Between clinical objectives, financial concerns, patient needs and complex payer dynamics, there don’t seem to be enough hours in the day for healthcare executives to address the diverse set of organizational goals they are tasked with accomplishing.
Tomislav Mihaljevic, MD, joined the Cleveland Clinic in 2004 as a cardiothoracic surgeon and went on to serve as CEO of Cleveland Clinic Abu Dhabi in the United Arab Emirates before becoming CEO of the Cleveland Clinic Jan. 1. Just nine months into his role, he took the time to speak with Becker’s Hospital Review for our “Living like a leader” series, which examines the daily routines of influential decision-makers to offer readers an idea of how they manage their energy, teams and time.
Editor’s note: Responses have been lightly edited for length and clarity
Question: What’s the first thing you do when you wake up?
Dr. Tomislav Mihaljevic: I’m an early bird so I’m usually up by 4:30 a.m. and I either go for a run or to the gym. I work out until 5:30 a.m. and eat breakfast. While I eat, I scroll through the electronic versions of three newspapers: The New York Times, The Wall Street Journal and The Plain Dealer, which is Cleveland’s local paper. By 6:00 a.m., I’m in the car and while I’m on my way to work I like to call over to Europe, where my daughters live.
Q: What’s the first thing you do when you arrive at work? Is there anything that makes your office setup unique?
TM: My office is pretty minimalistic, very clean. I don’t keep paper, so I do not have any stacks of paper in my office. I work on a standing desk, which I started about three or four years ago when I was still in Abu Dhabi.
The first thing I do at work is sign what I need to sign and review patient letters. I get a lot of patient letters directed to my office, so I make sure to read and answer them. I go over my schedule for the day and do a quick scroll through emails that have arrived overnight. Ideally, I like to empty my inbox by the end of the day so in the morning I have only a few messages to take care of.
The beginning of the week, and the beginning of the day in particular, is always associated with important operational work for the hospital. Executive team meetings, operating counsel meetings, anything that sets the tone for the rest of the week or sets a tone for the rest of the day is done early.
Q: How much of your time is spent with direct reports?
TM: A lot. I would say 50 to 60 percent of my time is spent with direct reports in one form or another. There’s a lot of official meetings along with walking into each other’s offices and taking care of issues that inevitably surface at any given moment. The one-on-one meetings with the director board typically happen on a monthly basis, but as I said, we take care of a lot of issues in a real time and I do not heavily rely on a schedule. My door is always open, so people kind of know when and how to find me. There are a lot of scheduled meetings, but there are a fair amount of unscheduled conversations.
Q: How often do you meet with clinical staff or perform rounds?
TM: I have daily interaction with the clinical staff. I’m a heart surgeon myself. Everything I do in my current position is viewed through the lens of my prior work as clinician, so I really enjoy interactions with the clinical staff. It gives a lot of perspective in the work that we do as an organization. I typically hold town hall meetings three to four times a week with clinical staff at our various locations. I work for them, they don’t work for me. I speak for 10 or 15 minutes and then we converse in an open question-and-answer format for about a half an hour. I try to regularly meet with our institutes and departments and then tour our hospitals.
Organizations typically spend a lot of time creating a mission, vision and values for the enterprise but in actuality, at least in my experience, most members of the organization do not remember those. So, what we have decided to do is use a paradigm that is easy to memorize. I told our caregivers, and I use this paradigm daily: “We have to treat our patients and each other as a family, and this place as our home. And if you use this simple framework for any and every decision that you make at your workplace, we are always going to arrive on the right decision. And I will always support you.” I reiterate this paradigm often during our town hall meetings.
I just really enjoy interaction with caregivers and I learn a lot through our conversations. When I used to run Cleveland Clinic Abu Dhabi, I would always eat lunch in the cafeteria with one rule: I never ate lunch by myself and I never ate it with someone I knew. So, I would always sit down with someone who I had yet to meet and have an informal conversation. I learned a lot during those lunches.
