Leading in Times of Crisis with Rita Pappas, MD

Podcast Transcript

Brian Bolwell, MD: Welcome to Beyond Leadership at the intersection of leadership and everything else. In this Cleveland Clinic podcast, we will commingle with extraordinary thinkers and explore the impact of their ideas and experiences on leadership and management.

Today, I'm delighted to be joined by Dr. Rita Pappas, who is the Medical Director of Hospital Operations for the Cleveland Clinic. Rita, welcome.

Rita Pappas, MD: Thank you. Thank you, Dr. Bolwell.

Brian Bolwell, MD: How long have you had this role?

Rita Pappas, MD: Since 2011, so 10 years.

Brian Bolwell, MD: That's a long time. What does it entail?

Rita Pappas, MD: I'm responsible for the occupancy and the capacity across the enterprise, meaning Cleveland Clinic, Northeastern, Ohio, as well as Florida. I work collaboratively with Joelle LoFaso, who's our director and what we do is help place patients at the right bed, at the right time, at the right place.

Brian Bolwell, MD: Well, it sounds like you have influence over most of the clinical operation of the entire organization. It's a very big job. How do you do it? How do you manage to interact and lead so many different ... I mean, for those of you on this podcast, we have, Rita please correct me. I mean, we have well over 10 hospitals in Ohio. We have another four or five in Florida. I mean, this is a very complicated thing.

Rita Pappas, MD: Yes. Thanks. I think one of the best lessons I learned early on was to build relationships. One of the things that I did once I was given the role, was to meet each institute chair, each hospital president, and drive, meet them in their offices. Not in my office, but actually venture out and meet people. We had meetings with the chief medical officer, the CNO and the hospital president for each regional hospital. Leadership has changed and so once that happens, I make a concerted effort to do that. I provide my cell phone, as well as building those relationships helps the ability for people to reach out when they reach challenges. Then we've earned credibility, Joelle and I, through the enterprise by actually delivering on our operations.

Brian Bolwell, MD: Give me an example of that.

Rita Pappas, MD: One of the things that happens is, what I've learned, is there's usually maybe three sides, one side to every story, plus somewhere the truth in the middle. But, what we've done is if someone, all of our calls are recorded. That has been very powerful when speaking to leaders, because people are very passionate about what their side of the story is. When you can provide data or evidence, a timeline of the events that occurred and believe me, when we make mistakes, we apologize and we are transparent that a mistake has been made and what action plans we have around rectifying those mistakes. I think that's what builds credibility.

Brian Bolwell, MD: Relationships are incredibly important. I think for any leader, developing them and developing trust is almost essential. But you've got a lot of different people you've got to work with. I mean, the main campus is obviously our hub, but an enormous part of the organization is elsewhere. You must know all these other hospitals very well.

Rita Pappas, MD: Yes. One of the things that we learned through the COVID pandemic was that when we huddle for a short amount of time, for when we were trying to deal with 800 COVID patients within our health system just in Ohio, we scheduled a huddle for 15 minutes to review a plan for the day where we could accommodate patients. And by doing that, then you actually continue to build those relationships and meet all the leaders there and building trust, then people will disclose and are more transparent in their struggles and challenges. So, oh, I'm sorry go ahead.

Brian Bolwell, MD: I'd like to hear more about how you huddled, but also probably you were as instrumental in navigating the COVID waters early last year as anybody in the organization. When it became clear in February of 2020, that COVID was real and it was invading the entire country, tell us how we managed that and how you led those efforts? Because the forecast back then, if I remember, were that we were going to be totally overrun by this virus.

Rita Pappas, MD: Yes, that's correct. I think one of the things that's probably the most important lesson that I learned was to express uncertainty is okay. Oftentimes, we hear that that makes you vulnerable and you will be looked on less as a leader. But to say that I didn't have a crystal ball, I had no idea really what was going to happen, but we took the information that we had and leaned on the information that we knew. I'll give a shout out to Rishi Singh. We were in charge of ... I was appointed as a chief medical officer for our surge hospital.

