Gora Agarwal (Intro): Too often, we reserve the label of leader for someone with a fancy title before their name.

Logan Pause (Intro): But great leaders are everywhere in our midst.

Gora Agarwal (Intro): I'm Gaurava Agarwal, but everyone calls me G.

Logan Pause (Intro): And I'm Logan Pause.

Gora Agarwal (Intro): On Anatomy of an Everyday Leader, we believe that everyone has the potential to be a great leader on a healthcare team.

Logan Pause (Intro): To find out what it takes and what it means to lead in healthcare, we talk to people from around Northwestern Medicine who are doing just that.

Gora Agarwal (Intro): Whether you've just started your career in healthcare or are a seasoned professional, have a leadership role or hope to take one on someday, this podcast is for you.

Logan Pause (Intro): Join us as we peel back the layers of leadership to ultimately make healthcare better.

Logan Pause (Host 2): Daniel O'Donnell is a physician assistant with nearly two decades of experience in orthopedics. He manages a growing team of advanced practice providers across multiple specialties and is one of the first APPs in a role of this kind. Daniel is known for his approachable leadership style, commitment to optimizing APP roles and advocacy for expanding APP leadership structures. Welcome, Dan.

Daniel O'Donnell: Thanks so much for having me. And yeah, really nice to meet both of you.

Host 1: Well, Dan, I have to tell you that as we were opening this up to say, tell me about a leader out there that you think we should be interviewing now that you've heard a couple of our podcasts, multiple people named you just spontaneously. And so, I was like, "Well, who is this person?" Because, you know, we got a lot of sort of single nominations, but you were one of the only people that several different people independently wrote me and said, "Hey, have you ever met Dan?" So, excited to have you here. Thank you for taking the time.

Daniel O'Donnell: Well, I'm honored.

Host 1: Maybe we could start by just having you tell our audience what some of these terms mean. If you wouldn't mind sharing a little bit about what's an APP, what's a PA, what's an APN? Just to make sure everyone's on the same page.

Daniel O'Donnell: Great question. And for the longest time, APP wasn't a term. PA's physician assistant. APN, np, you'll hear CRNA. These are all advanced practice nurses. And so, an APP is an practice provider. We lump all the APNs and PAs into one term, which does make it a little bit easier for everybody, to wrap their head around what does a PA do, what does an APN do. So, making us all APPs definitely does help

Host 1: Tell our audience a little bit about yourself and your clinical role, and the path to leadership.

Daniel O'Donnell: I've been a PA for—This is my 20th year now. I started in 2006 in orthopedics, in a private practice, transitioned over to Northwestern Medicine eventually. But back in '06, out of school, I went to this private orthopedic practice, which has been fantastic. And the first six to eight years, I was, you know, working full-time as a PA in the surgery and clinic, first in surgery mainly. Getting my feet wet, right, as a brand new grad out of school is a lot to take in, especially in the OR, on top of the clinical part, which took a little time as well, and that came later. But that was the first six to eight years.

Come—let's see—2014, after we had merged with Northwestern Medicine, the current PA manager that we had for our private practice stepped down. And so, I first hesitantly took the job. It was a gradual kind of ramp up into management. I was still full time as a PA, had no admin time. And at first, it was just really covering the operating room schedule, making sure all the cases were covered.

As it slowly evolved, I got more tasks from administration. A lot of it was recruitment. So, I started doing a lot of the resume combing, calling the candidates, doing the interviews, and they really kind of gave me the driver's seat to hire new APPs and that's how we grew up quite a bit over the last 10 years.

I was the big advocate for the PAs at the time, which is now APNs as well. And so, it kind of evolved into recruitment, you know, advocating for the APPs, getting on more committees. And it got to kind of an inflection point about four years ago now. The director at the time was a good advocate for me, and he gave me a formal manager role with protected time. And at that time, I expanded my management out to the far west in Sycamore, the orthopedic group there, and took on just one extra PA, but they were hiring. And then, I started the recruitment process there.

