Ep. 105: The Pursuit of Executive Leadership

Dr. Sanjula Jain: Good morning. My name is Sanjula Jain. I’m the Chief Research Officer at Trillion Health and a member of the Herstory Advisory Council, and it’s my absolute pleasure to introduce you to Dr. Janice Nevin, president and CEO of Christiana Care Health System, Dr. Nevin. Welcome and thanks for being with us.

Dr. Janice Nevin: Thank you. It’s great to be with you. Really appreciate it.

Dr. Sanjula Jain: Dr. Nevin is a particularly special guest for me personally because I’ve had a chance to know her for several years now, including her journey before becoming CEO Christiana. So it’ll be fun to of dig into her story. But Dr. Nevin, you didn’t start off as CEO. You started off as a physician, and so tell us a little bit more about how you got into healthcare. What inspired that interest to pursue a career in medicine?

Dr. Janice Nevin: Yes. I couldn’t have imagined becoming the CEO if you’d asked me several decades ago. I grew up in England. My best friend was the daughter of the local gp. And I was one of those kids that. Inspired early, and both my friend and I ended up going to medical school and becoming physicians, both of us family doctors.

Dr. Sanjula Jain: what were, as you, you’ve have a lot of different roles that you’ve hats that you’ve had to wear along your career. So I’m gonna fast forward this a little bit to, when you were more in the chief medical wearing your Chief Medical officer hat clinic, kind of system-wide administrative leadership, how did that differ in terms of some of the challenges and opportunities compared to more traditional clinical frontline leadership in academia?

Dr. Janice Nevin: Yeah, I think I’ll dial us back even a little bit more. When I started my career and started my leadership journey, I really anticipated being in academic medicine. And I had gone through, chief resident, associate program director, residency director, chair, and then my vision was, I was gonna end my career in academic medicine, not be a professor emeritus, be that, person in a wheelchair that’s still coming in to lectures to grow medical students and the next generation of physicians. And I came to Christiana Care, as I mentioned, really with that same trajectory, but I got some opportunities early in my tenure at Christian. One of them was the Health Management Academy Fellowship, and it really opened my eyes to other possibilities. And I got really interested in. Health systems and the systemness of healthcare. Got to understand there were capabilities that I hadn’t really thought of previously or developed that I had the chance to grow and got a terrific opportunity here at Christianity Care to, to grow and transform one of our acute care. And I came to realize that was the the fork in the road. Either I was going to continue on a more traditional clinical path, or I had the opportunity to grow and develop as a physician executive, and I made the choice grow and develop as a physician executive. That led me then. To the chief medical officer role, which was my introduction to the C-suite.

Dr. Sanjula Jain: No, I’m not a physician myself, but I know a lot of my colleagues and other leaders like yourself have talked a lot about that inflection point of more of that clinical leadership path to more of the system side where you’re all make having to make that trade off, on the clinical practice side, did you struggle with that decision? What was your thought process at that time, knowing that once you take that. Not so much in go back, but you’re choosing to move away from your early training roots and maybe your early aspirations at that time.

Dr. Janice Nevin: That’s a great question and I talk a lot to physicians who are earlier in their career about that. I think the struggle is in thinking about it, if that makes sense. And what I say is there will come a moment in time when there will be clarity around that. And the decision may not be. The struggle in the way that you are imagining. I will tell you I loved practicing clinical medicine. I treasure those times that I was, caring for patients. There is something very pure and it is the heart of healthcare to be in a room. With a patient having a conversation about who they are, what their healthcare needs are, and really working together to help them. So I valued those very much. It’s a wonderful profession and I’m so glad there are people who stay on that clinical leadership path. I work with amazing clinical leaders here at Christiana, but in that moment when I was essentially offered the choice to stay as a clinical. Leader or move into a physician executive role. There was tremendous clarity for me. I was passionate about the opportunity that I was given to lead the acute care campus. And a again, I, yeah I also, look back and everything that I had, Done, had accomplished as a leader to that point, I believe prepared me to take this new journey which has been tremendous

Dr. Sanjula Jain: We could spend an hour just unpacking that, but given that this is her story, so I’d be remissed if I didn’t ask the question. So given that you were also a female leader, I’m sure you’ve faced many unique experiences just based off of your gender, but have you felt that some of the unique challenges just by being a female in more the clinical side versus once you enter the C-Suite, did those challenges change for.

