Leadership: A Time to Learn
For David J. Cook, MD, MHA, FAHA, life is about learning. Learning, he says, comes from seizing upon opportunities for new experiences that force him outside of his comfort zone. Dr. Cook holds a B.A. in Biology and Philosophy from Lehigh University, an M.A. in Philosophy from the University of Tennessee, and an M.D. from Jefferson Medical College, with residency and fellowship training at Mayo Clinic College of Medicine. He was an anesthesiologist and faculty member at Mayo who received an executive MHA from the University of Minnesota School of Public Health, and has now chosen to live out the next chapter in his career in charge of operations at Jiahui Health and International Hospital in Shanghai. We recently spoke with David about the connection between leadership and life-long learning.
Q: How did you become a physician leader? What’s been your recipe for professional success?
Cook: Physician leadership typically begins with colleagues recognizing excellence in clinical practice. This is where credibility is established and it must be maintained as responsibilities grow. To this end, as a hospital president and enterprise COO, I will spend several half-days a month in the operating rooms and take some overnight calls. This is leading by example; it maintains credibility with the practice, and allows a leader to witness and listen to the challenges of the staff and practice. Credibility comes first.
The second thing, particularly important for physician leaders, is to identify what you don’t know. Physician leaders may be appointed on clinical skill or reputation, but one also needs operational, financial, regulatory, and even HR training to understand how extraordinarily complex healthcare is. The leadership transition begins in some ways with the statement: “Medical school did not train me for this . . . time to learn.”
Q: You’re opening a brand new hospital, with a new philosophy of care and a multi-cultural staff, all in China, where you don’t speak the language. What were your first steps and priorities?
Cook: Walking into an organisation as a new leader is like walking into the middle of the second act of a play without having seen the script. Within the first several weeks I tried to talk with everyone and see what they faced. Following that we did an organisation-wide heat map to try to understand what everyone thought were the challenges the organisation faced. Then we identified priorities and communicated what we would try to do.
Q: Many use the term “cultural competence”, the need for which may be an understatement in your situation. How has culture and language impacted your ability to be effective?
Cook: From day one, and now at a year, the majority of my job is about learning. “Organisational Culture” is a leadership buzzword, and there is that, and then there is China. What Chinese consumers want from healthcare is different from the U.S., how practice is organised differs, the knowledge base and training differs, the financial models are completely different, there is little management expertise, and there are also extraordinary challenges to figuring out how to operate under often ambiguous Chinese regulations.
I am at a disadvantage for not having the language skill, because the nature of communication in Chinese is typically non-literal; it does not have the linearity of English; some terms cannot even be translated. That is meaningful. This does compromise my effectiveness. Real language competence is not realistic in three or perhaps five years, so I can only persist in trying to understand.
Q: How do you integrate Western “standards of care” with an Eastern medical tradition?
Cook: This is the most creative and challenging effort of the enterprise. We have to make sense to consumers, we have to establish credibility in ways patients understand while maintaining Western standards. Anticipating a staff that is 75 percent Chinese nationals, we have to find out where they are, identify targets that are very practical compromises, then do lots of training and even more communication.
Q: In your tenure thus far what have been your greatest accomplishments? What leadership skills or strategies did you rely upon?
Cook: My greatest accomplishment as a new leader, and really an outsider, has been to restructure perhaps half of the enterprise strategic plan before the end of my seventh month. This meant unwinding a lot of things on the roadmap, which people had a stake in, and greatly increasing the focus of the organisation to do many fewer things well. We also introduced a lot of phasing in the strategic plan to be safe, but also to be able to pivot as we learn from the market.
Q: What’s the best career advice you’ve ever gotten?
Cook: There are a couple of quotes I often think about, which are relevant to hard choices like changing one’s life, or facing so great a challenge. I would urge anyone to read Roosevelt’s speech known as “The Man in The Arena”. The other is something Richard Branson said, to paraphrase . . . if a great opportunity comes up, and you don’t know if you can do it, say “yes” and then figure it out.
Q: What advice would you give others contemplating an overseas executive role?
Cook: My experience in China is that in one’s self, there is an absolute requirement for courage, tenacity and adaptability. In facing outward, into the organisation, and to the world it is mostly the latter. One must adapt to the environment, allowing oneself and one’s thinking to be changed. One’s identity and core principles must be maintained, but perhaps changing radically the ways in which those principles are made manifest.