599: Richard Winters, M.D. - Leadership Lessons From Mayo Clinic ("You're The Leader, Now What?")

26:39That can take a phone call or for you to sit down and be thinking about, okay, this is what I think. Jeez, what might they think? What might be their fears? How might they react? Even that little amount of stuff is going to be better than you just kind of thinking briefly and reflexively deciding. And again, there are times that leaders just need to decide. But when those leaders flex those, I'm going to decide muscles without considering other perspectives, or maybe they ask for perspectives and don't consider them, the problem there is, is that the autonomy of their colleagues is shot. They're missing out on key things.

27:19They're not going to be told things in the future and their ability to adapt is going to be hurt moving forward. How do you balance that out? Let's say there was a CEO of a fortune 100 company and i like this idea of dyads and triads and and also the fact that there that's not a triad of three doctors right it's a nurse and an administrator the administrative person i guess could be a doctor but but it you have three separate job functions coming together and you're valuing the perspectives of each person and then ultimately you do have to make the call. So how do you balance this? Yes, I want your input, but I'm also need to be known as a person who's decisive, who can make the call when it's really hard, when I don't have 100 % of all the information that I want.

28:04So how do you balance out that? Yeah. And I think that depends on the situation and the organization. And so there are situations where it's a leader who decides. There are places and times where it's the committee that decides, and there's places and times where you have a large group of individuals who come together and decide. I think that depends on the culture of the organization. But even in those places, and I do this stuff nationally and internationally, there's places where I'll be talking and everyone will look to the boss to see what to say. That boss still needs to look around their own blind spots.

28:36And so we still need to find ways of gathering this information, these kind of differences of opinion in a way that they can still make the best decision themselves if they're the final decision maker. I'm curious now from a coaching perspective, I go around and consult and advise companies and sometimes in group settings, sometimes one-on-one, sometimes large rooms. And in every room you go in, inevitably you're going to find some people who are just not, they're just not about it. They're too smart. They already know everything or they're, so they're above it. Or there's like, I just don't want to do this.

29:09I don't want to be trained. I don't feel like it. How do you handle those? And maybe it's an ego thing. I don't know. How do you handle those people who it's just maybe they're not growth mindset enough or they don't want to do it. Maybe some would call them problem students. What's your approach to people like that? Yeah. And I think this happens as you're talking about speaking to a room of individuals, but also happens as we're leading, as we're making decisions. We make this great decision based on looking around each other's blind spots. We've come up with all these different options, and now we've decided this way forward.

29:45It's not dissimilar. There are going to be people who are going to disagree. Even if you use the best practice, if you ask everyone, there's still individuals who are going to disagree. And so then what do you do? You've made this decision. Do you keep focusing on these individuals? Do you focus on the individuals who aren't paying attention? Do you try to change them? I don't think you can change them. I think they need to want to change. And so one of the things I think is we need to focus on those who are aligned and not on the resistance. That's what I, so I think you want to understand what are the things that they're against?

30:20What are the things that are their fears and worries? You want to take that into consideration. But then once you start getting going, you need to focus on those who are behind you and getting things going and getting things moving in the right direction. And I've seen leaders do this where they get emails telling them one by one all the things that they're doing wrong. And then they're cognitive, like there's that's all they're thinking about is how much they've um gee said this was a friend and i've hurt their feelings and i i really want to tell them things are right and things are going to be fine while they're doing that they're using up all their time and space and energy and they're not even focusing on the 85 percent of the people who are aligned it's that's it's hard to do but i think that that's it you still want to be listening but you don't want to be kind of you know kind of biting the hook and getting hooked by those negative feelings.

31:11Yeah. One of the questions I get frequently, Rick, is that maybe because of the name of my podcast is The Learning Leader Show and it's really growth focused. They say, well, I want to create a learning organization. I want my company to be known for learning and improvement and constantly getting better and learn-it-alls versus know-it-alls. I think Satya Nadella talks about that. What are some ways that senior leaders within companies can build a culture that is a learning organization? First of all, it's looking at decision-making processes. I think that's one thing. Is this one of these things where the leader is going to tell people what to do?

31:49And if that's the case, are they listening to different perspectives? And if they're not, then it's not really a learning organization. I think you can, in healthcare, we use a lot of all-staff surveys. And so we'll ask people, do they feel like their voice matters? Do they feel like they have the things that they need to get the job done? Do they feel like organizationally we are aligned with our values? And as we get those scores, we can do something about that. We can see, we're saying we're a learning organization, but are we truly? If we're a learning organization and people don't feel free to speak up, maybe we need to figure out what's going on there.

