Phronesis: Practical Wisdom for Leaders

Akram Boutros, M.D. - Leading From a Place of Love

May 21, 2022 Scott J. Allen Season 1 Episode 124
Phronesis: Practical Wisdom for Leaders
Akram Boutros, M.D. - Leading From a Place of Love
Show Notes Transcript

From the moment he arrived in Cleveland, Dr. Akram Boutros' visionary thinking has inspired MetroHealth to elevate medical care by providing and integrating social services to build equity, promote justice, and improve the health of people and communities.

With the 2019 creation of the Institute for H.O.P.E.™ (Health, Opportunity, Partnership, and Empowerment), MetroHealth is connecting patients and neighbors to fresh food, stable housing, education, career training, and other services that keep them healthy. 

Dr. Boutros paired that work with a $1 billion reimagination of the system's main campus on West 25th Street. The new MetroHealth Glick Center, which opens in October 2022 and will be the first hospital in a park in the country, has sparked the rebirth of the surrounding neighborhood while preserving its Hispanic culture. 

Dr. Boutros' focus on inclusion, diversity, and equity is just as significant. In 2020, 39% of MetroHealth's new hires were racially or ethnically diverse.

Under his leadership, MetroHealth has grown to more than 20 community health centers, four hospitals, five MetroExpressCare locations, and ten pharmacies. Those are in addition to MetroHealth's main-campus medical center, which is home to the area's most experienced Level I Adult Trauma Center, Ohio's only Ebola Treatment Center, and the only adult and pediatric trauma and burn center in the state.

MetroHealth's annual revenue grew from $785 million to more than $1.5 billion during his tenure. MetroHealth now treats more than 300,000 patients at more than 1.4 million visits annually. Since 2013, the health system has created more than 1,800 new jobs, sent doctors into more than a dozen local schools, and received the largest donation in its history – $42 million from JoAnn and Bob Glick. 

 A Quote From This Episode

  • "You only have to lead from a place of love. Leaders don't lead organizations; they lead other people. And if you don't truly love the people you work with and who put the time in to support the organization's goals, you're not going to fare very well."

Resources Mentioned In This Episode

About The International Leadership Association (ILA)

  • The ILA was created in 1999 to bring together professionals with a keen interest in the study, practice, and teaching of leadership. Plan now for ILA's 24th Global Conference online October 6 & 7, 2022, and/or onsite in Washington, D.C., October 13-16, 2022.

Connect with Scott Allen

Note: Voice-to-text transcriptions are about 90% accurate 

Scott Allen  0:00  
Okay everyone, welcome to the Phronesis podcast wherever you are in the world. Thanks for checking in. Today I have Akram, Boutros MD. And from the moment he arrived in Cleveland, his visionary thinking has inspired Metro Health, a health care system in our community to elevate medical care by providing and integrating social services to build equity, promote justice, and improve the health of people and the communities they live in. With the 2019 creation of the Institute for hope, hope stands for health opportunity, partnership, and empowerment. MetroHealth is connecting patients and neighbors to fresh food, stable housing, education, career training, and other services that keep them healthy. Dr. Boutros paired that work with a $1 billion reimagination of the system's main campus on West 25th Street, the new MetroHealth Glick Center, which opens in October 2022. And will be the first hospital in a park in the country and has sparked the rebirth of the surrounding neighborhood while preserving its Hispanic culture. Just as important has been Dr. Boutros is focused on inclusion, diversity, and equity. In 2020 39% of Metro Health's new hires were racially or ethnically diverse. Under his leadership, Metro Health has grown to more than 20 Community Health Centers for hospitals, five Metro Health Express care locations, and 10 pharmacies. Those are in addition to MetroHealth Main Campus Medical Center, which is home to the area's most experienced level one adult trauma center, Ohio's only Ebola treatment center, and the only adult and pediatric trauma and burn center in the state. During his tenure, MetroHealth's annual revenue grew from $785 million dollars to more than 1.5 billion MetroHealth now treats more than 300,000 patients at more than 1.4 million visits a year. Since 2013. The health system has created more than 1800 new jobs, sent doctors into more than a dozen local schools, and received the largest donation in its history. $42 million from Joanne and Bob Glick. There's more. It'll be in the show notes. But sir, I am so excited that this conversation is happening. You know, I think since you arrived, ever since you arrived in Cleveland, I've known Have you had you speak in my courses? And it's always such a treat to have you. And so to have you on the podcast now. I say thank you, sir. So good morning.

