Lara Jehi, MD

Podcast Transcript

Cara King, DO:
Hello everyone. Welcome back to Inspirations and Insights. This is Dr. Cara King here, and summer has finally arrived here in Cleveland, the sun on my face feels so good today.

Cara King, DO:
We are excited to have Dr. Lara Jehi in our episode today, Lara is professor of neurology at Cleveland Clinic Lerner College of Medicine and an epilepsy specialist at Cleveland Clinic since 2006.

Cara King, DO:
She is a chief research information officer for the Cleveland Clinic health system and director of the Outcomes Research Program for Epilepsy. In this interview today, Lara talks about transitioning to her new role of chief research information officer during the COVID pandemic, various communication styles and their perceived impact, and the importance of supporting more women into leadership positions. We hope you enjoy this truly insightful conversation.

Mary Rensel, MD:
Well we are very honored today to have Dr. Lara Jehi, the chief research information officer of the whole Cleveland Clinic health system. Welcome.

Lara Jehi, MD:
Yay, thank you for having me.

Mary Rensel, MD:
Thank you for spending time with us, I know your schedule is packed, right?

Lara Jehi, MD:
Yes, it's quite busy, but there is always time to make for important things. And this is important.

Mary Rensel, MD:
Oh, thank you very much. So let's go back to January of 2020. You were awarded this new position as Chief Research Information Officer at Cleveland Clinic, and then March comes and suddenly there is a global pandemic. Tell us what was that like, that moment in your new position?

Lara Jehi, MD:
It was baptism by fire. So I have to admit that was definitely not my vision for how I was planning to start a new role-

Cara King, DO:
So true.

Lara Jehi, MD:
At the clinic, and one of my mentors had given me advice to read this book that's called "The First 90 Days", which is actually a great book for somebody taking a new position in leadership. So I had this plan in my head for how my first 90 days were going to proceed and the people I needed to meet, and the meets and greets and the planning, the strategy and all of that. Then halfway through it, is when COVID happens.

Lara Jehi, MD:
So of course I threw the book out the window and we just had to react. So all of those plans that I had for projects I wanted to do, relationships I needed to build, structures I needed to create, it all was accelerated. That's a mild way of putting it, because of the pandemic.

Lara Jehi, MD:
So all in all, I think it was a good thing, because otherwise it would have taken a much longer time to figure out how to execute and who are the key partners and what are the highest impact initiatives to do. So I think of it now as a blessing in disguise, but that's not how I saw it then.

Mary Rensel, MD:
Absolutely. And what were some of the unexpected collaborations that came out of that time?

Lara Jehi, MD:
Many, both internal and external. Internally, within the clinic, I would say that in my field, so within my space as the chief research information officer, basically I have to interact with anybody who touches data. Patient data or patient biospecimens in the context of research. And those stakeholders go all the way from individual investigators to people who collect the data, to people who curate it, to legal, compliance, innovations.

Lara Jehi, MD:
And all of those stakeholders, when you're dealing with an emergent issue like the pandemic, all of the silos that usually exist just get shattered, and all of the walls that are built fall down, because people have to work together towards that common goal.

Lara Jehi, MD:
So in a way I got spoiled because now I'm used to all these people working together all the time as a team, and fortunately what I'm seeing is that those relationships that were built then are continuing to evolve. And the same applies to the external partnerships and stakeholders too.

Mary Rensel, MD:
Yeah, I love that. Yeah, so it can continue, all of that. Yeah, baptism by fire, it can continue all of those relationships that were... Yeah, deep, deep. Fast and deep, very quickly.

Mary Rensel, MD:
So you and your team built something called the COVID Risk Calculator. Tell us about that and what do you think that resulted in? How do you think that impacted patient care at that time, and even currently?

Lara Jehi, MD:
Yeah, it's been being used now actually. So at the beginning of the pandemic, one of the high priorities for the organization was to develop mechanisms to help us prioritize our care delivery for the betterment of... To provide better patient care. We needed to identify those at highest risk of either having COVID, once they have it, who's at highest risk of progressing to severe disease, ending up in the ICU, et cetera.

Lara Jehi, MD:
We didn't have enough tests, we didn't have enough hospital beds. So there was a whole operational set of priorities that needed to be addressed. In parallel, I remember sitting in my new office at the time and thinking, "Oh my gosh, I'm in this throne where my task is to be a data store, a provider of data. This is a new thing, I know a lot of researchers will want to study it.