32:28And so I think using that sort of a data, I think, you know, it just, I think the idea so we're a learning organization you want to see that in action and I think about that's probably a corporate value is we're learners and so you're gonna want to see behaviors about that and so the behaviors are that people are seeking other and other knowledge they're bringing things from the inside and the outside they're seeking other people's opinions they are sharing those opinions they're building upon what's being done yeah and if they're not, then they're not a learning organization. Yeah. And one of the things you've written about in the past is how to scale coaching within organizations, right?

33:13And you're like, not by like hiring coaches or reading books or holding like a, hey, learn to coach in a day seminar, but by this idea of providing your company with ongoing teaching of coaching approaches, practicing with real life challenges, and then creating opportunities for people to reflect and to develop. So if you want to scale any organization, not just within medicine, but any organization when it comes to like, I want to have a company full of coaches where people are regularly coaching and helping others, what are some more things you would do in that group? Yeah, I mean, I think, so again, that goes back to if we want a company where people are coaching and where people are learning, because I think they're very much in line there.

33:56Again, what is coaching, it's helping people see things from their own perspectives. And so as the leader, am I an individual who's having annual reviews with people? And am I telling them, you know, hey, you're out of here, and this is the thing you're doing good, and this is the thing you're not doing good, and we need you to do this? If you're having a conversation, and that's what it's about, it's likely not a learning and coaching sort of a scenario. If on the other hand, you're meeting with individuals and asking, so what's going on? What are you seeing? What are you afraid of? What are the things you need?

34:25How would you like to approach this? What would you like to be doing, it's actually doing things based on coaching as opposed to just saying coaching. I mean, the culture of an organization is dependent upon not only the things that they say they're going to do, not only the values that they expose, but also actually those behaviors. It's doing it. That's the culture. And if you're saying you're going to be a coaching organization, a learning organization, but you know what, when times get difficult, that's not how we are, that's inconvenient, then your culture is sour. It's not reflective of the things that you say that you're doing.

35:03How do you run one-on-one meetings with direct reports? So it's coaching, honestly. I think that I like the, so there are things as you're running a meeting, there's lots of ways of running it. I like, there's like a consent agenda, which is, these are all the things you need to know. This is informational. This is the data of how you're doing and et cetera. And so if there's something in there that I need to pull out, and I think it's important, I'll pull it out. But I'm not going to spend my time talking about this that much. What I'm going to spend a lot of time understanding is, what is it that's working for you?

35:32What can I do to help you? What would you like to be doing moving forward? How can the organization best help you? What things might get in your way? And so it's going to be 15, 20 % of the data that is organizationally how you're doing and how you fit in and stuff. but then the majority of it's going to be us thinking about how we can help you be the best who you are within this organization. So it's almost like this Socratic method of asking them questions, having them run that portion of the meeting, but then it's on us as the coaches, as the leaders to follow through, right? I've had those managers who asked that at times, but then the follow through isn't there and then it can go completely the opposite direction.

36:15So So you have to be a follow through machine as well, right? When they actually give you the good answers of this is what we should do, or this is what I think, or this could make this place better. As the leader, we have to also be willing, able, and ready to follow through on what they're requesting. Yeah. And as a leader, it's not like you're asking them, like, what should we do as an organization? What should we do as a department? Those decisions are being made. And so as we decided we're going to move forward with telemedicine, how do you fit in within that what are your thoughts moving ahead if they're like I don't like telemedicine I think it's dumb well that's that's what we're doing and so how do you see this fitting in with you we're going to move into this market well I don't think that's a good place I think we should move into this market well that decision has been made so given that how would you like to proceed how can we work together where do you see growth in this for you so it's it's there's still this leadership of what is our strategy and where are we going and how are we going to you know kind of win and be successful?

37:14And how do you fit into that? What do you think of Atul Gawande, I think his name, the checklist manifesto? This was about doctors essentially having a basic checklist before surgeries and everything else. What do you think of that? Yeah, I think it's very helpful. And that's, I think that falls within, as we're thinking about the decisions, like clear things, like there are, so I referred to the, there's a level red trauma, which I go into work tonight, There's going to be a level red trauma. And with a level red trauma, there are these people that need to be there from all these different disciplines.

