Operating with Empathy

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies and Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Steph Baer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio, and I'm very pleased to have with me today Andi Jacobs. Andi, welcome to Studies and Empathy.

Andi Jacobs: Thank you for inviting me.

Steph Bayer: Andi Jacobs is the Executive director of operations here at Cleveland Clinic. I am so excited to have you here today because every time I talk to you I have a great time and this is just in the course of everyday work. So the idea that I get to talk to you about one of my favorite things and learn from you as always happens is going to be so much fun. So, thank you for giving me this time. 

Andi Jacobs: You are very kind.

Steph Bayer: Well, and I'm telling you the truth. Let's start with your background, how you became the executive director of operations and what you do in your current role.

Andi Jacobs: So actually my background is I'm an attorney. I went to college, finished college very quickly, went to law school. My parents were insistent that I get a graduate degree in something. I did not have a burning desire to be an attorney.

Steph Bayer: So many misspent youths are in law school. Mine too. Yours too.

Andi Jacobs: I think I knew that about you. In fact, there are a lot of reformed attorneys around here, this place. But I did practice law for 11 years. I was a municipal lawyer and I liked it. I mean I enjoyed the prosecution work that I did for some of the municipalities on the east side of Cleveland, but when my boys were in school full time, I went to talk to a headhunter because I had been in that job for about 11 years and I was ready to move on and it had been recommended to me that I actually applied to be a director of development for a large, not-for-profit nursing home. I really liked the executive director during this interview and he asked me during the course of the interview what I knew about development and I honestly told him I didn't know anything about development. He stood up to end the interview and I was just shocked. I said, why are you standing? He says, because you don't know anything about development. Why should I hire you? And just this power inside me said, because I'm a trained advocate and I can advocate for your agency the same way I can advocate for a client.

Steph Bayer: That's a great answer.

Andi Jacobs: I guess it was. I got hired, he sat down and that's how I accidentally got into healthcare. I worked at that nursing home for the next 10 years and that job morphed into being vice president of planning and Administration and it was very challenging and I enjoyed working with the board of trustees a great deal. And year 10, my beloved executive director left. I did not apply for the top position. That's when I got the job at the Cleveland Clinic. The clinic had just opened the Beachwood Family Health Center right next door to where I was working and I had had all that experience being the prosecutor for the city of Beachwood. So when my beloved chairman, who I'm sure you remember, Dr. David Bronson hired me back in the year 2000. It wasn't because of what I knew about medical group management or even about how to run hospitals. It was about, yes, I had good experience in healthcare, but I really had good contacts in that area and we were opening up the family health center in those neighborhoods and I knew the players. I feel like I'm going on too long here.

Steph Bayer: No, this is fascinating. It goes into, I tell so many our summer interns to be open to say yes, and this goes into exactly that. We don't always know our path and this is exactly example of being open and saying yes and look where you are. So you got hired at Beachwood.

Andi Jacobs: Well, that was seven jobs ago. I mean, I am definitely an example of somebody who didn't know her path and I just had wonderful mentors and guidance here and opportunities were presented to me and I was in the right place at the right time, and that's how I was able to grow my career

Steph Bayer: With the skillset you were developing along the way. I mean where you had some luck, but a lot of it was preparation. 

Andi Jacobs: It is, and I think I used the word diligent before, but I also think in this organization, particularly if you are talented and people recognize that your talented investments are made in you, and I don't know if you had that opportunity here, but I was invested in, they did give me special leadership classes. Remember I went to school to learn how to be a lawyer, not to learn how to be a healthcare leader. I can remember rehearsing with executive coaches how to have crucial conversations and how to deliver disciplinary advice kindly, and that was all really very helpful.

Steph Bayer: It's so true. The organization is wonderful in that it will invest in you and talent is recognized. I've had the same opportunities where they've given us classes, they've given us ways to develop our leadership so that you're ready for new roles. I've even had roles created for me because this is an organization that respects and honors talent. If you are diligent and you work hard and you do a good job.