Brian Bolwell, MD: Can you describe what that is?

Rita Pappas, MD: The National Guard was helping us identify space in order to provide beds, considering we were thinking that we were going to have 5,000, at the worst case scenario, 5,000 COVID patients. My task along with Shannon Pengel, as well as our Colonel Stahl, Rob Stahl, was to erect, to take the Health Education Campus that's part of Case Western Reserve and turn it into a surge hospital.

Brian Bolwell, MD: Just for frame of reference for our listeners, how many beds do we have in Northeast Ohio total?

Rita Pappas, MD: We have over 1,300 on the main campus, so roughly total of about 3,000.

Brian Bolwell, MD: We thought we might have 5,000 COVID cases.

Rita Pappas, MD: Correct, that needed regular nursing floors.

Brian Bolwell, MD: That doesn't count ICUs?

Rita Pappas, MD: Correct.

Brian Bolwell, MD: That's a lot.

Rita Pappas, MD: It is a lot. It is a lot.

Brian Bolwell, MD: We didn't have the beds for that. So, we decided it to take our education building, which had just been constructed, which luckily is filled with a lot of open space, and turn it into a hospital.

Rita Pappas, MD: Correct.

Brian Bolwell, MD: How'd we do that?

Rita Pappas, MD: Through teamwork, through interprofessional collaboration between operations, medicine and nursing. What we did was we put safety as the priority. If you can imagine, there were decisions made rather quickly. We had less than three weeks to do that roughly. We said that we were going to make it a very safe environment. We huddled twice a day with all the teams together. That was very instrumental, getting everyone to buy in that we couldn't just run off in our own silos and create these work plans. That we needed to meet together in the morning and then again in the evening, and then everyone was tasked a certain amount of lists to do so that we weren't running over each other as we were trying to get the work done. Then when we huddled in the evening, the tasks that weren't completed, were then assigned to the next day.

Brian Bolwell, MD: So taking a non-clinical building, I mean, it might as well have been a barn and you're making a hospital?

Rita Pappas, MD: Yes.

Brian Bolwell, MD: What'd you do about oxygen? What did you do about just basic things? I mean, IV, storage? I mean, wow.

Rita Pappas, MD: I was referring to Rishi Singh. I tried to use data to inform the choices we were making. Rishi has a group of medical students that he works with. We asked him to look at the number of patients that we had currently in the hospital on the regular nursing floors and do a quick data analysis to inform us how much oxygen we needed. Through his analysis, he said that we would need at least three liters of oxygen to care for patients. Then we backed into working with a vendor to help meet that need, which was powerful because then we could care for those patients safely. There was discussions on what type of beds. One of the things that I really remember that resonated with me was I insisted on having bar coding done because of medication delivery, as you were talking about. How could we safely deliver medicine to people that were, if you can imagine, in a large area with just beds?

Rita Pappas, MD: We created these bed spaces in Epic to be able to barcode. That was a huge lift from the IT department and the Epic team to make that build. We thought about how we were delivering care. We adapted the use of Vocera, which is a communication device, because we didn't think that the beepers were going to be able to work well in our traditional care delivery. We had to in service all of us on Vocera and we brought teams in. We brought the medicine team in and we did practice runs and try to understand workflows and how everyone would work. Really through the help of Nate Hurle with Continuous Improvement, he helped us develop a playbook on all of those workflows, so that it could be safe for the next generation with the next pandemic, if anyone needed to build a surge hospital. We have that playbook available too, because I was very insistent that we had something that represented the work that we did, that we could pay forward to the next generation.

Brian Bolwell, MD: We had three weeks to build this hospital. Did we in fact do that?

