To Know Thyself - Chief of Staff Beri Ridgeway MD

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, and leadership and management.

Brian Bolwell, MD: I am Brian Bolwell, your host. I'm very pleased to have Beri Ridgeway with us today, who is the Cleveland Clinic chief of staff. She joined the Clinic in 2009 and has served as the department chair of OBGYN, the institute chair of the Women's Health Institute, and has assumed the responsibility of chief of staff approximately nine months ago.

This meteoric rise has been rather dramatic, and she represents the first woman to be our chief of staff at our organization. She's obviously extraordinarily talented. And we're actually thrilled that she's here today. Beri, welcome.

Beri Ridgeway, MD: Thank you so much, Brian. I'm excited to be here.

Brian Bolwell, MD: So, can you share with our listeners your leadership journey and how all this has come to pass in such a short period of time?

Beri Ridgeway, MD: I actually think that's a great question and I wish I had a perfect answer for that. To be honest, I don't. I will tell you that I'm someone who is curious and likes to be engaged in really interesting projects, and try to take things on that match what I know I can do. And in that, it has allowed me to progress. I'm not someone who's ever had a five-year plan, to be honest. And just being able to match and find those interesting questions and projects, as well as being able to give back, it has aligned nicely for me. And I also know I'm extremely fortunate and blessed to be trusted, as well as to have these options based on what women and others who have come before me have done.

Brian Bolwell, MD: I remember when we talked, you said you like to solve puzzles. And that's an interesting part of leadership is to try to figure things out. Why do you gravitate to that? Or why is that important to you?

Beri Ridgeway, MD: I think that in every problem, there is a solution that will make most people mostly happy. And that to me is the challenge. You're never going to get everyone with a solution that will please everyone. Not everyone will be a hundred percent happy. But when there are issues or complex issues, really, there are solutions in there that really address the needs of both people. And I think identifying what those needs really are, is interesting to me. And then problem solving or thinking of solutions that can help both sides both individuals or groups, to me is a really interesting challenge and things that I like to spend time thinking about.

Brian Bolwell, MD: Yeah, that's an interesting point. Certainly one fundamental leadership core is articulating what it is the goal is. And probably a lot of people don't do that enough, as simply to say, "Let's step back, let's look at the big picture and try to determine what we're trying to accomplish."

Beri Ridgeway, MD: Right. And even when people say they want something, that's not always really what they want or what they would solve the problem. And so, I think sitting down and really listening to those individuals and understanding what the need is, you can often come up with three or four solutions that would meet that need as opposed to what the original ask is. That combined with, obviously in most cases, there's at least one other side. And often in meeting a need, there could be three or four different possibilities, and at least one or two between the group tend to align. And it's creating those win-win solutions, where we can offer flexible schedules or flexibility in the workforce.

Brian Bolwell, MD: So, Beri, one of the things that I've known about you, is how important it is for you to engage your team as you try to solve those complex problems. When did you learn that? I mean, you've been a department chair, you've been an institute chair, clearly that's been a lesson learned that served you well.

Beri Ridgeway, MD: I probably have learned it along the way. One of the biggest lessons likely was when I began managing obstetrics and gynecology in 2017. So, I'm a urogynecologist. I did a residency in OB/GYN, and then a three-year surgical fellowship. And so, I've not practiced OB since residency.

And I was then in 2017 managing a highly productive, engaged, very large group of OB docs and other OB providers. And there were some significant operational issues or challenges, and really engaging them to find the solutions that were specific to our system, how they have worked in teams, and then defining sort of an end goal of what would be ideal, bringing them along journey, removing barriers to me was one of the more satisfying things that I've done. And then seeing the outcomes really with engagement that was better, as well as patient safety and quality indicators that were better. And in fact, in the last two years, we've had our two main maternity hospitals recognized by Newsweek as best maternity hospitals.

Brian Bolwell, MD: That's a wonderful accomplishment. Congratulations. So, you actually left the Cleveland Clinic at one point. And then you decided to return. Can you share some of the thinking behind that?

