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In this episode, we begin our series on being a female leader at Cleveland Clinic. Listen to Joanne Bruton, Executive Director of Nursing in Perioperative Services at Cleveland Clinic Abu Dhabi, and Lisa Minor, Senior Director of Mandel Global Leadership and Learning Institute, discuss the advantages of being a female leader in the healthcare industry. Joanne shares the specific leadership tactics she uses to navigate the many leadership complexities she often faces, outlines the importance of mentorship, and describes the mentors that have helped her along the way.

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Celebrating Women as Influencers in Leadership

Podcast Transcript

Michelle Lampton: Hello and welcome to Learning to Lead, a leadership development podcast from Cleveland Clinic. I'm Michelle Lampton. So far in this podcast, we have explored what it means to be a leader and what makes a good leader from several different angles. And something that we heard from you, our listeners, was a desire to hear more from women leaders at Cleveland Clinic and the unique experiences and challenges they may encounter. So today we're starting a new series where we speak with women leaders at Cleveland Clinic and learn more about their leadership journeys. Our first guest is Joanne Bruton, Executive Director for nursing in perioperative services at Cleveland Clinic Abu Dhabi, who spoke with my colleague at the Mandel Global Leadership and Learning Institute Lisa Minor. Here is their conversation.

Lisa Minor: Joanne, tell us a little bit about your role and your position at Cleveland Clinic?

Joanne Bruton: Lisa, my current role here at Cleveland Clinic Abu Dhabi is executive director for nursing in the perioperative services. I've been here since 2016. And I originally joined as a manager having made a lateral move, I was a manager previously in Australia before that in a very similar role in perioperative services. And in 2018, I was promoted to a clinical director here. And for the last year I've been working as executive director in peri-op. So that gives you a little bit of an idea of what I'm doing here. We have a team of about 200 nurses, approximately we're running about 25 rooms a day. So that gives you a little bit of an ideal of what I am doing here in Abu Dhabi.

Lisa Minor: Wow, Joanne, you are definitely busy. So you just mentioned over the course of your career, you had a lateral move at one point and you were promoted. Who has supported you in this journey? Have you had mentors along the way?

Joanne Bruton: Yeah, so I certainly have. 

Joanne Bruton: Some of the mentors I've had along the way have included both physicians and nurse leaders. I've had a couple of really impactful bosses back in Australia and then a couple of the sort of informal leaders, people whose ability to harness the cooperation of others. I was always really impressed with and often these were the informal leaders. Some of the physicians that I worked with were amazing women who, again, with great poise and dignity were able to get the best out of a team and get everybody working well together on a common goal. However I think it is important to note that for all of the good leaders that I may have looked up to and inspired to be like, and the mentors I have had along the way. I learned a lot the hard way from the bosses that weren’t so good, and pretty powerful impactful lessons on what not to do. How people might be motivated, how to not get the best out of people. So, I think a lot of my own approach is actually been doing the opposite of those things, and trying to lead people in a way that you can truly get some great engagement.

Joanne Bruton: Since joining Abu Dhabi though, it's been next level the ability for me to work with Cleveland Clinic Foundation and the group of women that we have working here in Abu Dhabi. It's a really huge privilege to me to have the mentorships of the women in town. There's a couple of people and I take a little bit from everybody, I guess, along the way, a couple of the directors of nursing that I work with who I can really look to for advice and chief nursing officers, and then some of my own colleagues here in the perioperative services. So I guess I've been very lucky to have this next level of mentorship here in Abu Dhabi.

Lisa Minor: That's excellent to hear that you've had mentorship along the way, not just in CCAD but also throughout your career. I'm sure being a female leader comes with its challenges and obstacles. So if you wouldn't mind just sharing what are some of those obstacles that you've faced and how have you been able to overcome them?

Joanne Bruton: So interestingly for the bulk of my career, being a woman was actually an advantage. In Australia nursing space, it's very heavily female dominated, and in fact that the men are in the minority. So it was always an advantage in the nursing world there. Physician space was more male dominated and there were a few obstacles back in Australia with some of that. However, the male physicians were when you're working in the same team is they may tend to lean on you to sort their problems out and help prepare the things that they need. And to be honest, it wasn't until I sort of got a little bit further on in my career that I've first came across male obstacles and it was more nonclinical partners of an organization that I was finding were tougher to deal with.