Dr. Janice Nevin: I think about, my generation and I have had so many experiences where I. The first or the only one in the room. In fact and I think I’ve probably shared this with you before when I started high school, I had the good fortune of going to St. Andrews School in Middletown, Delaware. It was the year that they became co-educational. So I, I was one of 26 girls. There were 150. That first year. So I often say it prepared me for the rest of my career. And it even, even dialing back and I won’t say how many years, even in sort of family medicine, there really weren’t that many women. who were leaders or were ahead of me in terms of their career. When I started as a young faculty member, I had my first child that first year, and there was nobody else of in the department that I could talk to about how did you manage this? What did you do? For childcare? I think it’s changed now. That’s really, that’s terrific. But certainly, I continue to have the experience of being the only one in the room. I would say coming into the C-Suite, there are more of those experiences, particularly in my current role. And there’s also, we have made progress but gender bias is. . And it comes in many forms. I still occasionally have the experience of being talked over, of sharing an idea, having it repeated by a male colleague and acknowledged it, it’s, so some of that work that we need to do. And I would say, given where I am in my career, I am committed to making sure that we bring up the next generation of women leaders, not only work to get them at the table, but really help support making sure that their voices are in the conversation.

Dr. Sanjula Jain: You’ve been tremendous about doing that through your leadership roles. I’ve seen it firsthand where you’re constantly advocating for others and coaching them and you’ve been, an implicit mentor to me along the years, whether you’ve seen it or not. Emotionally though, that support system is something that’s really interesting to think about. You mentioned this kind of, you were the only one, and often we say agnostic of gender, leadership can be lonely at times as well. How did you, like, where did you lean on for support? Was it family? Was it other, like how did you cope during those tough moments, especially in those early days where you didn’t have many other female role models to look up to or event to or bounce ideas off of?

Dr. Janice Nevin: I have had some wonderful male mentors. and it is so important for men to appreciate some of the challenges. Women may experience. And so some of my most important mentors, particularly in those early years, were men. And I credit that, the person who gave me the opportunity to really make that change in my career was my predecessor a male. And so grateful to have had those leaders in my life to help see the opportunity for me and give me the chance. To really grow my leadership, I would say. Now what I have found to be really important has been to cultivate a network of peers. You said it is, leadership can be very lonely. But there are others out there who are sharing your experience and I have worked intentionally to create that network. It is important, I believe, for. to make sure that they have that network of female peers again, to have those conversations about some of our unique challenges. But it always important to cultivate, grow network mentors. And you mentioned family. I’m, I’ve been married for more than 31 years. The two of us have managed to navigate. Two careers raised, two children. And I’ve been very fortunate that I’ve had a partner along the way.

Dr. Sanjula Jain: That’s actually a great segue to my next question. So being in a dual career family, I’m sure along the way you have children, you have a lot of responsibility. You probably had to make some professional and personal trade-offs along the way. I’m sure there are many, but is there one. Kind of trade offs that you remember making at some point in your career, that you just, you’d look back on to that kind of influence your journey today.

Dr. Janice Nevin: I always have an allergic reaction when people talk about work-life balance, because I look back, there was nothing balanced . And it, you give and take, be depending on what’s needed, what the circumstances are. So this phrase of work-life wellbeing, I, I talk about, I, I’ve learned how to integrate work into life in a. That is meaningful and purposeful and and impactful. I do, we all have choices along the way and sometimes I think we forget that, but we all have choices. And I can remember earlier in my career, I made a choice that I was not gonna pursue. Growing, going up the academic LA ladder. I was an assistant professor for a very long time. I’m now a professor. I got there eventually, but I made a very intentional choice that I had young children, but I was also a new residency director. I was growing my, my leadership with some national organizations. And so for me it was what’s the most I. For me in my life currently, and I prioritize, what am I willing to say? This can wait, or maybe even this comes off the list. But I do, I for women, particularly for young women in particular, remember, you always have you, you can make choices. You can choose what’s important to you about how you spend your time and and energy when it comes to your career.

