Trust Starts with Follow Through

Podcast Transcript

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

Hello, everyone. I'm your host, Dr. Brian Bolwell. Today, we have Dr. Richard Cohen, chair of Digestive Disease and Surgery Institute, and professor and chief of surgery of Cleveland Clinic London. He's also the deputy medical director of Cleveland Clinic London. Richard, welcome to the podcast.

Richard Cohen, MD: Brian, it's a pleasure and honor to be here. Thank you for asking me on.

Brian Bolwell, MD: Can you educate our listeners on two fundamental topics? One is, how does the NHS in the UK work? And secondly, what is Cleveland Clinic London?

Richard Cohen, MD: The NHS in the UK stands for the National Health Service, which is what it is. It was founded after the Second World War. The original intention was to look after, "All of the population from the cradle to the grave," was the expression, where all healthcare was free at the point of delivery. You can imagine that those are actually really good aims to have, but of course, come with a price, which is very expensive if you want to provide the very best care for absolutely everyone. We have population here of about 60 million.

It developed over the years to where we are now, which I have to say, I'm quite proud of our NHS. We have primary healthcare in the form of what we call GPs, or general practitioners, who are the gatekeepers of healthcare into the National Health Service. All families ... In fact, everyone in the UK is registered with a general practitioner. The usual course of healthcare was that if you had a problem, you went see your general practitioner. He or she would assess you and either treat you themselves, or refer you into secondary care, which is in the National Health Service.

Within the National Health Service, we have district general hospitals, which provide regular care. And then, we have our teaching hospitals. Ivory towers that provide tertiary care with very specialized functions such as complex oncology or complex surgery. That worked really well, I suppose. Or relatively well for many years. But when COVID hit us, we had a problem in that no one could go and see their general practitioner. A lot of things went virtual, but the hospitals obviously stopped doing routine work in the beginning. I'm sure we'll talk about that later.

We ended up doing our cancer surgery in the private sector, of which Cleveland is now a part, and generated very large backlogs of patients who are waiting to have treatment for their hips, their knees. A lot of what everyone would see as being relatively non-urgent, unless you're the patient who can't walk around, of course. In which case, it's very urgent. Having had a system that kind of worked reasonably well, it's been pushed very hard by COVID.

The other interesting thing that COVID demonstrated ... The hospital I work in, which is University College Hospital, is a big teaching hospital in the center of London. Flagship NHS hospital. We had 30 intensive care beds, which we managed with for many, many years. And then, when COVID hit, we had to expand. Now, we can go up to ... I think it's 75 or 80 beds, if we need to. The whole ethos and the way we work changed because of that.

But otherwise, I know that Americans have a bit of a dim view on the NHS. I'll never forget once when I was a senior manager at UCH, meeting a group of Americans who asked me where the death committees were. I said, "Well, what are you talking about?" They said, "Well, we've heard that because treatment is rationed in the NHS, if someone has a complex, expensive problem, they have to go before a committee that decides whether it's worth treating them or not."

Of course, such things do not exist. I'm pleased to reassure you that we provide care for everyone, but we do have mechanisms for regulating the value of certain healthcare. We have the National Institute for Clinical Excellence, which assesses many treatments to see whether they work or not. For instance, just take an example. One I can think of is arthroscopy, which has had to do with ... But there are various things that they look at and they say, "Is it worth," not just public money, but, "Is it worth putting patients through these various treatments?"

I hope there are no orthopedic surgeons that I'm offending there. When we have a new treatment, for instance, particularly in oncology, they'll bring out a new drug. My oncological friends consider it a huge success if the average extension of life expectancy is 20 minutes. NICE will ... Again, I don't mean to offend anyone. But NICE will assess that, and with very expensive drugs, come to a decision as to whether the NHS will provide it or not.

Often then, there's an uproar from various pressure groups involved in those various specialties. Like with all things, it all settles down eventually. I actually think we have a good principle for our health service, which is treating everyone from cradle to grave. We try and treat almost everything. Alongside that, we do have a mechanism for somehow putting a value on the treatment as to whether it benefits the patient, and some things that are extremely expensive, whether we should be doing them or not. Sorry. I've whittled on there.