37:44I have to be at this spot of the room. The patient's going to come here. The paramedic's going to say these things. There's very much checklist-y things that we're going through. And so that is in an environment where the environment is known. And that works out very well because there are things that are that. Because if we don't do this thing that we have shown decreases the chance of bad things happening, then bad things are more likely to happen. You can't use checklists, though, when we're in this complex, ever-evolving, volatile environment. The checklist is something that you get to when you're in this environment where things are quite predictable.

38:23Describe the difference between a time when checklist is good versus a time when it's not. So within medicine, how do we decrease burnout and increase engagement? There's probably some checklists out there, but do they even fit our group? I was talking to a group. Actually, I was taking a group through this the other day, and it was a group of HR professionals. And for them, they thought the way to decrease burnout and improve engagement were to have people go on walks together and use a calming app. And for them, that was very much working. And so they were wanting to do this organization-wide.

38:57these are sorts of the checklists, the things that they were going to do. I just envisioned that going to a medics exec and having a bunch of physicians there and the emergency physician saying, so you want us to walk together? So you want us to use this calming app? That checklist does not work there. And if you go to a group of surgeons or radiologists or whatever, it's going to be very different for all of them. And so there are going to be some things that you can kind of figure out what to do, but the environment is very different for individuals. and I love this kind of concept of, I think it was Stanley McChrystal, who was talking about chess boards within the military and talking about how we like to think that we can strategize like chess, which is if they do this and we're going to do that and we're going to move this piece and then they're going to move that piece.

39:47Oftentimes the decisions that we're talking about are multiple chess boards. They're moving independent of us. We're moving independent of them. and as you're going through your checklist, it just no longer matters. It's not helpful anymore. And so it's recognizing, is this something where we're in this place where it's common sense, where we all agree there are specific steps, use a checklist, or maybe the checklist doesn't work anymore. And maybe we're holding onto this traditional checklist, which is actually hurting us badly and we need to be thinking about things in new ways. i'm curious if you were building the ideal room of emergency doctors what are the things you would look for in a person to be who you could project would be really good at that job like what are the qualities obviously they got to you know go to med school and do all the basic table steak stuff i know that but i'm just talking about the qualities the makeup of the type of person that would be good at that job?

40:44Yeah, I mean, so, and I've certainly been in positions where I've hired and fired before, but the, the, the, it's just like for anything. I mean, the, the, they need to be there in terms of the knowledge. And so you're going to use whatever. And so it's for medical school and how have their scores been? They did residency. What were their evaluations? You're going to talk to people and hear about how they, they do and how they, you know, how knowledgeable they are. That's one thing. And then the other thing is how well are they going to fit in with a team? How well are they going to work with you?

41:14How well are they aligned with these values? Are their goals moving forward and aligned with the organization? And you're going to be asking questions about this. But I think that, and there's lots of ways of approaching this. At Mayo, the way things work is that you get hired, but you're not, you're kind of on this, you're not yet a full, we're hired as a senior associate consultant. You don't become a consultant until three years in, and then that's a vote by your department. And so there is a metaphor where, geez, I want to create an Olympic swimming team, and I don't remember where this came from.

41:51So there's this new coach putting together this Olympic swimming team. So what do they do? Do they put people in a room and ask them how fast they swim? Okay, they do. Oh, I swim really fast. Great, you're on the team. Or do they wait and see how fast they swim and how fast, you know, how well they take direction and move forward? you need kind of probably a combination of those things and so there's probably the interviewing but then after they come into the organization how well are you orienting them to the organization how are you are you developing them and aligning with values and then are you still making a decision whether the right person or not so in that analogy if if you realize oh man they're not a very fast swimmer are you able just to get rid of them or like what do you do yeah yeah i I mean, you know, and certainly it's not, it should not be a surprise to anyone.

42:37Yeah. There needs to be steps along the way of how are you doing. And for us, there are specific numbers of publications you need. There's ways you need to fit in with practice, clinical practice. There's education things. There's your, the, with the nurses, the physicians who are working with you, what they, how they feel. And so all these things come together. You don't want to start at year zero. And then at year three, this is how you've done. you want to have multiple points of contact along the way to help individuals. I think that's an interesting way to make hiring decisions and firing as well as promotions.

43:11My dad would always tell me that when I was trying to make decisions of who to hire for manager roles, when they're going from individual contributor to manager, he's like, you got to find a way to get them in the job, to have them do the actual job of the thing. So if you can simulate it as best you can, put them in a little probationary period of actually doing the role, they may actually realize they don't want to do that job too. That's another thing that happens. And so it's like, in a way, I think we all could probably get better at trying to put people in the actual pool swimming laps, as opposed to this listening and them tell you that they're fast swimmers.

