The Power of Daily Self-Reflection with Bradford Borden, MD, Vice Chief of Staff and Institute Chair of Emergency Services, Cleveland Clinic

Podcast Transcript

Brian Bolwell, MD: Welcome to Beyond Leadership at the intersection of leadership and everything else. I am Dr. Brian Bowell your host. And together we will co-mingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership. Today, I'm delighted to be joined by Dr. Brad Borden, Associate Chief of Staff at Cleveland Clinic and Director of Emergency Room Services. Brad, thank you.

Bradford Borden, MD: Thank you, Brian. Happy to be here.

Brian Bolwell, MD: Can you tell us a little bit about how you started in medicine and different leadership roles and ultimately when you came to The Clinic?

Bradford Borden, MD: Sure. It sounds like a, who am I kind of question. I'll go back to how I grew up. I grew up in a small town, Fremont, Ohio, about 100 miles west of here. Three siblings, have a brother who's an orthopedist. I have a sister, a banker, and another brother who's totally deaf from birth and teaches sign language. My dad was an internist cardiologist, primary practice, 41 years. And so that was my introduction to medicine. My mom was a homemaker. And three boys, one of which is in medicine, I have a second year cardiothoracic resident at Stanford. One of my twins is pilot training in the Air Force in Mississippi and an accountant in Chicago.

So my path with medicine started at Cincinnati, where I went to med school, came to Cleveland, did my residency at Mount Sinai, 23 years at Marymount, 17 of which I ran my own equitable group. And then almost 11 years at The Clinic. And my clinic jobs outside of coming to be the institute chair, which was in January of '12. And then I started in an associate chief of staff role, I think it was in '14. So I've worked with four of them, Joe Hahn, Brian Donley, Herb Wiedemann and Beri Ridgeway. And so for the last year and a half, I've had the Vice Chief of Staff title. So that's been the journey to date.

Brian Bolwell, MD: You've had four chiefs of staff of The Clinic in seven years, and the only common thread is you. So I'm not sure where to go with that, Dr. Borden, but in any event. So when you first joined The Clinic, you were in charge of a large private group of emergency room physicians, correct?

Bradford Borden, MD: Correct.

Brian Bolwell, MD: And The Clinic is a big group practice and I'm sure that culturally it was quite different. What was that like? And how did you manage it?

Bradford Borden, MD: It was and is quite different. I think the thing you have to realize, coming from a private entrepreneurial mindset to The Clinic is, it's a group practice. And you can't make decisions that only affect you. It's got to be the whole group, the whole enterprise. And it's a big ship and big ships sometimes don't turn quickly, as the saying goes. And you have to realize that, and you have to play by the rules and stay, I think, within those guidelines. But I also think you have to consider why you were brought here. And I think having outside ideas, having some of the entrepreneurial private mentality was helpful to me when I started. It gave a different aspect than somebody who perhaps came up through our system because my upbringing was different.

Brian Bolwell, MD: So give me an example.

Bradford Borden, MD: Well, just in a lot of things related to hiring and how we could do certain things, we have to follow certain rules here with HR that, not to say that we broke the rules by any means, but you could divide up a package a little bit different to attract people, and move a little of the compensation things around. If they didn't need healthcare, you could put that towards their salary and compensation. Little things like that.

And then I think you just have to remember that, when you do something in my institute, it may affect 20 other clinical institutes. And so you have to be very collaborative, I think, and learn to work within that system and go through the proper channels when need be. But also, I think you need to step out sometimes and say, "This is the way we have to do it." I think that's the way you ran Taussig. And then part of the job is to get that point across to others and hear their input and be collaborative in how we get things done.

So certain things, the medicine's the same. That doesn't change. The collegiality here was remarkable from day one. I always felt I could call any institute chair at any time, and I had their respect, they equally had mine and we'd work it out together.

