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SERIES: Inspiring Others | Driving Results 48,000 members, 48,000 individual opinions, and 48,000 individual priorities can drive results in a big way. Being at the helm means creating an environment where change is reinforced. Where peers inspire one another. Where a ripple change can affect many, many more. And that's the magic of associations. Listen as Deborah Bowen, CEO of the American College of Healthcare Executives, and Dr. Brian Bolwell, Chair of Physician Leadership and Development at Cleveland Clinic, discuss issues like diversity, equity, and inclusion, safety, leadership skills and being intentional.

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The Magic of Associations: Being Intentional with 48K Members - ACHE CEO Deborah Bowen

Podcast Transcript

Introduction: Welcome to Beyond Leadership, at the intersection of leadership and everything else. In this Cleveland clinic podcast, we will commingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership and management.

Brian Bolwell, MD: Good morning. I am Brian Bolwell, your host. Today, I'm extremely pleased to have Deborah Bowen with us. She is the president and CEO of the American College of Healthcare Executives, an interprofessional organization of 48,000 healthcare executives who lead hospitals, healthcare systems, and other healthcare organizations. Deborah has held a variety of leadership roles in healthcare.

Deborah, we're delighted to have you here with us to chat about driving results and leadership. Welcome.

Deborah Bowen: Thank you, Brian, and thank you for all the work that you do every single day serving patients. It's an honor for me to be with you today.

Brian Bolwell, MD: Thank you. Tell us about you. You're CEO of the ACHE. How did you get there? Tell us a little bit about your journey.

Deborah Bowen: Sure. I'd be happy to. I was raised in a middle class, predominantly white neighborhood. My parents were music teachers, but they were very differently wired. My mother was a social advocate, very involved in civil rights. My father was a business person. Both knew the meaning of hard work, and I learned that, too. And of course, when I was growing up, I really didn't know what I wanted to do with my life, probably like a lot of people out there don't know what to do with their lives. Particularly nowadays, there's so many choices.

So I was the first in my family to go to a college right after high school. Everybody else have really just pretty much started working. And in those days, you had to pick a major, and I couldn't figure out what I wanted to do. I started with A, went down the whole line, ended up with psychology because I had a sister who is bipolar. And from there, it, kind of, naturally evolved. I married up really my keen awareness, it was not an even-playing field out there along with my passion for understanding human nature. I pursued a master's degree in social work, started counseling heroin addicts, [and] met a physician along the way who was head of the State Medical Society in Wisconsin. So my very first association job was working for a physician association, which I cared deeply about. That's where I discovered the magic of associations, and I've been in associations all along. I worked for the medical society for 12 years, I've worked for the Society of Actuaries, and I've worked at ACHE for 24 years.

I came here one year after my predecessor became president and he was CEO for 22 years. Being an insider is sort of a blessing and a curse when you pursue the president role. So fortunately, I had already left the organization and come back. So it wasn't the only experience I had, and gratefully, I was chosen. So I've been president now since 2013 and it's been an exhilarating, wonderful journey for me.

Brian Bolwell, MD: Tell us a little bit about how your organization interfaces with healthcare leaders and what services you offer.

Deborah Bowen: ACHE has been around forever. It was founded in 1933 and it was actually founded by physicians who really began to understand that healthcare management was a profession unto itself, that it required certain bodies of knowledge. It required certain forms of standardization in taking care of patients that really weren't direct patient care, but were supply management and managing people. And all of the things that we know are so important today in our work world.

ACHE grew up and evolved. When we first started, we had 227 members. Now, we have 48,000, and the field and the body of knowledge has really evolved with that. We do a lot of things, but most of all, what we do is provide a professional home for those who are interested in leadership. Most people do not stay in the same job for their careers, so wherever they are, ACHE can go with them.

But we basically do three things. We provide a voice for the field on such important issues like diversity, equity, and inclusion. Safety is also another aspect of us that we're very passionate about. So you have to be a leader, but you have to lead with intention as well. We're also a connector. We have 77 chapters all around the world. So wherever you are, you can probably find an ACHE chapter. So it's this incredible professional network, which may seem, sort of, like a platitude except when you think about the pandemic early on and you think about how hungry people were for information, it's their networks that actually provided them the information and the navigation to move forward. And we're also a trusted partner. We want to be there for people. We have career services. Sometimes when people lose their jobs or in transition or having a problem, we are the first phone call they make. So again, I think being a trusted partner to leaders is very, very important. And that's really the combined effect of ACHE.