Joanne Bruton: So the non-clinicians, your partners in the facilities, finance teams, supply chains that when you would put your position for they often weren't understanding the demands of your area. And more of that when I arrived to Abu Dhabi, it's a patriarchal society and very, very heavily represented by males in the executive. So I think that has been an obstacle here and it's been challenging at times to work away around that. I think as a woman, it's been very important to be very well-prepared when you're trying to argue a point or try and get a resource.

Joanne Bruton: And is not just possible to have all the data ready at hand so that you have some great factual support to your claims rather than just stating a need to go very well prepared with the data and facts that's required has been one way. I've been able to overcome that obstacle. And I think it probably takes a little bit longer to develop that credibility amongst some male colleagues. And I think it's just being patient and continuing at all times to show integrity, being honest, being genuine. And I think in time, you are seen to be the good support for them that they need you to be. They may have underestimated your ability to be that, but once you can demonstrate, as I said the traits like integrity, you can get a little bit further with them, get them in the end.

Lisa Minor: That's really insightful, Joanne. I was just thinking as you were mentioning these are traits, absolutely credibility, preparedness, being honest. That's really great advice for really anyone that's a leader and who's trying to excel in that space. So thanks so much for that insight. I'm going to switch gears and ask you a little bit about tactics and routines that maybe you employ to help reduce stress? We all know especially now that those of us that work in healthcare and that are taking care of patients endure quite a bit of stress. So what do you do or advice that you would give to reduce stress?

Joanne Bruton: This is a really big topic. I think being a leader in healthcare is always stressful on both your time, there's a great deal of demands to be balanced, priorities to be juggled. And then demands on your emotional resources and your ability to remain resilient and never more so than during the last 18 months and the pandemic it's been next level. I think on a normal day, it's difficult and managing stress, I like to manage my stress by first avoiding as much stress as I can and remaining very well time-focused and time-managed. I like to make sure that goals and priorities are very clearly set.

Joanne Bruton: And therefore when you're working efficiently, you've already sort of mitigated unnecessary stress from being added into your workday.

Joanne Bruton: Then I have the other sort of the more personal side of that is how you deal internally with that stress when it does come, because of course it's unavoidable. It is very important I think to always remain calm, as calm as you can in the workplace. I try to avoid and mitigate conflict by again, really good goal and expectation setting, making sure everyone knows what's expected of them, that the code of conduct is really well-respected. And so people are coming to work with basic good behaviors. I focus very heavily on behaviors, in my expectation setting. And once you've done that, as I said, you sort of remain calm and mitigate some of the stressful interactions at work.

Joanne Bruton: I'm going to make two further points there. The first one I want to talk about, I think a lot of stress and anxiety can come from conflict, so I'm going to just dive into that for a minute. A very wise woman told me once there are three Rs to conflict resolution. The first one is to research, the second R is to rehearse, and the third R is to relax. So again, step one is to do your assessment analysis, get your data, get your facts, get both sides of the story, find out the background, why was someone late to work if you're about to bring them into the office for a conversation about that? Then to rehearse what you're going to say so that you're a little bit prepared with the leading introduction into the conversation. And then when you're in that situation, as much as you can just to relax. And it tends to take a bit of the heat out of the conversation and other parties also can calm down a little bit so that it's easier to resolve that conflict.

Joanne Bruton: So I thought that was a really cool thing, the three Rs, and there's a tactic I've employed ever since she taught it to me. I do it for big meetings and for much smaller just everyday interactions. So I think that's a really important thing. The second part then is to delve into the personal, and of course, work-life balance is huge. We talk about that a lot, what does that mean? To me, it means taking care of my own health with a good diet, a little bit of exercise. Every day I make sure I exercise just for 10, 15, 20 minutes, better than nothing, a little walk or some exercise. I do meditate, I think meditation is really invaluable even if it's just some basic breathing exercises that really helps to come and clear the head, a bit of yoga, I do a little bit of that.

Joanne Bruton: And then back to the time management. So it's for the time that you're at work to work efficiently with intent and purpose so that you're actually ticking off your priorities and getting through those tasks that you really need to do so that you can leave work feeling like you're on top of things that you've accomplished what you tried to achieve in that one day. So that's sort of a little bit of the balance. There's a great book I read once called Eat That Frog, I just can't remember the name of the author, but it's a really great basic time management book. And a wonderful tool they describe in that book is to write down at the beginning of every day, spend five minutes prioritizing what it is that you have to do. Write three things down, the main and first three things you cannot leave until you've accomplished today.