Akram Boutros  2:30  
Good morning, Scott. Thank you very much for having me. I've always enjoyed your classes, and the students there always have such a fresh number of fresh questions that keep you on your toes.

Scott Allen  2:42  
Well, sir, I am going to kind of start us off acronym. I read a book, and it's called range. And it's I think the byline is something to the effect of how generalists thrive in a specialized world. Your background is just, it's, I don't know if the word is eclectic. You come at this topic from experience in so many other different domains. Would you talk a little bit about some of those elements that are in your background in your history, and then how that's informed how you think about approaching serving as CEO or serving as a healthcare executive.

Akram Boutros  3:19  
An immigrant came to America at the age of 12, and my entire family and I emigrated at the same time, and how our world really turned upside down. It was not an easy experience to come to the US, but it was deliberate on our part, and we wanted to forge a path for our family and our futures. I pretty much kind of from early on was a son, the immigrant men mentality, right? You become a doctor, a lawyer, a teacher, an engineer, that's the only acceptable thing you can do. And it's education, education, education. Well, during my high school and junior high school, I began doing two things simultaneously that were thought were very interesting. One was art. And my dad is very artistic. And I used to sketch draw, and do all different things. I had my fondest memories as a just 17 and turning at Mad Magazine, which just actually taught me that is not a life. I want to be a part of it.

Scott Allen  4:39  
That had to have been pretty, pretty incredible at 17 to be interning at Mad Magazine. Wow. Yeah. And

Akram Boutros  4:47  
those artists at that time. So it was the very late 70s in New York City. Oh, yeah. Yeah, and Madison Avenue. So so a was just a crazy creative place. And I also used to work with my dad designing jewelry. So that and side by also had businesses on the side I was an entrepreneur and had everything from paper ads to in New York Cities, they're typically multi apartments and brownstone and you can have coin-operated laundromats I was I had had that business as well. So I, it wasn't just the sheer making money, it was just the ability to solve a problem. So I got into a multitude of things. So my children and I were just talking, and we're saying I clearly had ADD, maybe ADHD, and just figured out how to use it significantly less hyper. So I think every team might add by my not h part of it. So. So I was just interested in a multitude of things. And I continue to do that, throughout my career, whether it was in medicine and administration, or in teaching in business, I just am fascinated by the variation. And Suzanne, my wife says, When I get in the zone, she's talked to me for a little while, and I've been here. And she's also said that there are times when we're in the middle of the conversation, and she knows that something just came to my mind. And I will walk away. So she's unbelievably kind because she hasn't hit me yet. So

Scott Allen  6:46  
I had a friend recently say to me as well, I think I figured it out, Scott. And I said what and he said healthy add. I said, Well, I don't know if the healthy part is always there. But I probably agree with you. There's an insatiable curiosity, at least that I have as a lived experience. And, and it sounds like you have that curiosity as well. So you move on to medical school? And then how do you decide to move into the space of administration? Because that's oftentimes those can be two totally separate paths. But it sounds like you got into administration, and it turns you on you enjoy that you really liked that work of building and creating, right?

Akram Boutros  7:28  
Yeah, it's so this a lot of the credit goes to my mentor and Chairman of the Department of Medicine in New York, Dr. Jana Loya, and Suzanne, my wife, so I was an academician, get out of residency, became an academic faculty and was had a pretty aggressive goal to be a professor of medicine at age 40, to be the chairman of an academic department by the age of 40. And this was, there was nothing going to stop me from that. And at the age of 35. As I'm making significant progress towards that my chairman says to me, Akram, do you notice you constantly get nominated for teacher of the year but never when it has? Yes. And I count the votes. Right. So he said, and you see how badly you lose? He said, maybe this is not for you as well, you got to explain to me, why do you why I get nominated and don't win? He said, Well, specifically, because you are consistently focusing on improvements. You consistently focus on tinkering, that's not your job. When you're teaching, your job is to forgive what people have done and to help them learn, not about the outcome that they produced. And I said, Well, I have a hard time doing that. He says yes, and that's what makes you an excellent administrator. You're a very good businessman. And we're gonna have lots of people like you who are capable and educators and teachers. So if they want to be medicine doesn't have a lot of good business, people who can help. And frankly, at that time, it felt very much that the profession had lost its clout with professional administrators. So he said, I'd like you to change and I went home and spoke to Suzanne and the next day I started looking for my replacement and went into a different view.