And then, a couple years ago, expanded to non-orthopedic APPs. Much more of a learning curve for me. But the director I was working with, who I was working with in the Sycamore ortho group, took on an expanded role herself. And so, she asked me to help with the APPs that she took on. So, I've expanded now to 28 APPs that I am currently covering, and it's growing. So, that's my path, and it's ever-changing. It's been an adventure. And I'm still eager to learn more and a lot more to learn.

Host 1: I love that.

Host 2: Dan, it's great to have you on the show and get to chat with you. I want to go back to one of the words that you used to start your story. You said, "I hesitantly took the job." Tell us a little bit about why were you hesitant to go into leadership?

Daniel O'Donnell: Good question. And, you know, I obviously didn't go to school for management for leadership. So once this opportunity came, I had to really think, "Do I really want to, on top of what I'm already doing?" which was pretty hefty load with a busy surgeon. On top of all that, "Do I want to lead more than a handful of PAs? You know, am I capable of that?"

And I look back to some other aspects of my life. I was big into sports, played rugby in college, and was the captain for a while of the rugby team, right? And I look back at that, I'm like, "Well, if I'm able to handle that, maybe I can handle managing some PAs." But I also learned early on that when an opportunity comes, you should take it, right? Especially in Northwestern Medicine, I think always say yes when an opportunity comes, and then deal with what that entails afterwards.

Host 2: As you've progressed into a leadership role, how would you describe, Dan, your leadership style?

Daniel O'Donnell: First and foremost for me is be approachable. Be present. Be easy to talk to. Make it an easier aspect of their life to come to you. And relate to them. Relate to your colleagues and see what you can do to help them. And that's a big part of my leadership style. And it's still evolving. I am still learning to step away and remove my clinical hat and put on an administrative hat, right? I think that's a lot of what clinical providers that go into leadership grapple with. And that's one thing I do—definitely still grapple with—is when do I need to put on my admin hat while still trying to relate and advocate for my APPs.

Host 1: It's an interesting thing, because it relates to a word you use earlier as well, "I'm advocating for APPs." And what I just heard, when you want to advocate for your colleagues, that comes into play, but it is sort of an interesting thing. One of my leadership mentors talked to me a little bit about when you go into these roles, where is advocacy—the job—and where is something else required in leadership? And so, I think every clinician sort of struggles with this when we do transition into this leadership roles.

Daniel O'Donnell: Yeah, I agree. I mean, especially when you look at APPs as a profession, right? We're relatively new compared to physicians as a profession and nurses as a profession. So, there hasn't been as much advocacy from APP standpoint in which we are seeing growing, which is great. I think having an APP manager or leader. Managing APPs can help to see both sides, right? And try and explain, "Oh, this is what's needed," and then having to explain to the APP this is what's needed from a Northwestern Medicine standard standpoint. I think that's very helpful for retention, right? And having the manager be able to put on both hats, it is very helpful.

Host 2: You know, this idea of wearing two hats or toggling between clinician and administrator, how do you actually hold that tension? We've got leaders in our audience and throughout Northwestern Medicine that they might not be in the same role that you have, but this tension of leader and maybe other roles that they might have. And so, how do you balance that tension?

Daniel O'Donnell: Yeah, good question. It can be difficult, right? You have to try and relate to both sides. That's a big one. And if you have no experience or don't even have a seat at the table in the administrative side, you can't relate to them. And if you don't have any clinical experience or continued clinical experience, you are having a hard time relating to them. So, having the foot in the door of each one, I think, is very helpful, but you have to sometimes be realistic with them. Sometimes you got to be hard on both sides and you have to advocate for both sides. And that does sometimes look like you're pushing back on both sides. But it's important to be able to see both sides, And then, also make both come to the table to come to an agreement.

I look to my mentors, which are physician colleagues, my own APP colleagues, but even my director and my practice administrators that I'm learning a lot from and still continue to learning a lot from. And so, I still phone a friend, utilize the tools that I have around me to be a better leader.

Host 2: I love what you said. And I've found through my experience that the most effective leaders are the ones that are able to have a broad perspective and bring those multiple perspectives to their role.

