Episode 108

You’re the Leader

with Richard Winters, M.D.

April 13, 2023

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Richard Winters, M.D.
Director of Leadership Development, Mayo Clinic Care Network

Dr. Richard Winters is a practicing emergency physician and executive coach at Mayo Clinic. As director of Leadership Development for the Mayo Clinic Care Network, Dr. Winters facilitates retreats and delivers programs that train leaders at healthcare organizations worldwide.


I do not want to be offering advice. I'd rather be helping individuals make sense of their own world.



Nathan Bays: Welcome today to the Dairy Bisbee Show. We have Dr. Richard Winters as our guest today. Dr. Winters is a physician and a professor of medicine at Mayo Clinic. He’s also an international leader, and a expert in leadership development. Dr. Winters. Glad to have you.

Richard Winters, M.D.: Yeah. Thank you for having me.

Nathan Bays: Yeah, absolutely. And Dr. Winters, tell us a little bit about who you are, your background growing up, your childhood some about who.

Richard Winters, M.D.: Yeah, I was born to do exactly. This is actually not the answer at all. I was a high school kid who was getting C minus D plus. In my science-based classes and I was doing high school radio and playing in bands and skateboarding and doing all those sorts of things. Having fun with friends. And so if I would’ve, and actually the first time I told my parents, I think I wanna be a doctor. They’ve, they very appropriately laughed at me. And so after high school though I did I started liking science and thought healthcare as a potential career. At that time my grandmother got Lou Gehrig’s disease and so she was in our. And my mother took care of her and I helped on the side and I saw in their she started developing an interest in medicine and then started working at the hospital. I was a monitor tech, so I’d look at ECGs and work the night shift while I was going to college, and I’d go to sleep and I’d see ECGs in my head and, go to school during the day. And so that really was the start.

Nathan Bays: So tell me, Dr. Winters a little bit about, college and when you started to develop your interest in medical school.

Richard Winters, M.D.: Yeah, so I so I did very well in, in college. I ended up doing okay and then went to Mayo Medical School and so that was in Rochester, Minnesota, and that was, it was class size of 40. And so a very small school and very, a lot of great people and obviously, and Mayo Clinic is huge and so was this opportunity to be in this place to learn medicine. Where it felt like this was the place where discoveries were occurring and really difficult, complex diseases were being cared for. And it, it was very exciting to be a part of that.

Nathan Bays: So Dr. Winters, who were some of the individuals, classmates, professors who had a, had an impact on you while you were at medical school?

Richard Winters, M.D.: Yeah, so many, it was really Class by class. You’d see these you’d meet these professors and then obviously colleagues, the my classmates, the people I’d be working with, and it was just this. Concentration of in individuals that were, it was like this next level. That was very inspiring for me and it was exactly the right time for me. I’m gonna keep going with this theme cuz this has been the theme in my life where high school, I wasn’t this great student. College, I turned it on. And then in medical school I did well, but I was not an individual who attended all the classes. So I was an individual. I won the worst attendance award that was, so I guess for all the parents out there, there is hope for you. For me now as I look back, it was, it just wasn’t my way of learning. Was not sitting in classes. I ended up reading and getting the information in in different ways. But I think medical school, college was really growing into who I was and how I learned and that offered me that,

Nathan Bays: So you’re finishing medical school and you’re trying to decide around, what actually specific type of practice you want to have. When did you become interested and how did you become interested in emergency medicine?

Richard Winters, M.D.: yeah, medical school, I thought I was gonna be a surgeon. I I appreciated this idea of. Really technical ability and being able to go in and take care of a patient with pure skill and knowledge. And I found that there were a lot of different specialties that actually did that. And I started hearing about emergency medicine and I took a test, like a personality test I was looking at. Who I was and what sort of life I wanted to live. And I don’t even remember the name of the test at that time, but it ended up that emergency medicine was the fit for me. And so I ended up going into emergency medicine and it really is a fit. It’s it’s this opportunity to be able to take care of the whole breadth of the population at any age and anything coming in at any time. And being able to work with people who are doing that and at any hour, But on the other hand, going home and being able to have time to, to think about other things and develop myself in other ways.

Nathan Bays: So Dr. Winter. When did you start to become interested in leadership development? Was it related to your own leadership opportunities or was it al, has it always been an interest that you’ve had? Share a little bit about, when you started to focus your time and energy on understanding leadership, how to become a good leader and developing leadership development curriculum to, to teach others.

