Bringing Intention to the Work of Reflection (Podcast)

As Chair of Emergency Services and Vice Chief of Staff at Cleveland Clinic, Bradford Borden, MD, is mindful about creating time for reflection, both before and after the work day.

In an interview with Brian Bolwell, MD, for the podcast “Beyond Leadership,” Dr. Borden explains that he goes old-school every week, printing out his calendar so he can review it on Sundays and consider the week to come.

“I make notes on the meetings, so I make sure to get important points across, or the points I want to remember. But I remain very flexible,” Dr. Borden says. “In emergency medicine, you never know what’s coming in the door. So yes, things will get bumped around changed and you just go with it.

“But then before I leave the house in the morning, I look at that calendar once more, say, OK, what should I be thinking about here? And that’s the way I use my time (driving) in,” he adds.

Dr. Borden brings intention to these reflections, and to being honest with himself about his interactions with members of the team.

Podcast excerpt:

Dr. Bolwell: A lot of people say it’s important to start with why you want to go from point A to point B, but I think equally important is how are you going to do it? Saying you want to achieve X is great, and I think extremely important, but sometimes you also have to be with your team and say, “OK, if we want to do it, here’s the steps that we need to think about. And what do you guys think?”

And it gets back to your psychological safety point. I think you’ve done this very well. Do you think about this stuff?

Dr. Borden: I think the key to this is that, as a leader, you have to be reflective. And you can do that in a number of ways. I do it in the car going home. I have about a 35-minute ride. And it’s at that point in time when I am reflective for how that day went. And part of that is just having a self-mastery of your pros and cons and being just totally brutally honest with yourself. You know, if I pass somebody in the hallway at 10 o’clock and I say, “Hey, stop in and see me at 3 o’clock, I got to talk to you.” And I don’t tell them why, or I don’t say that the real reason is that I value their opinion and I need to get it on this particular topic because I got to make a decision, I just hijacked him for five hours. [He wonders], am I in trouble? Am I going to get disciplined? Is my job at risk?

And so those are the kind of things I think about. How did I interact with people? Was I transparent? Did they understand that the decisions we’re going to make are iterative, and we’ll come back and take a look? And like you said, if it’s a directive that we all get, sometimes we got to pass it down, then I’m not doing my job if I didn’t explain the why. Because, as you know, we’re all trained as deficit-based thinkers, right? Physicians, as I said earlier, are very intelligent, they’re going to fill in those gaps with their own stories.

And at the same time, I think back: Was I collaborative when I could be? Did I listen? Because your team’s only going to listen to you if you listen to them. So they’ve got to understand that the door’s open. Send me an email, pick up a phone. And that’s the way I think we get unified and we get a team spirit. As many of them have heard me say, there’s no bigger team game in medicine than emergency medicine, because we’ve are side-by-side our whole shift. So you’ve got to be a team-based player and the leader needs to be the same to his team.