Ep 19: Influencing Women’s Health Choices

Lisa David  0:02

I remember feeling like this should be easier and every woman should have the ability to make that decision for themselves. We set up a program for women with very challenging pregnancies that was done in total collaboration with all the pediatric subspecialties. What I learned from that is, you have to trust women. You give them the information to make their decisions. And honestly, you can’t predict what they’re going to do.

 

Lan Nguyen  0:29

That was Lisa David, President and CEO of Public Health Solutions, a public health organization dedicated to improving the health of low-income and high-risk communities throughout New York City. 

 

Lisa David  0:42

If you hear yourself saying, “Oh, we tried that,” or “I know, however,” it is going to respond to this recommendation. And so I’m not going to put it forward, you have to become part of the problem or the solution. 

 

Lan Nguyen  0:53

In this conversation, hosted by Dr. Joanne Conroy, President and CEO of Dartmouth Hitchcock and Dartmouth Hitchcock Health, we learn about Lisa’s career trajectory from consulting and academic medicine to renowned public health nonprofits such as Planned Parenthood, and the value of prioritizing influence over decision making along the way. So let’s jump into Her Story, a program where we explore the intersection of women, leadership and healthcare.

 

Joanne Conroy  1:27  

Welcome to Her Leadership Story. I’m Joanne Conroy, the CEO and President of Dartmouth Hitchcock and Dartmouth Hitchcock Health, and it’s my pleasure today to welcome Lisa David, who is President and CEO of Public Health Solutions. Public Health Solutions was formed in 1957, and its focus is improving the health of New York City citizens through several important programs. Number one, improving health generally, number two, making sure that grants are applied appropriately, to drive improved health equity in the city of New York, and finally, creating a network of all other resources across the city of New York. So, together, they can improve the health equity of so many citizens that fall through the cracks of our safety net. Lisa has been focused on being involved with women’s health choices for her entire career. And it’s something that we have so much to learn from. So Lisa, I’m thrilled to have you here. Let’s start off with your early career. Tell us how you actually started on the path that you’re on right now.

 

Lisa David  2:46  

Well, first of all, thank you, Joanne. I’m so honored and excited to be here and to share whatever wisdom I have with other women building their careers. I’m the child of two clinicians working in academic medicine, and I always had an interest in healthcare, and in particular, women’s health. And I think that stemmed from the fact that when I was in high school, one of my friends got pregnant and our friend group scrambled to find the money, figure out how to find a clinic, meant to take her there and help her post-procedure. And it kind of highlighted to me the enormous impact that having a child can have on your life, whether you’re not ready, and when you are ready, both positive and negative. And I remember feeling like this should be easier, and every woman should have the ability to make that decision for themselves. It was 1973, Roe had just passed, there wasn’t a big network. We actually found a Planned Parenthood clinic in the Yellow Pages–when you used to use Yellow Pages.

 

Joanne Conroy  3:52  

Well, you know, we talked earlier, and I think I got my first birth control at a Planned Parenthood in inner-city Newark because that was where you could find it. Had my first pelvic exam at a Planned Parenthood there. So yeah, you had to be pretty resourceful to find the resources.

 

Lisa David  4:12 

Yes, we don’t make things up for people in any dimension. And certainly being in the Northeast, it’s a lot easier than if you’re in the Midwest and there aren’t resources. It really had a strong impact on me, and I remember thinking, going into college, that my ideal job would be to run a Planned Parenthood health center. My parents were activists, I spent my childhood out knocking doors and canvassing for Boston politicians. They organized the whole Harvard Medical community to go down to D.C. to Vietnam War protests. And they never said so directly, but there was always the sense from them, that you needed to fight injustice, and you needed to have a positive impact on the world. I wanted to be in healthcare, and I did not want to be a physician living in an academic medical center world because I saw the political challenges every night at dinner, because they worked in the same place. But I did want to do healthcare, and in particular women’s health, so I wound up at a consulting firm that was a healthcare boutique and our APM, and the impact that I chose to have there because it was dealing with much higher strategic issues was to try and put in place a process to engage physicians to improve clinical quality. At the time that I was there, physician decision-making was like sacred cows, you couldn’t challenge them. And so we would work with the chairs and division chiefs, and we would pull data, which you only had out of the billing system at the time because they were all paper charts, and show the variability in how individual physicians treated what looked like the same patient, put that data in front of them and said, “This is weird. What’s the best answer? What are the right decisions?” So we built a really big practice and the wonderful thing about it was unlike most consulting projects that have long implementation timeframes, if physicians agree to do something differently, they do it the next day. There was an implementation, it was like, boom, and you would see resource utilization and bed utilization change overnight.

