Ep 28: The “Not So” Long Fix

Sanjula Jain  0:03  

Women make up 70% of the healthcare workforce but only 20% of its leadership. On Her Story, we’ll explore the careers of bold and influential women from Silicon Valley to Capitol Hill and learn how they’ve overcome the odds. I’m your host, Sanjula Jain and this is Her Story, a program where we explore what’s beyond the glass ceiling.

 

I’m delighted to welcome Dr. Vivian Lee, president of Verily Life Platforms at Verily Life Sciences, former dean and CEO of the University of Utah, and former Chief Scientific Officer at NYU Lancome. Dr. Lee, thank you so much for spending some time with us today.

 

Vivian Lee  0:40  

Hey, it’s great to be with you. Thanks for having me, Sanjula.

 

Sanjula Jain  0:42  

I thought we might start with a little bit about your background and where you grew up. If I remember correctly, you grew up in Oklahoma. How did that influence your career path?

 

Vivian Lee  0:51  

I grew up in the heartland of America. We were one of very few Asian families in Norman, Oklahoma, but I was very fortunate because one of my industrious teachers in junior high set us up to meet with various community leaders to try to get us going on careers. That’s when I met Dr. Howe Belnap who got me introduced to medicine. If it weren’t for that, I wouldn’t be in healthcare, so very interesting. Also, to have grown up in the middle of America, in a part of the country many of us who live on the coast may not feel we understand very much, so I bring a lot of that with me everywhere I go.

 

Sanjula Jain  1:31  

One of the things I was most excited to dig into with you, being a fellow academic and researcher, is you have taken on this academic, “lead with data first” approach to all your roles, both from clinical practice to what you’re doing now (which we’ll come back to in a minute). You went to Harvard for undergrad, you went to get your Ph.D., and then you went to med school. How did you think about which degrees to pursue?

 

Vivian Lee  1:59  

I hate to confess this, but I’m really kind of a nerd. That won’t be a surprise to most people who know me. When I was in school I loved math. My father’s an engineer, my mother’s a statistician. While I was interested in becoming a physician, I always had a passion for engineering, so when I received a Rhodes Scholarship to go to Oxford, it was a chance for me—before going to medical school—to focus a little time on engineering. I was able to do a research project in medical engineering there, which led to the Ph.D. After I got back to the states and went to medical school, some of that engineering came out in the course of my career selection because I ended up in radiology, MRI in particular, which uses a lot of engineering and a lot of physics. That has been something I’ve been really passionate about. I didn’t expect that that engineering mindset would influence the rest of my career (the administrative and leadership components of it) as much as it has. It’s been incredibly influential. I remember when I became the Vice-Chair for Research in the Department of Radiology at NYU. My boss, Bob Grossman, (who later became the dean and CEO and brought me into the C suite) said, “I want you to figure out how to get our department from being unranked [in terms of research dollars from the NIH] to getting into the top 20.” In retrospect, I took an engineering approach to it. I looked at the data for what the top 20 programs were doing in the country. What differentiated them? How could I model out using some of the skills I had from our research work? How could I model out different scenarios? How could I do a little bit of sensitivity analysis in terms of what were high-risk investments, or what or were lower-risk investments for getting us to a more successful state in terms of our research productivity? That more quantitative approach has been core to who I am. Now that I’m back in an environment filled with engineers in a technology company, I feel right at home, but even during the course of leadership in healthcare, I found it to serve me really well.

 

Sanjula Jain  4:21  

That’s music to my ears. I love the numbers. You have more “technical training,” then you alluded that you didn’t envision you’d be leading these multibillion-dollar organizations as you imagined your path forward. Do you consider yourself to be an accidental or intentional leader when you think about your leadership trajectory?

 

Vivian Lee  4:42  

That’s a really interesting question because there’s a mixture in your question of how much being a leader was part of my goal. There, not really. I’ve always described myself as being very driven but not particularly ambitious. I have a lot of energy. I want to do things, but I didn’t set out saying, “Oh, I want to become the CEO of a system or a leader in health technology,” for example. That definitely wasn’t in my mind, but all through my life, I’ve wanted to see the solution through. If I see a complicated problem, I get super interested in it. Like, why is this a problem? How can we solve this problem? Then how can we carry that out? I think that is an important characteristic of leadership. Others may have seen it was a journey towards leadership roles earlier than I did, but I certainly didn’t have that ambition.