Andi Jacobs: I agree, I agree. And I like to tell young people that as well when they start working here. So anyway, I worked in the family health center for six and a half years. I'd been told that I was ready for the next job and in fact, that was down on main campus working in the executive office. I was working for an executive who was very high up here. In fact, on the 77th day that I was working for him, he called me into his office and told me he was leaving the organization, which was shocking to me, but I was told, just keep doing what you're doing, you're doing fine. And my former chairman came back and told me of another job that was opening up in his division and encouraged me to apply, which I did and I did have some stiff competition for that job, but that's how I ended up having a job as the leader of all the family health centers and that was kind of my dream job. I mean, I love that world out in the region.

Steph Bayer: How long were you in that world? Were you an overseeing administrator for all of our family health centers?

Andi Jacobs: You're going to be shocked at the answer. I was in that role for six weeks.

Steph Bayer: Really? That's it.

Andi Jacobs: Right? Because decisions had been made that we were going to restructure and that regional medical practice as we then called it was going away and my beloved boss was going to be the chairman of the Medicine Institute and really, which was the great outcome, and I got to remain in my role as his partner, as the institute administrator for the Medicine Institute, and I was in that role for three and a half years.

Steph Bayer: That's another great lesson for people that want to work in healthcare actually anywhere these days is the flexibility. Say yes, be ready, but also be flexible because things change so quickly.

Andi Jacobs: I got more to tell you about being flexible because three and a half years in that role, when it finally hit my stride, I thought we had really built a great team. My boss was offered the job to be the president of the region and he asked me if I would go with him. So I became an executive director for him and all the regional hospitals. And so that was a whole nother set of learning and I was in that role for 18 months working on a lot of special projects with him, having to do with the integration of the system. When he called me and he told me he wanted me to be the chief operating officer at South Point Hospital, and I said, David, I don't know how to be a chief operating officer. And he says, if you're a smart girl, you'll figure it out.

Steph Bayer: And he was right. 

Andi Jacobs: Well,I did show up the next day at South Point was introduced as the chief operating officer at that hospital. That was a fabulous experience. I loved it there. It was like finding family, a really tight knit group of great intention people, and I was a change agent because I was trying to bring to them a lot of the resources that were available in the rest of the enterprise. They had basically been circling their wagons for many years and doing things on their own. I think they didn't understand how many resources there were out there, but 11 months into that job, that's when the chief of operations, bill Peacock, who was my current boss, approached me and asked me if I would join his team. I was shocked. He said, please go talk to David, my former chair. I said, why do you want me? He says, you are someone who has worked in all parts of our organization. There aren't that many of us more now, but certainly 11 years ago at that time, there were very few people who had worked in all different parts of the organization, so I kind of understood those different cultures and he says, and doctors, and I don't have anybody on my team who has that skillset. So I did go ask for some advice from my chairman and I did take the job and I'm happy to tell you that I've been happily in this role that I have now for the past 11 years.

Steph Bayer: That's a great journey and it also, it's fascinating when I ask people how they got to where they are because so many stories are like yours where you don't have a straight line and I love hearing how we become leaders with your role as executive director of operations, what is in the operations division here?

Andi Jacobs: Operations division is actually pretty large. We kind of set the table for all the clinical care that needs to happen. So the wide variety of disciplines includes buildings plus design, which would be construction and planning, the ARC curation, the environmental service teams, the real estate teams, the strategic space teams. Then we have clinical engineering, which is all the medical equipment in the organization, supply chain and patient support services, protective services. That also includes parking and shuttle, transportation and emergency management, marketing, philanthropy. The sterile processing department was added to our division just a few weeks ago, and we also are the liaison with the three hotels we have on our campus and we treat the general manager of the hotels as a member of our operational executive team. So we're about 3,500 people, current.

Steph Bayer: 3,500 people.

Andi Jacobs: That's right.

Steph Bayer: Wow. That is a lot of people that you've got a lot of responsibility and a lot of divisions that keep the hospital running. 

Andi Jacobs: We do, but you have to understand, we have a team of fantastic leaders. I mean all of those different disciplines that I name, they each have their own chief or executive director who has deep subject matter expertise in all of those areas. My role is more administrative. I am the administrative partner to our chief of operations. I make sure that the workforce decisions are handled correctly, the budget, the corporate compliance, special projects. I also represent operations. If there's an enterprise initiative and they need one person from operations to come and listen with an operations ear, that might be me, and then I can translate what needs to go back to all of the different leaders that I work with so people get the information they need. I also lead the supplier diversity efforts for the organization.