Daniel O'Donnell: Having the experience, which literally comes with time, right? That is important. And you can go to school for 20 years and get as much education on this, but a lot of it is just having the experience of going through these relationships and these conversations

Host 1: You talked about it's hard for either side to be relatable. And so, when I always say, "Okay, well, if I can't fully relate, then I have to take a leap of faith or have some trust that folks on the other side are making the best decisions for me and our patients and vice versa." How have you sort of learned you are most effective at building trust with people?

Daniel O'Donnell: Be present and be interested and curious as to what they're doing. And in my current role in a wide geographical area, that can prove a little bit difficult. But what I did, first thing I did when I took on non-orthopedic APPs that I didn't know anything about was I just sat with them for a whole day in clinic, and I just shadowed them. And although I don't know any much about GI, I don't know much about gen surg, I at least could see what is their every day like. What kind of patients are they seeing? What's their just day-to-day clinical workflow? And even though, like I said, I'm not any of those types of APPs, I'm still a clinician and you can relate a lot to that. So, be relatable and be approachable. You just talk their language, right? If you're in the clinical aspect of medicine, like a lot of my APPs are, I talk to them about the issues that I have in clinic and the way that I approach clinic as well. And that's how you can relate. And so, that's what I really try and portray to my current APPs.

Host 2: Dan, you've brought up being approachable twice. Can you tell us what you mean by that? What does that look like?

Daniel O'Donnell: Personable, right? Not feared. Don't walk in like you own the place. I'm your colleague. But I want to be relatable and approachable. And that is getting to know them personally, and also being vulnerable with them. Like, "Hey, I got three kids too. This is what I'm dealing with myself," right? And they immediately can relate knowing that, "Hey, I'm a human as well and I'm dealing with this as well."

And keeping it light, right? Trying to keep the conversation light and not always talking about clinical or work. Switch it up a little bit. Talk about what are you doing this weekend, what are your hobbies. I think that's a big part of it, especially if you're coming in not knowing anybody.

I've been working with the orthopedic APPs for several years, and that's easy enough, right? We've established relationships just by time, but the newer APPs that I'm now managing that that has taken some time and still is, but immediately trying to get to know them just on a personal level is, I think, important.

Host 1: Both of our podcast guests thus far have talked about presence and curiosity. So...

Daniel O'Donnell: Yeah.

Host 1: I'm getting the sense that these are two very, very important concepts. You've alluded to this idea that geographical distance between the folks you're managing is an issue. Is there any intentional way that you navigate how to have presence and build these relationships when your teams are spread out?

Daniel O'Donnell: Because it's so spread out, the easiest intentional thing I can do is having, you know, just quarterly teams check-ins, where I don't have to go drive to find them, especially when I'm still doing clinical a couple days a week myself. And so, for every APP I have, I have quarterly check-ins that are on the calendar. If there's nothing going on, we cancel it.

As far as geographically distant locations, that is one thing I personally need to work on more is setting time to just go to them and be present there. This is also where we need more leadership in the APP world. I can't be everywhere at one time. I'm lucky enough that my APPs are pretty darn professional and they're all really good at what they do. They don't need me there all the time.

But as I'm sure leaders can attest to, I mean, you go do rounds at the hospital, you can do rounds on your constituents. They're going to come with some questions, concerns that otherwise they wouldn't have if you don't go to them. So, that is one of my goals this year as well, is to establish those more monthly rounds. Just finding the time is also the fun part.

Host 2: Dan, I want to talk a little bit about your rugby career. What lessons from your rugby career do you feel like you've pulled into your role as a leader?

Daniel O'Donnell: That approachability right there. You know, I started as a freshman in college, as a young rugby player. And I looked up to those captains, those seniors that were leading the team. And once I got to that point, I thought it was very important to, you know, establish comradery. There's a big aspect of comradery and rugby alone, let alone lots of sports, right?