Brian Bolwell, MD: Thank you for that. What would be the rationale for the Cleveland Clinic to open a hospital in London, which it has ... Why might that work?

Richard Cohen, MD: You asked me about the role of the Cleveland Clinic. Sorry. I was waxing lyrical about the NHS. One of the main differences between healthcare in the USA and healthcare in the UK is that we have two sectors. Which I suppose is similar to your VA system, for instance, and then your regular healthcare system. The NHS is VA that covers everyone, but does it ... I don't know if it does it better or not. And then, our private healthcare system is people pay. Either they pay out of their own pockets, or they have insurance, as you do in the United States. What that does, it sort of turns you into a VIP.

You're able to make an appointment to be seen the next week on whichever day you wish to be seen. You can tell the surgeon that you fancy having your operation in two weeks' time, rather than three weeks' time. It gives you a huge choice in how you are treated. Our private practice, all of our patients, no matter who or what they are ... If they've paid their subscription to the insurance, or they can afford to pay the fees of the physician and the organization, expect to be treated like VIP.

Whereas, in our NHS system, they may have to wait for months before they're seen. And then, months before they get their treatment. Though the NHS, going back to it, is very good at treating either acute problems like car crash victims. Also, we're very good at treating cancer in a timely fashion. But everything else has gone by the board, because we concentrate on those things. Let's just say you are an 80-year-old patient who's got a bad hip that needs a hip replacement. In the NHS, you may have to wait three, four, five months to be seen.

You may have to wait a couple of months for your imaging. And then, you may have to wait a couple of months to be seen again. And then, you have to wait months and months before you have your operation. In the private sector, you pick up the phone, you phone Cleveland Clinic London. You say, "I want to see a hip surgeon next week." It's booked in. The hip surgeon says, "You need an MRI of your hip." It's done the next day. And then, you see the patient again the week after, and they book their surgery. That's quite a difference.

That's what Cleveland Clinic London is here to provide, is to provide the finest healthcare with the finest physicians. But we serve the group of patients who see themselves as being VIP patients, because they've subscribed to that. Now, it's very interesting. The NHS outsources work to the private sector. The best example of that was during COVID. We did all of our NHS cancer surgery in the private sector. Currently, Cleveland Clinic London is in negotiation with various areas of the NHS to do various types of procedures. We're at the early stages of that. Most of the private organizations in the UK now do provide some degree of outsourcing service to the NHS.

Brian Bolwell, MD: Tell us about you. How did your career start? Ultimately, why did you decide to join the Cleveland Clinic? On the one hand, it's a very unique opportunity to build something from scratch. On the other hand, it's very different than the NHS model that provides most of the healthcare in the UK. Tell us about you.

Richard Cohen, MD: I'm a nice Jewish boy from North London, which is where my community comes from. Age six, the first essay I ever wrote said, "When I grow up, I want to be a surgeon or a train driver." I went down the former route. And so, I did my preclinical years in a hospital called Westminster Hospital, which was closed as a result of cutbacks in London. And I had to do my clinical somewhere else. I went to Addenbrooke's, which is in Cambridge, which everyone's heard of. They'd just opened a medical school, and I was in one of their first cohorts of students to go through there.

And then, the way that training works or worked at the time in the UK was just slightly peripatetic. My best friend at the time married this girl who was daughter of the senior surgeon in Manchester. At the wedding, I made such an awful best man's speech that he took me aside and said if ever I wanted a job, I should give him a ring. And so, having done a bit of ER jobs and a bit of this ... I taught anatomy for a while. I rang him up and he said, "Your interview is tomorrow." And I went up to see him.