Steph Bayer: Tell me more.

Andi Jacobs: So the director of supplier diversity reports to me because kind of like Switzerland, we didn't want to embed that little team in supply chain. We didn't want to embed that little team in construction, but we work collaboratively to try and increase the amount of our spend with the diverse companies and they have to be certified diverse companies, but it's very rewarding and

Steph Bayer: So important.

Andi Jacobs: Oh yes, we're helping our neighborhoods. Yes. I mean, this is the way we can contribute back. It's just one of the things we can do to help our communities. Yes. So yeah, we're fully committed to it

Steph Bayer: With all of the responsibilities. I'm going to ask a tough question, but what are you most proud of with this kind of work?

Andi Jacobs: Actually, what I think what I'm most proud of is the team aspect of what we do. My role is a little bit like conducting an orchestra.

Steph Bayer: Oh, I like that analogy.

Andi Jacobs: Well, my son is a composer and I know our CEO and a lot of our colleagues and others in the world refer to it as a team of teams, but it's an amazing feeling when everything goes smoothly, the patients and the visitors and the caregivers and the neighbors are always happy with the operations and life at this large place because here on main campus alone, it's 13 million square feet enterprise wide. It's 39 million square feet,

Steph Bayer: 39 million square feet. I didn't know that number. 39 million square feet that

Andi Jacobs: The enterprise,

Steph Bayer: Our footprint is enterprise.

Andi Jacobs: Yes. Wow. Yeah, that's international. But I love working on teams and that was something I certainly didn't have the experience to do when I was working as a lawyer and I love the people who work here. I love the opportunity to give back to the community in this mature part of my career, I really enjoy the mentorship roles that I have both formal and informal with Young Careerists and I love learning so much as I do from my colleagues who have training and all the different specialties. You know what I'm talking about, right? I do.

Steph Bayer: I absolutely do the field, I mean brilliant people, and you're right. When it is going together and when it's flowing, that teamwork is, it's unmatched

Andi Jacobs: And just walking over to the studio this afternoon, it's inspirational. When you walk down the halls in this place and you see people walking and they're wearing their badges and they just have such purpose or you step aside because a patient transport is walking through with a patient on a car door. You just can walk and you see such acts of kindness as you walk through the

Steph Bayer: Halls. That's amazing. I actually did a little side note. I had lunch yesterday with our spiritual care department and I asked them what's new? And a couple of people were missing, and that's because they were putting on a wedding. They had taken one of our conference spaces and they had your team's help and getting the space reserved, and there was a patient who was having a big transplant and he wanted to marry his bride beforehand, and our chaplains were going to administer the wedding ceremony and it was just they missed lunch because they were putting on a wedding. That's the kind of stuff that is just so inspirational and Hallmark in addition to the care that we expect to see in a hospital.

Andi Jacobs: It is, and our intranet is so good. Our marketing and communications team is excellent, and I love to read those stories because I'm sure I've heard stories of at least three or four other weddings over the past 23 years that I've been here that have been performed here at the hospital. They always very touching moments.

Steph Bayer: What are some challenges in a role like yours?

Andi Jacobs: Well, it's relentless. This is 24 7, 365 operation, so the scope and the scale of managing all the work streams is pretty daunting, and we do it from this perspective of always being highly reliable and I love the training that we are now getting on a monthly basis about high reliability, and every single person who works here at the Cleveland Clinic is getting this training, so that makes it so much more relatable. But our jobs and operations, I say this to people, it's like if we do our jobs well, you don't know we were there. Things are just kind of going smoothly, but you want things from like clockwork. Patients need to be able to park their cars and get to their appointments and their surgeries on time and no one should fall down and no one should be neglected and no one should be lost. The lights and the power always have to be working.