But rugby is a lot of comradery embedded in the team, and that really can make the team better. You're going to have a freshman who's very afraid and very timid about coming on to the field. Getting to know them outside the field or off the field can really make you more approachable and make them much more comfortable. And that's one thing right away that I think I'm bringing to my current leadership style. But that was one thing with rugby that I definitely saw.

Host 1: The APPs have been a focus for us. Because as you noted, I actually think you are a group of people that hold sort of the keys to the future of healthcare delivery. And you talked a little bit about managing your clinical schedule, managing so many folks, how are you thinking about your self-care, your wellbeing?

Daniel O'Donnell: Prioritize, right? You need to be able to prioritize the needs of your APPs, the needs of the department, the practice, and the needs of yourself. And yeah, those are all buckets that take a lot away, right? You have to think about what's going to keep you happy and keep you not burned out. So, what I specifically do is, especially on the weekends, I try and unplug as much as I can and really try and keep work at arm's length at least for a couple days so I can come back refreshed on a Monday.

The APPs do put a lot of emphasis on work-life balance. And as a manager you ought take that into account, right? While also putting on the administrative hat of, well, you know, you also have to meet the standards of what an APPs is required of, or getting the APP to practice the top of the license is very important, because APPs are providers and we need to be able to see patients. We can evaluate, we can treat patients, we can really improve the access for patients and for practices to get the patients in the door and get them seen, get them treated, and that can be an excellent compliment to the physician. Getting the administrators, directors administrators educated in terms of what an APP does. I've established a pretty good structure in my week, and I'm fortunate to have the administrative time that a lot of APP leaders may not have.

The next thing that I want to bring into my leadership is establishing leads in my departments to be more present. So, I have 15 orthopedic APPs now. That's a big chunk of who I have of the APPs that I manage. And I'm having a harder time keeping up with that. So, I wanting to establish a lead to be another per point person for that big group itself so I can spend more time with the rest of my constituents and can help another APP get into leadership if they're interested in that.

It's the establishing the model of having more managers and more leads is what's going to help, I think, with burnout for directors and managers in the APP world. And we're heading that way, which is great. We have a long way to go. But that's what I'm doing right now to keep my head afloat.

Host 2: It sounds like you had worked on a project within orthopedics to specifically work on APP optimization. As you've led across specialties, how have you brought some of those learnings from that project to support and elevate the APPs and other specialties?

Daniel O'Donnell: Some practices are still utilizing an APP more only in clinic, for example, whereas they can be optimizing in the surgical standpoint as well. It can be very beneficial to both the physician and the APP to be both in the surgical inpatient as well as the outpatient side.

So, just evaluating and exploring that option, it can be eyeopening for a lot of practices. And that's just the surgical subspecialties, right? You look at the clinical only or ambulatory specialties. It's more looking at what procedures minor procedures can we do as an APP that can be explored more, optimized, and performed again for access. But also what patients can we draw onto our clinic so that physician can see new complex patients as well. That's also a big aspect, I think, of APPs in the clinic. Postoperative patients, right? They oftentimes do require a lot of education. And in time, APPs can provide that and that can obviously increase patient satisfaction scores.

Host 1: In my world, one of the misconceptions that we always have to deal with is that if we are leading in a way that improves the wellbeing of the people we serve, there's a cost. And that cost might be perceived as productivity. We have to see less patients, et cetera. I think that's a misconception.

And one of the reasons I believe that so many people recommended you to be the person we speak with is that my understanding is that you are one of the most productive groups there is, and yet your wellness is also not just sustained, but enhanced. Can you talk a little bit about how you've done that and maybe help us clarify this misconception that, frankly, the reason I got into this work is I firmly believe that if people are well, they will be more productive and better at their jobs? Not that there's a trade off.

Daniel O'Donnell: A lot of it comes down to work ethic. The physician I worked with for many years, that's one big thing he taught me, was work ethic—hard worker—still is. And he really ingrained that in me. And so I led by example. I think the biggest part of this group though, that really is impressive and helpful is we act as a team. It's a big group, right? It can be very busy in orthopedics. It is pretty high volume. But we act as a team so we are able to help each other out. When someone's working a bit much, a little more hours than they should be, someone else steps in and helps out. And we kind of spread the workload out, and that's where the wellbeing comes in in this group.