He gave me a job as a trainee surgeon in Manchester, which is one of the big cities in the north of the UK. He sort of looked after me. I then did two years of research. We do a PhD, except we call it an MD. You laugh because you say, "Everyone's an MD," but I don't know ... In Yale, in New Haven, looking at endothelial cell biology. I came back to the UK with a view to being a vascular surgeon, because the guy whose daughter I was best friends with the husband of was a vascular surgeon.

But I didn't really like vascular surgery. I didn't like encouraging everyone I knew to smoke. But I really liked colorectal surgery. I managed to get an appointment as something called the RSO at St. Mark's, which is a senior surgical trainee at St. Mark's Hospital, which is very well-known around the world for colorectal. I've always loved fixing bottoms and bellies and things. And then, the opportunity arose to get a consultant position at St. Mark's, which I went for and was appointed.

And then, about six or seven years later, I moved to UCH, University College Hospital, where I currently hold my NHS position. In October of last year, UCL, which is the university associated with UCH, made me a professor of surgery. I managed to pull the wool over their eyes and persuade them to do that. In the mix of all that, about in 2019, I got a call to say, "Would I like to come and see the Cleveland Clinic?" They were just setting up in London.

Obviously, every clinician in the UK has heard of the Cleveland Clinic. I knew Steve Wexner well, and I knew Connor. And so, I came and I met this chap called Tommaso. This odd gentleman that semi-enthusiastically took me through a PowerPoint presentation of what Cleveland Clinic values were all about. I sat there thinking, "Wow. All my life, I've tried to provide care in this fashion, and here these people are coming over here and they're doing it." And so, I said, "Well, A, I'll be very interested in joining. And, B, I'll be very interested in being involved in setting it all up."

The next thing I know, Brian often alludes to this, Brian Donley, is that I had a clandestine breakfast in Warren Street, which is near UCH with Brian. I told him that I would very much like to come and work at the Cleveland Clinic. And the rest is all history. I've been with the organization since 2019, and I've taken increasingly more time. I'm now full-time with Cleveland Clinic London, and I'm released to go and do some ... I still work at UCH.

I've never looked back. And I always tell everyone that working for Cleveland Clinic London, one gets younger every day. It's so interesting. To be involved in something where you are trying to make everybody's lives better. The physicians who work with us, for starters, and our patients. What more could anyone ask for?

Brian Bolwell, MD: For our listeners, Cleveland Clinic made the decision to go to the UK several years ago. The individual that Richard's talking about is to Tommaso Falcone, who's our chief of staff, who's a very good friend of mine and actually has done one of these podcasts. Tommaso was just here this week, actually. One of the things he emphasized when he approached his chief of staff physician was how important it was for him to hire the leaders of the various service lines.

We have about six or seven major service lines, one of which is digestive disease. For our listeners, we actually just opened the hospital a few months ago. And so, we'll talk to Dr. Cohen about that in a minute. But tell us a little bit about being selected as the leader, which meant that you had the opportunity to build a team de novo. From nothing. How you approached that.

What did you look for when you recruited? How did you connect with people? Because this gets into leadership philosophy. One of the things that we talk about a lot on this podcast is the importance of working as teams, and trying not to have overwhelming egos interfere with that. Emotional intelligence, building trust, et cetera. How did you approach building your team?

Richard Cohen, MD: First thing I would say is that, Tommaso, I'd like to consider him to be a very good friend of mine as well. He's the most amazing leader, who has a profound understanding of where he is working and who he's working with. I've learned so much from listening to him and observing the way he handles people. He was obviously born with this natural talent to bring people with him. It's my pleasure to work for him and try and make things as well.

Similarly, I would apply the same to Brian, who's a great leader. The two of them running this organization in London has been superb from that perspective. How do I choose leaders? Well, I'm at a stage in my career ... Or I was. Where I kind of know everyone in town and who's in private practice because I do so. In my own field of bowel surgery, a lot of them I worked with, or worked for me during their formative training. Being a bowel surgeon, I work very closely with gynecologists. I work very closely with urologists. All of whom are within my institute. Bariatric surgery, as well.