Brian Bolwell, MD: For our listeners, Brad, can you explain the breadth of emergency room services that exist within our enterprise and how large, really, a group of physicians and what a diverse geographic footprint we have? That's number one. And number two, you've done a fabulous job managing that and actually having alignment about quality safety and a lot of things. So I'd love to know how you approach that. So first, what's the playing field for emergency room medicine here at the organization? And secondly, how do you manage that?

Bradford Borden, MD: So when I started in '12, we had main campus and we had the freestanding ED at Twinsburg. So we probably had about 25 doctors, maybe 30, and about 12 to 15 APPs. Now we have somewhere between 155 and 165 physicians, and about the same number of APPs. So we've had exponential growth. A lot of that was in December of '15, when we added six of the team health contracts, they were at Fairview, Lutheran, Lakewood, Hillcrest, South Pointe and Euclid. And they were part of a large contract management group. And so one of the big jobs I had that Joe Hahn talked to me about when I was being recruited to put my name in the head for the institute chair was how to bring that group in successfully and merge them into our group here. So we did that and I think it worked out very well.

And we've grown since then now to have 14 total EDs, that are under ESI, two of which are the pediatric EDs in Hillcrest and Fairview, together in ESI, it's about 600,000 annual visits. And then we have relationships, obviously, since as an enterprise we have Akron General, we have Canton Mercy now, we have Union in New Philly, Dover, and the five hospitals in Florida. So one of my center directors, Steve Melton, part of his role is to be the liaison between those that I just mentioned that are actually not under the ESI umbrella, but which we're always available to help with ideas and consultations about the way we've done it, our playbook, et cetera.

So the second part of your question, what do I believe what my job is in my role? And I think the first is, obviously, I have to be supportive of my team. Next, physicians are smart. They see through things when you aren't genuine. And so you have to be honest, you have to be transparent, you have to live your values, you have to have integrity. I don't really see any other way to be a leader than to act that way. I think you need to avoid one offs because those always catch up with you and come around and bite you in the rear. And I think the other thing is your team knows that you have to own it. I'm a big fan of the Navy SEALs, whether it's McRaven's book about Make Your Bed or his 20 minute podcast, UT and the commencement, or whether it's another SEAL book by the name of Extreme Ownership, when the team fails, you've got to take the hit, you've got to fix it. You're the leader.

And I think the last thing that has helped us is we take great pride in driving results. And how do we do that? I think the biggest thing is you set goals. And try to make them the team's goals, not just my goals or the leadership team's goals, but the whole team's goals. And I think help people remember that a goal without a timeline, it's a dream, it's not a goal. So you have to put a timeline on things too, and how we're going to get there.

So I think those are some of the things along the way that have helped me to lead EI. And I think if you ask members of ESI, I think they'd also tell you that I hold them accountable.

Brian Bolwell, MD: Well, you just talked about 15 different leadership principles, so why don't we touch on a few of them? Number one, you talked about delivering results, Brad, and certainly I agree with that. How do you do that?

Bradford Borden, MD: Well, I think everybody first needs to know what their role is and what their job is. I think it all starts, Bri, with Jim Collins' Good to Great. It's who you hire, that's your HR issues right there. So when we recruit, I make sure that the people being recruited know there are three things for me that are vitally important. Doesn't mean, if they don't want to be a part of that, that they're a bad physician, a bad person, it might just be that we don't share the same values.

Mine are that number one, it has to be the right fit. They have to understand our culture. Our culture at The Clinic, our four care priorities, they have to understand the culture in ESI about being held accountable. And it has to be the right fit. They have to know that we can help them, maybe if their behavior needs to be a little tweaked, or if they need procedural competence or clinical competence in another way, we can tweak that. But we can't change the DNA. That's why the fit has to be there. I always say no arranged marriages in my recruiting. We both want to go to the altar, both got to be wanting to be at the same place, because if not, small abscesses become big abscesses. And so we don't want that to happen.

And then the other two things are professionalism. We're highly valued, highly compensated professionals. We need act like one, both on duty and off duty.