Brian Bolwell, MD: So tell us more about one of the tenets you spoke about, which is the leading with safety and safety being part of leadership. Are you talking about psychological safety? Or are you talking... just expand upon that for us.

Deborah Bowen: Our journey to be more intentional about our safety education and safety efforts really started in probably 2015, 2016. Not that we haven't cared about it before. Of course, we have. But to get a little bit more proactive on what it means.

So we started partnering with the Institute for Healthcare Improvement. And at that time, we were working with Tejal Gandhi. Tejal and I met very casually and we had a conversation. She told me that one of the things that they recently discovered, although we probably known it all along, is that culture drives a lot of safety. But oftentimes, we don't know what culture is, right? We know when we have good culture, we know when we have bad culture, but we don't really know every aspect of how to create good culture. So we decided to tackle that problem, right? How do we demystify what culture is and how do we make sure whether you're talking about workforce safety, equity and safety, leadership safety? How do the boardrooms and the leadership teams create cultures of safety? And that's really what that work is about.

Brian Bolwell, MD: So how do you do it?

Deborah Bowen: Well, there's a blueprint out there if you'd like to experience it. It's at a portal at\safety. So there's a blueprint. And there's actually even an evolve document that we recently produced with IHI and about 30 other organizations called “Safer Together” that came out last year. So that's also available to people. So I would encourage people to look at them. I think those documents are organized in an assessment base and they're designed to meet people where they're at, not necessarily where they think they should be, et cetera. So I think it can be a useful document and I would encourage your listeners to try and go and find it, and contact me if you can't find it.

Brian Bolwell, MD: I mean, the word safety is very interesting because in a healthcare organization like ours, we generally think about quality and safety and not harming our patients and producing iatrogenic events, catheter-related bloodstream infections. And yet, in order to achieve progress in that area, one of the essential items is to create an environment of just culture and psychological safety, again using the word, where people can feel free to speak up. And in fact, are encouraged to speak up if they see something that doesn't seem right. So I think the word has a variety of layers and meanings, which all of which are potentially quite important as you think about leadership.

Deborah Bowen: They are. I think the thing--and this is true with diversity, equity, and inclusion too--I think one of the premises of culture is it has to start at the top. You have to practice what you preach. You have to have it on the agenda. You have to have safety goals. You have to hold leaders accountable for it. But you're right, it has all these other dimensions to it about training, about what people actually do on the job, and what are the repercussions of them doing things or not doing things. So all of those things are our drivers, and it's really that integrated system that drives culture.

Brian Bolwell, MD: What are your thoughts about what all leaders can do to help promote this? Is it a matter of simply making it a priority? Is it a matter of making it something that's discussed routinely? But it's got to go beyond conversation, right? It's got to translate into action.

Deborah Bowen: It probably depends on where you sit, right, in terms of what you can or feel you have the power to influence. I'm a firm believer that everybody plays a role and an important role at that. Whether it's helping a colleague or a friend or sponsoring an up and coming person to cultivate them in a mentorship role, all of those things make a difference. But I think as leaders, it's also important to really make sure that diversity is being measured in the organization. What do we mean when we say diversity? Is it reflective of our communities? Is it reflective of the dimensions? Are we treating people in a culturally competent way? Are we training people? Are we looking at unconscious bias? Are we looking at our own structural biases? Do people get promoted? Do they not get promoted?

So just like safety, there are a lot of layers, I think, to diversity, equity, and inclusion in terms of what you measure, what you support, where it shows up or where it doesn't show up, who is at the table. It's often been said that diversity is having a seat at the table, but inclusion is having a voice at the table. So I think it is one of those things that has to be carefully and intentionally managed, right?

There's also this notion of being more intentional about sponsoring leaders, right? I mean, we run a lot of diversity scholarship programs and I am amazed at the stories I hear about people, unfortunately, not being supported in their own organizations. So sometimes it's as simple as checking in with people. So you have to have some courage, I think, to go places where that may seem a little uncomfortable, but I think are necessary discussions for us to have today.

Brian Bolwell, MD: You just brought up a bunch of great points. One of which is unconscious bias. You interact with many, many different organizations. I personally think that unconscious bias is a paramount importance, and I don't think you can over-train awareness of it. What do you see when you look at healthcare organizations? Do you think that it's widely taught and practiced, or do you think that it remains a pretty big opportunity for organizations going forward?