Richard Winters, M.D.: Yeah, I think it’s, I’ve always been an individual who I get interested in things and want to learn more about it and pursue it. And and so finished residency and now I’m practicing and taking care of patients and start seeing things that aren’t working, things that could work better. And then, and that was the time where I first started having leadership opportunities. And so then it’s geez, am I gonna go to the meeting? And just, it’s, I’m seeing a patient, I take a history, do an exam, and then I, physicians write orders and it can’t be too much different. So I’m gonna go in a meeting and I’m just gonna tell some orders and things will change. And then you find out that it’s quite different. It’s quite different inappropriately so and so as I’m in that sort of situation, feeling like I’m not doing a good job and wanting to learn how to do a good. That’s where kind of a leadership thing started. And so then I’m hearing the hospitals leaders speak a language of finance and economics and things like that, that I was not familiar with from medical school. And so then I did an MBA and that gained this understanding of the language and it was a lot of fun. And then as I was in my mba. And and this was another thing, I went to University of Texas at Dallas and this was, it was great because it was 40 physicians. I saw medical school as 40 physicians. And this train program for this MBA was 40 docs. And as part of that, there was a module about executive coaching, which I had never, I didn’t have really any idea. I thought it. Talk about your feelings. I didn’t really know what coaching was. It was either that or it was like Bobby Knight shouting things from the sidelines. But what I found in this program was coaching was this way of thinking about how I’m thinking, and about how to help others think about how they’re thinking and how to help them be effective. And so as I completed the MBA and the coaching course, Then the career just went different routes on the one hand coaching executives and so healthcare leaders and that practice. And that’s wonderful because then I’m learning about all these different spaces. On the other hand, becoming me I was managing partner of our democratic group and then becoming president of the medical staff and then hearing about all these different experiences from the other specialties. And then seeing opportunities within the managed care spa, managed care pa space of being able to take care of populations of patients and how to do that in a way that is high quality with good economics and empowering that, that was just gambling in all those different things. It was wonderful.

Nathan Bays: So when did you start to think about devoting more of your time and your career to leadership development? And how did that intertwine with, the transition back to the Mayo Clinic?

Richard Winters, M.D.: So one of the things that I found when I was in California, and it was great living there, was that I was looking for a system that was values-based. I found my sense at the time was that, Healthcare was being patched together in different ways, and that organizations would acquire other organizations with, bottom line reasons, which makes sense, but that the culture was not feeling right for me. And so during the kind of the later years in California, I started thinking about, geez what could I do that fits with. Who’s more like who I am. And I had this thought of going back to Mayo and I didn’t know how to do it. I didn’t, had maintained connections. And it’s not like you’d go on LinkedIn and just like friend someone and they’d say, okay, yeah, welcome back. And I was giving a talk cause I enjoy giving talks and one of the individuals in the audience was one of my former MBA professors. Who said, Hey, what would you like to do? And I said, you know what, I’d love to go back to Mayo Clinic. And he said, do you know this individual who was the chief HR officer of Mayo Clinic? And I said, no. And he said let me introduce you to her. And so that got me back into Mayo. And Mayo Clinic is is a place like many academic places are, where people go up the ranks where they didn’t have emergency medicine at the time. Emergency medicine residency, we do. But you would go from residency to fellowship, you’d stay on and ascend the career there. So it was a little unconventional at the time, less so I think now, but to be mid-career and jump into an organization like that where I don’t have the relationships. And so one of the, our chair at the time, ay Sadi, is a wonderful individual, said, Hey, would you like to be chair of finance? Because of the business background. And she admittedly said, I’m not sure what you would do with that. But I said, yeah, that would be great. And so I, on the one hand taking care of patients on the other hand, and we have 21 emergency departments chair of finance overseeing those sorts of things. And then really enjoying the coaching and leadership development aspect. Trying to find ways to be able to exercise that. And so it started growing from there and I’m happy to talk to you about how that happened. But that’s it. It’s continued to the day and I’m still, I still see patients 50% of my time is seeing patients and within the clinic. I think this is something that is special about Mayo, is that for the majority of our leaders at all levels, the physicians are still seeing patient. And then, so there’s always this connection. And then the other 50% of my time is divided amongst the leadership development and then also the finance opportunities.

Nathan Bays: So Richard, you’re spending half your time with patients and half your time with on leadership development opportunities. What was the transition, what was the bridge into to being more active on the leadership development side? Where did you start?

Richard Winters, M.D.: Yeah. And that started out so as an executive coach and there’s, there were less executive coaches who were physicians. I think there still are not many. I’d love to see more. I started coaching internal leaders and so chairs and so physician administrative and nursing leaders and starting some leadership development programs. Just talking about things that I had seen work in other places and things that I was reading and sharing that, and so that blossomed. I still am coaching my coaching practices less. I’m probably four or five clients at a time, internal clients focusing on, but then otherwise, it’s helping. Basically, leaders deal with really complex situations.