Dr. Sanjula Jain: It’s very well said. So you talked a little bit about, you are, you’re both, you consider yourself to be both an intentional and acceptable leader and probably more intentional as you progress throughout your journey. So I know, so going from kind of your C M O role to thinking more intentionally about the CEO role and. You’ve grown up in the Christiana Care system, and so you have a unique perspective that a lot of other CEO candidates that were applying for the job maybe didn’t have. Tell us a little bit about, I know it was a rigorous process despite you, having the mentorship of the prior CEO, your kind of known entity in the organization. You still went through a full process and you did a lot of personal reflection. You had to interview. What was that entire process like?

Dr. Janice Nevin: It was really important. I’m very grateful that I had the chance to go through that process. And again, I think it’s hard to characterize intentional at times for physician leaders. There’s an expectation that you go through this sort of natural evolution of leadership. There are roles that exist and I believe it’s always really important to take the time to reflect to assess oneself and again, do the work of what’s important. What are my capabilities and don’t underestimate them and what am I what is going to be important to me in terms of having an impact. And even though I’d been at Christiana for quite a while, at that point, the board decided to do a national search and it afforded me the opportunity to work with a coach. And to be very intentional about wanting to be a CEO to get to the point of being able to say, I want to be a CEO. I’m ready to be a CEO, I want to be the CEO at Christiana Care. But if it doesn’t happen here, it will happen somewhere else. And I believe having the opportunity to do that work as I was interviewing that, that sort of confidence. Certainty. The it, that optimism, I think, came through and ultimately got the chance to be the CEO here, which has been more than eight years now, Sanjula. Who could have thunk it

Dr. Sanjula Jain: So there’s so much to reflect upon of the different stages of that CEO trajectory. But if you can think back to, let’s say, those first 90 days of wearing that CEO hat. What was the most surprising thing for you? What did you not expect? I’m sure it was a whirlwind of new things and responsibilities you’d prepared, but what was just the one thing that you’re like, oh, I didn’t expect this.

Dr. Janice Nevin: I would say I I’ll reflect on one aspect that I perhaps underestimated and another that was a piece of advice that I got that I should have followed and didn’t in those early days. The, when you are the CEO, it is really important to cultivate the relationship that you have with the board, and particularly the board chair and intellectual. I knew that to be the case. But manifesting that took some work and when I talked to individuals now who are new in the CEO role, I always asked them to reflect on their relationship with the board chair, and how they expect to move forward because it’s a crucial relationship. the other I got a piece of advice from a very seasoned CEO who was not in healthcare but had a number of experiences and she advised me, build the team that you need as soon as you possibly can. And it took me probably about two years to do that work. When you’re new to an organiz, or new to a role in an organization? I think it can be, and you’ve worked with others on the team as peers, you have to be very intentional about how you show up in those relationships, and you have to recognize that an individual in a senior role may have been very successful. with, in their role with the relationship that they had with the previous CEO. But it’s not gonna work for you. And it’s, managing people is always the hardest part, I believe, of the job. But recognizing that early and making necessary changes, building your own team really important. And as I reflect back I got the. I should have known it took me a little bit longer than it probably should.

Dr. Sanjula Jain: So related to that, let me almost flipped that. So we talked a lot about mentors and all this great advice and having a network of peers and that can be very valuable to any leader, right? To get that counsel and perspective. But have you found that there are moments where sometimes you get advice that you disagree with or maybe to your point, it’s not necessarily aligned with your style cuz off, right? We’re all products of our personal experiences and that shapes the advice we give to others. And so how have you navigated those moments where whether it’s a mentor or colleague boss, peer Webber, it is where it advised you to do something and you’re like, I actually disagree with that, or that’s not gonna work. How do you think about that?