 

Joanne Conroy  6:23  

So what was it like for you, as a woman, and why do you think you were successful? Did you have some edge about your personality or some characteristic that allowed you to navigate, which–something that I expect would have a lot of, like, unwritten rules. A lot of male hierarchy? Healthcare was like that back then.

 

Lisa David  6:45 

Oh, my god, yes. They were all male physicians, and my consultants were all male physicians. There was kind of an edge being a woman, I got a lot of attention, and I was an MBA, I was a suit, but the thing about learning as a consultant is you have no authority whatsoever, all you can do is recommend and pull together all these fancy decks to support your recommendations. I cut my teeth on being an influencer, not a decision-maker. And so if you can just step back when the arrows start to fly and say, “Look, this is the reason we need to look at this. There can’t be 37 ways to treat a patient, some of them have to be better than another.” And then you have information and data to share, you engage people. And so I think being raised in consulting, where the best you can do is influence, and honing that skill has shaped my own leadership style. I am not a hierarchical leader, I am an influence leader. But what I bring to it is, I’m really good at 30,000 feet, I’m a systemic thinker. And so I can see, “This is where we need to get to, and here’s the intermediate steps,” and make the case. And the piece about making that work, I think, is, you have to understand all the stakeholders and their interests, because they basically just follow the incentives that they’re given. And they’re different. If you can relate to the way they think about things, and come up with solutions that work within that, you can make big changes.

 

Joanne Conroy  8:23  

You think your activist dinner table at home prepared you as well? Because I’ve never thought of you as reticent to speak out on something that you thought you could contribute to.

 

Lisa David  8:37  

Yes. I will particularly say that my mother was the most argumentative person, and well-read person that I’ve ever met. And she loved arguments. So she would take either side, it didn’t even have to be what she really felt, but she always had read everything, which is why my sense of academic medical center politics, I think, was so astonishing to me, but it’s because she didn’t accept anything. I’m sure that was inculcated into my essence of you should speak up, you need to be prepared to speak up, you need to have the case, and that you can make change.

 

Joanne Conroy  9:18  

I think women, sometimes, are a little bit conflict averse, and you have to be very comfortable with conflict and not take it personally and just be able to navigate that, Sounds like you had some great training around your dinner table. How about other mentors in your career?

 

Lisa David  9:35  

I’ve had mentors in almost every job I’ve been in. And sometimes when I was consulting, it was the founder of the firm, it might be just a senior manager somewhere else that you’d make that connection with but is wise and can give you advice. So earlier on in my career, it was very much people within the organization that I was in that were more senior that put their eyes on me and said, “I’m going to help her.” When I was a little bit further along, I actually had two formal coaches. I think every organization has its politics and its culture that have to be navigated. I think I’ve been at some that are pretty challenging. But it was different to have a coach because they’re really helping you drive your agenda and priorities, as opposed to how you go about doing the work you’re doing, and so I found both incredibly helpful. And because I had been given that kind of support, I mentor a lot of people, people that I’ve worked with long ago who still come to me and say, “Help me think through this.” Amazingly helpful, and I think it works best if you find each other as opposed to you’re assigned somebody.

 

Joanne Conroy  10:45  

I agree. The coaches that have been most helpful to me, our lives just collided. Let’s talk a little bit about your career journey because you ended up in academic medicine.

 

Lisa David  10:55  

I did. My parents were astonished.

 

Joanne Conroy  10:59  

So you actually had a wonderful opportunity at Columbia in the practice part. 

