Chief Residents Leadership Workshop

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic education podcast that explores the latest innovations in medical education, and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello, welcome to today's episode of MedEd Thread, an education podcast exploring the Cleveland Clinic's Chief Resident Leadership Workshop. I'm your host, Dr. Tony Tizzano, director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio.

Today I'm very pleased to have Dr. Jamie Stoller, chairman of Education, and the Sampson Global Leadership Academy Endowed Chair at Cleveland Clinic here to join us. Jamie, welcome to the podcast.

Dr. James K. Stoller:

Oh, Tony, I'm delighted to be here.

Dr. Tony Tizzano:

To get us started, could you please tell us a little bit about yourself? What brought you to Cleveland and your roles here at Cleveland Clinic?

Dr. James K. Stoller:

Oh, well, I'm a pulmonary critical care doctor. I've been at the clinic now for more than 30 years.

And as you pointed out, I serve as the chief of education and have the privilege of helping advance education comprehensively at Cleveland Clinic.

Dr. Tony Tizzano:

So and, of course, your reputation precedes all of this, and we're so happy to have you. But in today's episode, we want to explore the impetus for the clinic's Chief Residents Leadership Workshop.

And the growing importance of developing leadership competencies and professional collaboration within a team-based, academic medical center such as Cleveland Clinic.

Can you help frame the rationale for developing leadership as a strategic goal in an academic medical center?

Dr. James K. Stoller:

Sure, so a lovely question. Uh, I think we can all agree that leadership matters, leadership is important. Leadership is tied to high performance in every industry, and healthcare is, of course, not exempt from that. We need great leadership in healthcare, and so there are explicit competencies to lead as we'll probably talk about.

They are different in my view then the competencies to be a doctor or a scientist, or a nurse or a respiratory therapist. They're a discrete set of competencies. And so teaching these and developing these competencies in future and emerging leaders in healthcare, becomes an important, strategic goal for healthcare.

Dr. Tony Tizzano:

So in consideration of that, when you go about selecting who will become the chief residents, is it predicated on an aptitude for these things?

Or can it be developed in just about anyone, given the proper circumstances and mentorship?

Dr. James K. Stoller:

So, I guess, there are two questions embedded in your excellent question. One is, what are the criteria to be selected to be a chief resident? And of course, those decisions are made by the very able program directors who see talent, emerging talent in their respective programs, and nominate those individuals.

I'm sure that there's some sense of who will be a great leader, in addition to who's a great pathologist, who's a great lung doctor, who's a great cardiologist, who's a great obstetrician-gynecologist, as you are. That that's embedded in the decision to choose a chief resident. Beyond that, it's quite clear, and there's a- a bundle of research to support this.

That although some people are natively better at the competencies to lead, leadership competencies can be developed through deliberate practice. This is the work of Anders Ericsson and others that show that, Carol Dweck, growth mindset, that we can get better at things if we put our mind to it and we're disciplined about getting better.

Dr. Tony Tizzano:

So in the spirit of those goals, what does the leadership workshop look like for chief residents?

Dr. James K. Stoller:

Sure. We've been doing this for, this year will be the 17th year. So every year, late July, the chief residents, as you know, begin generally about July 1st. And about three weeks into their tenure or so, uh, we invite them to come offline, chief residents both at the Cleveland Clinic. We invite chief residents from university hospitals in Cleveland, chief residents from Metro.

So we try to make this a multi-institutional melting pot, if you will. We invite all those chiefs to come offline for two days. In those two days, we characteristically offer this at the InterContinental Hotel, so it's a nice, relaxed setting. We feed them and provide the sort of comforts around learning.

And we've assembled a curriculum over those two days that really unpacks leadership competencies. What do I mean? Things like emotional intelligence, change management, situational leadership, conflict resolution, organizational culture and strategy. And then we add mix there, some very important things for doctors in general, but certainly for chief residents.

Things like quality and patient safety, things like cultural competence. It's designed pedagogically for adult learners, so it's highly participatory. Teamwork is- is an immersive activity, in which teams form and work together, and we unpack their performance. And we try to make it fun and engaging, so it's not a talking head for two days, that would be absolute drudgery.

It's highly interactive and, I think, engaging. And we look for feedback every year, and try to calibrate the program in the spirit of continuous improvement, to make it better every year based on last year's feedback.

Dr. Tony Tizzano:

That's just fabulous. So in consideration of all of that, what evidence do you have or do we have that developing these skills matter and make a difference?

Dr. James K. Stoller:

They do matter, although there are still unanswered questions, of course, as there always are. There's a burgeoning body of evidence that leadership development matters in terms of translating into high performance. Our own work on virtue-based leadership clearly shows there are very few randomized trials here.