Beri Ridgeway, MD: Sure. I did leave the clinic briefly for about a year and a half. So, I sometimes joke that it was nearly a sabbatical. But at the time that wasn't planned though. I returned actually back to California. That's where I grew up, my whole family's there, and my husband's family is there also. I had a pretty extreme burnout when I left. And I had three children in a four-and-a-half years, as well as took on a very busy surgical practice. And it was a lot. My husband at the time worked nights and weekends. And it just was not something sustainable. And I also really wanted to reconnect with my family. And I envisioned going back and really being there forever.

When I was there, there were some leadership changes that happened right before, and the vision of where I was headed changed. It also was very hard for me to be outside of our system, to be honest. I love being in a place like here that has really comprehensive care, has sub-subspecialists in every single area, and works as a system. That to me was really lacking in that job. And so, I recognized it and I came back.

I often look at that when people say, "Oh, talk about mistakes you've made or other things." And I think you could probably call that an error or a mistake. But it's interesting, first I make a lot of mistakes, so I tend to try to put these things in perspective. And I'm actually so glad that I did that. I'm it did cause a disruption to my family -- three kids and moving back and forth, cross country in a year and a half.

But besides that, I really learned so much about myself, about what I want to do with my career, about our system, where I feel that I can make the biggest difference. And so, it really put into perspective, the great system we have here at Cleveland Clinic, but most importantly, the amazing people.

Brian Bolwell, MD: So, you touched on a lot of very interesting things there, Beri. First off, just for our audience, probably not everybody realizes that that obstetrics at the Cleveland Clinic is not done on the main campus. That actually we have regional hospitals rather which operate as their primary locations for obstetrical care. So, when you talk about system-ness, what we do here at the Cleveland Clinic is a little different, and maybe it could share a little bit more about that.

Beri Ridgeway, MD: Sure. Yes. So, we at Cleveland Clinic have a main campus, which really is almost quaternary care here. And we do have a very small footprint for obstetrics, and that's called a special delivery unit. And that's for babies that need surgery right away, fetal surgery, moms with extremely rare conditions, where the sub-subspecialist is here at main campus. And so, it's about the 120 or so births a year.

Our other hospitals which really function as tertiary care centers have between 4-and-5,000 births, and are very high volume birthing centers here in Northeast Ohio. And so, even for OB emergencies, that's really the place that is seeing them day in and day out. And now has a hospitalist system, laborists, safety rounds, all sorts of things, that have now really been standardized across the enterprise, whereas previously they weren't.

Brian Bolwell, MD: So, our system attracted you to come back among other things, which makes total sense to me. It really is rather unique in which we have tried, I think in all of our clinical specialties, to standardize things as much as possible so that the quality that we're known for, actually in reality, exists in multiple locations.

Beri Ridgeway, MD: Absolutely. Just being able to have a standard medical record -- many of our patients have been with us for any number of episodes -- to have those there; to have people in care, and to then be able to communicate and collaborate with their other physicians, to me, is something so special and important.

I remember when I was away, I was in an underserved area, but as a reconstructive surgeon. I was often making diagnosis of diabetes and malignant hypertension, and counseling cases, and having a hard time even really coordinating someone's care. And how we have our system, I really feel that I can provide the best care possible.

Brian Bolwell, MD: So, another thing you touched on when you were in California, was you allowed yourself self-reflection time and time to try to step back and ask yourself, what is it that you enjoy? What is it that you want to do? And it sounds like you were pretty intentional about that. How did that work?

Beri Ridgeway, MD: When I first went back, I had a break, first and foremost, probably about four or five weeks, where I just could, I think exhale almost. And in the beginning of that job I wasn't very busy. And when you're burned out, that sounds super appealing, right? "I'm going to have all of this free time to do X, Y, or Z."

One thing I learned about myself was that I don't really want a lot of free time. Part of me doesn't really want to say that about myself, but it's just a fact. I can't change it. And so, I'm just really more accepting of that, that I like to be busy. I like to be thinking. And having a lot of free time certainly doesn't make me more productive. And in fact, I think slows down the rate at which I work.

And so, I think that was something, as well as just having some roles in California that were much more operational than I had had here previously.