Rita Pappas, MD: Yes, we did. We did through the hard work, continuous work of a lot of people. We were able to have, we had 327 beds of setup and ready to go on that first floor with the ability to flex up to 1,004 beds in the entire Health Education Campus. That was another lesson learned. We were calling it the Health Education Campus, and then Samita Khatri said, "What we're building is hope." Then that was the inspirational piece that actually motivated people, I feel, to work hard because then we started calling it the Hope Hospital. That resonated with people that we were building hope for COVID patients, so the ability to care for them.

Brian Bolwell, MD: I mean, what a logistical challenge and to be able to actually execute that in a matter of a handful of weeks, incredibly impressive.

Rita Pappas, MD: Thanks. One of the pieces ... we've never had a patient in the Hope Hospital. Trying to also speak to the team to level set and say that we were going to do this and that we could potentially not have a patient, was also a message that we needed to deliver early on. But the team all felt very gratified that they were able to do this and they felt very supported by the organization in doing this. They felt that we actually were leading through a very difficult time, by taking action.

Brian Bolwell, MD: I mean, it's a great story. As it turned out, we didn't need it. I mean, as it turned out we peaked at, I think you said in the 800s and we did have the capacity for that. Actually, as I'm speaking at this very second, I'm sitting in one of the places where the Hope Hospital would've been, and instead it's a great place to do a podcast. What else? I mean, COVID is still going on and if I'm remembering last year correctly, I mean, it settled down in the summertime and then we had a pretty unexpected surge in the late fall. How did we manage that?

Rita Pappas, MD: Yeah, I think right now we're in our fifth surge. During the time that you're talking about, we actually created levers and created a surge plan, which ended up electively, we decided to postpone cases in order to care for those 800 patients per day. That was a very difficult decision. Our team struggled with the fact that there were people who were having surgeries, elective surgeries for instance, like a hip replacement or a knee replacement, someone who's in pain and that we needed to postpone their surgery in order to care for the COVID patients. We sat looking at the bed and the footprints that we had available across the enterprise, we ended up setting COVID census as the triggers for those levers to postpone elective cases. At one point, we actually closed one of the ambulatory surgical center in order to provide staffing to help staff one of the regional hospitals.

Rita Pappas, MD: Unfortunately, another disappointment, right? Didn't really go well. The number of staff that we thought we had that could potentially help, ended up either one, becoming sick because the vaccinations weren't there. They ended up contracting COVID. Then some of the employees decided to actually leave healthcare because of the stress of having to care for COVID patients. We had a few number of individuals that actually were able to step up and upskill their training and help care for those patients. But, when you're looking at numbers and data and thinking, we have these many people, in reality, that's not what would happen when we actually closed the center. Because of I guess, like I said, illness, mental distress, we weren't able to staff units that we thought we would actually be able to staff.

Brian Bolwell, MD: What's going on now?

Rita Pappas, MD: We're currently in our fifth wave of COVID and we've resumed our huddles that are happening. I think some of the things that we're learning during this wave is the patients are younger and therefore, their lengths of stay are longer with all of the interventions that our intensive care unit team are trying to do. So, even though we had longer lengths of stay with the fourth wave, our fifth wave is even longer length of stay. That's less beds that are available for patients that are now presenting to our emergency department who delayed care and are ill as well. Non-COVID medical patients, maybe who forgo having a scope now have colorectal cancer, late stages. We're dealing with a higher acuity of patients, of medical patients, of COVID patients, and then surgical patients, which is very challenging for a workforce that's been going strong for 18 months, roughly.

Brian Bolwell, MD: Yeah, I think that that's pretty ubiquitous in healthcare right now is workforce fatigue, certainly of the clinical caregivers. That's not easy to fix.

Rita Pappas, MD: No, it's not. I think one of the things that comes through on the calls is that people will look and see, and even if they could actually help by taking just one patient to try to ease the burden for someone else, that's still occurring, which is really wonderful to see. It happened today on the huddle call. We're specifically challenged in our Southern region where the vaccination rates aren't as high and those hospitals have been really carrying the burden over the last couple of weeks. But even through that, we had one of the CNOs offer to take patients today, which was very inspiring.