And then my third thing is psychological safety. So I make sure that everybody that comes in knows how important it is. Yes, the physician is the bottom end of the funnel for the decision making, but you got to be open to hearing it from everybody. It's the old Toyota auto manufacturer line, anybody can stop the line.

So I think knowing all those things going in helps people to know what their expectations are. We have a physician scorecard that we put out, Open Book Test, it's a one stop shop, there's links. And then within that, we have a merit physician scorecard and it tells them exactly what things we're looking for when it comes APR time to determine the merit for the upcoming year.

Brian Bolwell, MD: So that's really good, a lot of cool stuff there. Certainly psychological safety is incredibly important for teamwork and for really excelling and certainly driving results. A lot of people say it's important to start with why you want to go from point A to point B, but I think equally important, which I think you're particularly good at, Brad, is helping how are you going to do it? Saying you want to go achieve X is great, and I think extremely important, but sometimes you also have to be with your team and say, "Okay, if we want to do it, here's the steps that we need to think about. And what do you guys think?" And it gets back to your psychological safety point. I think you've done this very well. Do you think about this stuff?

Bradford Borden, MD: Bri, I think about it all the time and it doesn't mean... I mean, I have a good balance in life. It's not just all about emergency medicine and work. But yes, and I think the key to this is that, as a leader, you have to be reflective. And you can do that in a number of ways. I do it in the car going home. I have about a 35 minute ride. And it's at that point in time when I am reflective for how that day went. And part of that is just having a self-mastery of your pros and cons and being just totally brutally honest with yourself. You know, if I pass somebody in the hallway at 10:00 and I say, "Hey, stop in and see me at 3:00. I got to talk to you." And I don't tell them why, or I don't say what the real reason was is I value their opinion and I need to get it on this particular topic because I got to make a decision. Well, if I didn't do that and said it the way I said it, I just hijacked him for five hours. Am I in trouble? Am I going to get disciplined? Is my job at risk?

And so those are the kind of things I think about. How did I interact with people? Was I transparent? Did they understand that the decisions we're going to make are iterative, and we'll come back and take a look? And like you said, if it's a directive that we all get, sometimes we got to pass it down, then I'm not doing my job if I didn't explain the why. Because, as you know, we're all trained as deficit based thinkers, right? So if you don't explain the why to physicians, based on our training, physicians, as I said earlier, are very intelligent, they're going to fill it... those gaps are going to be filled by their own stories rather than the why that I think they need to think about.

And at the same time, I think back of was I collaborative when I could be? Did I listen? Because your team's only going to listen to you if you listen to them. Right? So they got to understand in that the door's open, send me an email, pick up a phone. And that's the way I think we get unified and we get a team spirit and as many of them out there has always heard me say, there's no bigger team game in medicine than emergency medicine, because we've got side by side to nurses, techs, et cetera, our whole shift. So you've got to be a team based player and the leader needs to be the same to his team.

Brian Bolwell, MD: Another thing you mentioned is the importance of being honest with yourself and being reflective. And I think this is something that we both do a lot. All the time. It's one of my biggest learnings from executive coaching is the knowledge that you can always improve, you can always handle situations better. And like you, I frequently think about interactions I had at, again, in a given day, and whether I managed them to the best of my ability. And if I didn't, what I could have done better? And yes, I think this is something that I do every day. I think it's an essential piece of learning, but I think that what comes with it is the knowledge that you can keep getting better. And it's almost a sense of optimism that if you do this and you work on it and you're willing to change, you can probably do a better job next time. And that's one of the reasons to go through the exercise.

Bradford Borden, MD: Absolutely agree. And I think, Brian, what leaders have to always remember is don't let your ego get in the way. And the reason I say that is, I think when you stay humble, you stay reflective. To go back to the SEALs again, they have a saying about your ego is not your amigo. And it comes from, you can't have somebody going rogue in the platoon or the whole platoon could be compromised. And I think that same thing has to apply to any leader because when your ego gets in the way, you stop being reflective, you stop valuing other people's opinions. And that's when you stop being a good leader.