43:48Yeah, I think that's very well said. And also, as you were saying, the recognition that it needs to really be good for both sides. Right. Because we hire someone we tend to think about from the organizational perspective. But if this person's in the wrong job for them, it's really best for us together to decide that we should probably move on and find a better place for each of us. Yeah. I'm curious, Rick, what's next for you? You've built this amazing career. You're still in the prime of it. What's next for you? Yeah, I don't know. Probably more of the same. You're going to write more books? That's a good question.

44:19Perhaps, perhaps. What would you write your next one about? I mean, the last one, by the way, is called, again, and you are the leader now, what leadership lessons from Mayo Clinic, what would the next one be focused on, you think? And so that book, it touched on one-to-one stuff, but it really is focusing on how to lead teams. And I think the next book would be really more from a coaching on a one-to-one perspective and how we can help each other, how we can help ourselves, yourself as a leader, kind of process the things that we need to do. I think that's it, how to be most effective as in these one-to-one conversations.

44:51How does writing help you from a leadership perspective? Yeah, it's definitely a learning thing. And it's not something that I think that's work, first of all. It's deciding to do that and then doing it and then going through and getting ideas out, playing with those ideas. For me, a lot of the anxiety that I had while writing was, geez, am I going to get this right? I'm building a lot of these ideas based on the ideas of others. and I didn't want to do disservice to those ideas. And so that in itself was learning about, first of all, myself and the concern about what other people are thinking and whether I'm serving their ideas well, but then also getting more in depth into those ideas and to better understand them so they can make sure that I'm really doing a good job.

45:38Writing is very much a learning exercise, very much. Doesn't it create, personally, I have to sense this from you too, it feels like, as you already said, it's a learning exercise. it creates such clarity of thought to get the thoughts out of your head onto the page. Because you don't fully know what you think about something until you try to teach it to somebody else. And writing is a great form of teaching. And so to me, I think leaders should have some sort of a writing practice, if anything else, even if they don't share the writing, but to do it for themselves to clarify their thinking. yeah and i and i think the also the thing for me that was helpful there was not just writing what i thought but also having the experiences to draw from it and so to trial some of these things out to see how they're working what's not working and so i'm writing on paper but i'm also editing in real life to try to identify what's working and what's not working and i think it created something better for it.

46:37And you being an active practitioner of this stuff in real time as a doctor, as a coach in the boardrooms, that adds so much credibility to the ideas because they're literally being brought to life every day. Yeah. And really the book is a lot about dumb things that I've done. And that's where, for me, where the points of learning and like how to improve. And I think for all of us as leaders is this acknowledgement that we're going to make decisions and do things that we aren't, geez, I would have approached this differently and learning new ways from it. The things I do offer me a lot of learning opportunities.

47:17In the military, they have these after action reviews after missions. I've spoken to a lot of fighter pilots, generals, right? McChrystal, you mentioned I've had them on a few times and they're really good about their after action reviews, the debriefs, the check your rank at the door, go in there and just let's talk about it. What about in the medical profession after an emergency comes in or at the end of the day? I'm wondering, what's your after action review process? Yeah. And so that's changed. And so it used to be, so when I was in training, we'd have M &Ms, morbidity and mortality, and you did not want to be called to go to M &M because it'd be talking about a case where a patient had a bad outcome, whether they died or whether they were injured based on the care and the way that was done was it was okay everyone let's tell winters all the things he's done wrong and how they you know he should have approached it in this way and it so is a very anxiety provoking and the way you learned was to hear about all the bad things that you had done and for someone any other people in the room you're thinking geez i'm glad it wasn't me because i could have easily done that not a good learning environment in an environment where actually you don't want to be found out and so now what happens is we do things we get rid of the names we have people review the charts so they can't necessarily tell who it was that was involved they go through and we're looking not only for the specific actions of the physician or the nurse or whoever was involved in the care but also stepping back and looking at the process as a whole oftentimes what happens is mistakes are made because individuals are put in positions where resources that are needed are not there, the support is not there, and that gets in the way.