At the time of my appointments, I was a director at UCH Hospital of GI division. And so, I was very involved at a high level in there as well. I spent a lot of time sitting on appointment committees for consultants. And so, I had a good idea in each of the rounds where I'd want to draw my resources from. What I would do is, I would meet with them. I'd introduce them to Tommaso, and we'd have a good think about whether these were individuals who we'd want to take on.

We met lots and lots of physicians. And the honest truth is that they almost self-selected themselves. The other thing which I haven't mentioned is that the Cleveland Clinic model, which is to employ physicians, was previously unheard of in London private practice. In fact, I had been to the chief executives of the London Clinic and King Edward VII, two big private standalone organizations in London, to say, "Please. Why don't you employ me? Employ my colleagues?"

They said, "That's far too forward thinking. We don't want to be in the vanguard of anything like that. Go away," sort of thing. And so, when we started talking to people, it became apparent that it wasn't for everyone. Because to work for Cleveland Clinic London, you've got to be a team player. It's all about the group practice. It's all about treating other people's patients as if they were your own. A lot of my physicians either selected themselves out, because it clearly wasn't for them. There were a few people, for instance, who were very well-known with enormous private practice in London, that ideally we would've wanted them to come with their work. But they just wouldn't fit. They would not be part of the team. And as I say, most folk selected themselves to some extent. I'm really pleased and very proud of all the physicians that I've brought onboard. They're all working very hard.

As you suggested, March 29th, the hospital opened for business. The first operation was done on April the 14th by myself. Assisted by Tommaso Falcone, who I have to say, is a very good assistant. We're now doing open heart surgery, open head surgery. We are really open for business. It's buzzing. Just so you know, today, in my own institute ... In one theater, there's a Whipple's for pancreatectomy for pancreas cancer. ; And in the other theater, they're doing an esophageal reconstruction for someone with a stricture in their esophagus. That involves my upper GI surgeons and thoracics. We've hit the ground running in terms of the sort of work we are doing. We've done two huge exenterations in my institute. They've been doing cardiac valve surgery. They've done awake neurosurgery. We really are open for business.

Brian Bolwell, MD: How much fun is that? To take something that was all theoretical and drawings on papers, and now you have a facility. Now, you have people and you pick the people and you're executing. Not often you get opportunities like that.

Richard Cohen, MD:Well, I say I love it. It's been really ... I continue to enjoy it as we go. There's a big difference between sitting around intellectualizing about how things are going to work, and patient pathways and everything, and then actually getting on with looking after patients. It's fascinating. I really enjoy it. What has impressed me the most, I suppose, is the way that both the physicians, nurses, all have stepped up to the plate.

They've spent months and months with an empty hospital, thinking about how we're going to manage these patients. How you're going to get a patient from the ward down to theater and Epic and everything else. I must say, it's my surprise and my joy, they've really pulled out the stops. I think most people are having a good time. If I talk to my surgical colleagues, they're delighted. Theaters are just fantastic. ITU, very good.

We're the only intensive care in London that has a 24/7 live-in consultant physician. I'm not sure what the equivalent is in the States, but a fully-trained physician. Our services run 24/7, 365, which is slightly unusual. Most private hospitals, on a weekend, it's tumbleweed. Not a lot going on. Whereas, here at Cleveland Clinic London, we can muster whatever we require to do whatever's needed. And it's just great.

Brian Bolwell, MD: Why is it working so well? You're one of the leaders. One of the things that has been mentioned is transparency. Having data at your fingertips, which is something that we frequently take for granted back here, but it isn't necessarily common. Transparency and being open and having data to share. Has that been a big deal?

Richard Cohen, MD:Well, I think the answer to that is, "Not yet." We've been open for such a short time. Today, for instance, we were showing a member of Parliament around the hospital. He said to me, "How many patients do you put through every week?" I said, "Well, actually, we've only been open for a couple of weeks, so I can't tell you that." But we are starting to get data on what we do, and obviously financial data in relation to our income and expenditure and things.