Dr. Janice Nevin: Yeah. My favorite piece of advice that I completely disagreed with came from my pre-med advisor as an undergraduate. Who told me that I should not go to medical school in no uncertain terms that I should think about a different career. That was highly motivating to me, , and obviously I did not follow her advice. And I’m a family physician and I think that I, I. Grew up working with with relationships, with specialists, with consultants. And I think I learned in my sort of clinical career that, that’s a form of advice, but it’s up to you because you know the patient and you have the relationship to apply that advice in a way that will. Have the desired impact, and I still talk with a team about that. We’ll have a consultant come in and say, I’ve assessed and you should do this, and this. It’s up to us to take that information and understand how we apply it to Christianity Care. And I’ve done that, I think in my own sort of personal journey also, I would say. And I still, I think some of the best advice I get not necessarily from peers I often consult my team, what do you think? How would you. This issue I’ve often said I should be making very few decisions because I, you as the leader on the team, you’re understanding the issue. You’re helping me understand the issue and you’re sharing your advice with me about how we need to move things forward.

Dr. Sanjula Jain: One of the things that you know, particularly as CEO e o, but many other leaders have to always balance is agenda setting, as right? In setting and priorities. And I hear a lot in my conversations around when you start a role, you have this grand planner. These are all the things that I wanna go tackle and make changes. But then the reality. are the external environment, right? So we had a global pandemic, or are there different environmental factors that under control, that influence, what our priorities end up being. Throughout your eight years as CEO in particular, how have you. navigated the shifting priorities of balancing things that, you wanted and you and your team felt were important for, Christiana and your, the communities you serve, versus things that you almost maybe had to do or, pivot towards and that kind of healthy tension of want to do versus have to do.

Dr. Janice Nevin: I think that’s such an important question, and it’s a, as you point out, the external environment over the last eight years has really changed and obviously over the last three years, I’m a big believer in culture. and the most i impactful work, important work I believe we did as an organization was about three years into my tenure. As you said, we had clearly looked at the future and said, we need to we need to embrace value-based care, population health. We need to go outside of the four walls and partner with the community. , I, I believe that organizations that are not only filled with people who are resilient, but organizations that clearly share their their values and connect people to those values are organizations that will not only survive but thrive. As the external environment becomes tumultuous, and we did that work and I wanted to do that work in a very different way than we had done work before, which is I said to the team, I want to be able to walk around this organization and at the end of this year, talk to anybody in any role, and they will share with me how they contributed to the work of defining our. And what emerged from that work. We did that. We engaged the entire organization. We had 400 ambassadors. That helped us with communication. And what emerged from that work was our value statement. I was not expecting a sentence. I was expecting that we would have a few words. I got a sentence. . We serve together guided by our values of excellence and love. We serve together a manifestation of the importance of teamwork, and not only the importance of the team that you’re on, but the need for teams to work together. Think about the last three years, how incredibly important that has been. Excellence. It’s in our d n. It’s exceptional today and even better tomorrow. I, we talk about breakthrough outcomes. It’s not to get to the benchmark, it’s how do we create a new benchmark, but the. Love emerged. So we served together guided by our values, excellence and love. And I was surprised as we’re the quite a few people in the organization and we had a lot of conversation about the word love. Love is, as I’ve come to learn, it’s, yes, it’s about compassion and anticipating needs and being generous, but even more importantly, it’s about doing really hard things. It’s embracing diversity, it’s showing respect, it’s assuming good intentions. It’s speaking the truth with courage and empathy. It’s being accountable. And so what we’ve learned is when I have learned is when you lead with love you, you must walk towards problems. You must do the hard things. And if you do that, excellence is inevit. And I’ve added, equity is achievable. You can’t shy away from some of the new light that has been shined on the issue. For example, of equity in healthcare. LA leading with love compels us to walk towards that problem, to create systems, to hold ourselves accountable to actually having an impact. And it’s, it I would say our values. Buoyed us over the last three years when we were in all of those different phases of the pandemic, and now I believe the challenges experienced by healthcare are greater than they’ve ever been. And it is our values, our mission, our vision, our strategic plan that is compelling us to do the really hard. Of change that’s needed for us to be here, for the people that we serve, for generations to come.

