Brian Bolwell, MD, His Ongoing Journey in Leadership

Podcast Transcript

Dale Shepard, MD, PhD: Cancer Advances, a Cleveland Clinic podcast for medical professionals. Exploring the latest innovative research and clinical advances in the field of oncology. Thank you for joining us for another episode of Cancer Advances. I'm your host, Dr. Dale Shepard, a medical oncologist here at Cleveland Clinic overseeing our Taussig Phase I and Sarcoma Programs. Today, I'm happy to be joined by Dr. Brian Bolwell, Chair of Physician Leadership and Development within the Mandel Global Leadership and Learning Institute at Cleveland Clinic. He's here today to talk to us about leadership. Welcome to the podcast, Brian. Good to see you.

Brian Bolwell, MD: Thank you, Dale. It's great to be here.

Dale Shepard, MD, PhD: Maybe you can start off... Tell us a little bit about what you're doing now here at the Cleveland Clinic, and we'll get into a little more detail later, but kind of an overview of what you're doing.

Brian Bolwell, MD: About two years ago, the Cleveland Clinic was recipient of a very generous donation from the Mandel Foundation, who was interested in having us start a formal physician leadership program. That's why the word Mandel is in the title of my new role. At the time, our CEO, Dr. Mihaljevic, asked me to figure out what it was going to look like. And I agreed to do that, but, as you know, Dale, I was still running the Taussig Cancer Institute and I couldn't devote a whole lot of time to this role in physician leadership and development. But last May, I transitioned to do this full time.

So there's different parts of what we're doing here in the program. We're partnering with Wharton Business School to have a very formal and rigorous leadership curriculum for our senior leaders, our institute chairs, and hospital presidents. We've launched a leadership curriculum for department chairs and section heads and parts of the organization, which include people in London and Abu Dhabi. We have a very large executive coaching group, which interacts with a great deal of our physicians across the enterprise.

We're doing a very formal process to try to identify successors for various roles of leadership in the organization, and trying to work with leadership development with them. We're doing podcasts to try to increase our brand, and we've done about 15 of those so far. We're also partnering with Korn Ferry to branch out, and jointly conduct a leadership curriculum with a very broad audience across the globe, given the connections that Korn Ferry has. So what we're doing here is varied, it's multi-faceted. I'm spending an awful lot of time right now, going on a listening tour, and it's been very enjoyable.

Dale Shepard, MD, PhD: So a lot of the programs that you're developing, are those more for the audience within Cleveland Clinic, or are you also going to be offering courses to other institutions, other healthcare leaders?

Brian Bolwell, MD: Almost all of this is within the Cleveland Clinic. The part that branches out, or number one, the partnership with Korn Ferry. We very much want to touch an awful lot of people outside of the Clinic, as well as of course the podcasts, which right now have an international audience.

Dale Shepard, MD, PhD: So you were the chair of Taussig Cancer Institute for 11 years, and certainly you talked a lot about leadership during your time there. And I know you've told this story on your podcast about the somewhat abrupt beginning of your leadership journey. What do you think were the biggest lessons you learned along the way as you were Chair of Taussig?

Brian Bolwell, MD: A lot of the lessons started before that. I was named the director of the Bone Marrow Transplant Program at a very young age. I was probably too young to be named a leader, but I was, and I was pretty consumed with making it really strong clinically. And I think we did that. I then had a lot of other leadership opportunities around the organization, which were very useful and gave me kind of a broader understanding about how the clinic worked. But through that, I became part of the Chief of Staff's office, and ultimately part of Dr. Cosgrove's, who was our prior CEO, inner circle. And when Dr. Cosgrove first became CEO, about 20 years ago, he wanted all of his inner circle to receive a pretty thorough 360, which is a process in which people who work with a given individual will comment anonymously on how their leadership is going.

And so I received a pretty large report about my leadership, and most of it was negative. And I was surprised, I was shocked actually, and I was hurt. I didn't like reading that at all. I thought I was a better leader than evidently I was. I didn't know that there was a literature out there about how to be a good leader, and I was determined to get better. And so I started to read voraciously about leadership, and I gravitated to the philosophy of serving leadership. And over the years, my philosophy has kind of morphed into a combination of a lot of things that I've read and studied along the way. And when I became Chair of the Cancer Institute, a lot of these things crystallized.

I think philosophically, I believe in fundamentally three things. Number one is that if you want to aspire to be a leader, you need to realize that your fundamental job is to support your team, and it's not about you. It's not about your glory. It's not about getting some sort of fancy thing on your resume. It's about working very hard to hire very strong people and to support them, to give them what they need to succeed. And then when success is achieved, you sit in the back row and let the people who do the work receive the credit for the success.