The rooms have to be at the right temperature. The air exchanges always need to be correct. We have to meet all those conditions of participation for the joint commission and all the governmental and licensure surveys. Our construction projects have to be delivered on time and on budget and all the preventive maintenance we need to do on the equipment has to get done and it can't interfere with patient care. So we have to make sure the supplies are always ordered and they're delivered correctly. We have to make sure that we don't have people overutilizing their supplies. We have to address the urgent needs. We have Cleveland Clinic Police Department as part of our division and the things that they handle, the workplace violence, the theft, the stories are could curl your hair. We have floods, we have leaks, we have wind damage. You just have to always make sure that everyone is getting what they need when they need it and where they need it. So that's kind of the challenge of working in operation. Like I said, and I have to qualify this, there are a lot of people who are paying attention. It's not just me. I have some fantastic

Steph Bayer: Colleagues, amazing folks. No, we know empathy is one of our core values at the Cleveland Clinic, and this is the topic of our podcast. So I'm going to ask some questions about empathy and one of them being how do you instill empathy in operations caregivers? Many of these folks are our first point of contact for patients from valet to red coats, to how do you ensure that they also get to embody the empathy value?

Andi Jacobs: So I think it starts in the interviews, and I've talked to a lot of my colleagues about this.

Steph Bayer: I am so glad we actually sat down with our recruitment about how recruitment is the front door to empathy, and I agree with you. I love

Andi Jacobs: That. Yeah, they do. I mean, when they interview the carpenters here, they ask a question about what do you do if a patient is locked in the bathroom? And it's not like they have to know the right answer, but it is a clue as to whether or not there's an empathic gene in that person. We have red coats try out. They actually have a tryout with colleagues to see how they're doing in the lobbies and interfacing with the public. We ask customer service questions in our interviews and sometimes you can tell a lot about a person just by learning what their hobbies are. What do you like to do for fun? Because this is very much a people place. This is like we were talking about before, this is kind of a team sport. You have to love helping people in order to work here.

And my attorney friends, the ones that I used to practice law with, when they ask me about, so how do you like it? I explained to them that it's not necessarily compensation that I can put into my paycheck, but it's daily compensation to know that I'm helping people. I mean, that really matters to me. I agree with you completely. Okay. Completely. I know. I don't think we would've been here so long if we didn't feel that way. So it just gives me purpose and that's very important I think to most people who work in healthcare is to have that purpose. If you work in direct patient care and pretty much two thirds of the people in the operations division do, I mean it's a daily reminder. It's a constant reminder of what our mission and our vision and our purposes are, but it's harder for administrative caregivers and now we have so many who work remotely or in a hybrid situation, so I always encourage our managers to bring their teams down to the hospital campuses, down to the inpatient and patient care settings.

It could be outpatient too, because there's learning that could happen there. For instance, my finance director, he has started to bring his team in once a week and I said, look around you. Look at all the experts you have sitting in this area. I said, you should do lunch and learns and just ask these colleagues to come and spend 10 minutes with your team and explain what they do. It will enhance their ability to understand what operations does. I tell everybody, I think our intranet is great. I already gave that a plug, but my people who work on my team know that I have an expectation that they're always staying current with what is on the intranet. I think it's important that we always recognize our caregivers. We can't do that enough, and there's so many of our caregivers are everyday heroes and they deserve the recognition too.

I think it's important that we always keep reminding our caregivers in our meetings what expected behaviors are, and that's kind of hard to call out sometimes. We have all these expected behaviors that are always going to make us the most reliable and the best place to work healthcare, but what are they? And sometimes it's just asking a question and letting the group talk about that. I have this stump speech I do about, you only have one chance to make an impression. The Will Rogers, and if a patient pulls in the parking lot and there's litter in the parking lot, we've blown it. If they walk in the door and the person sitting at the front desk doesn't say Hello, we've blown it. If they're calling on the phone and the phone has been ringing 12 times, we've blown the opportunity to make that great first impression. It's just kind of having those conversations. It's knocking on doors before you walk into the room. It's calling patients Mr and Mrs, not by their first names unless they invite you to do so. It's smiling, it's looking people in the eye. I'm saying a lot of obvious things, but I think that we just need to keep reminding our teams and talking about that and understand those are the expected behaviors. 