Dr. Sanjula Jain: I think your commitment to culture is really admirable, and it really sounds like it’s been a foundational element to keep everyone guided. Despite all the different changes in environmental things that are happening, that raises the next question around as you reflect. All these different initiatives, all these different points of your CEO journey, all the external environmental challenges, how has your personal leadership style evolved from, let’s say those, first four to five years to meet now those kind of post pandemic environments where we’ve seen, challenges that we’ve really never seen before for health systems, but the health economy broadly.

Dr. Janice Nevin: I have thought quite a bit about leadership over the last few years. and my natural instinct is to be collaborative to work. I’ll say, my job is to help each and every one of the people here exceed their own expectations. I am here as a leader in service to this organization. This organization is our people. I remember hearing about the pandemic in December of 2019, and my first. was, this is gonna be a leadership challenge. This is gonna be a leadership challenge globally, nationally, for healthcare and for me here at Christiana. And as we’ve gone through the various. Phases of the pandemic. It’s required a different style of leadership, and we’re in a, we’re in yet a different moment now. So early on it was a little bit more I would say, captain of the ship. We’ve gotta we’ve gotta do these things. I know we can, holding ourselves really accountable. That last winter was just really challenging. I mentioned, serving together, rolling up our sleeves, being willing to step out of. Usual role, our comfort zone. And in that it was more, holding people up, making sure that we had what we needed to get through that, that sort of that really challenging surge. And now it’s about really, I think again it’s about change in a way that we’ve never had to change before We talk about. We we can’t keep putting band-aids on the issues in healthcare. We have to build a new foundation and then we have to build a new house of healthcare and we’re not gonna the same minds that got us to where we are, not the same minds that will get us where we need to be. And so being very thoughtful about how do. create the change that’s needed, support people in making that transition hold folks accountable. Again, it’s accountability is a way that you build trust. It’s also a way for you to as an individual to explore and do differently and be creative and innovative to get the outcomes. And I do believe that we are in yet. Era of healthcare leadership, and I know I’m being very thoughtful in terms of the role I need to play, the team I need and how we will move forward as an organization.

Dr. Sanjula Jain: Yeah. I think to that point, it’s certainly gonna be a challenging next few years, but also hopefully a promising next few years to actually make me meaningful change that our system needs. So Dr. Nevin, I have so many more questions for you than Tom will allow, so we’ll have to think about a part two, but maybe I’ll close with one final question and that is given this new environment that you just described and these, the new way of leading, going back to your clinical. It’s no surprise that we have a clinical workforce shortage and a lot of challenges and burnout and as you think about the next generation of clinicians in particular, what advice would you have for them? For anyone who’s maybe contemplating and thinking, oh wow, this seems really tough. Or, do I really wanna put myself through this type of intensity given the environment we’re in? , what advice would you give them in terms of why they should still continue to pursue a career in medicine and maybe, a academic leadership?

Dr. Janice Nevin: Healthcare is a wonderful profession. Just think of the impact that you have on the lives of the people that you serve. I think, for somebody who’s contemplating going to medical school, it is it is an absolutely wonderful. Profession, you get so many opportunities to make a difference. I would say the same for nurses for individuals in business or finance. You can come and be part of a system that is truly gonna make an impact on quality of life, on equity, on accessibility to care, on affordability you can solve some of the most pressing problems that we. In society today. So I, I maintain that there, it, there is no greater calling than coming to, to healthcare. And I would say particularly now, we need people who are willing to do the work, bring their creativity, innovative ideas, to be bold, to be courageous, to be authentic. I’m very excited about the.

Dr. Sanjula Jain: Thank you for being so candid and being so willing to share your journey, and I think that you blazed the trail forward for those that will come after you. And so appreciate you spending some time with us today, Dr. Nevin.

Dr. Janice Nevin: Absolutely my pleasure.