Brian Bolwell, MD: Another thing you mentioned, Brad, is the importance of living your values. And that's something that I think is in just about every leadership book, and yet from so many, it's actually not always easy to do. Primarily because I think it takes a lot of courage sometimes to live your values, because it may be easier to be a yes person and then to agree with something that's being said, even if at your core, you don't agree with it. How do you muster up the courage to live your values? It's not easy.

Bradford Borden, MD: First of all, Bri, I've always admired that of you. You were never one to be afraid to speak up, if it didn't pass the sniff test or it wasn't perhaps the right thing to do at the right time, et cetera. So I admired watching you in meetings when you did that. I think for me, I think it goes back to, I'd go back to my parents and how they taught me. I'd follow my dad around the hospital, how he treated everybody in that hospital, not just his patients, the nurses, EVS workers, et cetera. So I grew up learning that. And then, many people know I'm a big University of Michigan fan and the legendary football coach there, Bo Schembechler, had a saying, he said, "There are no little people in our organization." And I think you have to live like that. I mean, everybody's important here.

And then I use this saying that my mom taught me, she still does, she's 91, just this past August. She still teaches me and holds me accountable. So she had such a big influence on me that part of the things that I tell our recruits and use it at other times is, "I hope you had a mother who loved you and taught you do the right thing, because I'm not going to be your second mother. Neither should my administrative team. You've got to take ownership and you've got to do this."

So, I guess, to answer your question, it goes back to how you were brought up. And then what role you've taken on. Because it's easy to just pass out the good news, right? You know that. As a leader, you've got to be able to deliver the not so good sometimes. And sometimes it's to an individual, sometimes it's to the team, but if you fall back and you don't stick to those values and you don't stick to the integrity, then they will see through it. You will lose credibility, not just with your team, but I think with yourself and your confidence.

Brian Bolwell, MD: And along those lines, Brad, you're somebody in our organization who actually teaches physicians how to have crucial conversations. How do you approach that?

Bradford Borden, MD: As you know, nobody gets out of bed saying, "Geez, I just can't wait to have a crucial conversation today." Right? So first of all, I think the biggest training that any of us get, we can read the books, but it's experiential. It's 90% experiential, in my mind. And not that I think there aren't some good books out there, there's the book called Crucial Conversations, the first author is Patterson. I think that's a great book. Kim Scott's Radical Candor is a great book. And what I think Kim Scott taught me, that I try to use in all these crucial conversations are, and this is really the mantra of our whole book and examples built around it, you have to care personally in order to challenge directly, so care personally, to challenge directly.

And so when we're going to have a crucial conversation, I think, first you have to have done your homework, right? There's always two sides, three sides, four sides, five sides, to every story. And I love a comment that Adrienne Boissy said recently, and that's, "Empathy and curiosity before accountability." So empathy and curiosity before accountability. So I think you have to go into every crucial conversation with that. And then you have to be honest in the crucial conversation. I think that if you don't make sure people understand that it's not about them as a person, it's perhaps this behavior and the perception that this created and help them to have insight so that they walk out saying, "Okay, now I get it." And a lot of this starts with, it's not what you preach, it's what you tolerate, right? So if you're not going to speak up and have that conversation, then you're tolerating it. And that's not a good way to go either as a leader.

So I work with Matt Donnelley in OPSA, and he's the executive director, and that's part of our job in the Chief of Staff's Office. And I think we fall back on that. We try to be understanding, what was the situation, what was going on in your life at the time, try to get the complete picture. And then if it was an area where somebody misstepped, then help point it out to them. And what do we got to do to get back on track?

Brian Bolwell, MD: It's not easy to do, but I agree with everything you said. I think that it's very important to talk about behaviors and not the persona for the person themselves, because that's HR 101, you never want to do that. And then yeah, you got to be straight. There's no way around it.