 

Lisa David  11:04  

I was in consulting for 17 years, 13 years at APM, and actually, somebody a year ahead of me in business school said, “I’m recruiting you.” We did a consulting project together, he says, “You’re going to go where I go.” And in fact, I did. Then, after 13 years, I actually left and went to a smaller, more boutique women’s health consulting firm, where I was managing director. And when I was there, I did a project with Columbia. There was a woman chair that we had worked with when she was in New England Medical Center, and she came in as chair. And we offered to do a turnaround plan for her because the department was financially a mess, and in several other ways, a mess. So I was there for months doing a turnaround plan. And at the end said, “I’ve been consulting 17 years, I haven’t done anything I can put my name to.” And I said, “Look, New York doesn’t have much in the way of women’s health, there’s nothing stellar. This is Columbia, it’s New York City, you are an amazing leader, and if you want it, I would be willing to stay and be the department administrator.” And she was absolutely delighted. In fact, I was there six years. The first three were very wonderful because we were cleaning up our house, and we had all the authority to do what we wanted to do. And we started to build some of the subspecialty programs, and we set up a program for women with very challenging pregnancies that was done in total collaboration with all the pediatric subspecialties. 

 

What I learned from that is you have to trust women. You give them the information to make their decisions, and honestly, you can’t predict what they’re going to do. I had families that had a baby with anencephaly, no brain whatsoever, was definitely not going to live for long, but they were going to be delivered, and they were going to be very resource intensive and very challenging families, and they decided to keep the baby. And on the other hand, I had a woman who tried three times with infertility and wound up pregnant with twins, and late in the third month said, “This is a mistake, I want to terminate.” You have to respect when you have to give them the information to support their decisions. And then the next three years, it was much more a battle within the hospital and medical school organizations, and I was successful in negotiating a lot of support from the hospital because this prenatal pediatrics program was putting a lot of babies into the NICU and a lot of pediatric surgeries. So they gave us support because we had a huge amount of Medicaid patients. 

 

And then a new team came in and didn’t think that we needed to have a strong OB-GYN department and we were the fastest growing clinical department. And he couldn’t go after my chair, who was an extraordinary woman, and I’ve been lucky to work for some extraordinary women. She was a triple threat in every sense of the word, very strong clinician, very strong educator, and very strong researcher. So they went after me. And people wanted to dismantle everything that I built, and he wanted the support that I was getting from the hospital to go into other clinical departments, which I thought, it was extremely emotionally challenging. I was a mess. And I have to say I give all credit to the woman who ran Babies Hospital at Columbia, came to me after a year of this torture and said, “You can’t take this personally. And you are not going to win. It’s time for you to move on.” Best advice I ever got. And after I left, he sort of left them alone. So from there, I went to Planned Parenthood. I had done a lot of pro bono work over the course of the years because the consulting firm, when we started, we were in the same building as the National Planned Parenthood Federation of America. So I did pro bono work for three different presidents. And when Cecile Richards came in, she was told by somebody from Columbia that she should talk to me, and I had turned them down a couple of times about taking a job there, but at this point, I reached out to them. And so, I took over their support to affiliate health services, I took over healthcare, and Cecile was yet another extraordinary woman, mentor, and just the embodiment of leadership. She’s an amazing speaker, an amazing visionary, and to this day, when I hit a challenging situation, I say, “Lisa, channel your Cecile.”

 

Joanne Conroy  15:30  

What a gift to really work in that organization at that time. You must have felt like your career had come full circle.

 

Lisa David  15:39  

I wanted to run a health center and I’m running national healthcare. It was great, and I grew, they gave me education, medical services, global work, and then when the COO left, they gave me those corporate functions of HR, finance and legal, it was probably way too much for one job. There was probably more stress because they were totally under attack all the time. We came in just as the Republicans had taken over the House and their first ten bills to hit the floor were to defund Planned Parenthood. So it was very challenging situations, but it was a different politics. It was external politics, not internal politics, and I felt every day like what I’m doing is critical, and it’s life and death for women. It was an extraordinary six years. And from there, one of the big donors for Planned Parenthood had set up a nonprofit pharmaceutical to create a hormonal IUD that would be affordable for low income women. So many of the planned parenthood and other reproductive health clinics couldn’t carry murena because it was too expensive. And so, it was part of the funding contract with this hormonal IUD would be available at $50. And I happened to arrive there, I was on the board for a couple of years, the founders stepped down, and I arrived there the year that we got FDA approval and launched the product. And I can tell you, what I didn’t know about pharmaceutical companies was everything. It was interesting. 

