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5 MINUTE READ THE FUTURE OF WORK

How A World-Class
Heart Surgeon Found
The One Leadership
Trait Many
Businesses Are
Missing
How could a decorated war surgeon and leader
of the best cardiac care clinic in the country
possibly have more to learn about leadership?

[Image: Flickr userHelge

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Helge V. Keitel]

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 M A R K C. C R O W L E Y 0 8.1 4.1 4 5 : 0 2 A M

Ten years ago, right before he became CEO

of the prestigious Cleveland Clinic, 65-year-
old Dr. Toby Cosgrove had good reason to
believe he’d already acquired all the
knowledge and wisdom he needed to excel
in his new role.

The man, who recently was President

Obama’s first choice to take over the
troubled Department of Veterans Affairs
following the resignation of General Erik
Shinseki, could not have been more
qualified for the position. And few people in
his field, moreover on the planet, had
amassed a more stunning list of career
achievements.

Dr. Cosgrove had earned a Bronze Star as a

Vietnam surgeon. He’d performed 22,000
surgeries, patented 30 different medical
inventions, created a highly profitable
venture capital group, written 450 journal
articles, and led the clinic’s cardiac care
team that U.S. News & World News Report
named best in the nation for 20 consecutive
years.

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 But as Dr. Cosgrove shared with me
recently, soon after he took on the job he
painfully discovered there was one essential
leadership lesson he’d yet to learn. And it
was largely a result of this late-in-life
epiphany that he was able to transform the
Cleveland Clinic into one of the most
admired, engaged, and profitable health
care organizations in the world.

LESSONS IN EMPATHY
The Harvard Business School was so
impressed with the decades-long success of
the Clinic’s heart care program that they
invited Dr. Cosgrove to participate in a case
study at its Cambridge campus.

While standing on a stage in an auditorium

filled with students and faculty, fielding
questions in what should have been an
entirely celebratory experience, he called on
a woman who’d raised her hand.

"My father is a doctor too," she said, "and he

has mitral valve disease. After doing
research, we know you’ve done more of this
kind of surgery than anybody else in the
country. But we finally decided not to come
to you because we heard you didn’t have any
empathy. Dr. Cosgrove, do you teach
empathy at the Cleveland Clinic?"

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 The student’s question left him shocked and
momentarily speechless. But it was 10 days
later, at the inauguration of the clinic’s new
facility in Jeddah, Saudi Arabia, where yet
another striking experience forced him to
fully confront the question.

"The president of our new hospital went to

the podium to make some remarks," Dr.
Cosgrove told me, "and he told everyone in
the audience, ‘This new clinic is dedicated to
the body, and the soul, and the spirit of its
patients.’"

When Dr. Cosgrove looked over at the

hospital’s sponsors, he saw that both the
Saudi King and Crown Prince were weeping.
"What I understood in that very moment
was that those tears were expressions of
sheer gratitude—for the fact that we
intended to care for much more than a
patient’s physical body," he said.

The back-to-back experiences were so

profoundly impactful that Cosgrove realized
he was "missing something very important"
that required him to take "a long, hard look
in the mirror."

What he ultimately discerned was that he’d

unconsciously subordinated his feelings—
his heart—in the interest of becoming the

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Page 4 of 17
 best surgeon possible.

Recalling that heart-surgery-related deaths

were in the double digits when he began his
career and that he’d witnessed five children
die on just one day during his medical
residency, Dr. Cosgrove realized he’d
unintentionally become a "cardiac surgical
technician." He’d become a doctor who
focused exclusively on the precision of his
work, rather than on connecting more
personally with patients and supporting
their emotional needs.

"Cut well, sew well, do well" was the

operating room motto.

CHANGING THE DIRECTION OF THE CLEVELAND

CLINIC
Dr. Cosgrove wasted no time putting his
new understanding to work and
immediately began to bring elements of
compassion, kindness, and empathy back
into how his organization was led and
managed:

In meetings held with all employees, he

announced that the mission of the
organization going forward was to make
patient health and well-being its sole
priority.

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Page 5 of 17
 "I believe everybody wants to be associated
with a higher calling," he told me. "Everyone
wants to be a part of something bigger than
they are, and I believe you have to give them
that vision. And so this was the beginning of
me trying to instill a soul in the
organization. Then and there, we answered
the essential question, ‘Why are we here?’"

Next, Cosgrove created the first ever chief

experience officer position and directed the
entire organization to work on greatly
improving the patient’s emotional
experience.

They hired famous designer, Dianne von

Furstenberg, who created a new "wrap
gown" to cover a patient’s formerly exposed
backside (and restore a little human dignity
in the process). They brought in architects
who found clever ways to add more light
and color to all 75 facilities. And they sent
43,000 employees to a half-day seminar
that taught them how to most successfully
support the emotional needs of other
human beings.