Bradford Borden, MD: Yep.

Brian Bolwell, MD: So you mentioned you're Vice Chief of Staff now, what does that mean? What do you do in that role?

Bradford Borden, MD: So a lot of it is when Beri is double booked or whatever, and I need to step in and do something for her, at any time I'm available to do that. Sometimes the bog recently where she's gotten called away for whatever reason. So I want to be prepared, what's on that agenda and where we want to go with that. I think the other parts of it are, what I'd said briefly, a big role is that Matt and I do a lot of the discipline interactions with our staff and then obviously go back to Beri and sometimes Tom, if need be. But Matt and I take care of a lot of them on our own. And it's not something that you're ever going to see on the skyway, right? And so it's just things that we do. And so we don't talk about it that much. And that's a big part of the role.

And then we help... Beri's put together some members of the chief of staff, there's couple other associate chiefs of staff, Susan Rehm, Kendalle Cobb, Andre Machado. And we meet at least weekly, and Beri might want to run some things by us to get our input. She's great about that. Beri does great with psychological safety and you can speak up and she may agree, she may not, but she's hearing another opinion. And I think one other thing she's done well that we all want to have that same mentality is we represent all of our professional staff and that's the way you need to think. So when your ideas are being expressed, they aren't just based on your institute, Andre is an institute chair, I am. So you got to take that hat off and put the whole staff's hat on. And how do we advise? What are we hearing? Where do we think we need to go with this? So those are all part of the roles.

Brian Bolwell, MD: Brad, one thing you and I have talked about previously is, you mention on your drive home that you're reflective about your day, but the other thing that I think we both do is the reverse, we actually try to plan the day ahead of us. What's your approach to that?

Bradford Borden, MD: So I'm old school. So I print my calendar for the week. And I think it drives my assistant a little crazy, because she has got to give me updates on all the meetings. And the reason is, on Sunday, Sunday evening usually, I take a look at that whole week. And I make notes on the meetings that I want to make sure I need to get those points across or what points I want to remember, if asked to give my thoughts on. So that's what I look at the whole week, but I remain very flexible. I mean emergency medicine, you never know what's coming in the door. So yeah, things will get bumped around changed and you just go with it. So that's the way I look at it. That gives me a good picture of the whole week. And then before I leave the house in the morning, I look at that calendar once more, say, "Okay, what should I be thinking about here? What should I be thinking about there?" And that's the way I use my time coming in, which is a little different than the reflective time going home. But that's what I do first, and how I finished it up when I'm heading home.

Brian Bolwell, MD: So you mentioned that in emergency medicine, you never know what's coming through the door. I do think that from a leadership perspective, you actually don't know what's going to happen in your day. And like you, I try to plan my day, but one of the things I've learned is that there's a certain amount of unpredictability to a leadership role that's inevitable. And rather than have that be obtrusive or mess up your day, probably is a better mindset to realize that's going to happen more often than not. And you've got to be adaptable. You've got to actually almost embrace it because otherwise it'll become just a series of annoying events that really doesn't get you very far. It's part of a contextual intelligence theory that I think is very important. Is that your approach? I mean, things do come up.

Bradford Borden, MD: Yeah, absolutely. I think the emergency medicine training helped immensely because I didn't grow up loving change. I think it's just something you have to either get yourself to wrap your arms around it, embrace it, and learn to deal with it, or it's not going to go well. And so being in emergency medicine, it did help me to just embrace that early. Because one of the reasons why I went into it, because I liked the variety and I liked what was coming in the door. And so it's like, well, you can't be against change if you like that. Right? So I had to get on board quick.