In terms of clinical outcomes, it's too early for us to say that, but we're very hot on compliments and complaints. And so, we take them very seriously. We use them to improve the way that we do things moving forwards. I think it'll be a year or so before data will be useful to us in the way that you're thinking of, I believe.

Brian Bolwell, MD: See, you've mentioned Brian Donley, who's our CEO of Cleveland Clinic London. From a leadership perspective, what is he doing well?

Richard Cohen, MD: He's great. He's almost evangelical. He pumps up everyone wherever he goes in the organization. Again, I watch him and learn from him. He takes care to make sure that everyone is included. He speaks to everyone in the same way, whatever their role is in the organization. I think he does that really well. Facing externally, in terms of the way the brand is perceived outside the organization, he's a real expert on handling the good and the great outside the hospital.

Of course, as I'm sure you're all aware, there was this considerable delay due to the pandemic. He managed that really well. Dealing with our builders. Building a hospital from scratch has been ... I'm sure there are loads of you out there that have had a minor alteration done to your house, and found it's be an absolute nightmare dealing with the builders and everyone else.

Imagine building a hospital from scratch. I think he's done a fantastic job. He and his leadership team have really pulled it together, so that we have a functioning opening hospital, where before there was an office building. It's quite extraordinary, actually, what he's managed to do.

Brian Bolwell, MD: For our listeners, those are several themes that I think are very important. I know Dr. Donley quite well as well. One of the things that Brian has always done is stress the importance of every employee and everybody on the team. He treats, as you said, everybody equally. He's very interested in psychological safety, so that everybody in fact has an ability to voice their opinion.

Again, I'm not just talking about docs here. I'm talking about the people who are the custodial workers. I'm talking about administrative assistants. Everybody on the team is treated equally. And it's a very important concept for many reasons. It's a great way to empower engagement and to generate high-functioning teams, but it's also a way to generate team success.

One of the themes that many talk about is having, "No passengers on a team." Making sure that everybody is contributing and have their voices heard. Et cetera. I think that from a leadership perspective, that's an incredibly powerful lesson that all of us need to remember. Do you agree with that?

Richard Cohen, MD:Absolutely. My predecessor when I was at St. Mark's was a very well-known, very English, three-piece-suit-wearing, "Whatever the weather," surgeon called James Thompson. I always remember he knew the names of all the cleaners in the corridors. When he went to the canteen, he knew the name of the lady on the till that was toting up the bill for him. And I've always done my best to do the same.

I think Brian takes that to the next level. Whenever he comes for lunch, he deliberately goes and sits with the nursing staff or the security staff. For me, that's really important. I model the way I like to behave on that. Because the truth is you can't run a hospital if you can't keep it clean and secure, and if you don't have nurses. It's the sum of the whole. Not individual parts. I think that concept of saying, "You have to bring everyone with you," is fundamental to success. Brian and Tommaso are very good at that.

Brian Bolwell, MD: Another thing you brought out was how sometimes he can be evangelical. I remember a few years ago, I was re-reading a leadership book. One of the tenants was, "If you've got a vision, you've got to preach it." The word that was used was, "Preach," which certainly has evangelical connotations to it.

I didn't really get that the first time I read the book. But the more I thought about it, and whatever vision I had for, at the time, running our cancer center, I needed to be somewhat evangelical about it and preach it. Sometimes that's a different way to project yourself, or to be, or to speak. But I think it's really important. I think it's a very useful trait for leaders to have. How do you approach that?

Richard Cohen, MD:Absolutely. I think you've got to bring people with you if you're a leader. For me, one of the rules, and I've always done this, is leading from the front. I would never ask someone to do something that I wouldn't do myself. For instance, in the NHS, if we're doing extra weekends to catch up with a backlog, I'd make sure that I did a few myself. I think you have to show that you haven't got a bad smell under your nose. Nothing's beneath you. You've got to bring people with you. I think that having your own enthusiasm about what you are doing can be infectious. If you show everyone around you that you're really keen, and you want to make it work, "We are here for the patients ..." I think that is one of the big things that gets me about Cleveland Clinic. If you put the patients first, everything else follows.