The second biggest piece of it is the quest to get better, and to be willing to be self-reflective and to receive feedback. I've had subsequent 360s since the first one, and they're always useful. And to try to keep learning and to try to keep getting better. And if you're going to get better, you have to change, and change is hard. It's very difficult for people to do, but if you actually want to improve, you can't keep doing what you're currently doing, you have to do something different. And that means you have to get better. And a lot of times, that's hard to do and that's associated with vulnerability. I'm a big advocate for Brene Brown, who talks about the courage to be vulnerable. I think that changing and admitting when you've made mistakes is risky, but I think it's the right thing to do, and if you can do it, and if you can keep learning and keep getting better, I think it makes you very authentic and it makes it easier to live your values. And I think that you're a better leader.

And then the third tenet is, of course, you've got to drive results. And I think the easiest way to drive results is to do the first two things. If you have really good people around you and support them, and if you're willing to be open about yourself and keep trying to get better, I think usually results will follow. Although I do think it's important for leaders to have a clear vision and to make priorities clear. I don't think that you can have a thousand priorities. I think you need to have a small number and focus to do them very well.

Dale Shepard, MD, PhD: You mentioned there's literature out there on leadership, and that's why I reached out occasionally, said, "Hey, can you recommend a book? Because there's a lot of them out there." If somebody is interested in taking up the topic of leadership and becoming a better leader, what guidance can you give about what sort of things that they should be looking at? You mentioned things like servant leadership, and all these different styles. How does somebody know kind of where to go, and how they would maybe be a best fit?

Brian Bolwell, MD: Well, step one is to just give some things a try. I certainly didn't have a roadmap. I think I pretty much went to Amazon and searched for leadership. And I found a few and I just started to read, and a couple of them just stuck. I read them and I was glued to the book. The Speed of Trust by Stephen Covey is fabulous. There's a book by Jim Hunter on the world's most powerful leadership principles. And then John Maxwell writes about the levels of leadership, all of which are very good places to start, and you kind of go from there.

So much of what all of this is about, is about working on yourself. I did an interview a few days ago about how to influence other people and a lot of books defined leadership as the ability to influence other people. But if you're going to do that effectively, I think step one is to work on yourself and try to be real, and straight, and authentic, and transparent, and honest. And walk the walk, don't just say the words. I think it's very easy for people to spot insincerity or spot fakes. So anyway, most of the literature, Dale, I think, focuses on your own personal development, and the whole concept of serving leadership is about supporting your people.

Dale Shepard, MD, PhD That's great. So you mentioned awareness and sort of being reflective, and sometimes people are in leadership positions and they may lack that. How do you really raise awareness of people who may be in most in need of these skills, to sort of take on the job of being better leaders? So sometimes it seems the people who probably need the help the most are least likely to seek it. How do we change that?

Brian Bolwell, MD: Well, that's not easy. There's literature and studies that show that the people who are the most sure of their abilities tend to be the ones who are the most incompetent. So it's not easy. In the past three or four months since I've taken this role over, I've talked to well over a hundred people about where they are in the organization, about their leadership skills, about how to make them better. And the people who are very interested in being developed tend to be a lot of fun to talk to, and I learn a lot, and boy, those are the people that you really gravitate you.

But there are a lot of physicians who really say the words, but it's very obvious that they're not very interested in learning more, or having developmental opportunities. And I think that's either because they're too insecure to actually look inward, or because they're so arrogant that they think they know everything about everything. Obviously academic physicians can fall into that category, but the problem is that they become limited leaders. Not in their own eyes, of course, but certainly in the eyes of the organization. And their ability to actually execute and to create engagement and to drive results is limited, unless you're willing to be part of the developmental process. And that starts with looking in the mirror.

Dale Shepard, MD, PhD: You mentioned before about taking on the Bone Marrow Transplant Group, and maybe being too young from an experience standpoint. When you think about the programs you're developing within the Institute, oftentimes people are kind of thrown into leadership roles without the preparation. Is that something that's going to be a large component of what we're working on here within the Institution?

Brian Bolwell, MD: So I think you raise a very good point. Number one, I'm part of Global Learning and Leadership Institute, which does a lot of our leadership development for our non-physicians. And that's been around for several years now, and that has all sorts of things that are available to every employee, certainly physicians. On the internet, there's a lot of cool stuff there, which part of my role is going to be to make that more visible. I don't think enough people know that it exists, but it's there, there's a lot of great content. We're also trying to determine how to launch a pretty basic curriculum for any physician, for any member of the professional staff here that will be accessible, and that's kind of a work in progress, but that's one of my goals for the next year is to see if we can make that happen and make that real.