Joanne Bruton: The next three things are three things that it would be great to do if you can, but if you don't get to them they would form your top three the next day. And then three other things that it would be nice to start working on if time permitted. The next day you come to work and you should work on those first three as your priority, so you start on them first up in the day. So this is a rolling list of priorities that really has helped me manage my stress at work.

Lisa Minor: Joanne, these are invaluable resources. I love the three Rs, research, rehearsing, where it's I couldn't agree more around conflict as a stressor for sure. And I really appreciate your insight on time management and prioritizing the three, three, three. Obviously things happen throughout the day and fire drills occur. Can you expand a little bit of on the list of three, three, three and how you navigate that when you have other things of higher priority that pop up throughout the day?

Joanne Bruton: I would challenge everybody to really sit and spend some time reflecting on what those priorities really are. So there will be patient safety issues, they're non-negotiable, they will obviously always fit onto your first three. There'll be some other deadlines, perhaps your own boss has got a deadline that's important to them, that might help you to work out. They're depending on you for an answer or a summary or some preparation of some kind. And I would suggest that would be on either the first or the second list to do before you leave.

Joanne Bruton: And then I think I challenge people to stop and think about the meetings that aren't really necessary, the forums where you're repeating information. A meeting where only half of the quorum are available should possibly be one of those items that drop to your third tier of priority and are rescheduled for another day when you can get all of the stakeholders at the meeting

Joanne Bruton: And I think leaders should just stop and reflect and keep reviewing that list of priorities, and is this still a priority?

Lisa Minor: Thank you so much for expanding. It's very helpful to think about it in terms of patient safety and other important priorities versus meetings that may not need to happen throughout the day. So we've been talking today a little bit about being a female leader and also some of those stress and routines, tactics, things that you've been able to do. As we think towards the future, I'm curious as to how you view the future of healthcare leadership and really any advice that you might give to a future leader in healthcare?

Joanne Bruton: That's a really, a very broad topic. And I think we have some really huge challenges ahead of us in leadership in healthcare. And certainly as a nurse, from a nursing perspective, we have some huge ones. Of course, the pandemic has changed the game where getting enough nurses into the field to start off with, and then retaining those nurses was always a challenge. But in the pandemic times, I'm hearing anecdotes of people who are actually leaving a career or together. They found that they've just faced challenges that to them were insurmountable over an extended period of time and they don't want to nurse anymore. I think this is a real risk to us in the future and some really innovative strategies need to be considered for retention.

Joanne Bruton: Another thing I think we're inadvertently doing in the nursing world is the manager. The nurse manager has such a huge burden of not only patient safety and ensuring that technical and behavioral competencies are well adhered to and nurses are well-prepared. But we are putting greater fiscal responsibility on these managers, we're putting human capital responsibilities on them. We're putting procurement responsibilities on these people where they have to a really diverse skill set to be a manager. Then they have great demands placed on them to then be sure that they're developing their leadership as well at the same time and engaging the teams so that you can work toward things like zero harm and highly engaged teams. Is just pasting such incredible emotional pressure on these people who are barely holding a head above water as it is who then have to be strong for everybody else.

Joanne Bruton: So I think when you look at a manager, they're becoming less and less the person you look to that you think, "Oh, that's the job I'd like." And in fact, we have found that very thing to happen here in Abu Dhabi, where we had a manager vacancy and none of the assistant nurse managers are the slightest bit interested. They're averse to the idea, they could think of nothing worse than taking on that additional accountability and responsibility. So I think we have to rethink the entire demands on a manager and work out what are our partners not doing that they should be? How can we be saying more as the customer, to the support staff, the nonclinical partners in an organization? So I think this is something that has to be urgently addressed, and I think we have to get really proactive, and quite innovative with this or I think we are not going to be building the next generation of managers. So that concerns me.

Joanne Bruton: Then the other thing I think is a big shift in the nursing space is just the ratio of novice to expert nurses is shifting. We have more novice than expert, more novice than ever before and up to the competent and proficient levels. And we're somewhat diluting our ability to learn from that deep experience, from those that one of a better word older generation of nurses that can impart a lot of wisdoms. Were losing the power of that storytelling if you like in health care. So probably the three things that are concerning me the most, the retention of the workforce right across the board in a time when it's gotten even harder, again with the pandemic, the perception of the manager role and the burden of that and as I said, the ratio of novice to expert nurses.

Lisa Minor: Your view is holistic, Joanne. And I really appreciate that as our listeners are looking for ways to think about their role at Cleveland Clinic and how they potentially fit into the future of health care. So as we wrap up our conversation, I just want to ask you, if you were speaking to a young girl or a young professional who would love to be in your shoes one day, what advice or well-wishes would you give someone like that?