Brian Bolwell, MD: Another thing that happened in 2020 was we had a national presidential election and the first presidential debate was actually here in Cleveland, right here in our health education campus, which was the Hope Hospital a few months before the debate. If I'm remembering correctly, you were in charge of all the logistics for the presidential debate. Obviously, you're quite the talented individual. Dr. Pappas. Without compromising any national security stuff, can you walk us through how all that transpired?

Rita Pappas, MD: Yeah, definitely. I think one of the first things that occurred was, how could we safely host the presidential debate in the middle of a pandemic? We focused on the ability to ensure that we could safely distance individuals within the health education campus for the debate, which actually meant then looking at the square feet and limiting the number of people who actually attended the debate, which was unprecedented. There was always open access and the media and dignitaries and leaders that were allowed to attend previously. Under safety, we limited the number and then what we ended up doing then was looking at our campus and our footprint and trying to understand how we could have people move safely through.

Requiring mandatory masking as they moved through the campus, limiting where they could actually put potentially go, and then insisting that they actually be tested within our facilities and using PCR testing in order to ensure safety.

In order to come in and out of the venues, we had color coded wristbands that would expire at a certain timeframe in order to maintain the flow of individuals through the debate and the debate hall. I think one of the things that became clear though, is we leveraged the use of MyChart, so that we could, we registered people. The lift was heavy in the beginning to try to ensure that everyone was registered and given MyChart access and then tested and then have those results released. But that way we had control when individuals tested positive, they weren't given a wristband.

Brian Bolwell, MD: For our listeners, MyChart part of our electronic medical record. It's a part in which patients have access to basically their own medical record and as well as they can receive alerts about test results, et cetera.

Rita Pappas, MD: Yeah and it worked out very well. Initially there was some concern that we were making individuals who had the ability to come and go as they please, that we were being too restrictive. But what ended up being applauded at the end of the debate was that how well controlled things were during the time, the week before and including the night of the debate.

Brian Bolwell, MD: Let's talk about the week before, because there were a couple things that were certainly evident for those of us who work here. One was the security concerns, because we started, I mean, we didn't know what was going to happen. I'm sure that you had a lot of inside information about that. And secondly, was the media crush started. Fox News would build a huge media epicenter right outside the cancer center. How did we manage those two things?

Rita Pappas, MD: Yeah, I think working with our marketing and team to try to understand all of the requests that were coming in and we ended up creating this perimeter. The perimeter we had tighter control of, but as you're stating the cancer center was outside of the perimeter. And there was a large emphasis in accommodating the needs of the media since we had such tight control in the perimeter. I felt that the Fox News tower that you're referring to was a compromise, in the sense that since there wasn't a lot of movement within the perimeter that we had worked with, Gordon Snow had worked with the secret service and a lot of individuals in order to maintain that strict perimeter. That's why the Fox News stand ended up outside by the cancer center.

Brian Bolwell, MD: It was actually quite entertaining for our patients who were receiving who were receiving infusional therapy because they actually looked right over at this thing being built and Fox News was the ... I mean, Chris Wallace was the moderator for the debate, so they were the host media people. Yeah, that was interesting.

Rita Pappas, MD: Yeah. I think in terms of compromise, it's difficult. You're trying to maintain this tight control of what needs to happen. Giving and taking, I think is a skill in negotiation. One of the things though I think was very difficult, was the ability to actually maintain the confidentially, the details that we were starting to learn about. No communicate them, which is part of what we usually do. We can't over communicate, and so that was a struggle for me personally as well.

Brian Bolwell, MD: Yeah. We're certainly big believers here in transparency and communicating to all levels, as soon as we know information. I mean, that's one of the tenants of any leader. But I think the clinic certainly, that's part of our culture. And yet, I'm sure that there was a lot of information that for security reasons, et cetera, you were unable to communicate it at all.