Lara Jehi, MD:
How are we going to give them the data that they need? From that came the idea of let's create a registry for the enterprise that streamlines the collection of COVID data, and then that data is what we will use to create those calculators to stratify risk.

Lara Jehi, MD:
It ended up being included in our epic, our electronic health record system, so available for use in the context of any clinic visits. The epic, the vendor nationally picked it up and extended its use to all patients through My Charts, 250 million of them, so it's available nationally and outside of the States. And within the clinic it's been used to prioritize patients who have COVID for the home monitoring program. We last looked at its use a few weeks ago and it was used 204,000 times per month.

Cara King, DO:
Wow.

Mary Rensel, MD:
Oh my gosh, amazing.

Lara Jehi, MD:
And then internationally, I've been contacted by several organizations, Denmark, the UK, India, who want access to it so they can use it. So it's been very helpful.

Mary Rensel, MD:
Geez, that is amazing. So you've had global impact on the care of potentially 250 million patients, of patient lives. How does that feel?

Lara Jehi, MD:
It is great, I have to say-

Mary Rensel, MD:
It feels great.

Lara Jehi, MD:
It feels very good, and I am just so grateful. I am grateful for the opportunity, I am grateful for the team. I'm very happy to be able to work with people who are just so committed to what they do and who are so focused on the mission of the Cleveland Clinic as a health system, so that we all spend what it takes to get something like this done.

Lara Jehi, MD:
You feel rewarded that the effort that you put and the leadership that you provide ends up making a difference.

Mary Rensel, MD:
A global difference. Bravo.

Cara King, DO:
That's amazing.

Lara Jehi, MD:
Thank you.

Cara King, DO:
I can just picture you sitting in your brand new shiny office and being like, "I'm going to read my book, first 90 days here, this is going to go well." And then you get to chapter four and you're like, "Where's the COVID chapter? I need the pandemic COVID chapter, where's that?"

Cara King, DO:
I can't imagine. Okay. One more question around COVID kind of. So in one of your interviews previously, you said that one lesson that you learned from COVID is efficient and direct communication. Now I'm from Boston and we are very much known for our direct communication, which I currently very much value, but I'm just curious. With this type of communication, have you ever noticed that this can sometimes be received differently if it's coming from a woman or a man?

Lara Jehi, MD:
Oh yeah, for sure. I don't think this is a subjective observation, there is literature that validates this, whether it is with written or verbal communication, the same words coming out of a woman's mouth are perceived very differently than when they come from a man's mouth. And that difference in perception is both there for men and women who are listening.

Lara Jehi, MD:
So it is actually a four way thing. It is not just the... So it's both on the listening end and on the speaking end, there is that difference. And I think we all, men and women, have to be aware of it and know that it's there so that we can perceive it. And I think of it in my specific context and the way I communicate, I am direct and I hope efficient with both. I don't think of, am I speaking to a man or a woman?

Lara Jehi, MD:
When you're dealing with things like the pandemic, for example, you just don't have the time to sugar-coat things. And when you establish that trust with the team that you are working with, it takes care of a lot of the perception issues. And again, that applies to men and women. If I don't have trust with the people I'm speaking to, then no matter what I say, there is the risk that things could be misjudged or misinterpreted or misconstrued. So that's why personally the way I work is initially I spend a lot of time on building trust, and then after that I go into the let's do this together kind of thing. But it starts with trust.

Cara King, DO:
That is such an incredibly important point, that trust and that psychologically safe space, when you're leading or whether you're teaching or whatever interaction you're having, if you don't have that, then sometimes the lens of what you're saying can be construed, right?

Lara Jehi, MD:
Yes, exactly. And I know when you're dealing with people who are working really hard, very motivated, and people in healthcare usually are like that. Whether it's in research or it's in clinical care, when I see something and I don't like it, I have to remind myself that the person who say made this mistake, didn't make it on purpose. They really wanted to do the best job they could. And this is the best they could come up with.

Lara Jehi, MD:
So when I'm talking to them, I start with, "We're all here to do a good job, and focus on the job, not the person." Focus on the task, what needs to be done. And how do we get there? And I remind my team all the time that I want them to give me feedback too. So you don't make a big drama out of it, but you're just there with them. You're available. You ask them, you include them in the decisions.

