How Sarah Sinclair creates positive change at The Cleveland Clinic

Sarah Sinclair, Executive Chief Nursing Officer, Cleveland Clinic Health System; Chair, Stanley Shalom Zielony Institute for Nursing Excellence

Sarah Sinclair says she could run a Toyota plant or a chicken farm. After all, it’s all about people and processes.

As the executive chief nursing officer for the Cleveland Clinic Health System and chair of the Stanley Shalom Zielony Institute for Nursing Excellence, Sinclair is charged with overseeing 11,000 nurses. When she started, her role was a new one, so she had to focus on the people and create processes in order to make changes to improve the organization.

“It’s not that hard, but it’s hard work because it’s about building relationships,” she says. “People will go with you in the change process if they believe you’re sincere and have good integrity and you’re not in it for something for you, but you’re in it for the right thing in the organization.”

It’s key to make sure you paint a picture of where you want the organization to go.

“It goes very much to being able to create a future state in the form of a vision, which allows people to get engaged in that process,” she says. “That’s the most important thing because if people can see where it is they’re going, why it’s important and be a part of creating that, then they have a vested interest in wanting to go there.”

To start, Sinclair asked whom the changes would impact the most in the organization, and she gathered groups of those constituents together to talk to them. This included patients, physicians, leadership, professionals with whom nurses worked and the nursing leadership and staff nurses. She talked to them about what was important and what needed to be prioritized to make the organization better.

“Surprisingly enough, there will start to emerge common themes of all the various stakeholders of things that are important and things that they see have an opportunity to be better in a future state,” she says.

As these themes emerged, she captured those in the work they did and went through a process called multivoting with each of those stakeholders to prioritize the objectives based on what they thought was needed most immediately. Each person was able to select his or her top three choices.

“It’s really looking at what gets the most votes,” she says. “It’s not a democracy, necessarily, but it is, in a way. If 40 percent believe this is No. 1, and the next closest is 20 percent, then probably that is the priority to the bulk of the stakeholders. There’s usually good thought put into it.”

She says to pick the top two to three items to focus on moving forward. It’s also important to remember that going through a process like this takes time, and you can’t rush it.

“Take the time to do it strategically, methodically, and cross all the T’s and dot all the I’s,” Sinclair says. “Don’t try to race through it to some end that you’ve determined — take the time to build the relationship and get your stakeholder input.”

It took Sinclair about three months to go through this process when she started, but that’s because the Cleveland Clinic is a large organization. If you have a smaller organization, you may be able to do this more quickly.

Once you determine your top objectives, then the real work starts. Make sure your structure reflects the objectives you’re working on and put people in key leadership positions who can effectively move you forward. You also need to create project management around your objectives.

“If you had three different themes, it would look like three different projects with timelines, objectives, how often are people going to meet, what are the outcomes, how are you going to measure their success,” she says. “It’s putting the structure around the process to make sure you hold people accountable to getting the work done.”

As you move along, it’s also important to make sure you’re prepared to make a change if need be.

“It’s pretty clear,” Sinclair says. “Usually, it’s when your stakeholders are telling you something’s not quite right. It goes back to listening and intuitively watching the signs of your organization — when it’s going through fatigue, when it’s not moving at a pace you’d like to move at — sometimes you have to energize it. …You’ll know when your team is beginning to tell you things aren’t working or the team suggests something new.”

How to reach: The Cleveland Clinic Health System, (800) 223-2273 or