Rita Pappas, MD: Yes. One of the things that we really wanted to make sure was to be able to continue delivery patient care during that time. Working with the institute chairs and the hospital presidents to make sure that we had workflows that would continue on. I was responsible for the health education campus and my partner, Jim Simon, was responsible for everything across the street, including the hospital, communicating with the institute chairs. They ended up doing basically a mock drill to try to talk about events, so that they could prepare workflows on how to care for patients as a way to empower people with the information that we did have.

Brian Bolwell, MD: Well, again, we didn't know what was going to happen and the security concerns were very, very real. Most major cities that had a lot of uprisings a few months earlier, and we didn't know what was going to happen. Thankfully, nothing really significant did, but we didn't know that ahead of time.

Rita Pappas, MD: It's true. It was very concerning. We had, in terms to prepare just like other events, we have critical transport vehicles that are available, that were outside of the perimeter. We had workflows established if something happened within the perimeter. How we were going to get people out and we drilled on those workflows as well. But right, it was very uneasy.

Brian Bolwell, MD: How about the night of the debate?

Rita Pappas, MD: The night of the debate was very surreal to me.

Brian Bolwell, MD: Well, you were there obviously, right? I mean, you were-

Rita Pappas, MD: Yes, I was. It was powerful to see everyone come in with their wristbands. We had set those expectations and the spacing that occurred. We had plans outlined related to, and everyone walked in with their masks on and the wristbands on. But as you know, as a public event, there were some challenges that occurred. What I learned through is that with national security, the secret service, the presidential secret service actually has domain once they enter a facility. Even though we had our plans that if people had to maintain their masks during the entire time, the presidential secret service though, ultimately decided what happened and what didn't happen.

Brian Bolwell, MD: Well, again, I mean to your credit, to your massive credit, I mean, the event went off without a hitch. I mean, just the logistical lift to host something like this in the middle of a healthcare campus, a striking achievement. I mean, so huge congratulations.

Rita Pappas, MD: Thank you. It was a team effort, honestly. Many, many, many individuals across the organization were instrumental in making it a success.

Brian Bolwell, MD: Rita, you're also a pediatrician and a few years ago, there was a change in leaderships of our Pediatric Institute. You stepped in and became the interim chair of that institute. I think that one of your initial challenges was there were some cultural issues that were not ideal in the Pediatric Institute. How did you approach all that and what did you do to try to address the challenges that were happening?

Rita Pappas, MD: Yeah. In order to step in, I started in the Pediatric Institute in 2004. I had relationships with many of the chairs that were working within the institute, as well as I clinically practice in the children's hospital. One of the first things I did once the announcement was made, was to gather up all the leaders in the room and to set expectations and assemble structure around what was previously mentioned, or ... Sorry, I was thinking about it like one outline that I had an open door policy. Then there were, I wanted a quick leadership win to build trust. It was as silly as the timing of the meetings that the leadership met, the cadence and the time. They asked to change the cadence and the starting time, which I agreed to, because I didn't think that the leadership needed to meet on a weekly basis very early in the morning. Then we restructured so that we would have certain agenda items that started, so they understood what the cadence was and what we were covering during those meeting times.

With the open door policy, what ended up happening was that people did use it pretty frequently, almost too frequently. But I would rather to build that trust immediately, it was definitely necessary. If you remember at the time, we were actually opening, we were on target to open our outpatient center. There was a lot of nervousness about what that would look like, because each of the prior, or each of the chairs had their own areas. We were bringing everyone together into one space. I had to deal with some promises that had been made by the previous leadership that we had to untangle, again for patients, what was best for patients. Having those conversations and being transparent about them in the first 90 days, was led to success. I also tried doing a retreat with the help of Chris Nagel, to bring the lead leaders together, to try to build trust as well. That was the first time that they had gotten together-

Brian Bolwell, MD: Wow.