 

Sanjula Jain  5:37  

One of the unique aspects of your path is that you have touched different “sub-sectors” of healthcare. Now you’re back in the technology world, which is different than where you started. What prompted the decision to move on to Verily?

 

Vivian Lee  5:52  

I had been in academic medicine my whole life. I had just finished six years of leading the University of Utah’s health system, being the CEO and the dean and the senior vice president there, which was an amazing experience. I learned so much about leading a large, complex organization that embraced innovation and was passionate about improving the health of the population. We got to do a lot of really, really fun things there. Then I had a year sabbatical. In that year, I was able to write this book, The Long Fix, which represented not just stories about Utah but stories from across the country of impressive and inspiring lessons from things that could be done to improve our health system. Through writing the book, I was able to digest a lot of it and reflect on it. Then I was about to join another healthcare system. I had the offer in hand, I was already calling friends to say, “Hey, do you want to come and join me there in this new role?” I was pretty excited about it. Then the folks at Verily came back at me. I had already pretty much decided I wasn’t fit for technology. To give you a sense of it, I went to these Google Alphabet Verily interviews clutching my Blackberry phone. I didn’t think I was ready for a move like that, but they came back and said a couple of things that persuaded me. First they said, “Vivian, if you are fortunate, when you go to this new healthcare system, knock on wood, you can influence that system, you can have an impact on that community, and that’d be wonderful.” But isn’t that the problem? Isn’t the problem that we are only seeing successes at individuals centers and we can never seem to scale that success? One thing that technology—at least this company I’m a part of—understands is scale. How do we bring solutions at scale and that engage individuals, patients, consumers, whatever you want to call us that are engaging? That was one piece where I said, “That’s definitely true.” Then the other piece was they said, “You’ve just written this book about fixing healthcare, why don’t you come and put that book into practice? Come and do it. Come and fix healthcare with us.” As much as I was interested in that CEO role, those kinds of opportunities would likely still be there, but this was a chance to transform healthcare. I thought, “Okay, this will be an adventure. Let’s try.”

 

Sanjula Jain  8:25  

Wow, that’s really exciting. For those of us who may be a little less familiar with Verily, could you give a little bit of background on what the organization does, and then specifically where you focus a lot of your time?

 

Vivian Lee  8:40  

Verily used to be called Google Life Sciences. It was Alphabet’s purpose-built, Life Sciences, and healthcare company which was started about five years ago out of Google X. When Google became Alphabet, it was rebranded and we are now called Verily. Our roots are in clinical research and clinical trials, in a project called Baseline where we collected a lot of data about individuals and their health and tried to figure out how we could better predict the future of health. How could we better use that kind of data to enable more people to participate in clinical trials so that we can accelerate the progress of innovation in practice? That was the cornerstone project of Verily, together with a number of projects that are around hardware solutions— sensors, devices, surgical robots, for example. We have multiple teams full of outstanding engineers doing that. On that foundation, I was recruited three years ago to come in and build health platforms. I’m the president of Verily Health Platforms and our goal is to leverage this incredible capability of data and analytics and models and so on, plus the hardware and the sensors and the devices to improve the delivery of healthcare. We are driven by the triple, quadruple aim. Some of the secret sauce we bring to the table is the ability to ingest lots of different kinds of data about people, including new sources of data, like the sensors, which can tell us about your particular blood pressure, your blood sugars, your mood, your mental well being, for example (that may be very different from me or from others), so you can have a personalized experience at scale. They can also engage you as a patient and consumer, engage your provider, your clinician, as well as the payer systems. Our health platforms’ overall thinking is that we need to have a viable ecosystem of products and platforms so we can get alignment across the system to improve health. That’s what we’re doing. We started three years ago and now we have five businesses within the health platforms. I’m happy to tell you more about them, but they do focus on different areas, whether it’s digital health for people with chronic diseases or digital health for people who have COVID. We have a COVID product, which I didn’t expect to be leading, but it’s a large business for us. We have a product around health systems, a whole business around insurance. We have a stop-loss insurance business and then one around substance use disorders. It’s all a doubling down on mental and behavioral health. That’s what we are now.