Steph Bayer: That was a really meaty answer. I want to try and say it back to you if I can, and you can help because it was really good. I want to make sure that I'm capturing the important stuff, so how we instill empathy, how we ensure that value is being lived. It starts with recruitment and making sure that we're looking for the right candidates to bring into our teams. You then said that it's also about immersion and bringing people on site even if that's not their role, and getting them exposed to where patients are so they can be reminded of the mission. You mentioned expected behaviors. You said civility, the smiling, the how are you doing, as well as maybe going the other duties as assigned. My job might not be to pick up the trash in the parking lot, but if I'm walking by it, I should, and then I love that you also landed with recognition in how we have so many heroes amongst us, and they're not always the heart surgeon who replaces the valve who was a hero, but also the everyday heroes who helped that scared, anxious, lost person way. Find who pick up the trash so that we are without infections. Those are important jobs.

Andi Jacobs: Very important jobs,

Steph Bayer: And recognizing that is critical.

Andi Jacobs: We have to own this place too. You know how huge this place is, and it would be easy to step over that piece of trash or to ignore that outdated sign that's on the wall or the crumbling bricks that you see in the corner. But I mean, I want people, especially who work on operations teams to report that and don't worry that it's maybe not your job or maybe somebody's already reported it before. It's like, take a picture, send it into service express, report it so we can check on it and make sure that everything is as it should be. I also empower people to take down scotch tape signs. People know me. They know that this is my absolute pet peeve is scotch taped signs.

Steph Bayer: Well, I'll be on you for that. If I see any, I'll take it down. 

Andi Jacobs: Please do. Thank you.

Steph Bayer: For the listeners out there who maybe not familiar with their leadership rounds, I want to just offer a little background to what leadership rounds. Leadership rounds. When we do a monthly meeting, this happens enterprise wide. We invite our leaders to come together on a topic and the topic could be one of our values. It could be patient experience, it could be high reliability, a topic with that topic. We go out and we talk to caregivers and patients and we find out more about how they feel about that topic or how the patient's experiences. Then we come back and we kind of regroup what we've discovered in these rounds, and we're not the only hospital doing these, but what we've discovered is that our caregivers love to see our leaders come to their work stations and interact with them. Our patients are excited to share their experiences and we can find opportunities for improvement and recognition.

So these are really critical monthly meetings that happen. What I love, and it's our biggest attended, it's my favorite leadership round. Every year we do walk in their shoes, and this is where we invite our leaders to not only go talk to the caregivers, but to spend that hour doing the job. The last couple of years, I've had some really powerful ones. Last year I got to meet Arletta who works in our environmental services unit, and I got to fold towels with her, and when I say fold towels and I'm not just folding towels to put on a shelf, we were making animals. I asked her, how did you learn to do this? And she said she went home and self studied. Self-taught. She

Andi Jacobs: Went on the internet, yes, YouTube. Okay,

Steph Bayer: And they're having butterflies or birds and that we've created space for her to do this. I was nowhere near as talented as she was, so I've got some work to do.

Andi Jacobs: Well, it's at 10,000 hours of experience,

Steph Bayer: The Gladwell stuff. She was awesome. And then this past year I was actually partnering with our chief caregiver officer Kelly Hancock, and we became transporters for a day. For an hour. Just an hour. We were transporting patients and helping them get discharged. I can't tell you the number of steps we had, but I asked the transporter we were working with, how many steps do you get? And he said He gets his 10,000 steps by 11:00 AM. Right? I mean, it is incredible work. Can you tell us about walk in their shoes and your view on it, why this is important, and maybe you've got some stories from, I know you have some stories from this work,

Andi Jacobs: So I love this leadership rounds as well, but our teams love this. I mean, they love to prepare for it. They get so much positive affirmation when the top leaders of the organization come and learn their jobs and understand what they do, and the conversations afterward when we all get back together as a group are pretty fascinating too, especially with some of the comments from the doctors who realized that the HVA system in the hospital is the same as the circulation system of the body. Yeah, yeah. You remember that comment? That was the, but we actually, we divide people into small teams, and I think we offer between 25 and 30 different experiences here on main campus. Now. This year, it was amazing, your colleague Hope and my colleague Dallas, they actually managed how to form teams and to make this happen enterprise wide, enterprise wide, so it was amazing, but we have people going into food service and cooking and serving people, working in linen and laundry, doing the patient transport like you did. We have people doing red coats. We have them working in the retail cafeteria. We have them going down in materials management and working in the depots and doing some of the inventory management tasks. We have them talking to the purchasing team, so understand how we do product procurement. We have people on the shuttle buses in the parking sources. We do a police ride along for a couple of lucky people. 