Scott Allen  9:36  
I want to fast forward now because at the opening of our episode today, I shared some pretty staggering statistics. In the time that you've been in Cleveland and in our community, a lot has been accomplished with you and the team. And what I would love to really spend the heart of our time on today are what are those three or four hallmarks is an individual who was on the Round every day building, creating, shifting, transforming. What are some of the hallmarks that you keep on your radar to help you navigate the complexities of transformation, the complexities of COVID-19 the complexities of the great resignation and staffing challenges? I mean, this is not been an average seven years you were transforming and building amidst a pandemic? And what if some of the life preservers has been that you hold on to that keep you in that storm? Keep your bearings with sound? So yes, I just have great respect, sir, I would

Akram Boutros  10:43  
say, look, the nine years and MetroHealth have been the most exhilarating, motivating, self-satisfying experience in my life. I love this organization. And I love everyone who works in it. And I say that with a full heart, I just love everyone who works with me. When I came to MetroHealth, it became clear that there are some fundamental things that needed to change what our ultimate destination was going to be I didn't, I knew certain things needed to change. First and foremost, people were walking around because of maybe three years of relentlessly negative news stories, about MetroHealth looking around with their heads down. And they didn't deserve that. I mean, certainly, maybe the way we did things was open to criticism, but not other frontline folks, they weren't, they were just innocent bystanders. So I needed to be able to lift up the price of the other organization. The other thing is that during my interviews, people defined our mission and vision, and values very differently. So during my fixed my first six weeks, we redid the mission vision values, because we weren't going to use them every day. And making decisions. Also, MetroHealth was highly dependent on support from the county and wanted to make sure that and had a very erratic financial picture. So the 10 years before I got to MetroHealth, the total income of those 10 years, was $60 million. Wow. So the big years of wins and losses at MetroHealth, that if you take our current budget, there'll be the same 10 years that I am here, there'll be income every year, and a total of $720 million. I needed to restructure the business. So it has Foundation, the good finances because you can't do anything. Without good finances. If you're constantly trying to make ends meet. If you can't figure out what the future's so it was about the mission, vision, and values of the organization being very clear about it, changing the attitude of the staff to being proud of what they do, instead of being embarrassed to work there create this financial support structure that can lead us then it was about creating a very aggressive and innovative platform for the organization. And that's really one of the most interesting things because, in my view, people's mental models for their own success and what they can accomplish is the greatest prison that they create for themselves. It is so self-limiting at times.

Scott Allen  13:49  
I think Gandhi once said something of that effect that put one of his greatest challenges was helping the Indian people understand that there could be a different way, if I'm not mistaken, right. The mindset itself becomes, like you said, almost a prison,

Akram Boutros  14:06  
even for successful people, right? So it is so self-limiting, because we're risk-averse because we want to not fail. I've said this maybe 10,000 times since I met at MetroHealth. And I talked about failing effectively, and people say What are you talking about? There's nothing effective about failure. And I said, Well if you fail small, if you fail fast, and if you fail forward, that's very positive. That is an effective way of failing. If you're telling me you're not if you're not failing at anything, then either you're not trying hard enough, or this job is too easy for Wow. So if you're going to expand your areas of focus, if you're going to become a better leader, you have to fail. So that's the model that I had to figure out as to how Have people really be innovative. And once you gave them that I built here, they create a lot of really wonderful things. And I will tell you, my staff will tell you that I have reasonable expectations of okay, the uniform will tell you my expectations of them are unreasonable, they will also tell you that I gave them an unreasonable amount of support. Okay. And when you ask them, what was what's been the outcome, they will also tell you that nine times out of 10, they exceeded my expectations and their expectations. So this idea of the main thing, setting goals that are very high, and being unbelievably supportive of people creates this, this leap that really finally gets rid of the gravitational pull of insecurity. 

Scott Allen  15:59  
Fear creates that environment. I mean, and what you've at least honed in on for me, there is one of the fundamentals, at least in the leader development literature, which is, and the education literature, but this whole notion of challenge and support, we're going to high challenge, high support, if on that four-quadrant model, we're high-high on those two dimensions, we're going to have growth, but obviously, if we're unrelenting in their challenge, but low support, or low levels of challenge, but high support, you're not going to get as far as creating this environment of innovation, challenging unreasonable expectations, unreasonably supporting them. And then building that self-efficacy, because I imagine once they came back to you, and they had exceeded your expectations, and there's, you start to build, and I imagine you've witnessed literally before your eyes, a shift in mindset from some of these folks, right? I mean, you can just see it, there's a total shift in the energy. Is that accurate?