Brian Bolwell, MD: So, you returned and you were department chair of OB/GYN, and then the opportunity to apply for the Institute role for Women's Health occurred. And that was something that you were successful at attaining. And an institute job here is kind of like being a CEO of a part of the healthcare organization. What were your biggest challenges and how did you deal with them as, in that role?

Beri Ridgeway, MD: Yeah. And those were jobs that I just really loved and enjoyed. And for me, it was about the group and the people. Really, they're so amazing and I care so deeply about them, and what we're doing for our patients and for women all over the world really. And so, it is like running a business pretty much.

And I think one of the biggest challenges is finding that intersection that I talked about previously of, what's right for the organization, what's right for our doctors. The piece in the middle of course, has to include, foremost, what's best for the patients. And then creating programs and messaging that, so that people understand the why, the why for the organization. And then also providing a loop back to the organization of how measuring something this way or that within a context of your book of business may not be the most effective way, but here are other options. And then, following through, making decisions, trying things out, making mistakes, iterating, and measuring again.

Brian Bolwell, MD: We spoke earlier, Beri. There are a couple of things that certainly resonated with me. One of them was your ability and your goal of empowering people around you to participate in decision-making, which we've touched on earlier. And the other thing was to discuss uncomfortable truths, which I think doesn't come easy for many. Tell me more about that.

Beri Ridgeway, MD: I think it's a must. It's something that I feel very strongly about. And I think in not doing it, it actually disrespects the other people, or the other party in this case. We underestimate others' abilities or interests in hearing the truth and being able to accept the truth in most cases, right? There's always exceptions, but we really overall underestimate that.

And we also can't expect that other person or party, or group to make the right decision and do the right thing if they don't have the actual facts, and they're operating on false pretenses. We owe them though respect to be clear, not to be rude or mean, but to be really clear and explain the why. And as a leader, if you can't do that, I always question, are we doing the right thing then? And that's a totally separate conversation. So, if I can't think of and explain why, and have it make sense in that context and communicate that, then I have to question the reasons behind the ask.

But I really found in being open and upfront, and being caring, and being willing to listen, most people can understand. And then also asking them, "How does this fit in your schedule? How would you ideally do this?" So, that they've have some control over this. And I always often say to them, "I can find a solution. I can give you what I think is best, but I can guarantee you, it's not the best solution and it won't be tailored to how you and your group think about things. I'd like you to actually come up with that and let's make sure it fits into what we're doing." And they often do come up with a better solution. And they should, they're the real content experts of themselves, of course, but of the group or of the situation.

Brian Bolwell, MD: And now, you're chief of staff.

Beri Ridgeway, MD: I'm glad you have to remind me.

Brian Bolwell, MD: And boy, that's a big job around here. How have your first nine months gone?

Beri Ridgeway, MD: Technically, I was a January 1st.

Brian Bolwell, MD: Oh, I'm sorry.

Beri Ridgeway, MD: So, I'm not quite there yet. It does sometimes feel like nine years. No, I'm just kidding. I don't know. How has it gone? That's a hard thing for me to answer.

Brian Bolwell, MD: I think it's gone spectacularly well. So, for all of our listeners, Dr. Ridgeway, does what she talks about. I think for those of you who have listened to this podcast before and know how important I believe honesty and transparency, as well as authenticity, I think sometimes I'm probably a little authentic, although I try to make sure that that's tempered a bit. But Beri has done a wonderful job walking the walk, acting as she speaks, as you all have heard her for the first part of this podcast. So, I think there's a renewed sense of optimism with you as chief of staff, Beri. I think that that's really been cool. That's been fun. So, how's it been for you?

Beri Ridgeway, MD: Well, thank you. I like how I fish for those compliments. I was wondering if you'd be like, "Yeah, you've tanked, but you still have some time to figure it out."

Brian Bolwell, MD: Now, we're going to come to your mistakes in a minute. That's one of our next stop.

