We already know General Rice, I introduced him extensively. And then next we have Valerie Camilo. She's the past former president and CEO of Comcast Spectator Sport and Entertainment Division, which includes the business operations of the Philadelphia Flyers and the Wells Fargo Center. She's also previously served the Washington Nationals and the NBA marketing business. And so she's got extensive experience in Philadelphia and with the Nationals here in DC. Dr. Bobby Chhabra can't join us. Ironically, he's recovering from knee surgery. We have Dean Taylor, who you know because he's your next president. He's a West Point graduate and director of the Fagan Leadership Program, which focuses on leadership. And so he has a lot to offer both this panel and all of us in his leadership next year. John J.T. Tokish, also a fellow Air Force Academy graduate. So we have three of us up here. And the current ANA president. And finally, we have Ned Amendola. And Ned is the 46th president of AOSSM and the current vice president of the American Academy of Orthopedic Surgeons and the Leach Award recipient. So I think I've got everybody. I'm going to ask some questions now. And we'll start with General Rice. And we'll work our way down. And then we'll work the other way in the next question. So General Rice, what was the biggest challenge you faced as a leader? Yeah, great question. Probably when I had my final position as commander of Air Education and Training Command, one of the organizations I had working for me under my command was basic military training for the Air Force, where we trained all incoming enlisted members of our Air Force. And we had a situation where, the really short version is, we had a situation where we discovered that our military training instructors who were responsible for that training, that we had over a period of many years a situation where a number of them, that ended up being 35 plus at the end of the day, over about a decade, had been involved in inappropriate sexual relationships with trainees. And so that was a situation that blew up quickly. Had me testifying before Congress, talking to the White House, et cetera, et cetera. And so that was a challenge that I felt sort of required everything that I had learned about leadership to that point. And we can talk, if helpful, about the particulars of it. But that was the largest challenge. And fortunately, we had a good team. And we mapped out a strategy at the beginning of that. And we're able to navigate our way through a fairly challenging and complex situation. Great. Valerie, same question for you. Yeah, I would say across the different stops that I've had in sports, the biggest leadership challenge always revolves around communication. And communication to communicate your vision, the direction that you want to take the organization, but also as a forum for inspiring the workforce. So I always found that being able to communicate to my direct reports people that I was close to was something relatively easy to manage. Regular meetings, frequent exposure, that level of communication was always satisfactory. But the further you go away from that core center of the people that you work with, the more difficult it becomes. And as I've gone through my career, I realized that the degree to which you're inspiring workers, those concentric circles away from you, is incredibly important. And they have a profound impression of you with almost limited to no direct interaction. If you think about the people that are working closely with you, they may walk into that meeting with an impression one day, but they meet with you again, and again, and again. And over the years, they have, OK, I have a sense of who Valerie is, where we're taking this organization, what I believe about this organization. But the further you move away, those people may have one interaction with you, or perhaps read something, even in the press. And that becomes their forum for thinking about where they work, and for how they feel about where they work. And so communication is just so important to push it all the way out in the organization. And you're relying often on a cascading down of the messages that you're communicating, as well as these broader communication means that you may have, whether that's communicating with your staff through memos, or emails, or other things. We found that working in sports, working in a land where you have social media, and we have leaks, that those messages that were the broad-based ones that were in writing became more and more sanitized over the years. So the impression, again, that we had 400 people working in the front office of the Philadelphia Flyers in the Wells Fargo Center. We had 1,200, roughly, game day employees. Those are the folks that come in to work the concessions, to take the tickets, work security. Those are the people that really make the customer experience, and make the organization run. Those people are the folks who have the least understanding of your vision and your values. And so that would be what I would say would be the biggest challenge. I'll leave with one thought, because I'm sure many of you work in somewhat similar environments. Perhaps it's hospitals, where you're interacting with thousands of people who have an impression of you, but you may not know who everyone is. One of the things that we did that was incredibly effective was start a name tag program for all arena staff. And that was helpful for our customer relations, but it was also helpful from a leadership perspective, because it gave a way for us to always be able to address people by name. It was a very helpful function, having us remember people, and remember their stories. And those small moments that you might have with someone who is working in a public-facing environment, who knows exactly who you are, and wants to feel inspired every day. That one thing you might be able to remember about their life story and their