Lara Jehi, MD:
So then when it comes time to holding people accountable, it is not this thing that's falling down from the sky out of nowhere. It's part of the routine and it's happening in every meeting. So that again, regardless of men and women, at least that's... For me, that's how I operate. And I find it the most effective and the least confrontational way of giving feedback in a direct and efficient way.

Cara King, DO:
That's so wise. I'm going to take that to heart right now, because I'll be honest, communication's something that I constantly work on, because again, I'm east coast in the way I talk and I... My first job was out in Madison, Wisconsin, and they talk very differently than I do. And even just teaching. And I love how you're saying, "Look at the end point, take the personal part of it out." We're all in it for the same exact reasons, to optimize patient care or whatever the task may be, create that psychologically safe space. Ask for feedback yourself. If you're getting feedback yourself, then it's probably a little bit easier to give feedback to others and it puts everybody on the same page. I love those lessons. Thank you.

Lara Jehi, MD:
Yeah, it's easy and it helps. It helps everybody. It takes the pressure off you as the leader too, because at the end, nobody knows everything. So always I end any meeting by what did I miss? My team knows that too anyway. So at the end of every meeting, at the end of every new project that we are working on, I always end with that. What did I miss? What did we miss? So we're all thinking about new ways of doing things. You're from the east coast, I'm Lebanese for God's sake. So.

Mary Rensel, MD:
I love it.

Lara Jehi, MD:
Anybody who's not used to the Lebanese culture, you put them in the middle of a family. Like when we're just having dinner, and if somebody walks and looks at us and they think we're killing each other, and we're just talking.

Cara King, DO:
I'm just asking how their day went. What? Yeah.

Lara Jehi, MD:
Yeah, we all had to make adjustments. I think I was pretty scarier to my fellow residents when I first came to the states, but you know, you adapt.

Cara King, DO:
I'm just talking, exactly. Seriously, for my residents in Wisconsin, I had to sit down with my chair and she was like, "You actually can't talk to them exactly like that here in Wisconsin." And I was like, "What? Talking like what? They needed help there." But anyway, I can understand completely.

Cara King, DO:
So another thing that I've heard you say is you were asked if you could write your own autobiography and title it, what would the title of this book be? And you said, "I would call it work in progress."

Lara Jehi, MD:
Work in progress. Yes, I would still call it the same.

Cara King, DO:
That is just so humble and transparent, and so vulnerable. And I just love that on so many levels. Why would you name it that exactly and what kind of things are you working on personally right now?

Lara Jehi, MD:
Yeah, I think every life is work in progress actually, otherwise then it's death, isn't it? So death is the end. When you're not changing anymore, you're gone. For me, that's it. Otherwise it'll be really boring if there is nothing new to learn. If there is nothing new to offer, then what's the point.

Lara Jehi, MD:
And every day it's intentional. I take the time to think about what could I have done differently? What new lesson did I learn? And it seems it's an attitude thing I think, it's not just professional. It's how you are as a person, even with everything I do. Like I love to cook for example, so I never make the same thing the same way twice. I always change it up. It's a problem, because then I never remember how I did it if I like it to do it again.

Lara Jehi, MD:
But it's that attitude which keeps things interesting, it keeps me moving. And it gives a sense of purpose, but a sense of wander, amazement at things that keeps you open to new things that you can see. The worst fear is if you find yourself in a place where I know it all, this is the way something should be done, and then you miss something really good because you think you're above it. So that's why I gave that answer and I would still give it.

Cara King, DO:
So good. Now you mentioned being stuck in this state of automaticity, like you get in this rhythm of not really looking at maybe the details of what you're doing on a day to day, and giving yourself that space for self-reflection, to actually just take a second and take the space to see where you can maybe make improvements, I think that's so important and something that a lot of us don't do.

Cara King, DO:
How do you give yourself that space for self-reflection? Is there anything that you do personally that allows you to take that space?

Lara Jehi, MD:
I do it, I squeeze it here and there. I've tried... It's the same thing with exercise, different things that you know you have to do that are really important for you. And then I've tried different ways of doing it, like dedicating time in a day. And I find that really hard. But it makes it so much more complicated and it's a higher bar, but if I know this is priority and then I have few minutes now, so then I squeeze it in. I sprinkle it throughout. When the weather is good, I like to go out for a walk say every day.

Lara Jehi, MD:
And then when I'm walking, I think if I'm inside, then... When you're just doing everyday things, not everything requires your full attention when you're doing it. So you could use that time instead of complaining, you could [crosstalk 00:18:30].