Beri Ridgeway, MD: Oh yeah. There's a whole book. So, I think, I can't really say whether it's gone well or not. I have liked the role. I'm really excited and I feel really passionate about being the person at the table at the exec level who will have the voice of our docs. And I'm not afraid to use it. And to be clear, I still practice, I still operate. I still see patients. I still am plagued by Epic on days. I'm still frustrated when like there aren't enough clinic rooms or there are other patients are late, and then they're upset. And I live this. And I think that's so important that I can also sit at the table and when big decisions are being discussed and made, that I can authentically represent the voice of our doctors. And doctors being, of course, our physicians, other doctorate level, healthcare professionals and scientists.

Brian Bolwell, MD: One of the things that's very important to you, Beri, is to help our docs who seem to have to go home to finish their day job and seem to have to close charts at night, or deal with prescription refills at night, when that's the only time they have to be with your family. You have a passion about that. Tell us a little more about that.

Beri Ridgeway, MD: Sure. We work long hours. Our responsibilities are huge. We carry a burden of our patient's disease and illness, complications, recurrence, anger, all sorts of things with us. And you need some resiliency built into that to deal with that on a day to day. And if you don't have a break, whether it's being with your family or being alone, or doing a yoga class, or spending time with your pet, if you don't have that time to disconnect, I don't think you can continue to face the challenges that we as physicians face every single day.

And the documentation piece is a necessary evil of course. The amount of time that we're putting into it currently, it's taken a life of its own on. And so, I am passionate about providing solutions so that people can take a break, so they're not tethered to your Epic inbox. And that it doesn't overwhelm you.

The average person should not be doing Epic at night. Every now and then we're all going to have that. I've had it myself many times. But even in this role, I have it. But that should be the exception and not the rule.

Brian Bolwell, MD: As I do these podcasts, I frequently talk a little bit about my own views about leadership, which fall into three categories. And the first one is, is that it's not about you, it's about your team. It's about developing people. It's about supporting them, et cetera. And I think, I mean, as you said, Beri, that's something that you have done consistently your own leadership journey.

The second piece for me is that of self-reflection and being honest with yourself when you make mistakes and trying to improve, and actually be willing to change, and hopefully to live your values and have the courage to do that, and have the courage to be vulnerable. Can you share some of that part of leadership with us, how self-reflection becomes part of your leadership DNA?

Beri Ridgeway, MD: I think leadership is a journey. And I think to be an effective leader, one really has to know herself. I mean, really. And understand why when someone says something that annoys you, or why you want to react in a specific way. And that takes a lot of self-reflection and a lot of thinking, and a lot of work -- this could be with a coach, with a counselor, with a therapist, with a mentor. But it doesn't just happen spontaneously. It is about really trying to understand yourself and trying to continually work on yourself, being curious about yourself, and then trying to get better.

Interestingly, you would think, thinking and working on yourself will just make you feel worse about yourself. But it actually is freeing in a lot of ways in that you know why you are the way you are; you also know what reactions. And also you can start to really clue in on when your triggers and other things that I think can help you be a better leader.

Brian Bolwell, MD: So, one of the keys to this is that if you want to improve, you have to be willing to change. A lot of people can get this information, but change is obviously very difficult. It's very difficult for teams, for organizations, and it's very difficult for individuals. But if you want to get better, you've actually got to change your behaviors. You've got to change how you act. You've got to change what you do. How have you tackled that?

Beri Ridgeway, MD: I can't really speak to a process to be honest, but I'll give an example. One thing that I've worked on actually during a maternity leave of my third child was about empathy. And about understanding how in certain situations, I really wasn't that empathetic and forgiving. And that came up in a leadership course. For me, that was really very hard to hear, of course. When you're working so hard every single day, and to hear that, it really hurts, frankly. But in the work that I did, I was able to understand so much better.

And you would not think that empathy is teachable, like you're born with it or not. I actually don't think that's the case. But in the work that I did, I really started to understand myself so much better. And in that, I most importantly, it provided grace with myself. And in doing that, it allowed me to do it with others, which is not how I expected things to happen. And it's not really what I thought would be the best outcome, but it has been. Because in understanding and being open that I make mistakes, I have problems, I can fix them. I can now extend that to others.