journey will make an impression and a commitment to loyalty, as you say, that will last their entire career. Great. Dean, biggest challenge? Well, Mark, biggest challenge for me is something that involved leading both myself and leading others. And about eight years ago, I had something happen that followed a long journey that I'd had when I came back to Duke in 2006. I felt we could really move the needle in health care by emphasizing leadership development as an important part of what we would do in undergraduate medical education and graduate medical education. And you mentioned the Fagan Leadership Program. That grew out of that. And so for years, I was teaching leadership, and teaching leadership to students and residents and fellows. And when I started that, I thought I knew a lot about leadership. I was a West Point grad. I was an Academy grad like you guys. I feel outnumbered up here with three Air Force Academy grads. We did that on purpose. Feels like the week of the Army Air Force game when I was at the Air Force Academy as an exchange cadet, and they stole all my clothes. But we're all grounded in that leadership and constantly bombarded by it. And then a career in the Army, I thought I knew a lot about leadership. But I have to say that some of the behaviors that I had when I was an orthopedic surgeon in the Army, throwing trainees out of my operating room because I thought it was detrimental to patient care because they might be contaminating the field or something, that was horrendous for building the team. And those looking back on it now, in the name of patient-centeredness, I was exhibiting really behavior that was not conducive to effective leadership. In 2015, in my operating room, in the middle of a case, my ulnar nerve was cut. I put my arm on a Mayo stand where a scalpel wasn't intended to be. And with laser-like precision, it cut my ulnar nerve. And that was my biggest leadership challenge because I had to lead myself in that moment. I had to lead everybody and influence everybody in that room to make sure we got that case done. But I also had to influence all of us to make sure that we took care of each other. And the lessons that I learned from that led to, I hope, safer operating rooms, a better understanding of the importance of communication, a good result for that patient, and I think it made me a better person. So while I would never want that to happen to anyone, I can't imagine my life as a leader without it because I think it's made me better. That's fantastic. JT, biggest challenge? I think, for me, it's flexibility. When the mission changes and you have to adapt, you think you have one plan. Circumstances change, and then you've got to learn to adapt to a new environment. The great philosopher Mike Tyson once said, everybody's got a plan until they get hit in the mouth, right? So for me, I guess the biggest one for me on that one was I was right at many of you fellows that are out there that are finishing your year and heading on to your first job. So I finished my fellowship on August 1st of 2001. I went back down to my alma mater at the Air Force Academy where I was going to be back with the team that I played for, the coach that I played for, and I was going to be their team doc. And 10 days later, September 11th happened. And it wasn't because I had any special talent. I can promise you that. I just happened to be, as these guys will know, I would happen to be the FNG. And as the new guy, they said, go home, pack your bag, and get on a plane. And so we were the first group. October 7th of 2001, where I thought I was going into this screaming hot sports practice and go back to the alma mater. And 48 hours later, I was in Pakistan with a 70-pound backpack and four buddies trying to figure out, as combat operations started, what this new mission was. And we thought we were told there, of course, because we were pretty good at wars and remain really good at wars. Back-to-back national World War champs, by the way. But in that time, we thought, well, it's going to be a quick one. Everybody was saying, you guys will be there 45 days. And six months later, we were still there. Young family, wife, young son. And trying to figure out, OK, the mission has changed. It's probably a much more important mission than I thought it was going to be at this point in my career. And we're seeing trauma. I mean, the cases that I was scared of was maybe a PCL or a multi-leg knee. And we were getting blast injuries off the field on day three. And you have to face your own horrible inadequacy. And you have to come to terms with the fact that sometimes you're inadequate for the challenge that you're facing and how to get your team to face that as well, how to overcome it, and how to do the best in the situation you can. And I think the lessons of that were you look yourself in the mirror, you take a hard line, you forgive yourself, you certainly forgive your team, take all the responsibility and pass out all the credit. And I think when you can learn some of those lessons, I think it can take those situations and turn that flexibility into success. These are great stories. Ned, biggest challenge. Well, thanks, Mark. Again, I'm not a military person. But I think I could have been. And I don't have any military stories. But I really enjoyed it. You could have been Coast Guard, Ned. I'll just follow your leadership, JT. But I enjoyed General Rice. And one of the comments he said I think really is important to me. He says, the sign of a good leader is one who leans in. When you ask them to do something, they lean in and kind of take it in. So as you all know, I've been involved in a lot of organizations. I was president of this organization. I'm on the presidential line of the Academy. And I was on the American Board of Orthopedic Surgery. And you wonder why you spent all this time. But we have a great profession of orthopedic surgery, sports medicine, and all the subspecialties. And