"We also discovered that one of the biggest

complaints patients have is with their
doctor’s communication," Cosgrove told me.
"So we mandated that all of our physicians
be re-trained to be more attentive, caring,

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Page 6 of 17
 and thoughtful."

By digging into the details, the clinic

discovered that 130 different people come in
contact with a surgery patient from the time
they arrive to when they go home. And in
recognition that "any one person along the
line could mess up the patient experience,"
Dr. Cosgrove decided that all employees in
the institution would be called "caregivers."

"It didn’t make a difference if they worked

on a loading dock, swept the floors,
delivered the food, or were a neurosurgeon,"
he told me. "I wanted to ensure every person
knew that they were important and part of
the team. And almost immediately, our
people began taking greater ownership and
contributing at much higher levels."

In the decade Dr. Cosgrove has led the

Cleveland Clinic, he’s nearly doubled its
size, expanded it internationally, and
ensured it continues to be recognized as the
most innovative health care organization in
the country.

But the reason President Obama was so

vocal with his respect recently is because of
its extraordinary standards of care. Last
year, the average emergency room wait was
just 11 minutes—and they fulfilled 98% of

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Page 7 of 17
 patient requests for same-day
appointments.

Dr. Cosgrove insists that deeply caring

about people—patients and employees alike
—is at the root of all their success (and the
nearly $1 billion the clinic earned last year).

But he doesn’t seem to realize how

uncommon and enlightened his leadership
philosophy is in business. "I’m not brilliant,"
he insisted. "I just responded to the cues."

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Page 8 of 17
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TO M A S C H A M O R R O - P R E M U Z I C
1 2 .1 7.1 6 5 : 0 0 A M

This story reflects the views of this author,

but not necessarily the editorial position of
Fast Company.

However the hiring process may be

changing, there's no sign job interviews are
going away from it. It's still almost
unthinkable to land a job offer without
going through some form of interview,
whether in person or remotely. But anybody
who's been on a handful of them knows how
much one job interview can differ from the
next—despite the plethora of advice about
the
the
the
thebest
best
best
bestquestions
questions
questionsfor
questions
questionsfor
for
forhiring
hiring
hiring
hiringmanagers
managers
managers
managersto
to
to
to
ask
ask
ask
ask and which cues to look for.
the best questions for hiring managers to
ask

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Page 9 of 17
 As a result, some job
interviews are much more
Small talk effective than others at
invariably sorting out whether a given
evokes a candidate is the right fit.
range of
biases, After all, while humans in
focusing general are fairly good
interviewers' judges of one another's
attention character, plenty
plenty
plenty
plentyaren't
aren't
aren't
aren'tbut
but
but
but
on totally still
still
still
stillthink
think
think
thinkthat
that
that
thatthey
they
they
theyare
are
are
are.
irrelevant plenty aren't but
behaviors. still think that they are
There are ways to control
for this variability, but that
means turning the
interview process into more of a science
than an art. Still, there may be some serious
upsides to doing that. Here are a few of
them, and what it might take to do it.

GIVING THE JOB INTERVIEW A CLINICAL

MAKEOVER
What would a more scientifically rigorous
interview process look like? Researchers
have devised psychometric
psychometric
psychometric
psychometrictests
tests
tests
tests that aim to
standardize and measure the types
psychometric tests
personality features that many of us—
including interviewers—just try to guess at
subjectively.

A more "accurate" interview might be less

pleasant to experience, but it would likely
need to be more structured
structured
structured
structured—even to the

structured
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Page 10 of 17
 point of resembling a multiple-choice
questionnaire. It would also need to be
longer than most sit-downs with job
candidates tend to be, progressing through a
sequence of carefully selected questions that
are coherently linked to the role in question,
and previously shown to evoke answers that
actually reveal candidates’ potential.

And as in any good

psychological study,
there would always Make no
need to be multiple mistake:
interviewers present.
There's
nothing
The same interviewers natural or
would need to assess all authentic
candidates, though, and about a job
use standardized interview.
scorecards to evaluate
them afterward. Very
few interviewers in the real world probably
set up these sorts of parameters, and it's
understandable why—imagine the resources
and training it would take to turn an entire
HR department into a team of clinical
researchers.

But the alternative means regularly making

deeply subjective, inherently
inherently
inherently
inherentlybiased
biased
biased
biased, and
often painfully misjudged hiring decisions,
inherently biased
no doubt contributing to turnover
turnover
turnover
turnoverrates
rates
rates
ratesthat
that
that
that

turnover rates that

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Page 11 of 17
 are
are
are
aretruly
truly
truly
trulystaggering
staggering
staggering
staggering.

are truly staggering

At a minimum, it doesn't hurt to start small
and weed out some of the most glaringly
ineffective interviewing practices. Designing
more scientifically accurate interviews
would require technical expertise and
clinical experience, but curbing these three
common mistakes definitely doesn't.