Brian Bolwell, MD: I mean, I think that's quite profound. One of the things that we're uncovering in the Cancer Center is the concept of self-compassion. And people ask our palliative care physicians, how can they do what they do? Because they deal hourly with people who are frequently dying. And one way is simply to develop a sense of self-compassion that you do absolutely the best you can, but if things don't go perfectly, you've got to cut yourself a break. I think that's not always easy for physicians to do.

Beri Ridgeway, MD: I agree. And that is exactly what I think was so instrumental for me personally, is I was a perfectionist before. And now knowing I try my best and I'll have mistakes, I think -- and I've never thought through it this way until this podcast. So, thank you -- I draw it back to, I think when others make mistakes, my gut now says, "And they've been trying their best." And for some reason, it sounds like such a simple little loop, but living it has really transformed how I lead, but also my peace of mind.

Brian Bolwell, MD: One of the things I read a while ago, it was a quote from Gandhi who said It takes courage to forgive. And I find that to be quite true, because it's easy to hold on to grudges or grievances about other people, but the vast majority of the time, people who work with you are doing their best, and they want to do a good job, and they want to -- if you're their boss, they want to try to make you proud of what they do -- and that's always important to remember. And you're right, Beri, that's something that I think I learned far too late in my leadership journey, but I think it's a really key point.

Beri Ridgeway, MD: It's true. No one comes to work, especially here, to cause a problem, to make a mistake, to have a bad outcome, to have a negative interaction. No one does. There's a lot going on that gets in the way of their best effort. A supportive work with them can actually help instead of the negative thought process.

Brian Bolwell, MD: Do you enjoy receiving 360 evaluations? Recently a lot of us went through a Hogan Personality assessment. Do you learn stuff from that?

Beri Ridgeway, MD: I love doing the Hogan and other things, because it's super, like, really interesting to me. The 360s are hard, because despite the ones I've had, there are many nice things. There's always areas that I have to work on or situations where I've angered someone, or someone's perception that I'm this way. And I'm human, and of course I will leave that thinking of those, that handful of things, and not think of everything else that was written despite.

And so, I'm going to do a 360, probably in the fall after being truly being in the role for about nine months or close to a year to get some feedback. And yeah, I'm looking forward to receiving it. But I also, I will be honest, I will be nervous, and because I am trying my best, I am really hoping to always do a good job, but I'm also human.

Brian Bolwell, MD: Yeah. I always learn something from them. As I think, probably, most of our listeners know my kind of journey on all this stuff started about 20 years ago when I had a 360. It was a 25-page report and 24 and a half of the pages were about other things I did poorly. So, I hated receiving that and it hurt me a lot, too, but it was also a highly motivating to things, to learn more about leadership and to get better. And I'm obviously in retrospect, I'm extraordinarily grateful for having received that very open and honest feedback.

Beri Ridgeway, MD: Oh, so grateful. And that's where my work in empathy began. That's where a number of things that I've worked on and even perceptions, and other things started. So, incredibly grateful. And time heals all. And I can look back and say, wow, but when I read it the first time, it's hard.

Brian Bolwell, MD: So, before you got the role of chief of staff, Beri, you were also one of our leaders dealing with the COVID pandemic, which I think organizationally, we're all very proud of how we managed that. What are some of your reflections about the past 14 months with respect to COVID and your leadership during the COVID pandemic?

Beri Ridgeway, MD: It's interesting. In so much of this, I don't really see what I'm doing or what I've done. I think the thing that stands out for me is the teams that we put together. And some of us didn't even know each other, and I had just heard, "So and so is great." I randomly called them and I was like, "Hey, let's work together. Can you help with this?" I hate to say this in the midst of a pandemic, but it was a really inspiring, and parts of it were really fun. Working with these multi-disciplinary teams and assembling the team -- really listening, coming up with the best suggestions, moving things forward, messaging, really relying on others -- that I think has been my favorite part. Because nine times out of 10, I said, "This is what I'm thinking, run with it, come back." What they came back with was better than I would've ever done. And I just really do feel so fortunate.

And really, we have amazing, amazing people in this organization who work so hard, who are so smart, who are always doing the right thing, and who volunteered really to do this on top of their day job. No one had time for this. Sometime for many months, we were huddling twice a day. It really helped us operationally and to get to know each other.