48:59Or perhaps where there were so many things going on that it would be hard for anyone to deal with that. And so it's very much more of this kind of learning environment. It's looking at the system issues. It's looking at the individual issues. And a good M &M Now or quality sort of analysis these days is going to look at all these different causes. And then there's going to be some homework on process things to improve and much better. That's good to hear. That is. I think we also can learn from all of the successful, the great outcomes, not just the ones that go bad. We learn from success and failure.

49:39Rick, one more question before we go. I feel like you just have this overall life knowledge in addition to building an amazing career and living it out as we speak. So I'm curious to ask if you're meeting with somebody a bit earlier in their career and they say, Dr. Winters, I don't necessarily know what I want to do yet because I just graduated undergrad, but I do want to leave a dent in the world. I want to make a difference. I want to be a positive contributor to the world. What are some general pieces of life slash career advice you'd give to that person? Yeah. And I think number one, I am not, for me, I'm not going to be a mentor there.

50:16Meaning I'm not going to say, hey, geez, if I were you, I'd go to this college. And if this is your interest you should take this major and after you do this major then hook up with these people that's just i feel like and at that time and we can we i mean individuals are going to listen to me to you and they're gonna like it's a blueprint for their life and i i feel like i can do a lot of harm in that sort of environment i feel like i want to coach and so what i want to do is to help them understand like what is it that's interesting about this to you i'm gonna And so what is it you're thinking about doing?

50:53How can you better kind of understand what your options are? Who might you reach out to to hear different things? And so that's one thing. And I think another thing is to understand that, I guess, this would be maybe the mentoring thing or the teaching thing, which is that, as we talked about earlier, the job that you're going to have tomorrow is likely not even available today. And so if you're looking at what the jobs are today and you're trying to prepare for it, it's just not where you should be going. It may not be you. And so going back to identifying those things that are of interest to you, where you want to put the work in, doing it, and then moving on to the next thing.

51:37But along the way, I think seeking multiple different perspectives is a helpful thing. Again, from that individual, this is in a complex space. You don't want to just listen to the father or the mother or the uncle or this person that was very influential. You want to get multiple different ideas and figure out how to move forward in a way that's best for you. Super helpful. If you want more, I think the book is called You're the Leader, Now What? Leadership Lessons from Mayo Clinic. Dr. Richard Winters. Man, it's awesome to have you here on a Learning Leader Show. I would love to continue our dialogue as we both progress, man.

52:12Yeah, definitely. Thank you, Ryan. And a big thank you to Ed Batista for connecting us. Another great coach. He told me, like, you're going to love talking to Rick, and he was absolutely right. So a big thank you to Ed. And again, Rick, thanks again. Talk with you soon, man. Thank you.

52:28It is the end of the podcast club. Thank you for being a member of the end of the podcast club. If you are, send me a note, ryan at learningleader.com. Let me know what you learned from this great conversation with Dr. Richard Winters. A few takeaways from my notes. I liked the three parts of leadership. First, teaching, which is sharing with others what they need to know or how to do something. Then mentoring, help them see the world from our eyes. Then coaching, which is where we really focused. Help them see the world through their eyes. To do that, we must be good listeners, ask questions, listen, ask follow-up questions, and challenge them.

53:12But it's important to understand the different elements of leadership, teaching, mentoring, and coaching. And then follow what's interesting to you. In order to figure out your passion, you have to do stuff. You've got to take action. That's really the only way to fully learn what you're good at and what you want to do is to get out there and do it. You have to be willing to try, fail, and keep going and figuring out where you excel and what you're most curious and passionate about. That's how you find what your true passion is and if you can create a career around that. Some people can, some people can't, but the only real way to figure that out is to do it.

53:55And then I like that the structure is leadership dyads and triads at Mayo Clinic where they may group up a doctor, a nurse, and an administrator to help them make decisions because this way you gain the perspective from a wide variety of people from different angles and different set of life experiences where they all can share, hey, have you thought about this? and setting it up in a triad, I think, could be useful if we could figure out a way to do this beyond just in healthcare and do it at our places of work. Once again, I want to say thank you so much for continuing to spread the message and telling a friend or two, hey, you should listen to this episode of The Learning Leader Show with Dr.

54:39Richard Winters. I think he could help you become a more effective leader because you continue to do that, and you also go to Spotify and Apple Podcasts, podcast, you subscribe to the learning leader show, you rate it hopefully five stars and you write a thoughtful review. And by doing all of that, you are continually giving me the opportunity to do what I'm passionate about, what I'm curious about to do a job that I love on a daily basis. And for that, I will forever be grateful. Thank you so, so much. Talk to you too. Can't wait.