1. CUT THE CHITCHAT

Although it's useful to break the ice and
build some rapport with the candidate,
small talk should really be kept to a
minimum, ideally to two minutes or less.
That may sound stern, dispassionate, and
inhuman to some; companies often like to
use the interview experience to let loose,
show off their culture, and see what kind of
chemistry emerges organically. And that's
fine, but it almost certainly won't lead to
making consistently high-quality hiring
choices.

Small talk invariably evokes a range of

biases, focusing interviewers' attention on
totally irrelevant behaviors. If interviewers
want to indulge in it, they'll need to treat
that banter the way reporters treat off-the-
record conversations—something that's
completely irrelevant and not to be included
in the analysis of the candidate.

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 What's more, chitchat can actually give the
wrong impression to the candidate, who
regards it as part of their performance and
over-interprets a hiring manager's behavior
while chatting as either positive or negative
feedback—even if the interview hasn't even
commenced. To be sure, it's is impossible to
control the impressions candidates make on
interviewers and vice versa. But establishing
a clear starting point to the interview and
focusing only on the actual interview
questions is every capable interviewer's
main task.

2. STOP IMPROVISING
When job candidates and interviewers
actually enjoy the interview experience, it's
usually because of the (relatively) natural
personal interaction—at least compared
with tests, simulations, or application forms
that the hiring process often involves. But
make no mistake: There's nothing natural or
authentic about a job interview.

Candidates who approach them as a

spontaneous and natural encounter,
thinking they can "just be themselves"
(common career advice), are likely to fail.
It's of course important to appear authentic,
but the most successful candidates,
researchers have found, tend to put on a

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Page 13 of 17
 carefully
carefully
carefully
carefullyrehearsed
rehearsed
rehearsed
rehearsedperformance
performance
performance
performance and
prepare as much as a classical pianist.
carefully rehearsed performance

Why not expect the same

level of preparation from
Without interviewers themselves?
deliberately No matter how much they
providing a enjoy the sociable
standardized
environment component of the
to all interview, this is an exam
candidates, for them, too. It may sound
you're harsh, but if hiring
already managers are really
being committed to combatting
unfair.
their own biases and
making fairer, more
accurate judgments about
candidates' characters and competencies,
they need to stop improvising. Every
psychological researcher knows how
important it is to follow a carefully designed
script control their own emotional affect as
much as possible. Without deliberately
providing a standardized environment to all
candidates, you're already being unfair.

3. DON'T ATTEMPT PSYCHOANALYSIS

We all make automatic inferences about
others’ personalities even after a few
seconds of interacting with them, but most
of these inferences are wrong. To make

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 matters worse, people are generally unable
to evaluate the accuracy of their inferences,
so we often end up feeling sure about what
someone is like even when we're totally off
base.

Some simple tricks, like aggregating

impressions from multiple evaluators (five
or more) can no doubt enhance the accuracy
of our inferences, but even that would be
less valid and more time-consuming than
scientific
scientific
scientific
scientificpersonality
personality
personality
personalityassessments
assessments
assessments
assessments (unless
the raters already know the person they're
scientific personality assessments
describing well).

At any rate, rather than

trying to psychoanalyze
candidates, you should [Job
focus on a factual and interviews]
data-driven evaluation
are best
approached
of their skills, as a means
knowledge, and for
experience. While the obtaining
job interview can be job-related
used to complement information,
other insights gathered
rather than
vetting
through personality character.
assessments, it's best
approached as a means
for obtaining job-related information, rather
than vetting character. Keep in mind that

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Page 15 of 17
 narcissists and psychopaths tend
tend
tend
tendto
to
to
toperform
perform
perform
perform
very
very
very
verywell
well
well
well during interviews (and first dates),
tend to perform
but scientific psychometric tests can spot
very well
these individuals.

Some of this also helps explain why

computer-driven evaluations of candidates,
as extracted from digital interviews, show
show
show
show
such
such
such
suchpromise
promise
promise
promise. Machines can inject as much
show
structure as needed into unstructured data
such promise
(like a 45-minute conversation) and capture
millions of data points, which can then be
analyzed—not by intuition, stereotypes, or
prejudices, but actual evidence.

While it's impossible even for the most

open-minded human beings to ignore (or
avoid making assumptions about) signs of
candidates’ socio-demographic categories
(age, gender, nationality, ethnicity, social
class, etc.), computers can be trained to
disregard these and any other data. And
while algorithms are only as unbiased as the
people who write them, they could—at least
in theory—prove far more consistently
objective than human beings.

There will be some major hurdles for

technology to overleap before that happens,
of course, which means the typical job
interview isn't likely to change dramatically
anytime soon. But that's all the more reason

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Page 16 of 17
 why a few of the most ineffective human
habits really need to go—sooner rather than
later.

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