I'm sure that's true if you look after your patients. I've found that throughout my career, if you're good with people, empathic, listen to them, and take them seriously, whatever they're telling you ... You can't go wrong. I think that bringing people with you is very important. Evangelism in effect is an extreme way of bringing people with you by instilling in them that desire to make it work.

Brian Bolwell, MD: But as you said, it's got to be coupled with a keen ability to listen. I think you're preaching your vision, which is really important. But again, there are no passengers. You engage everybody and you listen to them. But another thing that you brought up that I think is very important is you talked about how your enthusiasm for what you're doing is a big deal.

I think that's infectious. I love being positive. Saying, "Look, we've got challenges and we can overcome them. We can figure it out. We've got some great people here." I always said that we're the, "Can-do Institute." Don't tell me we can't do stuff. Let's do it. Let's figure it out. We can do anything. What an opportunity you have, again, building something from scratch to instill that kind of attitude in everybody.

Richard Cohen, MD: Well, I think without challenges life would be really dull, [Brian laughs.] is my view. And so, I very much enjoy working through the challenges and helping to get things to work. Because the challenges, they all involve lots of individuals. And if you can work through the challenges, you can make lots of individuals' lives better. Ranging from nurse to physician to patient. Fixing logistic challenges, such as catering and cleaning.

It's all really important for that one goal of putting a patient first in patient care. I think you're right. I think you have to see everything, even challenges, are very positive. Because that's what makes us who we are, is the way that we handle those things. If everything was really easy, and there was nothing to sort out, why would you bother?

Brian Bolwell, MD: We do a lot of leadership development work here at the clinic. We spend a lot of time on it. I think more than pretty much any other academic center in the States anyway. You participate in some of our programs. What have you learned? What have been some takeaways that stuck with you and that you try to implement going forward?

Richard Cohen, MD:For me, I really enjoy operating with colleagues. With senior colleagues. Why? Because I learn all the time something that I hadn't thought of. Or that they do better than I did. And so, one of the beauties of the Momentum Program is that you work with other senior colleagues. You guys that run the program, in effect facilitate us helping each other to, "Wow. Gosh. I've never thought of doing it like that." I think that's a really useful way forward.

I'm lucky here. Because I get to observe at up-close quarters, Brian and Tommaso, and learn from them about leadership. And then, on the Momentum courses, there's so many fabulous people who do things in their own way. Just like when I was training to be a surgeon, I picked this from that surgeon and that from another. You pick up things. In particular, I picked up how to deal with people and patients. I used to love going in with a senior colleague and watching the way they handle a patient in a consultation.

You just learned, "Gosh. I'm going to use that phrase." Or, "I really like the way they did that." And so, I found ... For instance, as part of the leadership training, we were taught about appraisal and how to deal with some difficult customers. You think, "Well, actually they did that really well. Maybe I should dock that technique in when I'm next doing it." It's an opportunity for us to see many, many ways of doing something in terms of how you lead your troops. It's been a really useful journey. I've really enjoyed it.

Brian Bolwell, MD:One of the things that I think has been really important the past few months is being able to do it in-person. We tried to do it virtually for the past few years. Obviously, that's been tough with COVID. But I just participated in a session that was out of town with about 30 or so colleagues. Simply being able to be with them for four days offsite was incredibly powerful and very wonderful actually.

I've talked frequently on this podcast about the value of being authentic. Richard, you're a very authentic person. Do you think about authenticity? I assume it kind of happens naturally. But how do you think that positively affects your leadership? Being as straight and authentic as you are?

Richard Cohen, MD:Well, I think if people know that what they see is what they get, that engenders trust from the people that you're leading. I try and be open and transparent, as you've alluded to previously. If you tell someone you're going to try and do something to help them, you've got to try and help.

You have to show that you've at least tried, if not succeeded, in whatever it was that you were trying to do. Authenticity is very important. I think people can immediately smell a whiff of lack of authenticity. I think it comes across quite quickly. I'm certain that's a vital aspect of leadership.

