to think about doing that as often as you can because inevitably you learn things.

Tim, you're doing really well, and you've had a lot of success. As we wind up our chat here, what are some of the core values that you find are just essential every day as you do your job, and you think about leadership going forward?

Tim Barnett, MD: Yeah. Three things that I take forward with me…the leadership framework that I try and operate on is transparency, humility, and communication. So, every conversation I have, every room that I go into, I'm always thinking about those things, and how do I exhibit those leadership skills for the benefit of my team and what we're trying to accomplish. And then, I think as a leader, we just want to challenge ourselves and challenge each other to get better. I think, to your point about trying things and taking risks, there's a lot of opportunity in the unknown. And rather than just looking at numbers and saying, "We're doing good here," I think asking the question is, "How can we do better? Can we do better?" That's a responsibility that I take very seriously, and we're doing some great things here at Lutheran Hospital that are reflecting that. We've been able to open up access for more patient admissions, and we've been able to grow surgically to serve more people. I think our role as healthcare providers is to be sure that when somebody needs care or wants care at our institution, that we're able to provide it.

Brian Bolwell, MD: I really agree with that. I think that not being satisfied with the status quo is a pretty big deal. Gosh, I remember that access, as you mentioned, is incredibly important for people who are asking for your help. Certainly, something that I stressed a lot when I was leading the cancer center. You also talked about communication. I think communication is you can never over communicate, it's impossible. People receive communication in different ways, but I do think that it's always important to remind folks that the best way to communicate with somebody is to be in front of them and talk to them.

Unfortunately, I think in today's world, the default of sending out emails might be efficient, but it's rarely the most effective way to communicate. I think the other thing that always bears repeating is that your words don't just convey facts. They also are received with an emotional impact. So how you say things, how you phrase things is crucial to engagement, to being an effective leader, and to supporting the people who you work with. There's an awful lot of nuances to communication. It's something that I've had to learn a lot over my career, and something that I think I was terrible at earlier in my career.

Tim Barnett, MD: Yeah, I agree with you. I think we've learned a lot over the past couple of years with the pandemic. And when we went remote and we were behind our masks and on Teams meetings and Webex meetings, you lose a lot of connectivity and the meetings after the meetings and the ability to communicate and talk through problems. I'm glad to see that we're able to get back there. I think the one thing that I love about the Cleveland Clinic is that it does expect its physician leaders to continue to practice clinically. I think that presence of still taking general surgery call, being in the operating room next to your team, seeing patients in clinic, really roots you into identifying where there's areas that we can get better, what we're doing well, and what the patients are saying. So, to your point, when you have that face-to-face connectivity with a team or with a patient, you're able to learn the most and to make the right decisions as a leader moving forward.

Brian Bolwell, MD: Tim, thank you so much. This has been fabulous. A lot of great, wonderful points about leadership and continued success. To our listeners, thank you so much for listening. We'll look forward to seeing you on a future podcast of Beyond Leadership, and I wish everybody a wonderful day.

This concludes this episode of Beyond Leadership. You can find additional podcast episodes on our website, clevelandclinic.org/beyondleadership, or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcasts. We welcome any topic ideas you may have for future episodes, comments and questions about this or any past episode. You can let us know by emailing us at executiveeducation@ccf.org.