Deborah Bowen: First of all, I do think there's plenty of room for improvement. I don't think any of us could sit here today and say that we're proud of where we're at today. I think there are organizations that are doing a lot, I think there are probably organizations that aren't doing much of anything, and everybody else is probably somewhere in the middle, right? So yes, I do believe this is an incredible opportunity. I do think the time is such. I mean, you can't turn on the television without hearing of some incident. So I do think it's important that we not only connect with our own workforce, but that this is a time to be more intentional about how we're addressing unconscious bias and there is plenty of room for all of us to learn and grow from this.

Brian Bolwell, MD: How receptive are healthcare leaders to learning?

Deborah Bowen: Well, I think everybody wants to learn. I guess the question is, are they in this area at least, which can be sensitive for people depending on where you're at, or they just may not know. I mean, sometimes it's not really intentional, right? It's just, I don't know what I don't know. So I just think everybody wants to learn, but the pace of that learning and the adoption rate from learning requires obviously more supporting systems than just showing up at a training and expecting that you have arrived, right? You do have to have a plan. There are plenty of people out there to help with this. I mean, we talked a little bit about the network, right? There are plenty of people who are making good progress. And I would hope that those who want to go on this journey or those who don't know much about the journey will connect with us so we can help them try and understand how to uncover that layer that may be covered up right now.

Brian Bolwell, MD: So I think unconscious bias is also an example that if you want to get better, you actually have to change what you do. It's not just a matter of going to a class and, "Okay. Now, I've got it." If you don't change how you select people, if you don't change your processes for advancement, then you really haven't acted on whatever increased knowledge you have. And for many, change is difficult. What are your thoughts about how to take it to that level? Because checking a box and going to a class, obviously, isn't enough.

Deborah Bowen: No. I mean, some people are doing diversity audits, having a third party come in once again because you don't always know what you don't know. I think that others may see things you may not, or others may not. I think those kinds of pursuits are very worthwhile. But I also think that unconscious bias can happen in many different forms. It is about recruitment and hiring and promotion and who is in the boardroom and who isn't. But it's also just about how you uncover that and how you move forward. The single X that you may encounter where you need to listen perhaps more. I mean, there's an adage out there, right? We have two ears and one mouth for a reason. Maybe there's more we can learn.

Brian Bolwell, MD: I think that's totally correct. Another thing you mentioned just now is the concept of courage. I mean, I'm of the opinion that courage is essential to good leadership. When you said courage on this topic, what did you mean and how do you see courage being part of leadership excellence in general?

Deborah Bowen: We've been doing studies on the advancement rates of people of different ethnicities for quite some time. We've been doing them since the early '90s. And one of the questions we ask whites, Blacks, Hispanics, and Asians is, what is your perception of race relations in your organization? And not surprisingly, whites think they're fine. 82 percent of them think they're fine. Whereas, Blacks are probably just hovering around 51 percent. So that right there tells me that things do exist. Maybe we don't want to see them, maybe we don't want to address them. It can be a simple comment or an attitude or talking over someone in a meeting.

So when I say courage, I really mean having the courage to understand we may not have all the answers in this arena; and being able to ask someone else who may have a better perspective, or at least be closer to a personal experience to share that with us. And to admit we don't know. I don't think admitting we don't know is a bad thing at all. I think leaders can only progress if we understand where we're vulnerable. Sometimes we're not our best judges, right? Self-awareness is one of the key strengths of leaders.

Brian Bolwell, MD: I wrote a column once on the value of saying, "I don't know." I personally say it all the time because it's highly accurate. Most of the time, I have no idea about whatever. Thank you for laughing. The other thing you mentioned is you referenced Brené Brown a bit, talking about vulnerability and courage. And boy, that resonates with me that if you're going to exhibit courage, it frequently is accompanied with a certain amount of vulnerability.

Deborah Bowen: I would tell you, even in my organization, I represent 48,000 individual members, and that means I represent an organization with 48,000 individual opinions and individual priorities and individual interests. And I appreciate that very much. I think it's the richness of our community that fosters that trust that we do have with each other, and I didn't hear from any of my members. But when I wrote an ACHE statement against racism, I wondered if I would; and not because I don't think people don't think it's morally wrong. It's just that it was probably a more courageous step than they were used to us taking. And it was an important step and a meaningful step and a needed step. That's an example of courage, I think, when you put your actions where your beliefs are and you're willing to accept the repercussions.