And I think it was interesting, Brian, when you were saying that, I thought of what Tom said recently, which it was very impressive, the insight into the way he's handled COVID. He said, "We don't know. We don't know what's going to happen next. And we just have to trust ourselves, we're going to make the right decision based on the facts that are in front of us. And if we have to change, we'll change. And at some point it might be we have to put the brakes on and stop and think about it for a while. Or other times we have to act on it right now. But we don't know what's going to happen next in this pandemic." And I think that's been his MO throughout this, and I think it has served us very well. And I think going back to his core values have helped immensely in his decision making through this.

Brian Bolwell, MD: So for our listeners, Tom is Tom Mihaljevic, our CEO, and that's who Brad's referring to. And that brings up actually another key point, Brad, is decision making. And I've always been somebody who likes to try new things and if they're working out, that's wonderful, and if they're not working out so well, then we need to course correct. Sometimes they may not be working out at all and we have to abandon the idea, but I'm okay with that. And I think that sometimes I see leaders think a great deal about arriving at a given course of action or a plan. And then they stick to it no matter what. They don't really absorb input or are very reluctant to course correct. And I think that's a real limitation of some leaders. And so just what you said about an ability to change and adapt is vital.

Bradford Borden, MD: Mm-hmm (affirmative). Totally agree. I think it goes back to being confident in your leadership role to say, "It's okay." And as I tell other recruits, I said, "We will be iterative. We'll be transparent, we'll be iterative. And we're okay with that." And I totally agree with your thinking on that. And if you're not confident that it's okay to do that and you get stuck in that, that wrong path, it can be very, very detrimental, not just to your team, but to your leadership ability going forward. Because others around it see it and they probably know that you know it, but if you aren't willing to change, you got to question the next time you're making a decision on a direction. And part of that, I think, Brian, goes back to that humility. Again, just being humble to say, "Okay guys, we screwed up. We're going a different direction here. Thanks for the input. And we'll reevaluate this one." So I have no problem doing that. And I think that's a key to... every good leader should think about that and think hard about it.

Brian Bolwell, MD: Yeah, I totally agree with that. And the other thing, Brad, about change is something that, again, I think is a corollary with the reflective part of leadership, which you articulated, is it's one thing to think about how you did today or yesterday or whenever. But it's another thing to actually be honest with yourself and then try to change to improve. And I think that it's easy to say words like serving leadership and live your values, but we all make mistakes, we all mess up. And I think the importance is to realize when you're messing up and to be willing to try to change your behaviors so that the odds of you repeating that mistake diminish. You'll never be perfect, you'll always screw up, but I am so convinced that leaders who are willing to change and evolve and really willing to get better and try to get better... And I think you're a great example of this, Brad, I think you're better every year at this. I mean, it's very impressive actually to watch. But those are the people that you really admire. And also, I think those are the people that you like to hang out with. There are people you like to have conversations with and you like to kick ideas around, but the ability to change yourself becomes very, very important. Do you agree with that?

Bradford Borden, MD: I definitely do. And yeah. And thank you for that compliment. I think a lot of it stems from just the atmosphere that you create, whether it's within your team, within your leadership group, it's all about building relationships. And having the relationship that people can come in and just say, "Look, I don't think we're going in the right direction here." And not being afraid that you're going to bite their head off or say, "Well, no, forget it. How could you be so stupid not to see, we're definitely right." So I think the relationship thing is critical in life, it's critical with your colleagues, it's critical with your team. And I think that's a big key to being able to feel comfortable, to get a different direction, to continually be improving your game, because you build the people up around you and they get better at their game. And we all, I think, benefit from that. So that's the way I've done it.

But the same time, I think, Bri, when you think about that with your team, you also can't be the easy button for them, right? You got to hold them accountable, but not hold their hand. And I think that helps you to be better and you to be reflective and you to change when need be, as you go through and realize that we don't all communicate as well as we think we do. And that's been probably one of my bigger surprises is when some of the center directors said, "Not all ED physicians read your emails." I'm like, "What?" They said, "Nope, sorry to break that to you, but they don't, that's why we got to keep repeating the message." I remember when McChrystal came and the team of team's talk about just the communication over and over and over. And even after you did it a number of times, and he had some funny example, but it was like, "Yeah, I can relate to that now."