Lara Jehi, MD:
I don't know, it's become second nature.

Cara King, DO:
Absolutely. No, I hear completely what you're saying. You're right. We're so busy, it's hard to carve out that time. But then taking time during things that don't take a lot of thought, it sounds like maybe for you cooking, like you enjoy cooking.

Lara Jehi, MD:
Yeah.

Cara King, DO:
So in that time you can take the space to reflect, I love building that in, that's great.

Lara Jehi, MD:
Yeah, just do something that's completely different. And it's a way to get problems solved actually, isn't it? Like when let's say you're stuck in the middle of it, you can not think anymore. Then I stop and then go do something else, and then in the back of your mind, that's still simmering. And then when you're done, the solution presents itself. See, all of these solutions that present themselves, they present themselves because you took the time to step away.

Lara Jehi, MD:
Something else that I find useful actually is to not take anything too seriously. There's a difference between being committed to what you do but then taking yourself and what you do too seriously, it's a fine line. I don't know how well to communicate it, but it's... I'm trying to teach it to my kids too, where work is important, it's very important. Your word is very important. You commit to something, you have to do it. You have to make it happen.

Lara Jehi:, MD
But there is a line that you should not cross. Every person is so much more than their job. And if they make themselves about their job, they end up doing their job much worse, because they are so... Then they become focused on themselves and how they look doing it rather than what it's supposed to be. That's another way that has helped me be able to focus on things and take the time to think through... To reflect.

Cara King, DO:
I love that. I think that is so wise, your kids are so lucky to have you in their heads.

Lara Jehi, MD:
Yeah, they don't think so, but that's okay.

Cara King, DO:
Yeah, mine neither. Yeah, I think that means we're doing something right. That's what I tell myself. And you're so right, sometimes being a physician, that's all we feel like we are, that becomes our identity, but we are multidimensional people. And when we put all of our successes or failures into one thing, it becomes really volatile.

Cara King, DO:
So I completely hear what you're saying. I think it's so important to nurture those other areas as well. You're brilliant, I love that.

Mary Rensel, MD:
Let's go back to you as a student in Beirut. And did you ever think that you would have this global influence on a pandemic that was coming down the pike in so many decades later?

Lara Jehi, MD:
I had no idea, no idea. I remembered there was a... I studied at the American University of Beirut, our system there was similar to how it is in the states. You go to undergrad for three years and then you take the M-Cat and you go to medical school. So it was very competitive those first three years, and I remember in my first chemistry class, it was one of the toughest ones at the time. And I'm new to that school, I knew nobody. I'm sitting there and then right behind me, there was this row of... There was four or five guys and then they were talking, and then the one off them, he kept at me. I didn't know the guy, but then he was like, "Why are you doing this? Why are you going to medical school? You will just get married one day and stay home."

Mary Rensel, MD:
Oh my, yeah. What did you say?

Lara Jehi, MD:
Don't remember, back then. That was the first day of college. And then I remember, I just looked at the guy and I turned back and then I kept going with the class, and moved on. But yeah, so no idea.

Mary Rensel, MD:
You should have said, "I'm going to be a global leader someday and make some major impact on the healthcare of 250 million people. Thank you."

Mary Rensel, MD:
So speak to some students that are in different countries around the world, some young women that are thinking maybe medicine is for them. What would you say to them?

Lara Jehi, MD:
Yeah, I would tell them, "Don't take no for an answer." If every time somebody said to me, "You cannot do this," I actually listened to them, I probably would have still been back home doing... Just do the cooking. Now I cook, I have kids, but then I also do this other stuff.

Cara King, DO:
Other small job.

Lara Jehi, MD:
Yeah, don't take no for an answer. These people who say no now will be eating your dust later once you move on.

Mary Rensel, MD:
Eating your dust.

Lara Jehi, MD:
Just stick with... Decide what you want to do actually, that is the best advice. It's figure out what you want, figure out what is important to you? What makes you happy? At the end, when all is said and done, if you look back and you know you did this one thing, would you think it was worth it? And once you find something that the answer to that is yes, then don't let it go, and do whatever it takes to get there. Nobody will take you there. You have to get there.

Cara King, DO:
Nice.