Brian Bolwell, MD: Yes, yes. I agree totally. When you see leaders do well and compare them to leaders who struggle, do you find there are some commonalities or themes about what the differences are?

Deborah Bowen: Well, I think there are themes, definitely. First of all, leadership is both art and science, and the science is the field of management, but the field of management is relatively new. But there are things we know about engagement, strategy, financial acumen, all of those things. But from my experience, when I see leaders get in trouble, it's usually not their technical skills that get them into trouble. It's a no-confidence vote from the physician group, or it's a relationship with a board member that went awry, or it's some dimension of an interpersonal relationship issue, or a matter of some judgment in how something was handled. That isn't something you can learn in a book. It's something you can only learn through experience and time. And so, I would say understanding yourself, understanding where you might speak too much, where you need to listen more, where you are, as we just talked about, vulnerable, where are your own development needs and how can you improve on them is definitely a recipe for success.

I also think when it comes to other types of leaders, let's take women for example. I talk to a lot of women about their leadership journey. And I think it's true; it's probably true for women who have been in the workforce for quite some time. I don't think it's just true for women now, but I do think it still exists, and that's this notion of just leaning in to your career; being intentional about it, that you're raising your hand, that you're doing all those things that you need to do.

And I think there's more internal dialogue somehow in our heads about, "Can you do that? Can you not do that?" And that self-doubt can really be a barrier, I think, for people, so understanding that and addressing that and overcoming that. There's a notion about executive presence that is really important. People don't know. It's kind of like culture. People don't know how to describe it but you know it when you see it. And it's unwinding those dimensions of yourself about how you show up what you talk about, what your focus is, how you work with people, how you support people that really, I think, can be differentiators.

Brian Bolwell, MD: So for somebody who's struggling with self-awareness, what sort of things can such an individual do to improve? One of the more common things is executive coaching, which I personally am a big advocate in. I think that executive coaches can be very useful in helping to shine light on some things that maybe individuals are not very aware of. What are your thoughts about coaching or other techniques?

Deborah Bowen: Yeah, coaching is great. Mentoring is great. Usually, we see that people activate mentors earlier on in their career, or they might stumble on one, for example. Sometimes that happens. I think executive coaching can be very, very useful. Different organizations do different things. There are tools to understand your self-awareness. There's 360-degree feedback, which I'm a big believer in, because that allows you to hear the perspective of others and understand what the delta is between how you see yourself and how others see you. Those can be very, very powerful. But executive coaches can do that qualitatively too. If you pick people either in your peer group or outside your peer group, people who you may want to influence or have an influence on you, and ask them to participate in a short interview with a coach, sometimes those qualitative 360s can be equally revealing.

Brian Bolwell, MD: Yeah, I agree. I think 360s are invaluable. They've been invaluable for me and I know that they can be very, very useful. I think it's essential though. Again, it's a willingness to use the information to actually change. One of my quotes that I like to use is from Leo Tolstoy, who at one point said, "Everybody wants to change the world and nobody wants to change themselves." 13 months ago in March, things were very tense and there was a lot of unknown and a lot of uncertainty, and that certainly spread for the next many months. How did you approach it?

Deborah Bowen: Well, first of all, we're in the face-to-face education business; or we were. So that was really a challenge for us. Obviously, I mean, this is a people business. This is a relationship business. So people were used to education, networking, getting together. We were on the verge of planning our large Congress on Healthcare Leadership. We were having record registration. We were over 4,000, and growing every day. So we were all suited up to have a great Congress on Healthcare Leadership. And all of the sudden, it was like a tsunami of cancellations started happening. And on March 6th, I brought the board together and I said, "We're going to have to cancel our meeting." I don't see a way for us to say we prioritize safety and have a meeting with 4,000 people. That's too dissonant. It's not who we are. And they agree. Obviously, they agreed even though it was early on.

My chairman coincidentally at the time was from New York Presbyterian and he had one of the first COVID patients in New York. So it was evident that things were going to change quickly, so we canceled our meeting and the repercussions of that. I mean, obviously that's a big part of our revenue. That's a big part of how we engage with our executives. It's a big part of how we support students. It's a big part of who we are.

So we quickly then went into what I think a lot of organizations did. I didn't make this up, but we had a respond, recover, re-imagine kind of mantra, if you will. At first, we had to refund all the money and take care of people. And of course, all of our members were really heads down during that time. And we didn't hear from a lot of people because people were too busy taking care of patients. And I respect that and I honor that. So we were busy just trying to figure out what we needed to do next.