Q: How do you think your routine is different from that of other healthcare executives?
TM: I cannot really speak to this because I do not know the routine of many of my colleagues, but mine is very focused on interactions with the clinical staff. We have locations around the U.S. and in Abu Dhabi, and we want to ensure patients and caregivers at those hospitals feel like a part of the system. That typically involves a lot of direct interaction via teleconference with all of our hospitals twice a week. I have a real-time feed into their activities, so we know every single moment what’s happening in every part of our healthcare system. This year, we implemented a Tiered Daily Huddle everyday at 11 a.m. We receive the real-time information about the quality and patient safety environment in every one of our hospitals, as well as utilization of our resources. I can tell you everyday whether there are any safety events, complications or issues that would adversely affect the environment and safety of our caregivers and patients. On a day-to-day basis, I know how we are utilizing our resources, how many patients we have served and how successful are we in fulfilling our mission.
Q: What is the hardest part of your day?
TM: Well, the hardest part of my day is obviously to navigate a number of different priorities that show up in a day. The hardest part of anybody’s day who is in a leadership position for such a large organization is to reconcile the big picture, where we need to go as an organization, with the needs of different departments and individuals. You must focus on being true to your organizational principles, being true to yourself, and acting in accordance with the values and the culture of the organization.
My transition to CEO with the Cleveland Clinic was made easier because [former CEO Toby Cosgrove, MD] was phenomenal and continues to be a great ally and a huge help. We had a very well scheduled transition that happened over a period of four months where we were literally joined at the hip. We toured the entire organization and he would introduce me to different parts of the Cleveland Clinic. I learned a lot about what is going on in the enterprise during those four months. He was, and continues to be, immensely helpful.
Q: What is the most rewarding part of your day?
TM: The most rewarding part is when I receive a letter or a phone call or somebody approaches me and compliments me on the care that they received at the Cleveland Clinic. That’s by far the most rewarding part of my day. Also, to have caregivers who approach me and thank me for the opportunity to work in our organization. Just this past weekend, we had our first-ever family day at Jacobs Field, where the Cleveland Indians play. It was a wonderful opportunity to invite many of our caregivers to get together and bring their families with them. As I said, we work here as a family, we use the family relationship as a principle for everything we do at the Cleveland Clinic.
It was great. We had the kids of our caregivers, and may of the caregivers themselves, run the bases and to go out on the field. It was just a wonderful reminder about how great this organization is and how deeply people care about the Cleveland Clinic. We’re the largest employer in Cleveland and second largest in the state of Ohio. We play a phenomenally important role in a community, so having a family day was a small token of appreciation for the hard work people put into that.
Q: What’s the last thing you do before you leave your office?
TM: Typically, I want to make sure my inbox is empty. I tend to be pretty good at it. I usually leave around 6 or 7 p.m. Four or five times a week I have some type of reception, dinner or event to go to. But I try to clean my inbox so things do not agglomerate.
Q: How do you unwind when you get home?
TM: I do not usually carry much work home with me. By the time I’m home, I’m done. I’m an early bird, so I try to get to bed on time because having enough sleep is important. That is something I’ve learned as an executive. As a leader you meet hundreds and hundreds of people a day, and every interaction you have with folks is being measured and perceived differently. These conversations may be just one conversation out of dozens and dozens in a day for me, but to the person I’m speaking with it may be the most important conversation they will have in an entire year. So, to be completely focused and dedicate the appropriate amount of attention and respect in conversations with your coworkers, you have to be at the top of your game every single day. You cannot do that unless you take good care of yourself.
I do not watch television, but I like to read. I always have books everywhere. Before bed I’ll get a good read and that’s about it. I tend to read several books at the same time, and I’m currently reading a book by Steven Pinker called Enlightenment Now. It’s very interesting. Another one I just completed was a book of essays called Watermark by Joseph Brodsky about his winters in Venice. It was a wonderful read.
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