Lara Jehi, MD:
You'll find people to help you, but if you don't know where you're going nobody can help you get there. So it's very hard actually, it's not easy. And it's a lot of ups and downs. And if you don't have that drive, it's easy to give in. So figure it out, focus on it, and don't lose sight of it. Don't lose people along the way. Relationships are very important and people are very important, and everybody wants to get somewhere. So you need to help others along the way. You cannot just take, you have to give. For your own good, you have to give. For your own value, you have to give.

Mary Rensel, MD:
Very wise, very wise. Absolutely. So focus on the end and it is a journey. And bring people with you, help people along the way, but honor the people that helped you.

Lara Jehi:, MD
Yes, of course.

Mary Rensel, MD:
That's what you're saying? Yeah. Do you want to call out anyone that helped you along your journey, any surprising people that had an impact to support you along your personal journey?

Lara Jehi, MD:
Many people, that's really hard and it's different people at different stages I have to say. So early on it was teachers, then afterwards it's mentors who gave me initial chances at doing different projects. And then afterwards it's folks who have supported me when I wanted to pursue education, even after practicing at the clinic. For example, I remember at some point I wanted to study how to design clinical trials, and there was this [course at case 00:25:31]. And my center director at the time, [Dr. Najem 00:25:37], I talked to him about it and I had a full clinical schedule.

Lara Jehi, MD:
Well he goes, "No, this is important to you. I will create your time. You go." Then later on, there was a point when I wanted to get this master's in healthcare delivery science at Dartmouth, that was a much bigger investment [inaudible 00:25:55]. Good, [take a course at case 00:25:57], and when I talked about that with Andre Machado, he was just wonderful. So he supported that decision. And I think it was a key turning point in shaping who I am as a leader. [Sirpal Erzurum 00:26:16], she is... For the past I would say since 2012, she's been the most important instrumental person in my career. And I know many other peoples, not just women, people's careers at the clinic, I owe her so much. So I mean many, many people along the way.

Cara King, DO:
Build your tribe, right? Build a tribe around you. I can tell that you have so many people who you've helped as well though, and we interviewed [Sirpal 00:26:47] on here a couple of episodes ago, and she is a force I can tell you. Absolutely.

Lara Jehi, MD:
Yeah, yeah. She is a force. That's her.

Cara King, DO:
My gosh. So we're wrapping up our time here, thank you so much for spending your afternoon with us again. Is there any last words that you want to tell the women of Cleveland Clinic? Any last words for people who are thinking about going into medicine or are early on in their career, or even people who've been out for awhile?

Lara Jehi, MD:
Yeah. I just want to give them a message of... It's really a call to action. So it is the go for it, do what you want to do, and at some point you get to a place where you forget all the woman versus man. When you reach a critical mass, there's enough women leaders around you, then that becomes the... Then you're talking about the culture of success, and it's not... Gender doesn't become an issue anymore. And that is what... I always thought that the best way to create more women leaders, it is to create more women leaders.

Cara King, DO:
Oh yes. Love it.

Lara Jehi, MD:
There is really no magic about it, just like when you have enough women who are leading, then you forget to think about who is the woman and who is a man, it just becomes who's the best person for the job? At the beginning, it has to be intentional. But after a while, it doesn't have to be. We all have a chance to give it forward, pay it forward, and help others around us and be inclusive.

Cara King, DO:
So good Lara. So not a message really, but a freaking call to action.

Lara Jehi, MD:
Yes.

Cara King, DO:
Can I say that?

Mary Rensel, MD:
Yeah.

Cara King, DO:
Okay. A call to action.

Lara Jehi, MD:
A call to action. The time of thinking is gone, now it's the time to act. We have thought about this enough.

Cara King, DO:
Come on ladies, get out there. We're at a tipping point, that's what I'm talking about. [crosstalk 00:29:00] Change the culture.

Lara Jehi, MD:
Stop moving, suck it up, and then forget about the no, you cannot do this. [inaudible 00:29:08]. Say's who? I can and I will. So move on.

Cara King, DO:
Get over and join the WPSA, we've got work to do.

Lara Jehi, MD:
Yeah.

Cara King, DO:
All right, Lara, thank you so much for your time. You are absolutely fantastic. We're excited to have you back sometime soon.

Lara Jehi, MD:
Thank you, thank you so much.

Outro:
Thank you for listening today. Join us again as we draw inspirations and insights from women doctors, past, present and future. You can follow us on Facebook, Twitter, and Instagram at WPSA1, that's at W P S A and the number one. This podcast is supported by Cleveland Clinics women's Professional Staff Association, as part of the Cleveland Clinic Centennial celebration.