Steph Bayer: I want that one. Yeah.

Andi Jacobs: We do technical protective operations, which is the folks who do all the swipes and learn what they do with alarms and swipes. That's a huge role here. We had a few teams who were with marketing teams. We had some in media production where we're sitting right now, and we have folks who actually go to the signage. We have a few teams who work with EVS. We have one team that goes to actually the rot, alas and the chutes and learns about trash collection, and then we have so many different facility shops, and those are great experiences too. Electric shop, plumbing, refrigeration, the machine shop, HVAC, general maintenance. We have some teams that do fire and life safety. I know I've forgotten a few of these examples, but those are just some of the examples of what our leaders are experiencing and the fact that they're doing the jobs. They learn what experts, the operations caregivers are in those areas. It's really impressive. It is a wonderful activity. I prefer to do it in the summertime because then we get to do some of the outdoor experiences too, but we don't always get to do it at that time of year.

Steph Bayer: Well, we can make it happen. I know people we'll make it in the summer next year for sure, but it is incredible. What I also appreciate about it is we're talking empathy. It allows leaders to have empathy for the folks getting the work done, because when it goes right, you mentioned this earlier, if we don't seek your operations team, it just goes right. We see them when there's challenges or when it doesn't go well. This is an opportunity to do that recognition and to have that empathy and appreciation.

Andi Jacobs: A lot of the jobs, most of the jobs are very hard jobs. I mean, I too have volunteered in patient transportation during Covid when we were so short staffed, we were having our administrative caregivers come in and volunteer to work with some of the operations teams. I was exhausted and I only did four hours in patient transportation, and I'm pretty fit, but I mean, I went home and went directly to bed. I was just so tired. I was hard work pushing those wheelchairs, especially across the carpeted areas.

Steph Bayer: It's just a great experience and I'm so grateful that you take the time to help us make it so meaningful, and I hope those are listening that're not part of the Cleveland Clinic and pick up this, and we're happy to share how we make it happen, how we operationalize our operations walk in their shoes because we get so much meaning from it.

Andi Jacobs: Yes, and again, I'll reiterate how meaningful it is to the operations teams to have that kind of recognition and that kind of opportunity to show their expertise to others.

Steph Bayer:  Andy, as we wrap up, is there a story you can leave us with that shows empathy in our operations team and just shows the meaning of why they go together?

Andi Jacobs: Well, there are a lot of stories.

Steph Bayer: I'm sure

Andi Jacobs: There is a story that just blew me away. I'll share with you. This is about Sergeant Ryan Ball, who is a police officer, and he's actually the officer in charge of our main campus location, and he found out that we had a young patient who was receiving end of life care who always wanted to be a police officer, so Sergeant Ball, he connected with his colleagues and he put together a gift box for this patient and it included a little police patch and a challenge coin, and so they presented the gift to the patient in a ceremony right at the patient's bedside, and they made him an honorary Cleveland Clinic police officer, and the nurse pinned the badge on the patient and told him that he was now one of us. That was such a meaningful moment for that patient, that young patient, and such a meaningful moment for the folks who work here who are able to bring that joy and make that a positive moment.

Steph Bayer: That's a beautiful example, and I want to thank you because it's also the leadership of you and Bill and all of our operations experts that allow people like Sergeant Ball to step forward and to say, I have an idea. I want to connect with this patient this way and create those moments. That is a beautiful example. I can't improve upon that. 

Andi Jacobs: Thank you for inviting me. It was really an honor to be here today.

Steph Bayer: This concludes the Studies and Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies and Empathy podcast and iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.