Rita Pappas, MD: ... in a retreat to set forward what we were going to do. And the other piece was aligning the PEDS institute with the mission, vision, and values of Cleveland Clinic on the adult side. We were able to do that within the retreat.

Brian Bolwell, MD: And it sounds like it went very well.

Rita Pappas, MD: Yeah, it did. It did go very well. We were able to open the building on budget and on time.

Brian Bolwell, MD: Congratulations.

Rita Pappas, MD: Thank you. One of the other pieces is that I went back to the institutes that weren't originally involved in the building and invited them to participate, really for the children. And so for example, ear, nose and throat, general surgery, the other sub-specialties that were taking care of children, were then invited to participate in the pods that we had created. So that children could have all of the access and resources available, like child life, medical assistance, that were used to working with children. And that was a success as well. So we were able to open up our pods, not only for the Pediatric Institute, but the other institutes as well.

Brian Bolwell, MD: As you reflect back on that time, what are your lessons learned?

Rita Pappas, MD: One of the best lessons I learned was in terms of you can't over communicate. You can't over communicate. And two, you have to be inspirational. I do remember one of the staff members coming up and using my words, which was very powerful because I kept saying, "It's our time. This is our time. Our time to build this, open this outpatient center. It's our time to lead the organization and research. It's our time to mobilize and increase access." One of the staff members walked by one day and said, "It's our time." Yeah, be inspirational, be transparent and really build trust. I think those are the three major lessons and I wasn't able to make everyone happy. That's really hard. As a pediatrician, we try to make everyone happy. I had to actually understand that I wasn't going to make everyone happy and that there would be people that would criticize the decisions that were made. But I really tried to, I made the decisions on what was best for the patients and what was best for our staff.

Brian Bolwell, MD: I think the bit about inspirational is interesting because it's not always featured in leadership literature. But one of the essays that I wrote was talked about the power of preaching and how, if you're going to be a leader, you almost have to be somewhat evangelical in how you communicate your message and your vision to your constituents and your team, and other people who are associated with your group. Not necessarily an easy thing to do and I think it's an acquired skill. How did you do that effectively?

Rita Pappas, MD: I believe it started with my parents. I'm the oldest of five of Lebanese immigrant parents. One of the things that, and my parents both worked. I was in charge of my four siblings, and so responsible for getting them up and getting them to school. Lunch is made, the entire gamut. Learned very quickly on not to be authoritative or dictatorship-like, but actually to communicate effectively on things that needed to happen. We used to do, and it didn't go always well. It did not always go well. But that actually, I really believe it started with my parents. And then I learned from others. I learned from watching the role models. In high school, I attended Beaumont High School, which was an all-girls school. I believe I found my voice there by running for student office and participating in activities.

Rita Pappas, MD: Then I was a nurse for 10 years. I worked at the Cleveland Clinic as a nurse. I learned pretty quickly that I needed to give data up front, offer a recommendation and close loop communication in order to be effective, in order to care for my patients. But the inspiration piece, as you said, came later, really through watching role models and how people communicated effectively. I took a lot of leadership courses to try to improve my executive presence and how to actually deliver messages in a clear and concise manner.

I follow this rule of three, that people will only hear about three things. As you said, it took time. Before meetings, I would sit down and write out what was my message for that meeting for that day? What did I need to ensure that everyone walked away with? I used terms like, to be clear, this is my ask. It's very difficult. It takes time and effort, while you're trying to juggle a lot of needs. Your patients' needs, your staff needs, everyone else's needs.

Brian Bolwell, MD: As you look at other leaders, what do you think the key aspects of really good leadership is?

