Q&A with CIO Ed Marx, Part 1: “You always need a fully functioning, high performing team.”

Throughout his 20-plus year career, Ed Marx has had many difficult conversations. But perhaps none as complex, emotional, and raw as when he sat down with individual members of the leadership team in June and said three game-changing words:

“I have cancer.”

But for Marx, who has always prided himself on being transparent and authentic, it was critical that the news was delivered in the most beneficial way possible, which was through one-on-one conversations that enabled his colleagues and friends to have a genuine reaction. By keeping his team informed, Marx was able to continue to build trust — something CIOs and other leaders need now, more than ever.

Recently, we spoke with Marx about his cancer journey, from how he ensured his team was prepared to continue in his absence, to the insights he gained as a patient at his own organization. He also talks about his vision for digital transformation, the incredible impact volunteering can have, and the importance of empathy.

Chapter 1

• Creating a matrix of roles and responsibilities
• “It was very well organized.”
• Breaking difficult news
• “It’s always best to be transparent. Transparency builds trust.”
• One-on-one conversations with leadership team
• Cleveland Clinic’s strong focus on patient experience
• Reacting to mistakes with “kindness and grace”

Bold Statements

With this matrix, we listed the roles and responsible parties from my team, and also named the C-level person who could provide additional oversight. It was very well organized, and as a result, things went very well.

Everyone reacts differently to rewards and to discipline, and so it’s beneficial to have those discussions on a one-on-one basis and tailor it to the individual. I thought it best to take that same approach in this situation.

I decided to make the most of the experience, and use it to learn and form my thoughts around digital transformation, and develop a better understanding of our culture. So it really turned out to be a positive thing.

When there was an issue, it was handled in a very professional, very empathetic way. I was able to see a different side of how culture works and informs the way people treat one another.

Gamble:  Hi Ed, it’s great to hear your voice. Before we get into the discussion, I want to say congratulations on getting a clean bill of health.

Marx:  I’m very thankful.

 

Gamble:  I know you’ve been through a lot, and we really appreciate you being willing to share your story and spread awareness. What was your approach in coming back to work — did you return on a full-time basis?

Marx:  I did. I returned to work full-time in late August.

 

Gamble:  Was your thinking that it was easier to dive right in than to ease in part-time?

Marx:  I stayed engaged through a lot of it. I kept in touch on a variety of things that were going on, but I also took the time to convalesce and spend time with my family. When I did come back, I jumped right in. I felt fine, and so it made sense to get back into things.

 

Gamble:  A lot of people in leadership roles are faced with situation where they have to take time off. When it became clear to you that it needed to happen, how did you approach it?

Marx:  I’ve worked really hard to develop a strong team that I believed would be able to keep things going. There was no doubt about that. And so fortunately, we didn’t need to bring in an interim person or anyone to supplement our team. They were pretty self-directed to being with.

One thing we did to add some additional firepower to the team while I was gone was to create a matrix of all my different roles and responsibilities. We assigned one person from my team to each of those roles, then added a member of the executive team to provide that extra layer of leadership when needed.

When a CIO or another executive leader is away and direct reports take over, you can become susceptible to not getting the right amount of attention or resources. It brought great comfort to the organization, as well as my direct reports, knowing that in my absence, this specific person is responsible for cybersecurity, and he or she can go directly to the chief operating officer, who will provide the same coverage I would have provided. With this matrix, we listed the roles and responsible parties from my team, and also named the C-level person who could provide additional oversight. It was very well organized, and as a result, things went very well.

 

Gamble:  I would imagine it’s not something you can put together at the last minute; it has to be established in advance.

Marx:  Yes, definitely. If you have 30 days’ notice, or even less than that, you’re not going to be able to make a change in that amount of time. You always have to have a fully functioning, high performing team.

You can create a plan fairly quickly, but if you do it in a rush, you’re going to miss something. I think it’s good to always have a full understanding of everyone’s roles, and to have a matrix for everyone in leadership. If something happens that wasn’t planned for, you don’t want to miss a beat. Understanding everyone’s roles and responsibilities — and doing cross-training — is critical. The goal is that at any point in time, any member of your leadership team should be able to step into another person’s role, without any degradation of performance.

 

Gamble:  In terms of what was happening with you and why you needed time off, were you fairly open with your team?

Marx:  I was. I think it’s always best to be transparent. Transparency enables trust; it enables relationships. People are going to find out anyway. If you try to keep something this big a secret and it leaks out, it tends to not be accurate. Who knows what the rumors might have been.