We have within GLLI, a small group of people who are charged with leadership content and how to deliver it. And they're very good. And I think we'll be able to do that. I'm hoping, this may be naive on my part, but I'm hoping that simply having this office, and having somebody who's got as much gray hair as I do leading it, and then having that be somewhat visible, will allow people to reach out. And a part of my job is going to be to simply interact with people who are curious about this, and that's fun. That's fun for me. And so that's another way to just get involved. For our more senior leaders, we actually have programs in place. I mean, once a new Institute chair is named or a new department chair is named, actually the GLLI team will reach out immediately to that individual and start a coaching process and a developmental process.

Dale Shepard, MD, PhD: You had mentioned coaching before, and executive coaching. Does the executive coaching program in any way interact with the other coaching program here on campus?

Brian Bolwell, MD: So for our listeners, we have basically a couple of different programs. One is a physician-led program on coaching and mentorship, and currently Dr. Andrea Sikon leads that, and that's something that, really any member of the professional staff can participate. Obviously, you need to be trained to be a coach, and there's a certain skill set that needs to be acquired, and coaching and mentoring are different. Coaching as much more probative, in which you ask questions, and with the ultimate goal of having whoever you're working with come to their own conclusions on how to improve. Mentorship is a little more directive. And by all accounts, that's a wonderful program. It's an award-winning program.

And so that's one. The second thing that we have over here in GLLI are people who are not physicians, but they're full-time executive coaches. And they're on salary, they're part of our employee group. And they're great. They are highly skilled, they're very enjoyable to interact with and talk to. I've been a client, and gosh, I can certainly vouch for their knowledge, their skill, their abilities. Another one of my goals, again I've only been doing this for a few months, so I've got a lot of goals, two of which have been realized, but we'll get there, is in fact to integrate the two a little bit more than they currently are. Because I think there's value in both. I think the tough part for the physician one is just bandwidth because so many physicians, we operate at a very fast pace here at the clinic, and it's not always easy to have enough time to devote to coaching. But universally the people who are part of the program really, really enjoy it, and I think there's a lot of opportunity there. Yeah.

Dale Shepard, MD, PhD: You mentioned goals, this actually was the next thing I was going to ask about. You mentioned that part of leadership was driving results. If you think about your role, how do you foresee measuring success? What is success going to look like to you?

Brian Bolwell, MD: Well, that's a very good question, and it's something that I've thought a lot about. When you're an Institute Chair, there's a lot of pretty hard metrics that are very important. Quality and safety is very important. Patient experience is very important. Access is very important. Volumes are important. The financial data's is important. Research is very important. Education's very important. These are all things that can be quantified fairly easily. Leadership development is not something that can be quantified very easily. I think that, ultimately, the goal would be, years down the road, that it's easier for the entire organization to, in fact, achieve the results that it wants to achieve. I think when you think about change management, I think all change management is about leadership. And it is inevitable in healthcare that change is going to continue.

Culturally, I'd like to think that we can touch enough people to raise the cultural bar of our leadership organizationally. I think if we do, physician engagement will hopefully increase. We want to try to improve the way we choose our leaders. And I think that we can achieve that. And I think, ultimately, we want to populate our leadership positions with people who understand the concepts that I previously discussed, that leadership is about serving others. And that leadership is about growing yourself and developing insight, both about what makes you tick as well as how others perceive you. There's actually two parts to insight. And if we can do that, even though it's hard for me to say, "That's a seven on a scale of one to 10," I'd like to think that it will be felt.

Dale Shepard, MD, PhD: You mentioned about picking leaders. Tell me a little bit more about what your thoughts are. Oftentimes, if there's a group, the leader is just sort of chosen, and there may well be people in the group who would like to have the opportunity to lead that group. So how can we do a better job of making sure that people have an opportunity to have leadership positions?

Brian Bolwell, MD: Yeah, I think that's a very important point. I think that one of the things we have achieved is earlier this year, with the help of our Chief of Staff and our President of our hospitals, we basically told everybody that there's going to be no enterprise position that will be awarded to anybody without number one, being visible on our internet, on.com and number two, without some sort of process. Too often, I think people have just been anointed. And that means that there's a possibility for unconscious bias, or even conscious bias playing a role in that decision. And we need to eliminate that. I also think that when we talk about diversity, which is extremely important as we pick leaders, that number one, the opportunities have to be public, and we need to know about that. But we also need to be as intentional as is reasonable to promote women and minorities into leadership positions.