We quickly went into reorienting all of our programs into virtual face-to-face. We quickly went in to try to help our chapters. Fortunately, we had already had a new learning system that launched April 1st. So the learning management systems really worked in our favor and we ended up having huge demand, probably toward the summer, toward the end of the year. We sold up practically every virtual education we offered.

Plus, we started holding right away these frontline series featuring leaders from different organizations, just trying to help people: “What do we need to think about? How do I need to prepare for this?”

Because it was a way, right? It wasn't just happening unilaterally across. It was a little uneven. Some people had the benefit of planning. Some people did not. So we were very active in providing education. 50,000 people registered for those events. So what was interesting to me is, what we lost, perhaps, in the face-to-face connection, we brought together in the virtual environment to help leaders really navigate to help patients.

We just had our virtual Congress on Healthcare Leadership this year, and we had twice as many people as we've ever had. So these challenges can be navigated. But once again, you really do have to be intentional about how you're re-imagining and you've got to meet people where they're at, where their demands are, where their needs are, and make it convenient to them. So now, we're all about applying the lessons learned, how do we hard-wire these lessons of telehealth and diversity and all these other things, and really enabling leaders to really understand how to navigate to the future.

Brian Bolwell, MD: One of the things I found was the importance of connecting with your workforce because there was so much fear, and probably your organization played a wonderful role in helping people with different strategies of how to do that.

Deborah Bowen: Yeah, I think what most people prioritized was really communicate, communicate, communicate. If you don't communicate, people make things up in the absence of understanding what's going on. So that's not a healthy situation to be in when you're trying to manage surges and all of those other things. And I think what people also talked about, the leaders always prioritizing, transparency in information, authenticity, frequency. Again, I think those approaches really worked well in terms of giving people a little bit more hope and a little bit more confidence that we would navigate well through this.

Brian Bolwell, MD: I think those lessons learned are important. I think that you can never over-communicate transparency and authenticity. Authenticity, actually almost especially. I mean, I think that was very useful for us was just to, for me anyway, in which I showed my humanity through... This was affecting me like everybody else. I couldn't find any toilet paper at a grocery store. And just simply communicating that would somehow lifting. But there are some lessons that I think are certainly applicable going forward for just about any form of leadership. Again, be transparent, be authentic, be honest. Say "I don't know" if you don't know. These are all very useful lessons that I think are applicable to almost any leadership situation.

Deborah Bowen: I completely agree.

Brian Bolwell, MD: I was fascinated when you talked about: you spent time as a social worker with heroin addicts. Tell me about how that influenced you and if you still reflect on those experiences.

Deborah Bowen: I do. They were very informative. First of all, you know heroin addicts, the rate of recidivism is very high. And it really led me to this notion that I could continue to try and help people one-on-one, but it really enlightened me to systems thinking. How do you get on the front end of problems? How do you manage the ecosystem so these things may not either occur as frequently or occur as severely, or perhaps even save a person's life? How do you create the ecosystems to make change? And it's really that experience that led me to work for the state government.

I worked for the alcohol and other drug abuse area for quite some time in Wisconsin really because I thought I needed to influence change in a different way. And that's really why I also love association work. Because, yeah, I could try and go and convince you, Brian, or can convince another leader to try and do something but if I can create an environment where that's reinforced and where you have a plan or create an opportunity where you hear it from another peer in a compelling way that really makes you want to change, then I can really affect a ripple change that will affect many, many more. And that's really the journey that I was on early on.

I was fortunate to find association work. I know a lot of people think, "Well, we don't know what they do. And lots of times, they lobby." We don't lobby thankfully. I thank the American Hospital Association every day for the work that they do. But again, I do think there's power in the collective and power in the community, and that's what inspires me and that's why I love the work.

Brian Bolwell, MD I think that's really cool, and I think that's a great way for us to wrap up.

Conclusion: Thank you for joining us for this episode of Beyond Leadership. We welcome any topic ideas, comments, or questions about this or any past episodes. Email us at [email protected] or by clicking on the link in the show notes.

Beyond Leadership
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Beyond Leadership

Host Dr. Brian Bolwell escorts you through a network of thought leaders, sharing world-class insight on leadership and cutting-edge hospital management approaches. They will inspire and perhaps compel you to reinvent your practices – and yourself.

Developed and managed by Cleveland Clinic Global Executive Education.

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