So I put it all out there. I said, ‘I’m sorry to inform everyone, but I’ve been diagnosed with prostate cancer. I’ve made the decision to have a prostectomy. I’ll be out for approximately 4 to 6 weeks, depending on how things go. Let’s pull together as a team, dust off the matrix, and add the executive column to it, and prepare the rest of the organization.’ To me, there was no other way to approach it.

I did speak individually with everyone on my leadership team; I didn’t do that in a group setting, because I knew each of them would respond differently. And it was very healing. It was a very important bonding moment for many of my relationships. After those one-on-one discussions, I made a broader announcement.

 

Gamble:  I’m sure it wasn’t an easy conversation to have, especially with more than one person. But it really speaks to the level of trust you have, and the awareness that people will have different reactions.

Marx:  When you think about it, everyone reacts differently to rewards and to discipline, and so it’s beneficial to have those discussions on a one-on-one basis and tailor it to the individual. I thought it would be best to take that same approach in this situation and address it individually with people who are close to me, whether on a professional or personal level. That way, someone who is emotional can express rather, whereas if it was done in front of them, they may not be able to have a genuine reaction. And they need to, so I felt it was the right thing to do.

 

Gamble:  I’m sure that was really appreciated. Interestingly, this isn’t the first time you’ve been on the patient side, having gone through a heart attack last year. But did this particular experience change your perspective as a leader?

Marx:  Absolutely. This was my second big life event. The first was in a different state, and it all happened very quickly. In 24 hours it was done and I started healing. This was a planned event; it was major, very invasive surgery. But it happened locally — in my own health system, in fact — and so I definitely got a good dose of what it means to be a patient at the Cleveland Clinic. I was able to get a lot of insight into the patient perspective, as well as the provider side and the caregiver side.

I decided to make the most of the experience, and use it to learn and form my thoughts around digital transformation, and develop a better understanding of our culture. So it really turned out to be a positive thing. I’m glad things turned out the way that it did, and I’m glad I was able to help a lot of people through my experience.

 

Gamble:  Cleveland Clinic seems to have a strong focus on patient experience. You have the annual Empathy and Innovation Summit, and you’re one of the few organizations with a dedicated Chief Patient Experience Officer (Adrienne Boissy), so clearly a lot of resources and efforts are put toward understanding the patient perspective. Do you have any advice or thoughts for organizations that want to do more in this area but are lacking in resources?

Marx:  When you think about it, organizations and people are imperfect. Not everything is going to be stellar, and so when you have a culture of empathy and extreme care for the patient, it can really be a differentiator. That cultural piece, I believe, is one of the things that has set the Cleveland Clinic apart from others. It wasn’t perfect. But when there was an issue, it was handled in a very professional, very empathetic way. I was able to see a different side of how culture works and informs the way people treat one another.

At one point in my journey, I experienced something very frustrating. I won’t go into details, but I will tell you that the nurse in the room recognized that my wife was very upset by this particular experience. And so the nurse came over and gave my wife a hug. No words were expressed. It was genuine, warm, human emotion.

That went so much further than saying ‘I’m sorry’ or making an excuse. She didn’t have to say anything; she just gave her a hug, and then it was like, ‘okay, let’s move on.’

 

Gamble:  Something like that can have such a strong impact, both on patients and on those caring for them.

Marx:  The bottom line is, we all make mistakes. And even if you don’t make a mistake, something you say or do, or even an expression you make, is going to frustrate someone. The best way to react is with kindness and grace

And it’s hard to teach that. I think it’s an art to find that within everyone. I think it exists within everyone, but trying to draw it out, especially from people who may have been hurt or scarred by difficult situations, is very challenging. I find it really interesting how an organization of our size (more than 66,000 caregivers) can create a culture like that — it’s truly amazing and special.

And again, it’s not perfect, but it’s pretty good.

 

Gamble:  Right. And maybe it’s not the kind of thing that can be taught, but it can be recognized.

Marx:  I always say that empathy is caught, not taught. I think that’s part of the magic that happens here at Cleveland Clinic. People come into the culture and observe how things are done, and they think, ‘This is a special place. If I want to be part of it, I should adopt some of these behaviors, because I see the impact it has on fellow caregivers and on patients.

And so I think oftentimes it’s caught through actions, not words.

Chapter 2