Akram Boutros  17:05  
Oh, absolutely. And it actually happens sometimes sitting in front of you, as you as you're asking the person. So tell me, how did this feel? So tell me, how did you go from here? And what's fascinating, what I will tell you, what's interesting is that some people, what you get out of this is a confidence in your ability to solve problems. Yeah. Not no confidence in you. What you know, or what you're capable of. All you know is that faced with issues, you know, you and your team are going to be able to fix them. Some people see that as cocky. Yeah, the theater is someone who is just an egotist. And it's not, we're not afraid of failure. That's not ego. That's saying, Look, I will make mistakes, learn, I will make mistakes. The team and I know how to fix it. We'll figure it out one way or another. The other thing we had to do was, we have to become relentless problem solvers. Okay, say more. For us. No, it is just the beginning of the discussion. When when when someone says no, you can't do this. It's just that's just the start of the discussion. Or if you go and you're talking to somebody you want to do a partnership with or something, and you make an offer. And they say, No, that's when we that's when actually life begins. I'll give you the most interesting example. As you know, lawyers are very methodical, often very risk-averse, and, and my first year and they have a chief legal counsel, who is one of the most wonderful people I've met in my life, Michael Phillips, would say, Mike, "I'd like to do this." And he'd say it's Akram... You can't it's against the law. I said, why is that? That's not how I did it. And New York on now is as you're not for Iran, not for profit hospitals. This is a governmental entity. You can do that. And here's the law that says you can't do that. So after a year and a half, he said to me one time, Akram it's against the law. I said, Okay, that's it. We're changing the law. He said, I said, we're done. We're changing the law. I said it's stupid. We need to change it. And we're gonna do that. So that's the mindset, right? So Michael said, What do you mean, you're changing?

Scott Allen  19:39  
That mindset, that mindset? No, you can't you can't change the law. That's I'm gonna stay right here in this space. That's not a possibility. Right.

Akram Boutros  19:49  
So So Metro has changed the law that governs public hospitals in Ohio, more times in the past six years, than in 80 years prior. Oh, wow. So we said, we went and said, Look, this was this law was made for single hospitals that are in accounting, and where, you know, typically rural, and most of them are under $100 million of net revenues. MetroHealth is $1.6 billion net revenue organization, we have all these programs that were massive, you can't apply the same standards. So we changed the law as it relates to Metro Health and what governs it. So now I'm on to the federal two years ago, I started on the federal, I got the same, I got the same, you can't do that. I'm like, Yes, we can, it may take a little longer, but we're gonna do it. And we're actually pretty close to getting a special designation for hospitals like MetroHealth in the federal registry, so that our place in caring for the most vulnerable, is cemented, and all the laws are going to go forward.

Scott Allen  21:02  
So talk a little bit more of some of the other ingredients we've got, we're going to clarify who we are and what we stand for, we're going to ensure that we have our finances in order, we're going to create this atmosphere where failure is expected, where we have these unreasonable expectations, but unreasonable levels of support. We're going to shift the mindset in our confidence in our ability to problem-solve, we're going to have the mindset that no is the start of the conversation. What were some other ingredients,

Akram Boutros  21:35  
I wish I knew this as a dad early on because I think it would have made me a better parent, you only have to lead from a place of love. Hmm. Leaders don't lead organizations, they lead other people. And if you don't actually truly love the people that you work with, and who put the time in to support the goals of the organization, you're not, you're not going to fare very well. That's one of the things that every interaction, everything we do, including making some tough decisions like requiring vaccination for all our employees, and no one else is doing it in the area, you have to be respectful, you have to come at it from the point of view of not thinking that people are any less or different than you, but just that they have different viewpoints, and they want the same thing. And you have to do right by so you know, you talked about the great resignation. And when the region was hit with the largest number of COVID hospitalizations MetroHealth had its highest number of inpatients in the past two decades. And we clearly did not have enough staff without overtime to safely care. For those patients. We had, we needed 10% More of the staff, and there weren't staff around and you could hire maybe traveling nurses, but they weren't going to be as helpful as the ones who already know the system. So my team and I just had this discussion, and we said, Okay, we're going to be making more money because of these and patients, right? Said Yes, I said, and even though they and I are gonna have to put in a little extra time, what we do is not going to become proposed to the frontline staff. So I said to the team, what if we took all the money that we make from those additional patients and gave it to the employees? What if we just gave it straight to them that made even more money for the organization? What if we just gave it straight to them? So we took that as the premise and work that equation backward? Yeah. If you gave us an additional 16 hours a week of overtime, you get paid for each hour of overtime at five times your rate. Wow. So imagine being a porter and somebody working in environmental services, making $90 an hour. For that extra overtime, we had zero uncovered shifts. We went from being very short to not having any uncovered shifts, nurses were making $200 an hour, two $50 an hour for overtime. And we got to be able to take care of all the patients. And that's when I say you got to lead from love. You have to care enough about the staff to be able to do this. We can't do it the whole time. So we ended up saying and that we changed our overtime policy that instead of just one and a half times You can go now to two times, and now two, three times if you give us more time, and that's going to be, I believe, a permanent approach to overtime. That's problem-solving, caring for the people who are doing the real work.