you really, really, really want this to be the best specialty. And you want to be better every day as an orthopedic surgeon and be at the top of your game. And so the biggest challenge to me was when we had an issue come up when I was on the presidential line of the IOSSM, there was a movement by the American Academy of Orthopedic Surgeons and some of the other subspecialties to change the accreditation process for orthopedic surgery. And in my mind, I thought it was very simple. It's like, why would you want to do that? We have an accreditation process. We have a subspecialty examination in sports medicine. We're all doing our best to maintain our level of expertise. So why would you want to change that and maybe lower it to a different level? And so to me, that was really kind of questioning, what are we doing here? Why aren't we all together? And why are we moving forward? So I was part of the task force representing IOSSM. And there was members from other specialty societies, members from the academy on the task force. And we went through this process. And you realize that there is more to it than your own way of thinking, that there's other people and other organizations have other opinions and have input. And it's really important to listen to what everybody else is saying, what are the goals and aspirations of every organizations? And at the end of it all, I realized that, I didn't have the answer completely. And that it was really important to kind of listen to the whole group. And as a result of that, we really came up with a very good solution. I think it improved the relationships of the various organizations. They came up with this longitudinal pathway for recertification, which I think is another additional element in maintaining your expertise and your profession and the level of your profession. So to me, I learned a big lesson in that, in that I think there's always room to listen. And I think the sign of a good leader is really when he make, you know, the leader makes the environment completely safe to voice your opinion and listen to the other people and what they have to say, because it's always valuable. That's great. So take a breath, Ned, because we're heading back the other direction now. So how do you, as a leader, how do you deal with difficult followers? Well, again, I- You can mention me if you want. Anyways, we got a great, great team at Duke. I've had the opportunity to work with great people, but yes, Mark, there's always, you know, people that have different aspirations and again, first of all, I think you have to realize that you can't expect everybody to be thinking the same way you think. I think secondly, when you communicate, I think you have to communicate clearly what your expectations are and what, you know, you would feel is important for them to achieve. So I think clear communication and understanding between the various parties is important. I think you have to get a really good understanding of why they're not following, why they're not in agreement and what are the differences of opinion and, you know, we had a workshop recently on leadership and I think that that is personally one of my, you know, one of my traits is that I want everybody to get along. I feel like everybody should get along and I don't think that happens all the time. So sometimes you do have to respect differences of opinion, but I think the most important thing is to listen what the other party has to say and understand their point of view. JT, same question. I think it's particularly challenging with many of you in the audience with, you know, resident education is a perfect example. You have a particular specialty and that is some of this awesome, right? We always say that residents are the great magnifiers. When they're really good, they're the best your job can be and when they're really bad, it's a sad face day, right? You guys all know this. And so I think the challenge becomes is what do you do when the resident that's coming to train under you doesn't care what your specialty is, right? You got some guy that's doing spine or a gal that's going to do foot and ankle or something and they come and they're going to do sports medicine for a while and it's kind of mandatory, if you will, as part of their training. And I used to struggle with that a lot. I used to think, God, I'm going to get to a place where I can just do fellows because they're coming just because they want to be there and then they're motivated. And the truth is, it's a cop out. It's easy for us to teach those who come super motivated. We can teach somebody who's not very good and turn them into somebody that's technically really good if they're motivated. But if they lack motivation, wow, that's tough. And I would say that the way to overcome that or at least that's been successful in my life is focus on something else. I think if you have a personal relationship with that student or that trainee or that mentee and they know that you care about them first, I think it breaks down all those other barriers about the interest in a particular technical aspect. We're lucky in medical education that so many people that are coming to us are really passionate about what they want to become. But I think sometimes we let our own sort of preconceived notions get in the way of what that package should be. And I'll give you one example. I had a student who was maybe one of the best residents I ever had. And I think that I tried to put that person in a box a little bit because I saw this incredible potential. And she went on to doing an entirely different thing. And for a few years, she told me later, she said, gosh, I didn't really want to talk to you about these other plans because I thought you'd be disappointed. I didn't publish these papers and I didn't do these other things. That woman went on to redefine how we care for paratroopers and para-jumpers in the U.S. military. And her leadership skills in