Brian Bolwell, MD: You mentioned that it helps breed trust. What are the other things that you think are essential to developing trust?

Richard Cohen, MD:Well, I think showing that you're willing to put your own effort into whatever it is you are trying to achieve. Being there above and beyond the call of duty, and trying to help your teams in as many ways as possible. If they can see that you're there to try and help them to succeed along with the project that you are working on, I think it's very powerful.

I think people have to trust that what you say is what you're going to try and deliver. One shouldn't promise the earth or other or whatever, and then not be able to deliver it. I think you're right. I never even thought about that, but I think trust is a very important feature of leadership.

Brian Bolwell, MD: I think it's absolutely essential. And I think that everything is better and easier if you have a trusting relationship. One of the things that happens ... Actually, I just read this. If you have a trusting relationship and you've got a deadline, and you're late.

The other person will give you the benefit of the doubt, because you've already established a track record and credibility and a trusting bidirectional commitment to each other. Keeping your word is essential. But boy, if you can have a track record of trust? I think that things tend to go even quicker than they otherwise would. But if things mess up for whatever reason, it's easier to forgive somebody who you trust over somebody who you never met. It just all is a much more positive environment.

Richard Cohen, MD:Also, it's a bit like you have a bank account full of trust, as it were.

Brian Bolwell, MD: Yes.

Richard Cohen, MD:You can draw down on it. If you want to get people to do something, which they would normally not really want to do or feel is inappropriate, but they trust you ... You can say, "Well, trust me. If you do this, it'll be better." The more you have in the trust bank, the more that can happen. Equally, if the bank gets drained, then you're in trouble next time. Aren't you?

Brian Bolwell, MD: Well, I think that's a great way to put it. I really like that. I think that you have a trust bank. Ideally, you just keep making deposits.

Richard Cohen, MD:Absolutely.

Brian Bolwell, MD: Where do you think Cleveland Clinic London is going to be in five years?

Richard Cohen, MD:It sounds very arrogant, but I think it's going to be very successful. We're already doing well. I would hope that in five years, we'd be full. We'd have problems with capacity and that we would be needing to expand our footprint in London, so that we can help even more patients in London. I'm confident that's going to be the case. There are some areas strategically that I think we may need to move into that we have not had the capacity to do thus far. We're already looking at that.

What I'd really like is in five years time that we're a household name. Because every doctor in the UK has heard of the Cleveland Clinic, but the public haven't. They don't know. So that when someone's got a problem, they say, "I'll just phone the Cleveland Clinic and go and see who's available the next day." I think we will get some way to achieving that. So that, if you've got a bad knee, you just phone up and say, "I need to see a knee surgeon." They'll say, "Well, tell me when?" You go, "Wednesday afternoon." They'll say, "We've got the following doctors. Which one do you fancy?" You've picked one and go and see them, in the knowledge that you'll be well looked after by any physician that works in the organization. I think that is very achievable. I think we'll get there.

Brian Bolwell, MD: As we wrap up, Richard, this has been fabulous. Thank you so much. Are there any leadership pearls that you'd like to leave our listeners with that you think are really important? Both in terms of being a successful leader of an institute, as well as just building something, again, that really didn't exist a few years ago?

Richard Cohen, MD: Well, as we've discussed along, I think you need to gain the trust of your team. You need to lead from the front, and show them that you are very happy to be on the shop floor. Clean the floors, if required, yourself. You need to support people in their aims in life.

You need to find out what your physicians in your team and other staff want to do moving forwards. Show that you're going to facilitate them in their own careers. I think it's really important to demonstrate career progression within your own team, so that everyone else will want to come and work in your team, because they know they're going to move up the ladder.

Brian Bolwell, MD: Thank you so much, Richard. This has been delightful and very informative. For our listeners, I hope you enjoyed today's episode. I wish you a great day and hope you continue to tune into Beyond Leadership. Thank you, everybody.

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