And interestingly, when we had that third spike in December where we were then managing the bed capacity on a bed and day-to-day thing, where we would try to move a case back a day, because we didn't think there was going to be a bed in our system, we could have never done that work successfully, had we not lived those first two times together and brought surgeries, down and all clinical activity, and switched to virtual, and then switched back and brought things up. We could have never done it. And it's funny, I've seen some of those people recently, and I'm not in those groups at all anymore, and I'm like, "Wow! I miss you guys."

Brian Bolwell, MD: Yeah. I think that what the organization accomplished was stunning. And actually I think every one of our clinical leaders job changed, whether it was what you were doing, which was on an organizational and system-wide leadership role, or locally. I mean, locally, it's now the end of May, but we were still dealing 12 months ago with an extraordinary amount of uncertainty and fear, and simply supporting your team and being as transparent and as informative, and as supportive as possible, I think became really our primary role, because our caregivers are everything. We don't do what we do without the people who were at the bedside, whether it's physicians, nurses, everybody.

Beri Ridgeway, MD: Absolutely. And everyone's stepped up and stepped up in every way you can imagine. And I think it really solidified a lot of people and their purpose. And it really, I think will help us as an organization move forward for the next 100 years.

Brian Bolwell, MD: Yeah. I agree with that. So, I like to say I have a PhD in mistakes. You said you have a book about them.

Beri Ridgeway, MD: I always say, if I ever write a book, it will be titled, Pivoting From One Mistake to the Next. No one on this podcast steal my title, please.

Brian Bolwell, MD: Well, there's a risk, Beri. So, in the past year, what mistake have you learned the most from?

Beri Ridgeway, MD: Gosh, that will be really hard for me to answer, and it's not because I have not made mistakes, I've made five million of them, but I really try to live in the moment and I try to make the best decision that I can with the data that I have, knowing that we'll reevaluate that decision and iterate. And then, I also sometimes will try to look back and say, "Should I have decided, made a different decision." And by doing that, I really look and say, "At the time here were the data that we had, I would still make that decision again."

But what I try to focus on is where should we go, knowing what I know now, which is a term I use often -- knowing what I know now. Where should we go with that? And then also, what can I learn from that? And I try to really put those things into perspective and own it, and say, "Okay, that was the decision we had to make at the time. This has been the consequence." Or, "Wow, we should have maybe thought of things differently. What can we fix?" And also in my mind, who should I call and say this, or apologize, or if I've hurt someone, or someone mistook what I said, or I said something kind of offhanded. Those are the things that I try to own right away. Because those are things that fester, and over time only get worse. And I try to be very upfront with those.

Brian Bolwell, MD: So, what you just said, I think is a wonderful example of leadership philosophy. It's a lot of self-reflection. It's a lot of owning issues. It's a lot of, you know, life isn't so much about what happens to you. It's how you react to the challenges that you have. And we all have challenges all the time. And then finally, humility and the courage to reach out to people, and whether it's apologize or thank them, or whatever. I think these are so important that for a leader to do, and not just to talk about, but to actually do it. So, that was a lovely summary. Give any closing thoughts for our listeners about leadership here and where you are, where you'd like to go.

Beri Ridgeway, MD: As I said, I don't do any five-year plans or even one year right now. I want to contribute to the organization. I want to develop others. I want to make this the place where everyone wants to come to do science, practice medicine, treat patients. That's really my goal. And I think it's a problem that I will find interesting and be able to work on for quite some time. I'm just so grateful for the opportunity. And I learned so much from you, Brian. So, I always appreciate our conversations. And I look forward to partnering with you in your new role.

Brian Bolwell, MD: Thank you, Beri. Actually, one of the best things about my new role -- so for our listeners, I have transitioned fully to being in charge of physician leadership -- here is frankly working with our chief of staff, Dr. Beri Ridgeway, who I think you all now know is a truly extraordinary individual. And we're in very good hands. So, thank you very much, Beri, for joining us.

Beri Ridgeway, MD: Thank you. You're far too kind. I appreciate the opportunity.

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 executiveeducation@ccf.org, or by clicking on the link in the show notes.