But there's a bundle of observational data, including observational cohort studies, that show that leaders developing specific cultures around the seven classic virtues. For example, trust, compassion, hope, justice, wisdom, temperance, courage. That when leaders create cultures that are anchored in those principles, that releases discretionary effort in the organization.

That is to say people will do the right thing when no one's watching, as opposed to carrots and sticks. And that's where high performance comes from, and so the evidence clearly supports that. We've also looked at the Chief Residents Leadership Workshop through that lens. And you know, using the well-known educationally Kirkpatrick scale from reaction, to learning, to behavior, to results.

Results being the highest level of the Level 4 Kirkpatrick. Uh, we have data to suggest based on the program director's feedback, that the participants in the Chief Residents Leadership Workshop demonstrate improved behaviors, and have bigger impact in the aftermath of the course than they did before.

Dr. Tony Tizzano:

That is very interesting. To do the right thing when nobody is watching, doesn't that just speak volumes? And isn't that what we all look for and hope for?

So, you know, I know that you have great interest in the science of organizational behavior. What inspired?

Dr. James K. Stoller:

(laughs) Well, it's a long-

Dr. Tony Tizzano:

Yeah.

Dr. Jamie Stoller:

... and winding tale and- and lots of serendipity, but I'll summarize it briefly in response to your question. So I came to Cleveland Clinic to be an academic pulmonary critical care doctor, and- and- and I think I am that. Along the way, and I think this is now embedded in every career in medicine.

There's a phenomenon that I've since given language to or learned that there is language for called the arrival fallacy. What is that? The arrival fallacy regards the idea that the achievement of goals creates a sort of deflation of energy, that was not present in their pursuit (laughing).

So in my own case, to answer your question directly, uh, again, I came to be an academic pulmonary critical care doctor and to engage in all of those activities. To write papers and get grants and, you know, rise through the academic ranks of hierarchy and so on, and I cherish those things.

But having done so earlier in my career, I experienced sort of a deflation of energy around my work, because I had checked those boxes. And that created for me a bit of a tailspin. I became aware that the same phenomenon affected many colleagues. None of us had language for that.

Long story short, I was referred to talk to a professor of organizational behavior at the Weatherhead School, which is the Case Western Reserve University School of Business. And I went over and talked to Eric Neilsen, described this phenomenon, and he provided insights into why that happens.

And to make a long story short, all of us, as doctors, are challenge-driven animals. We- We couldn't be a doctor without taking on challenge, because becoming a doctor, as you know, and as all of our listeners who are physicians know, this is and it's supposed to be a challenge-driven act- activity.

At the same time, all of us reach mastery, relative mastery. No one knows everything about medicine, it's impossible, but your learning curve flattens over time. And that cyclicity happens generally in- in about seven to 12-year cycles. And so when you juxtapose a flattening of your learning curve with this challenge-driven activity, that creates this conflict, right?

And for me, that conflict resulted in the awareness that organizational behavior provided some insight into that and a deep curiosity about it. So I, purely on curiosity, signed up to do a master's degree in organizational behavior at the Weatherhead School. And that changed my lens around the importance of leadership.

I was then invited to develop courses like the Chief Residents Leadership Workshop, and a course called Leading Healthcare that ran for about 13 years at Cleveland Clinic, and has now been expanded materially with our wonderful Mandel Global Leadership & Learning Institute. And then created in me the appetite, not only to teach leadership, but to see if I was any good at it.

And that was what prompted me to put my hat in to be considered for the role that I'm lucky enough to serve in as chair of education.

Dr. Tony Tizzano:

Well, having had the privilege and opportunity to attend the leading in healthcare program that you had several years back.

I can tell you that it- it showed a new horizon for me. So the capability you brought to that task, is nothing short of impressive.

Dr. James K. Stoller:

Well, you- you're kind. Uh, we're proud of the work, yeah.

Dr. Tony Tizzano:

So looking at where we've been over the last few years with the pandemic.

You know, has this cast a different light or a new light perhaps on the importance of leadership in healthcare?

Dr. James K. Stoller:

Yeah. You know, I love the term VUCA, which comes from the American military, volatile, uncertain, complex and ambiguous, VUCA. And I think if anything, the pandemic unleashed the VUCA-ness of healthcare, right? Early on in March of 2020, we were dealing with a virus about which we knew little, and for which we had little therapy and were scrambling.

Not thankfully at Cleveland Clinic, but many places scrambling for personal protective equipment, PPE, and so on. And I think that really revealed the importance of great leadership. And, you know, a little bit of a- of a evangelistic comment, but we were lucky, very lucky at Cleveland Clinic to have Tom Mihaljevic's superb leadership, in which he provided an insight about stability in a very chaotic time.

Uh, commitment that we were going to go through this all together without layoffs or furloughs. Quite unusual at that time in healthcare, which again, reinforced engagement and produced high performance in the organization. So the pandemic in general, unleashed great leadership and also surfaced the need for great leadership.