It doesn't work for all groups, right? It really depends on the makeup, how many physicians, staff, and nursing staff do you have, and how many APPs you have that are able to do that. And we have been able to continue being productive, even with a high volume of call by helping each other out. That is a big part of it. And being cognizant of someone's wellbeing. If they're having a hard time, they had a hard weekend, you know, we take call. So, someone that worked really hard in the weekend and they had long days, long nights. The next day, even though they might have a surgery case they have to cover, we're going to get someone to get them out of there as soon as we can. And that's where I think we've continued to have high job satisfaction and productivity at the same time.

Host 2: This idea of modeling, I think, is really something that that is very clear in talking to you that is this a consistent model or example for the people around you is one of the things that I hope that our audience takes away as being really transformative to the productivity or the success or the wellbeing or the teamwork that is byproduct of that. So, great job, Dan.

Daniel O'Donnell: Establish relationships, right? You got to establish relationships. That goes a long way. You might not think it is going a long way by just asking them a couple extra questions, but I think it does.

Host 2: Well, Dan, we've reached that moment where all our guests gets some rapid fire questions from us, so...

Daniel O'Donnell: I think I'm ready.

Host 2: You're not spared either. So, you talked a little bit about work ethic, and I think people can develop that over time, but I've also realized that a lot of this work ethic comes pretty early. So, curious what your first job was?

Daniel O'Donnell: Lifeguard. I started early. I was 14 or 15.

Host 2: Dan, if you hadn't chosen a career in healthcare, where might you have landed instead?

Daniel O'Donnell: Coaching, some kind of sports-related job. I grew up in sports. Still try and play them, even though everything hurts now.

Host 1: Dan, I know that when I moved from a more clinical role to more administrative, I was reading everything that I could find about leadership, listening to leaders. Any resources that you picked up that you said really shaped your thinking about leadership? Or was there someone that you feel had the greatest influence on you as a leader?

Daniel O'Donnell: My administrators, my coordinators, director. They really still shape me. My current APP program director. She's a fantastic mentor for me. I still ask her many questions and still will continue to ask her many questions. She's really helped me kind of see a lot of the administrative hat side of things, while also relating to the fact that she was also clinical as well and trying to change that gear. That has been helpful.

Host 2: Dan, we often grow as we walk through the valley. Is there one perceived failure or setback that you can identify throughout your career that's helped shape you as a leader?

Daniel O'Donnell: I'm going to get my list of failures I got over here, I'll say one that I'm still working on, but has definitely shaped me, was being too reactionary or someone's coming to me with an issue and I immediately react and get defensive and I definitely failed the administrators when I did that. And I'm still learning to not do that. And I take a step back now. And that's really helped me try and analyze things before I approach an issue.

Host 2: What I love about that answer is you "humanize failure" and I don't think there's a leader out there that doesn't have the opportunity to think about the micro that you just talked about, right? Am I over reactionary? Am I responding in a way that I'm impatient or rushed? And so, yeah, thanks for sharing that. I mean, I think we think of failure, it needs to be some, "I didn't get the job that I wanted," right? Or something that's big. But a great takeaway for our audience and also for me as well, is what are the small things that I can improve upon every day? So, great answer.

Daniel O'Donnell: And it happens a lot, right? So, I think that's something that we can work on because there's lots of scenarios like that happen daily. Like you said.

Host 1: Thank you for taking your valuable time with us. It sounds like you're a busy man, and we're really grateful that you're willing to spend all this time with us and share your experiences and learnings with our audience. So, thank you again very much.

Daniel O'Donnell: Thank you both very much. This has been a pleasure and a joy, and I had a great time doing it. So, thank you.

Host 1: Thank you for listening to Anatomy of An Everyday Leader.

Host 2: Subscribe to the show wherever you get your podcasts so you don't miss an episode.