that area far surpassed anything she could ever do in the area of simple orthopedic surgery. And so I think for me, the lesson was in somebody that may just not fit your particular impression, go figure out which box they do fit in. Help them find that passion because these are insanely talented people and they'll exceed your expectations every time. That's great. Dean? Can you repeat this challenging question? You said these were going to be softball questions. Well, this is maybe it is a little bit of, you know, a softball really isn't that soft. All right. So as a leader, how do you deal with difficult followers? So I like what you guys talked about and it goes to what General Rice talked about. I think it is we try to help people learn to be better leaders because I don't think you can teach leadership. We've developed a model in it that the keystone of that model is emotional intelligence. And Ned, when you talk about listening, you're trying to create that awareness of others. And JT, same thing. I think you have to have that skill of social awareness, being aware of what somebody else wants. And also, as General Rice said, that self-awareness. In self-awareness, self-management, social awareness, relationship management. That's the key in trying to understand better where that person is coming from, putting yourself in their shoes. Mark's smiling because JT, I've been trying to put myself in your shoes and I knew you've been trying to put yourself in my shoes because we're both presidents of phenomenal organizations and we're working together to make each of those organizations better. And I think by doing, having that emotional intelligence and working at it, we're going to do that. And so for me, it's about emotional intelligence and coming to an understanding and then working with that person once you come to that understanding. That's great. So Valerie, how do you deal with difficult followers as a leader? So one of the first things I ask myself is why is a person being difficult? And I don't always assume, you know, I think naturally all of us here are probably very confident in our abilities and our leadership ideas, but I do challenge myself and say, is there something I can learn about why this person is being difficult and not be completely dug in and stubborn on my direction or my idea? So I will ask myself that question, sort of pressure test. But again, in time, all of us are going to deal with, you know, consistently difficult members of our team. And the number one thing that I found for success is to just be direct, to be direct with them. I find that giving direct feedback to people, even seasoned, experienced leaders struggle to do that. And it takes a little bit of courage to have difficult conversations, but you have to have them or people won't develop and grow and ultimately lead to the success of your organization. And sometimes an easy way to do that harkens back to what the general said is we had a statement of core values at all of the places that I was in a leadership position at that sort of said this is who we are as an organization, and it depersonalizes things. So we talk about we're committed to teamwork, hard work, respect for other people. And then when you're giving that direct feedback, you have this framework against which to give the conversation and depersonalize it, not make it about them and their behaviors, but to say, you know, is the way that you're approaching this in line with our core values, in line with the way we want to treat other employees, in line with our, you know, collaborative pursuit of the mission that we have. So I would just say those two things, you know, be open to examining why the person is difficult, including your role in that, and then be direct with the feedback that you need to give, ideally against some sort of framework that helps you give the communication they need. Great. General Rice? Sure. Great, great, I think, comments on what to do. Two things not to do, in my judgment, when you have that, one is to ignore it and hope it goes away. I think it's very situational on what to do, but the one thing not to do is to ignore it, get after it, deal with it, and move on. The other thing not to do is to spend too much time on it. Oftentimes I, others, I've seen you spend too much time on the squeaky wheels and not enough time on the people at the top, on whose performance the actual success of the organization depends. And they need help, too. I mean, they need help to reach their potential. And so think about how you get after something, move on, and make sure you're not spending extra time that's not warranted on that part of the challenge. Excellent. So here comes your softball, Dean. This is a rapid-fire question, so I'm going to ask each of our panelists to give us one trait, character trait, that makes a good leader. Ed, you get the first character trait that makes a good leader. Courage. Courage. Valerie? Integrity. Nice. Dean? I already said emotional intelligence, so I'll say teamwork. Good. JT? Empathy. Okay. Ned? Do the right thing. All right. Perfect. Okay. So here's the question. And you're back again, Ned. How do you identify and train future leaders? Are you asking me? Yeah. Okay. Well, I think there's a little bit of controversy in terms of leadership if you have intrinsic leadership qualities or you develop leadership qualities over time. But I think the most important quality of a leader is self-awareness, personally. So when I talk to, say, people interviewing for residency or interviewing for a fellowship program, and they ask me, what do you think are the most important qualities of a fellow? And I usually tell them that the most important thing I'm looking for are fellows that can tell what's going on around them. They're aware of the surrounding. They're aware of who's working with them. They're aware of how they're doing. And that's the most important thing, is how they're fitting in to