Because the absence of great leadership resulted in catastrophic circumstances, both organizationally and, you know, for some individuals as well.

Dr. Tony Tizzano:

You know, you said the word stability, and I must say, as- as we all looked at that moment when it all began to unfold, and it did so very rapidly.

You know, what does this mean? What does this mean for us, our patients, for us personally as professionals? And he did have a calming and stabilizing presence.

Dr. James K. Stoller:

Yeah.

Dr. Tony Tizzano:

I must say that-

Dr. James K. Stoller:

Yeah.

Dr. Tony Tizzano:

... when you said that word stabilizing, it hit me right off the bat. And of course, it spawned numerous different kinds of positions.

And rising to the occasion, and I mean, converting the medical school into, what was it, a 300-bed respiratory hospital?

Dr. James K. Stoller:

No. A bigger, a 1,000 bed.

Dr. Tony Tizzano:

Okay.

Dr. James K. Stoller:

You know, the Ho- Hope Hospital. Oh, yeah.

Dr. Tony Tizzano:

Yeah, just incredible.

Dr. James K. Stoller:

Yeah.

Dr. Tony Tizzano:

So, you know, it's easy to see the Cleveland Clinic, a traditionally physician-led organization, focusing on leadership development.

But are these same sorts of efforts commonplace across other institutions, particularly academic medical centers?

Dr. James K. Stoller:

Well, that's a great question. You know, the concepts of leadership development began outside of healthcare. Early on, General Electric in 1956, their CEO established a campus, which ultimately grew to Crotonville, which is being now disassembled.

And I was fortunate enough to visit Crotonville, a 55-acre college campus on the border of the Hudson River in Up- Upstate New York, where GE employees would go to learn leadership. And many other industries, Boeing, Toyota, have leadership development.

Healthcare itself has been slow on the uptake, although I would think that we at Cleveland Clinic, we're probably on the leading edge of healthcare uptake, um, 20, 25 years ago. I'm happy to see that leadership development is becoming more common in healthcare organizations, both academic and nonacademic.

Although it's still in the relative minority of institutions that have a deep commitment to leadership development, but it is happening much more recently than before. And I think that's a reflection of the realization that leadership matters.

And that the competencies to lead can be taught and should be taught, and are not natively present in doctors. So that's where it's going.

Dr. Tony Tizzano:

Yeah, I think that's fabulous. And I know in just poking around the Harvard Business Review a little bit now and then, and I'm sure you know stranger to it. You know, they talk about how developing belonging, which takes leadership.

And some of those virtues you talked about, I mean, they resonate, they go directly, they speak directly to developing belonging, has huge consequences for an organization. And they- they manage to quantify it, uh, and monetize it to say that for a company of 10,000, it's $52 million to their bottom line.

Dr. James K. Stoller:

Yeah.

Dr. Tony Tizzano:

With increased advancement, retention, raises, recommending your employer, so, you know, bringing these skills to the table. And, you know, it's not just at the very top.

There's so many layers, particularly in healthcare, where, you know, I think there's a trickle-down effect, and I- I hope we see that.

Dr. James K. Stoller:

Well, I have two reactions to that. Two quotes come to mind that speak to your why that I love. One was Nietzsche's quote that, "He who has a why can endure almost any how."

A- And the other one is Mark Twain's quote that, "The two greatest days in your life are when you're born and when you figure out why." Yeah, I think those are quite apropos for this conversation (laughing).

Dr. Tony Tizzano:

Yes, yes, yes, agree. So looking at other industries, you- you bring this up in how we may be a little behind their curve.

Do we look at other kinds of industries as a matter of course, to look for gleaning skills that we need to bring to the table in healthcare?

Dr. James K. Stoller:

Oh, absolutely. I think all of us have modeled our behaviors and the needs assessments out of other industries. Obviously, the competencies we're teaching in healthcare are healthcare specific. But you know, I'm aware that when our colleagues in the Mandel Global Leadership & Learning Institute undertook that, they did a listening tour right among industries.

Went around the country, sat with Boeing and Toyota, and sort of took best practices, and I think our approach has been similar to that. You know, what works best? H- How do we deliver it? There are still many unanswered questions about leadership development, what's the best way to do it?

Dr. Tony Tizzano:

Sure.

Dr. James K. Stoller:

Best delivery mechanism? Exactly when should one do that in one's career, et cetera, et cetera? But I think we've learned a lot empirically.

Dr. Tony Tizzano:

Yeah, that's my thought. The book, Why Hospitals Should Fly.

Dr. James K. Stoller:

Uh-huh.

Dr. Tony Tizzano:

What can we do to enhance safety in the way that the airline industry has had-

Dr. James K. Stoller:

Yeah.