Nathan Bays: When you’re spending time with clinical leaders, with physicians today what is the largest challenge? What do you spend your time? You know where is most of the time allocated to?

Richard Winters, M.D.: The largest challenge is just this, you’ve heard of like vuca, right? This volatile on certain complex, ambiguous space, and healthcare is all that things are changing tremendously. The the financial aspects of it the disease, the technology the patient needs. All this is just, it’s not at all static and The biggest issue is dealing with this complexity. And so on the one hand you have all this complexity and on, on the other hand, finite resources and time, and how do you deal with that? That it’s just and so the you can throw a number. There are lots of problems that people face, but that’s generally it. And then as we’re seeing within healthcare, how do you maintain yourself? How do we not burn out? And as we’re making decisions how do we not burn out each other? It’s very d.

Nathan Bays: So you mentioned Dr. Winter’s physician burnout and physician burnout is particularly post covid. It is. An issue that I think we all hear about frequently. It’s something that physicians and clinicians more broadly are struggling with. It was an issue before Covid, but Covid has certainly amplified burnout. Share with us a little bit about, burnout from your perspective and as you’re working with leaders, how do you, clinical leaders, how do you shape their thoughts around you? Leading their teams, leading their staff in confronting the burnout issue.

Richard Winters, M.D.: Yeah. And so with this complexity comes change and this and that change can be. And let’s just go back to, let’s say 10 years ago. And so when I’d give talks, if I were to ask how many of you are experience are experiencing burnout? And hardly any hands would raise. And then now as I ask, how many are experiencing burnout? It’s really the whole room that raises their hand. And so have we created burnout? Did it not occur 10 years ago? And I think that it did occur 10 years ago, maybe not to the degree. Maybe to the degree, but I think now we have a language. We understand what burnout is, and so as we develop a language, we can see that, geez, there’s, this is not good because as individuals are burned out. We know that quality goes down. We know there’s huge personal effects. We know that the care of the patient goes down. We know costs go up with churn. There’s lots, all these sorts of reasons why burnout is bad. So what do we do? And I think then the next step, and I think we’re honestly, we’re still at the beginning of the next step, which is what is the language of the opposite? And so one of the questions I’ll ask, I’ll give a talk to all our new physician and scientists hires. And I’ll ask ’em. So how many of you can name six causes of metabolic acidosis and they all raise their hands? How many of you can name the 12 cranial nerves and they’ll all raise their hand? How many of you can name the six components of psychological wellbeing? Nothing. So we’re physicians like we have the language. I can tell you about everything, all the anatomy and physiology. A language of wellbeing. We still haven’t, we still haven’t created. And so I think we’re starting to understand different elements of that. But now as a leader, I can start to think about, geez, what, how am I making sure that people are feeling heard? How am I making sure that I’m connecting with individuals, not offering opportunities? How am I representing and embodying the mission and the values of the organization? And so the, so now there’s like process things and tactics and ways that, that we can move forward.

Nathan Bays: What makes a good leader? From your perspective? What are things that you look for and what are characteristic?

Richard Winters, M.D.: So and so this, I think is, this is another part of the language and I think of leaders as wearing different hats, and I think the inclination of that sort of circumstance would be to really mentor that individual and tell them from my perspective, what I see for their future and what’s gonna happen. And I can’t think of anyone as I’ve gone through my career and where I’ve come from and where I’ve gotten, that would’ve given me the advice that, that would’ve made any sense at any point in the way to where I am right now. I know that today there are jobs that weren’t there two years ago. And I know that, that tomorrow there’s gonna be a new job that isn’t there now. And so I think an error that many of us have and not just within medicine, is approaching individuals like what’s happening now and what our perspectives are, and thinking that if we can tell them how we created our cv, our resume, that this is going to work for them. And so more and more I’m trying to encourage individuals to, to not proceed as a mentor and but to proceed as a. And so for me I do not want to be offering advice and I’d rather be helping individuals make sense of their own world. And so the difference. A mentor looks at your experience at what’s going on in your life and tells you what they see through their eyes of your experience based on what I’ve done and said I think you should do this. You may wanna consider that they may do this, so you may wanna do that. I would suggest that you do this so you can add this to the cv. That’s a mentor sort of phrase. Whereas a coach is helping someone see through their own eyes. And so as someone is wanting to be a leader I think that’s great and someone wanting to hear more about that. What is it that you’re interested? And so what is it about leadership that’s attractive to you? How do you think you might pursue this? How have you seen others pursue this? And as much as possible approach from that perspective. And I think generally that’s not just one-to-one conversations, but that’s also as we’re with colleagues in groups of colleagues dealing with these really complex situations, I can either go in there and say this is what I would do. I’ll write an. Or I could ask my colleagues what are they seeing? What do they think is going on, and then where do they think we should move from there in helping to facilitate those sorts of directions.