the room and the operating room and clinic and the rest of the group. And it's not about surgical skill. It's not about anything tangible, anything that you can measure immediately. It's just about their ability to assess where they are so that they know how they're doing and they can keep learning and get better. JT, how do you identify and train future leaders? The identify part, I think, is that we should provide opportunity and make that opportunity an equal shot, and the cream will rise to the top. I think that's the key to it. We have to open those doors so that everybody feels like they have the opportunity to compete, and then nature will take its course in many cases. But the extroverts get the advantage here way too often in our society. And so when I say provide opportunity, I don't mean just as you might traditionally think of it. You have to find the quiets, right? I'm not that, and I'm lesser for it. But I got one of my kids who is. And when you want to learn how to be a leader, be a father or be a mom, you guys know this. One of my kids is a quiet one, maybe the most talented of the bunch. And when you learn to sort of read that and provide these opportunities, you say, okay, who wants to raise your hand? And sometimes there's the best kid in the room hasn't raised their hand. So I think learning to identify the quiet, the introvert out there, and go up and encourage that, will teach us to find those diamonds that are out there that I think we've ignored for far too long. Nice. Dean? JT, that's great. And I'd like to build off of that because I'm one of those introvert guys. It may not come across as that, but it takes a lot of energy for me to be up here on stage or to really engage as somebody that is much more comfortable being alone and thinking about things. And I think expanding on that, we have to recognize that, but we also have to recognize that there are people that may not see people of their skin color, people of their gender in leadership roles. And we need to think about them and how we can encourage them to be in leadership roles. And when you say, how do you identify leaders or potential leaders? Everybody in this room is a leader. Because at least in healthcare, the definition that we use for leadership in healthcare is the ability to influence others for the benefit of patients and patient populations. And everybody in your hospital, everybody in your clinic has a leadership role because they can influence things for the better. And so for me, it's not so much identifying who's a leader or who's a potential leader, because I think everybody is, but it's about how can we enhance the leadership skills of everybody at the level that they are. And for me, I think big, I want to do it for all of undergraduate medical education and graduate medical education. We need to change what we do. We do a great job of teaching the technical skills of being a doctor, being a surgeon, but we need to intentionally teach leadership skills. And that's how we're going to treat our patients better. Valerie, how do you identify and train future leaders? So if you're working in sports entertainment, in addition to your day job, you're probably working 200 nights a year between the games that you may have and then the events that take place in your venue, be that a concert or some other special event. And so the first thing, the foundation that I look for is who has a profound capacity for work? Like who has that motor and that drive that comes from within, that love and that passion for what they're doing that allows them to commit? Because that is, you know, it is a lifestyle in many ways. I'm sure not too far afield from what it is to be in the medical community. So I look for that motor and then if that commitment, that profound capacity for work and self-improvement and continuous improvement is there, you know, you can find that you can work with that person and shape and mold them into all sorts of exciting leadership opportunities. General Rice, let's wrap this obsession up with you. Sure. I'm less interested in what a person knows than what they can learn. And so from a leader's perspective, I'm looking for people that can learn it and lead it. And so I put them in different unfamiliar situations and see how well they can understand the environment, again, separate the important from the unimportant, the important from the very important, et cetera, and then get results. And so there was a point in my career where I thought the only requirement for the job that I was in was that I didn't know anything about it because they kept putting me into positions that, you know, were unfamiliar to me. And now I understand why. It's this opportunity to see how much you can stretch and how well you can learn and lead. And so it's a way that I develop my leaders as well. That's great. How about a hand for our panelists? Just a quick couple of announcements before we leave. There's a handout on your chairs, and there are some copies of this book, Coaching Mentorship and Leadership in Medicine, Empowering the Development of Patient-Centered Care. This is a compendium of articles on this subject edited and solicited and input taken from your next president, Dr. Dean Taylor. And so we're going to give out some copies to those that want some. If you don't want one, don't take it and just throw it away. But if you really want one, we're happy to give you a copy until they run out. We're happy to sign them also, if you like. And you're welcome to do that after we break. Final announcement, Mars update. The Mars update meeting will be at noon at the Capitol Congress Room. So those individuals going to the Mars meeting can grab a boxed lunch, and all of you can grab a boxed lunch in the exhibit hall. Please visit the exhibitors, and then we'll adjourn for lunch. Thank you so much. Thank you.

leadership

difficult followers

panel discussion

experiences

challenges

communication

empathy