Brian Donley, MD,


Published 8/1/2016
Terry Stanton

The Surgeon As Executive

Foot and ankle specialist describes his second act as a physician leader
For most orthopaedic surgeons in clinical practice, medicine is a singular calling. Care of patients and all that entails constitute a career that offers more than enough challenges, rewards, and personal fulfillment to provide a lifetime of professional satisfaction.

Like many people, however, physicians have interests and talents outside of "the job." For some, these interests lead to career pathways that veer away from traditional practice, either completely or in ways that complement a professional life centered on patient care and surgery.

During the 2016 American Orthopaedic Foot & Ankle Society (AOFAS) Specialty Day, several surgeons who pursue opportunities beyond the confines of clinical practice shared their perspectives in a symposium titled "What Else Can I Do with My MD?" Among the speakers was a foot and ankle surgeon who related how his interest in physician leadership and organizational administration led him to an executive position at the Cleveland Clinic.

Dr. Donley described leadership as a journey, one that began during his 20 years of clinical practice and that he continues to maintain at Cleveland Clinic. "I started out learning leadership traits through involvement with AOFAS committees and as an AOFAS board member," he said. His track at the Cleveland Clinic began as director of the foot and ankle center and vice chairman of the orthopaedics department. As he amassed lessons about leadership, administrative skills, and the importance of "rock-solid character and integrity," he became president of one of Cleveland Clinic's community hospitals, a 250-bed facility with 1,000 employees. In 2015, Dr. Donley assumed his current position as chief of staff and clinical operations for Cleveland Clinic Health Systems, an organization with 49,000 employees, 1.9 million patients, and $8 billion in revenue.

Making an impact
Although physicians become leaders for various reasons, a common motivation is a desire to positively influence the healthcare system, according to Dr. Donley. "For me, it's about making an outcome impact," he said. "It's a second-half, extraordinary opportunity to improve the lives of patients and employees and their families."

The desire for personal and professional development is also a driving force, he said. "All of us—no matter who we are—want opportunities to learn and grow," he said. Yet for physicians, the path to organization leadership is not always clear. "Unfortunately, there is no training for it," Dr. Donley said. "In medical school, our clinical training is completely different work. You'd never expect orthopaedic surgeons to be cardiologists; it's the same with physician leadership. You can't just take clinical skills and walk into leadership and think you'll be effective."

Aspiring physician leaders can benefit from education in business and organizational management, to which Dr. Donley can personally attest. In 2014, he attended an executive program at Harvard Business School. As the only physician in the class of 160, he spent "8 weeks, 6 days a week, getting an external look at leadership in the business world."

The knowledge and experience of physician leaders also brings considerable value to healthcare organizations. According to one study, Dr. Donley said, having a physician as the chief executive was the strongest correlate for a healthcare organization's top rank among its peers.

A new skill set
The leadership, an orientation that is derived from its roots. "We're a physician-run organization," said Dr. Donley. "It's a very subtle difference, but at the Cleveland Clinic, we're actually a physician group; we started in 1921 with four physicians and now have 3,200 staff members. We are a physician group that owns a healthcare system, not a healthcare system that has a physician group, and we put time and resources into developing leaders from among physicians.

"Leadership competencies differ from clinical or scientific competencies, and are not taught in traditional medical curricula," Dr. Donley said. The educational process, he said, "is not only about business, finance, and marketing, but also developmental skills—communication and emotional intelligence."

For example, the Cleveland Clinic offers a curriculum covering basic skill sets and knowledge domains required for managing complex organizations in the following three "buckets":

  • Clinic mission, vision, and values
  • Business, finance, and marketing
  • Organizational developmental skills (communication, emotional intelligence, team building)
Brian Donley, MD,
Fig.1 The four domains of emotional intelligence (EI).

Dr. Donley further identified the following core competencies for physician leader excellence:

  • Knowledge of the healthcare environment: The understanding of the healthcare system
  • Professionalism: The ability to align personal and organizational conduct with ethical and professional standards
  • Communication and relationship management: The ability to communicate clearly and consciously with internal and external audiences
  • Business skills and professional knowledge: The ability to apply business principles

The Cleveland Clinic specifies "driving behaviors" that it expects leaders to exhibit. These behaviors include leading change, fostering teamwork, developing self and others on the team, and demonstrating character and integrity.

Dr. Donley also stressed the importance of emotional intelligence, which consists of 18 competencies across the four domains of self-awareness, social awareness, self-management, and relationship management (Fig. 1). "If you have any interest in physician leadership," he said, "this may be the most important thing you need to get your head around."

In presiding over a massive and complex organization, Dr. Donley concentrates on the broad mandates of strategy and culture. Under strategy falls the principle of "Patients First—continuously improving quality, safety, and patient experience." For employees, termed Caregivers, the goal is to "make the Cleveland Clinic the best place to work." The goal of Affordability is described as acting as a "steward of our resources," and Growth is the "responsibility to sustain our mission."

Dr. Donley also noted his six guiding principles: trust, relationship building, clarity and simplicity, listening, talent, and passion. "These are the things I've learned along the way, the things that guide me in my leadership as I've been on this journey," he said. "Trust is essential. If you are going to be effective, it is critical to develop trust among your team and the people you lead. One of the ways you can do that is through relationship building."

In the very complex world of health care, clarity and simplicity are also important, as is the art of listening, Dr. Donley noted. "Our responsibility in leadership is to provide a simple, very clear message to the people we lead," he said. "Listening is also critically important. When you are in meetings in a hospital," he suggested, "take inventory of how much time each person spends talking. You'll see that the person who talks the most is probably your least effective leader."

Dr. Donley added that leaders must also recruit—and retain—great talent. Finally, he said, "You must have passion for what you're doing."

In detailing these guiding principles, Dr. Donley displayed a photo of a speed boat plowing over the water. "This is a picture I use a lot," he said. "At Cleveland Clinic, we remind all our leaders that they are just like a boat—the bigger their leadership role, the bigger the boat and the bigger the wake they leave behind. So I always ask our leaders: What kind of wake do you leave behind you?

"And as a physician," he continued, "as you work at your hospital and everyone is looking at you to be a leader—what type of wake do you leave behind? Do you have a nourishing wake, where people want to come work for you, want to be their best? Or do you leave a destructive wake behind you?"

When asked why he made the transition to executive leadership, Dr. Donley explained, "It is an exhilarating job that I really enjoy. It's all about meaning and purpose. As much as I still love taking care of patients, I get the same meaning and purpose through physician leadership in an administrative role. Only it's on a bigger scale, affecting the lives of 49,000 employees and 1.9 million patients."

For others who may be considering a similar transition, Dr. Donley offered the following advice: "Find your sweet spot," he said. "Your success as a leader is defined by making others successful and creating the framework to allow them to be the best they can be. Lead by example, have passion, and always be positive."

Terry Stanton is the senior science writer for AAOS Now. He can be reached at