Scott Allen  25:14  
You had mentioned, you had mentioned team, talk a little bit about the team because you said me and the team and I got together. And we kind of came up with this. And then we worked it backward, talk about the sense of team that you've facilitated, and fostered throughout this process. Because I know you're an incredible team builder,

Akram Boutros  25:31  
I would just say this to you a few years ago, and again, something I wish I learned, I've decided to no longer work with people I don't like. So I am I, if you're not likable if you cannot be someone who I want to hang around with, and you want to hang around with me, you're not getting hired as a part of my team. It's not going to happen, irrespective of how talented you are. Because that gets in the way, we tend to have very fuzzy lines between organizational chart and MetroHealth. Because, you know, we just need to help one another. We keep focused on the total mission and our vision and our values. And then that relentless problem solving, people have different experiences. And they say, Well, I've done this in the past life, let me help you do this. Or let us try it. Let's give this a try. And we're okay with failing in an attempt to be also nice. We sent a notice to all our employees, hey, we've been carrying all this holiday time for you, you haven't been able to take it, and we want to pay you for it. Okay, so we made the decision, we're going to pay you for it, it's about $6 million. We're gonna give it to the staff. Well, about 5% of the people don't want to get paid for it and are just angry. Absolutely angry that we would tell them that they couldn't keep it. And here we are trying to be what we thought was being good stewards and nice people so that they get to elect right. Okay, choice when we make mistakes. And this is a mistake with Excel. Yeah, right. We're not just wedded to it. So the team also when we win, we win together with all our performance-based variable compensation, especially for the senior executive team is TEAM based, mostly team-based and what how we accomplish things. You know, one of the things, Scott that we didn't cover, but was really critically important is with all these things, there has to be a strategy. And when I came to Metro Health, what was clear, was, that we were viewed as the third-ranked health system in traditional medicine and Cleveland. So there was the Cleveland Clinic, University Hospitals, and then Metro Health, everybody wanted me to do what I've done in New York, which was build increasing specialties in the health system. And the reality is that there was no way Metro Health was going to catch up to the Cleveland Clinic and cardiac surgery, there was no way mental health was going to catch up to University Hospitals and cancer care. It just, it was silly. It was a silly thing. So I really believe in that serenity prayer. Just give me the serenity to accept the things I cannot change. And I couldn't change the environment that MetroHealth was going to change our competitors, that was not going to be they were not going to do something different. Give me the courage to choose the things I can and the wisdom to know the difference. So I said to the folks, as we had this discussion, what is no one do? What are the gaps, and there were typically the gaps were businesses that were significantly needed but didn't make money. So I said, Let's not focus on the money. Let's focus on what we need to be able to do. Hence the social determinants of health focus, on the institute of health, primary care, doing a lot of risk contracting for patients who are underinsured, or Medicaid. And then once we figured this out, oh, what we did was take that relentless approach to problem-solving, and our ability to experiment and figure out a way to make it work financially. We didn't spend the time saying, we're going to compete with the clinic. I never worried about what any of the other health system's strategy was. That's just negative energy.

Scott Allen  29:49  
You know, I'll never forget because the first time we met, I was giving a presentation at my university and you are in the audience. And I think I gave a couple of examples of healthcare institutions in the community, I said, University Hospital Cleveland Clinic, and you walked up afterward very kindly said, I would appreciate it if you would include Metro Health in the future when you're talking about health care systems in the community, and you had an MRI your card, and I took it, and I said, Great, I will for sure. Thank you so much. And afterwards, I looked down at the card, and it said CEO. And I thought, wow, and literally, acronym, four days ago, I'm, I'm presenting to a group of people in our community. And that lesson has always stuck with me MetroHealth was on that list. I want to kind of wind down your commitment to inclusion, diversity, and equity. I think this has been and there are some beautiful videos that have been produced, that I was exposed to by Alan Neville, and I just I will place those in the show notes. But there's just been a strong focus by you and your team in this area, would you talk a little bit about that? It