Brian Bolwell, MD: Yeah. I always tell everybody that's it impossible to over communicate. And I truly believe that, it can't be done.

Bradford Borden, MD: Totally agree.

Brian Bolwell, MD: Speaking of your team, one of the things that you're very good at is developing your leaders of your team. You've got a very deep bench. What's your approach to that?

Bradford Borden, MD: Well, I think number one is I try I to... I tell them all in the beginning, when they go into a role, I say, "Look, I learned as much from watching people do it the right way, probably more along the way when people weren't doing it the right way. So learn and watch every leader, me included, when I do it right and when I do it wrong. Because both of those, especially when they do it wrong, will stick. You'll just adapt the ones that are right, but you won't really ever forget when they really didn't do it so well." So I tell everybody that early.

One thing we did recently that I think is going to be good, very good, is we had... there's some roles that they have to have more than one role. It just, it is what it is. But we tried to spread the roles out. So an associate medical director at a site, shouldn't be also an associate QIO for substance or stroke or STEMI. So we split those and said, "Okay, you're going to stay in that role, but let's open it up to a new leader to take on this. So that they can get a little more enterprise experience, get a little pushed, get a little stretched and they'll be better." So that's, I think, a great thing that we recently did.

And I think the other is just giving people, when the opportunity's there, not to push it down their throat, but let them know a little bit more about my journey and what things I've read and heard, and what I've read and what's made a difference for me. Might not be the same for them, but it might peak their interest.

And a lot of people don't like to get another book to read, but if I quote a book, I keep a stack of books over here of the ones that have helped me along the way, and say, "Here don't feel like you need to read it. By all means, this is not an assignment. We will not talk about it again. There's no quiz. But if you're interested in where I got this from, here it's explained better in this book than I can explain it to you." So I have four or five of them that I use. That's been part of, I think, a role that has helped because people come back and quote, "Thank you so much for that. I got this out of that." I'm amazed at how many of them actually read it.

Brian Bolwell, MD: Yeah. Brad, this has been fabulous. Lots of true pearls of leadership. Do you have any closing thoughts that you'd like to leave with our listeners about their leadership journey?

Bradford Borden, MD: Thank you for that. I think there's one thing that I think is vitally important. It's own your own timeline. And I'll tell you what I mean by that. If you're asked to take on a role and it's not the right time, you probably won't do that well. Or else you got to decide upfront what you're willing to sacrifice. My wife, Becky, worked for Procter and Gamble in Cincinnati, when I was in med school, and then up here. And if you didn't take what was offered, you fell out of the queue. And I don't think that's the way an ESI... I don't do it that way at all. I think it's got to be the right time. If you've got young kids and you're committed to a lot of things outside, you're not going to excel. It's got to just be the right time. And just be honest and say, "I need a few more years. Please don't forget about me, come back." So that's one thing that I think is vitally important.

And then I think the other thing is for young physicians, try not to chart a course. I think that puts too much pressure on yourself. Focus on being good clinically first. That's the way every leader in medicine gets noticed, but just keep your eyes and ears open. It comes along the way. And if you're passionate about it, or if you think, as Tom Mihaljevic likes to say, if you're going to fill a need that nobody else wants and go do it well, and don't worry, you'll get noticed. Whether it's either of those two, when the timing's right, go for it, but don't feel like somebody else should own your timeline. You should own it.

Brian Bolwell, MD: Yeah. That totally makes sense. And I think it's great advice. At any point of your career. I mean, that's not specific to young people. And I just did an article on career transitions, and then so I think that it's applicable at any point in your career. Brad, thank you so much. This has been great. And thanks to everybody for joining us.

This concludes this episode of Beyond Leadership. You can find additional podcast episodes on our website, ClevelandClinic.org/BeyondLeadership. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcast. And to our listeners, 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 ExecutiveEducation@ccf.org. Have a great day.