Rita Pappas, MD: I think it's evolving. I feel that leadership, that the millennials this time are not responding maybe to the leadership of prior times. I think one is trust, building trust. Two is communicating effectively, and three is the willingness to change and modify whenever action plans or items that you've set out, don't actually don't come to fruition. I think that's very difficult. And to admit when you've made a mistake, which shows vulnerability.

Brian Bolwell, MD: Well, I think the last point is really important. I think that I remember many, many years ago when I was a fellow, one of my attendings told me that in academic medicine, bad ideas die hard. And boy, I think that's true. A lot of times people take a long time to make a decision, and then they stick with it, whether it's working or not. But far more important for leaders, is to have the willingness to be straight and honest. If it's not working, then you course correct. You try something different, or sometimes you have to discard it entirely. But, you have to acknowledge the truth. You have to acknowledge the current state and not spin and distort reality. That's not always easy when you spend so much time arriving at a course of action.

Rita Pappas, MD: Yes, that's really important. One of the things when we started the hospital operations daily huddle, there was a lot of people who believe we shouldn't have done it, or that everyone was talking to each other. It was 15 minutes of the day and we've needed to modify. Every year, we'd sit back and say, "Okay, what do we need to change? What do we need to do to make this better? What do we need to do to make it more effective?" Adapting to change is I think very critical and important, especially when you're leadership and assessing, do I need to continue to doing this? Is there a value add in what I'm doing and how I'm spending my day and how I'm asking other people to spend their day?

Brian Bolwell, MD: Yeah, I agree with that. And the other point you mentioned of course, is trust. For those of you on this podcast, who've listened to it before, you know that I like to quote Stephen Covey's book called The Speed of Trust. I think it's a wonderful read for anybody interested in leadership. But then how do you do that? I think that one of the things in that book actually talks about what makes some organizations consistently successful in comparing them with organizations that aren't? Covey believed that the biggest difference between the two was simply how they treated their fellow human beings.

Brian Bolwell, MD: Did they treat people with respect and dignity? Were they in fact, applying the principles of serving leadership and supporting their team, or were they not? And in general trust means that you deliver on your promises. It means you listen and certainly what's worked for me is being authentic. Being straight and being very, very clear in what you were. Saying. You alluded to that when you said you liked to use the line, to be clear, this is my ask. Boy, I think these are all very essential parts of being a good leader and I would agree with what you're saying.

Rita Pappas, MD: Yeah, I did. I think one of the other pieces is within medical operations, I don't have any physical direct reports. What I do is based on influence. I have to influence others around projects and accomplishing works, as like setting up Hope Hospital, or being ready for a presidential debate. That's one of the biggest keys I learned. When I thought about it, when I was the interim institute chair, I didn't pivot, because technically those people directly reported to me. But instead, I tried to use influence as a skill, as opposed to thinking that people directly reported, and I think that built trust as well.

Brian Bolwell, MD: Well, many people think that's what leadership is, is the ability to influence people, regardless of whether they report to you or not. It sounds like you've done that very successfully.

Rita Pappas, MD: Thank you.

Brian Bolwell, MD: Any other closing thoughts about leadership in healthcare or elsewhere?

Rita Pappas, MD: I just want to publicly acknowledge you Dr. Brian Bolwell, as a mentor through my leadership journey, as well as Dr. Robert Wyllie. I've learned a lot from both of you and how to become an effective leader. I am forever grateful for one, all of the lessons that I've learned from you and two, I'm paying it forward by mentoring other leaders within the organization and outside of the organization too.

Brian Bolwell, MD: Well, you're very kind to say that Rita. But the fact is I think that all of your success is probably in spite of me, as opposed to anything positive that I've contributed. But, your accomplishments are truly wonderful and outstanding and it's been a pleasure having you here on our podcast, so thank you so much.

Rita Pappas, MD: Thank you.

Brian Bolwell, MD: To our listens, we welcome any topic ideas you may have for future episodes, comments and questions about this, or any past episodes. You can let us know by emailing us at executiveeducation@ccf.org. Thank you very much.