 

I hired a wonderful OB-GYN to be the President, and just went back on the board, but while I was out there, and this was in San Francisco, I got a call from somebody from Planned Parenthood, somebody from the funder, and somebody from Columbia saying, “There’s this organization, Public Health Solutions, and the CEO is retiring. And we think you would be great for them. And this would be great for you.” And they recommended me to the search firm, and I wound up with that CEO job. And I didn’t know anything about public health – I was an acute care person. And the public health system is much more complicated and tortured than the acute care system, but we were really a partner of the New York City Department of Health, and almost all the work that we did, they had asked us to do. Recently, we’ve been trying to knit that contracting ability and direct service experience to create a more formalized public health infrastructure at the community level. Putting together a variety of community-based organizations inserting technology that allows information to flow back and forth. So we actually know if we make a referral, do they actually get services? And we get back how much they got. And then having to integrate that back into healthcare. This is, in this organization, how I think we can change the world. This is desperately needed, and will have a big impact on community health and individual health. 

 

Joanne Conroy  18:31  

I think that public health and public health equity is actually coming into its own. You are perfectly poised, from your experience, from data, to having a systemic view, because you can’t get too lost in the weeds because you’ll never find your way out. There are a few signature questions we like to ask. I think I know the answer to some of these. Do consider yourself to be an accidental or an intentional leader?

 

Lisa David  19:01  

It’s funny because I’ve moved from place to place with a network of help. So in some respects, I wind up being CEO accidentally, though I will say I never aspired to be a CEO until I went through the legacy program that you set up. I never step back, my whole lens was impact, not power. So, I never set out to be a CEO. I can’t say I’m an intentional leader, but I have felt like you don’t need to be a CEO to be a leader. I felt like I’ve been a leader in every single one of the roles I’ve had. So in that respect, it is intentional, that if you focus on where you are, and think about the bold ideas that you can put in place and make them happen, you’re going to have impact and you’re going to grow. So it’s a little bit of both.

 

Joanne Conroy  19:51  

What piece of advice would you give your younger self?

 

Lisa David  19:54  

Well, my advice is pick a job that you really want to do. And I know that’s hard, and it’s even harder for young people today than it was when I came out. I’ve never been driven by money for a job. My first job at Harvard School of Public Health paid $10,000 a year. And I remember hearing somebody on the sidewalk, who must have been a Harvard Business School student, say “I got my 40,000,” thinking, I’ll never make $40,000. I think life is just so much better if you’re committed to and enjoy what you’re doing, so I would prioritize that over money. What I do every year at the end of the year, as I start a new year is, I say, “What do I want to learn next year? And what do I want to get accomplished in this organization?” If that’s a compelling thing, I agree to, I’m committed to stay. But what I’ve learned over my job tenures is it’s equally as important to decide when to leave as when to go to a job. And if you hear yourself saying, “Oh, we tried that, or I know how everybody’s going to respond to this recommendation. And so I’m not going to put it forward,” you’ve become part of the problem, not part of the solution. So I stayed in this consulting firm five years too long, for sure. And didn’t have the kind of impact that I’d had. And I had to be guided out of Columbia from somebody. I was so intent on fighting, that I was destroying my emotional health. And all I was doing was defending, I wasn’t moving the place forward. If you want to make change, requires new ideas and energy, and at some point, you bypass that, and it’s important to recognize that and say, “Okay, time for something new.”

 

Joanne Conroy  21:38  

That’s great advice.

 

Lisa David  21:39  

And we don’t think about it. And we think of that as failure and challenging, but if you want to keep having impact, you got to move on.

 

Joanne Conroy  21:46  

And finally, if you wrote your story, what would you title it?

 

Lisa David  21:52  

Bold Ideas: How to Change the World. I’m not so egotistical as to think I personally have changed the world, but in each role that I had, I have had ideas that we’ve been able to nestle people committed to them, and get them done, that has had significant impact on the quality of care.

 

Joanne Conroy  22:15  

Thank you, Lisa. I’m just so impressed that the journey to really support women’s health has been the touchstone of all of your career choices, and you have made an impact in every single one of those and we still have a lot of work to do.

 

Lisa David  22:34 

We have more work to do than we did ten years ago.

 

Joanne Conroy  22:37  

Yeah, yeah, but I feel confident with you in our corner. Okay. Well, thank you so much.

 

Lisa David  22:42  

Thank you.

 

Lan Nguyen  22:44

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