Akram Boutros  31:10  
doesn't come from a place where it doesn't come from a place of this is a moment in time and we need to do this, this has to do much more with the personal way I view the world, which is there's fair and unfair. And fairness is critically important for anybody to be happy, successful, and achieve anything else. That if you remember children saying but that's not fair. And you remember how frustrated they would be? Because they couldn't reconcile what the prior position of a parent was to this one, or how it compares to someone else. And they're saying, but that's not fair. And that has always stuck with me as a critical component of being a good leader, being someone who cared for the people who work in the organization. Fairness was really important. So six years ago, I got an email from a lady who said, By the way, highly competent, very talented, but I can't get an interview for this position. I read her resume, and I'm like, she's excellent. I call my HR staff and say, Hey, what's going on? She doesn't fit the educational qualifications. I said, she's done the job for 13 years. What do you mean, she doesn't fit the educational qualifications? So the turns are all along with the job descriptions and healthcare and otherwise, we set these artificial requirements. So I said, go redo every job description. And by the way, bring an experienced equivalency. I don't care if you got a master's degree or Ph.D. or whatever. If you've been doing the job, you should be able to apply for it. Well, not only did she get hired by a manager, who told me that's why we have 40% of our managers, ethnically or racially diverse, but you also have to understand is that for us, and for me, I understand that that talent and skill are equally distributed in the world opportunity is, we have to make sure as much as possible, opportunities become equally distributed. When I look to hire chief diversity, Officer Allen came on board, and he's our chief equity officer now, and we have Dr. maudlin who is our Chief Health Equity officer. They helped us have the conversation, very uncomfortable conversations, but have the conversations about race, and ethnicity. What is structural racism really mean? Because people have, especially white people have a very hard time with that terminology, what structural racism. And it's the idea that if you don't think about what the obstacles of everyone else say, You will tend to make rules that take care of the majority, that doesn't take into account the minority. And we've done that, and we've been able to have these conversations and these videos are really the start of a conversation for people. So they understand both how hurtful these actions are, the small things can be, and how wonderful when somebody pays attention. It can be how he can create bridges. And we have people who just talk really plain language and just say what it's like. So this is a sense of fairness and respect that we have for every human being. However, however, they find themselves in how they are defined by the society we need to do. Good for them.

Scott Allen  35:05  
Very well said, Very well said. Anything else that you want to mention, sir before we wind down,

Akram Boutros  35:12  
I would say, and I know that your listeners are from all over. But I would say, Cleveland has great promise. And one of the reasons that I've decided to retire at the end of 22, is we need to know when to shift to new leaders. And we need to be able to figure out how passing the baton is just as important as running the race. Because I think most executives see their time in the chair as equivalent to a race. It's just a single leg. I am the 28th, CEO or precedent for a 185-year-old organization, there are only six people who will I've been in the seat longer, for as long as I have an organization. So there'll be seven of us and 185 years, we have to be very cognizant about passing the baton because you want the next person who comes after you to be more successful than you are and help the organization move forward. So we have to do more of that we have it has to become much more of a bigger responsibility for the chief executive and for the board to ensure excellent, excellent transfer of leadership here.

Scott Allen  36:40  
That is so well said, passing the baton and knowing when and striving for that next person to do better than you. That's what the organization deserves. That's what the patients deserve. That's what our community deserves. So well said, Before we close, is there anything that you want listeners to know about maybe it's a resource that you absolutely love, maybe it's something you've come across recently having to deal with this topic of leadership that you would turn them on to? Well, I'm

Akram Boutros  37:11  
gonna tell them my favorite book of all time, which is Leadership and Self-Deception. Okay, so written by the Harbinger Institute, and I think he goes to that discussion with firsthand which is about the mental model, and the prison, and how we create our own prisons, for our own success sometimes. So I would, I would suggest, it's a very easy read. So it's leadership and self-deception by the arbiter Institute.

Scott Allen  37:43  
I think I think you should write a book a leadership book called escaping Alcatraz.

Akram Boutros  37:49  
You know, Suzanne, and I want to write a book together because we come at things from very different places on a very large scale. She's very empathetic. But we come to the same conclusion often. So we may one day write that,

Scott Allen  38:05  
sir, thank you for the incredible work that you and your team do in our community in the world. I can't wait to see what the next chapter holds

Akram Boutros  38:13  
for you. Thank you very much for having me, Scott. It's always such a pleasure.

Scott Allen  38:17  
Okay, be well

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