Nathan Bays: So you’ve developed your own framework. You spend lots of time sharing your framework and your lessons with aspiring leaders and active leaders. Share with us a little bit about, what makes a good leader and what is important in the development of leaders.

Richard Winters, M.D.: Yeah, I think that’s the question is why even focus on the development of leaders? Why not just hire smart people and have them make decisions? And they’re, I think we, we know so, so there, and I love the work of David Snowden the Conent framework, this concept of what sort of decision are we making? And so just briefly, there are decisions that we make that are clear where we would all agree on what to do. And so when a patient comes in with a trauma, we have 20 people in the room. There’s specific things we do that is easy. There are things that are complicated. And for those things that are complicated, all we need is our. People who have been there and done that and know what to do. And in both of those decision types, those domains we’re dealing with knowns. And so we can we know what to consider, we know what the possible outcomes are, and we go from there. And as a physician, oftentimes I’m dealing with the known stuff. I’m an expert and I’m going into the room, taking care of patients, taking care of the trauma, the heart attack, those sorts of things. Leadership is not that. And in most cases, leadership is not that. It’s actually. Complex, uncertain, volatile stuff. And so in that space, if I go as a leader, just hire someone who’s smart and has some boldness and can tell people what to do, I’m gonna be making decisions that are, I’m just gonna be missing out on key things, big blind spots. And how do you help individuals? Escape this like expertism and go towards being able to, to include other perspectives, do so efficiently. Being able to represent mission and values of the organization, achieve goals and those sorts of things. It means you’re gonna have to train individuals to be able to do that. Cause this isn’t something that is innate for both for most.

Nathan Bays: So Richard how do you think about the right leaders at the right time for different organizations? Obviously small companies, entrepreneurial companies need different leadership skills and attributes. Some different skills and attributes than larger organizations. Just talk to us a little bit about right leader, right leadership skills in the right time or growth stage of the organization and how you think about that as an expert in the space.

Richard Winters, M.D.: Yeah, I think that very much depends on the situation, the life cycle of a company and the size of the organization. And. So there are some organizations where things are changing quickly. There’s not a lot of time and you need a ne a leader who’s just gonna call the shots. And it’s a time where resources are available and you’re just gonna keep pushing and that is what’s needed. And so do you need the masses to admire what you’re doing? And are you needing connect? Maybe in those moments you’re not. But at some point for all organizations, there’s this curve that happens where it moves from this rapid. Cycle to, to something that’s smoother and slower as you’re scaling. And so it requires this agility. And if you’re going to be working in a way that’s going to not be encouraging autonomy, not going to be encouraging the growth of those that you’re working with, not going to be encouraging relatedness between those that you’re working with it’s not gonna be working out long term and. I don’t, I think that’s maybe the question for me. It is our best leaders are have this agility to be able to pivot. They can step into, to making decisions sometimes, which are not popular but need to be made. But on the other hand during appropriate times, they also step back and they’re able to facilitate the larger group. And as a part of that, that’s gonna involve more empathy and hearing and hearing of different experiences and stepping into individuals world, which is maybe gonna be more supportive.

Nathan Bays: Final question, Richard, from for me is, advice that you would have for aspiring leaders who are in a medical school, graduated medical school, young physicians, clinicians in their career. What advice do you have and would you share with them?

Richard Winters, M.D.: Yeah, I think the key thing is, To pave your own path. And that can be difficult because you’re gonna be wanting to understand what the path is. And as you’re trying to figure out the path, it’s very uncomfortable. And so to recognize that those moments you’re gonna make some bad decisions, you’re going to do things that you wish approach things in ways that you wish you had not done that, that to understand that you’re growing in those moments. And so these are the times where you step back and figure. How to do better and how to approach things in ways that are more helpful. I think a lot of the leadership stuff is leaders learning themselves, developing themselves, recognize their own fears and worries and then working through that.

Nathan Bays: Perfect. Dr. Winters thank you so much for joining us today on the Gary Bibe show. Your insights around leadership development have been valuable and will be invaluable to the. Audience that’s listening, you’ve had a fantastic career. Thanks for sharing a little bit about your life and childhood trajectory, career. Hope to have you back some point in.

Richard Winters, M.D.: All right. Thank you, Nathan.

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