So it's something that we have made progress on and it's something that's very important. The other thing is when we think about search committees, I think there's an awful lot we can do better than we have historically. I think too often, our search committees have been dependent on the perspective of the Chairman. And so, we're in the process of trying, actually the Taussig Cancer Institute is one of our test cases, to have a little more standardized approach, with standardized questionings, with potentially the help of an executive recruiting firm, and a variety of other things, which we'd like to expand across the organization as makes sense. So I think that these are important topics, Dale, and things that we're working on.

Dale Shepard, MD, PhD: Well, you certainly have a lot of fascinating things that you're working on. So if I take a step back and look around the country, how unique is this as something that we're doing here at the Cleveland Clinic, having an Institute that really is focusing on leadership and all these important issues?

Brian Bolwell, MD: I'm not aware of any major academic center having anything like this. Certainly, I think healthcare is behind industry in many, many ways, and this is one of them. I was talking to an individual who's in a leadership position in another Institute earlier this week. And he was saying this very thing, that healthcare tends to take a long time to catch up. I mean, grocery stores have been using barcodes for 20, 25 years, and we're only recently using barcodes to scan in how patients receive medications. But certainly in leadership, a lot of industries, very formal leadership training programs. I mean, most actually large corporations do. And they spend a lot of time on this, they spend a lot of time on things like psychological safety, and other topics, which I think are very important. Healthcare doesn't.

One of the things that I have found interesting is talking to Wharton Business School. I said earlier that we're partnering with them on a big program. And I asked them, how do you teach leadership? And they said, it was kind of like a three legged stool, with the first leg being kind of 101, which is how to have a hard conversation, how to read a financial spreadsheet, et cetera. The second one being emotional intelligence and what they call the soft side of leadership. And the third is change management, and strategic thinking, and how to deal with uncertainty, and kind of higher level stuff.

And I've thought about that and that's all great. But in my opinion, the second one was by far the most important. So the whole emotional intelligence self-awareness insight is, I think, the number one priority, because when you look at why leaders fail, I think they never fail because they don't know how to read a financial spreadsheet. And I think it's very unusual for them to fail because they're inept strategically. I think they almost always fail, if they're going to fail, because of a lack of emotional intelligence, because of interpersonal failures, or because they stop living their values. They don't have enough courage. They don't have enough integrity. So as you think about what we're doing, to some degree it's unique, but I think it's needed. And I think it's very, very important.

Dale Shepard, MD, PhD: You've provided some great insight. It's always good to hear your take on leadership. And so, I guess I'm wondering if you can leave us with homework. You mentioned Stephen Covey, Brene Brown, John Maxwell. Can you recommend a book that would be a good place for people to at least start?

Brian Bolwell, MD: Again, I like The Speed of Trust, by Stephen Covey. In the middle of that book, he actually has 13 behaviors, which he thinks the leaders should aspire to. So one of them is talk straight. Don't use big words, use small words. Say what you mean, and mean what you say. Too often, people spin the truth. Admit your mistakes. Work is about relationships and life is about relationships. And if you can have a trusting relationship, everything is easier, better, and a lot more fun. But in order to have trusting relationships, again, you need to look inward and work on yourself, and make sure that you're real and straight and true. And that those words mean something.

It's easy for people to say these words, anybody can say them, but to actually do it isn't all that common. All I can say is that for me, Dale, when I started to read this literature, it was eye-opening. Because when you say it, it all seems kind of very much like common sense. But man, when you have a good author put this into context, it certainly resonated very much with me. And I think that for many of our listeners will resonate with them.

Dale Shepard, MD, PhD: That's excellent. Well, to hear more insights on leadership, listen to Brian's podcast, Beyond Leadership. You can visit clevelandclinic.org/beyondleadership, or you can find it where you find podcasts. So thanks a lot for being with us today, Brian.

Brian Bolwell, MD: Great to talk to you Dale. Thanks for the opportunity.

Dale Shepard, MD, PhD: This concludes this episode of Cancer Advances. You will find additional podcast episodes on our website, clevelandclinic.org/canceradvancespodcast. Subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. And don't forget, you can access real-time updates from Cleveland Clinic's Cancer Center experts on our Consult QD website at consultqd.clevelandclinic.org/cancer. Thank you for listening. Please join us again soon.