Dr. Tony Tizzano:

... to have these multiple layers? So what do you see on the horizon? What's next?

Dr. James K. Stoller:

Well, I think a couple of things. I think there's the general issue of understanding optimal ways of doing leadership development. And many of the institutions that are engaged with this are- are trying different things. So there's the pursuit of excellence in leadership development, number one.

I think there's also all of the megatrends in healthcare, and how do those impact on healthcare leadership development? Artificial intelligence, what lessons does that have for developing leaders? I think we're just beginning to imagine what that might look like. Just-in-time learning, personalized learning, just like personalized precision medicine.

All of these things will impact the way we approach medicine, and the way we approach leadership development in medicine, so it's a very exciting time. We just have to keep our eyes open and embrace the novel trends.

Dr. Tony Tizzano:

You know, we talk as an organization, one of the pillars is educating those who serve. And you don't have to spend long in education i- in Cleveland Clinic to understand that it's not just saying it, it's walking that walk. But you are so immersed i- in the ability to weigh and measure efforts at educating people, it just fascinates me.

I- I never thought about it before, but I hear it more and more from various people who say, you know, "This is how you should design a presentation this way to not overburden one's mind when they're trying to get it on." And all of those things, maybe n- not any single one of them, but collectively, the impact, I just have to im- imagine is huge.

Dr. James K. Stoller:

You know, we're- we're blessed actually with, um, the vision of the organization. This goes back to the four founding physicians, you know, Bunts, Lower, Phillips, and Crile, of course. This goes back to their initial vision, that education was part of the clinic and that it was going to be integrated, fully integrated.

And so today, as education has grown, the medical school in collaboration with Case Western Reserve University, our Graduate Medical Education programs, continuing medical education. All of that is integrated under the rubric of education, working closely with our nursing colleagues, of course.

And we're advantaged by that integrated structure, and I think that we are the beneficiaries of their original vision around the importance of being integrated.

Dr. Tony Tizzano:

Yeah. I can tell you, I think the f- former Wooster Clinic, when it became the Cleveland Clinic some probably now 20 years ago, one of the biggest changes were the fact that we became better educated.

And it was because there was protected time to get educated. Whereas we were a eat what you kill kind of practice, everything was measured by production, and so you did CME at home.

Dr. James K. Stoller:

Mm-hmm.

Dr. Tony Tizzano:

You did self-directed CME, whatever you could get. And the thought that you were going to go someplace outside of the organization to learn, was not very common. And then all of a sudden, we began and we began changing the way we did things.

And then we started adopting various practice pathways that the clinic was using and saw that we can make a difference. And of course, you know, in a- another community outside of th- the clinic's influence, people kind of scoffed at it. But then all of a sudden, things like our C-section rate was significantly lower and so forth, and all of a sudden.

So that whole thought of education raised the bar for our entire community and it- we were like a little experiment because we were all self-contained. And so, you know, we all look back on this and we say, "Thank goodness we did this."

Dr. James K. Stoller:

You know, I think your, um, your comments are reminding us all about the importance of organizational culture and its impact on practice performance effectiveness. I- I- I think that's a case study.

Dr. Tony Tizzano:

Yeah. So what have I not asked that you think is important for our listeners to know?

Dr. James K. Stoller:

Well, I think you've done a lovely job framing the questions, Tony. I very much appreciate the conversation. I- I think I would simply underscore what I regard to be an important activity. That is to say developing leaders in healthcare at every level of the organization. We've been focusing on chief residents, of course.

But I would suggest that leadership development is important for medical students, as it is for senior faculty and everyone, allied health providers, nursing colleagues, administrative leaders. There's nothing specific about doctors in this regard. And you know, my encouragement to listeners is to embrace the idea, explore this in your environments to the extent to which you lack it.

I would take it on, because I think the lessons have been quite clear from industry in general, and more recently in the last several decades from healthcare.

Dr. Tony Tizzano:

Yeah. I think we did that with patients first at Cleveland Clinic.

All of a sudden, you took every single, solitary person, and put them through a few-hour course that people from all over sat around the same tables-

Dr. James K. Stoller:

Mm-hmm.

Dr. Tony Tizzano:

... over the course of six months. And we turned on a dime.

Dr. James K. Stoller:

Mm-hmm.

Dr. Tony Tizzano:

That became a North Star-

Dr. James K. Stoller:

Mm-hmm.

Dr. Tony Tizzano:

... for the clinic and still does. Well, Jamie, thank you so much. This has been a wonderfully insightful and thought-provoking episode of MedEd Thread.

To our listeners, if you'd like to suggest a medical education topic to us or comment on an episode, please email us at Education@CCF.org.

Thank you very much for joining, and we look forward to seeing you on our next podcast. Have a wonderful day.

Dr. James K. Stoller:

Thank you.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic education podcast.

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