Joanne BrutonI beg you to do it. We need a new generation of nurse leaders desperately so I highly encourage it. It's incredibly rewarding. And there's a lot of built-in altruism in nursing, you can't go home without feeling like you did something very important for someone each day that you're at work. And I think as a leader that is multiplied. So I never go home feeling bad, I go home every day feeling incredibly humbled and rewarded with the work that I've done. So I think the job is its own reward if you know what I mean?

Joanne Bruton: I think for the young woman coming through the ranks, I think the importance of asking yourself the question, what do I really want in my career? What am I good at? What am I suited to? Where do I see I would fit? Be really probing as you ask yourself that question. There are some people who can find leadership is a little bit glamorous, they feel it may be the natural progression. And not everyone is going to thrive being a formal leader in an organization. And I am really interested in the concept of the informal leaders, the people who are the quiet achievers in a team, who are really clinically competent, they have great expertise, they're very approachable, they're kind and compassionate to people and people gravitate to them.

Joanne Bruton: That informal leadership I really do think needs to be a little bit more celebrated and recognized, and we do it in some ways but I think it is very important to ask yourself. What do I want to do? Where do I see myself? The other thing then is the difference between being a manager and being a leader? Managing as described is a set of technical skills, balancing the books, so to speak. Managing our schedules, is quite a different task and skillset to leading people, which is the most difficult thing of them all is to be responsible for the development of others and the leadership in a team.

Joanne Bruton: So I being really asking yourself is it something that I'm interested in that I want to be able to help others by being a leader? If that is the case and that is something that suits somebody from there, I would say that spend the time to get as much technical experience as you can to build on your knowledge or multitude of forums, including formal learning seminars, any sort of development opportunities that are offered in-house. And then to develop the experience where you will need it.

Joanne Bruton: I think another very important thing to remember is that integrity. When you're looking for promotion and growth within a team, I think every day that you come to work, you're being assessed by others on your integrity. Are you where you say you will be? Are you doing what you say you will do and being able to demonstrate that on a daily basis? I think it’s much harder to be developed as a leader because of this important aspect that you have to build your credibility over a period of time. That was certainly the case for me and my job, I would say that I was a steady plotta not in a leadership situation, but one of the informal leaders in a group for something like 10 years before my first leadership opportunity presented itself, and I was encouraged to apply for the leadership position pretty much based on that on my informal leadership, and that I had demonstrated integrity over time.

Joanne Bruton: So I encourage people to think that way, to know that it's very important every day to do the right thing, to be honest, to be genuine.

Joanne Bruton: And then the other final point I think I encourage people to recognize is how much compassion is needed in leadership. And I encourage people to approach their colleagues with kindness. And I think kindness and compassion are very similar, understanding that other human being in front of you and what their needs are. And I think if you can develop that in your leadership, I don't think it's ever difficult to motivate a team and get people to come along with you. And you can have to give some pretty tough messages along the way, but if you're doing it with a compassionate, true compassionate intent, I think 95% of your team will be more than happy to cooperate and give their absolute most.

Lisa Minor: Joanne I couldn’t help but hear as you giving advice our Cleveland Clinic values in your comments.  Joanne, it was wonderful to hear you speak candidly about the importance of teamwork and integrity and really showing that compassion and empathy for your fellow caregivers. This has been such an opportunity for us to learn from such a great leader at Cleveland Clinic. Joanne, I just want to thank you for your time and your expertise and your dedication to the profession of nursing in Cleveland Clinic.

Joanne Bruton: Lisa, thank you for your kind words, that's far too kind. I really appreciate it. And it's my absolute pleasure to speak with you today and impart any wisdom that may help anyone. I'm so delighted to be able to do that, thank you for the opportunity.

Michelle Lampton: And that's our episode. Thank you so much to Joanne for sharing her insights and advice, and thank you to Lisa Minor for being a part of this series. That's it for us at GLLI. Stay curious and keep learning.

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Learning to Lead

This podcast is designed for Cleveland Clinic caregivers looking to develop their leadership skills both personally and professionally. Listen in with leadership experts on the topics that matter most, and what makes our culture what it is at Cleveland Clinic. We'll hear from aspiring leaders to seasoned experts on hard lessons learned, best practices, and how to grow and develop. No matter where you are in your journey, this podcast is for you.
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