 

Sanjula Jain  11:29  

Quite a broad portfolio. I want to come to The Long Fix in just a second, but given your origins on the data side and now you’re on the technology side, have you seen in your current role a “healthy tension” between the pace of innovation and scientific discovery? How long does it take from the system level—the incentive schemes, the payer reimbursement—for that to meet where the innovation is? Is that something you are seeing in the work you’re focused on?

 

Vivian Lee  12:00  

One thing that has been eye-opening for me in moving into the commercial sector, particularly in health technology, is the pace of change. If you think about it, three years ago we were just starting Health Platforms. We had a joint venture around the diabetes digital health solution, but most of what I described to you was nascent or maybe a slide deck or maybe even just a dream. In the time that, if I were in an academic setting, it might have taken for me to have a faculty member get their first R1 grant. In that time, we were able to build out multiple significant businesses. That is a reflection of the pace of change that can happen, which is breathtaking. As somebody who has been living in the last few years, it’s remarkable to see. The challenge is how do we marry that accelerated pace of change with the culture of healthcare, which is very risk-averse and has generally been pretty slow to adopt new innovations change? One of the things that’s going to continue enabling that to happen is the COVID pandemic. With the pandemic, we saw all those telehealth barriers that had been holding us back for years fall overnight. With the economic impact of COVID on our healthcare system and on our economy, we have to figure out solutions faster— even though my book is called The Long Fix. I named it before the COVID pandemic. Now I think it’s the not-so-long, it’s probably a quicker fix because I think we all understand that there’s a lot more urgency. If the digital health and health tech and other industries that are coming into healthcare can help facilitate that acceleration I think all the better.

 

Sanjula Jain  13:57  

One of the things you said earlier that resonated with me is this idea of scale, and that was one of the appeals of making your recent move. I think writing a thought leadership is another way to have that skill of influence and impact. One of the key papers you wrote in JAMA when you were at the University of Utah was the foundation of one of the dissertation papers and the work we were doing at Emory healthcare. All that to say, your influence from sharing these insights and research does have tangible impact. Your book, The Long Fix, is that next piece, at least from my personal bias. As you know, on the show we like to ask all of our guests, “if you were to write your autobiography, what would you title your book?” You’ve already written the book, so what motivated the decision to take the time to write it and put it out there?

 

Vivian Lee  14:51  

When people talk about health care, they often feel rather pessimistic about it. It just seems so large and complicated and difficult to understand and almost an intractable problem. However, as we’ve seen in the last year, we need to figure out our healthcare system. This is absolutely critical for our future success for the next generation. There’s no question about it. I actually have emerged from my years in healthcare surprisingly optimistic. I’m inspired by the lessons I’ve learned, not only in our systems but in systems across the country. This book came out of a series of lectures I gave to our first and second-year medical students who were essentially fresh out of college. I thought to myself, “You are the future of healthcare and I want to explain to you how healthcare works, as simply as possible, through stories.” This is not a textbook. We’re not getting into the nitty-gritty of billing codes or anything like that, just giving you a general sense of how this business works. It’s the information I always wish I had when I finished medical school. Even in residency and fellowship I still didn’t understand how the business of healthcare worked. I probably didn’t understand the business until I became the CEO. Even then, there were still some areas I had to learn about in order to write the book. I wanted to make it easy to understand, easy-ish to understand for everybody, not just people in health care but people who are interested in health. Then also make it actionable. In order for people to feel engaged in this whole issue of “how can we fix the healthcare system in this country and make health better for everybody,” we have to all feel like there’s a role we can play. At the end of every chapter, I have an action plan with some suggestions for you as a patient or consumer, for you as a provider, clinician, as an employer or somebody who’s paying for health care—there are lots of employers out there struggling with how to manage their health care bills of their employees—and then of course, as a policymaker. I found being able to think about the problem through each of those lenses to be empowering and helpful. I’ll just give you one example. We talk about the cost of care being so high. A lot of the narrative is between doctors and insurance companies and this sort of battle between the two about who can get paid more, etc. At the end of the day, you have to realize that each of us individually as patients are the ones who are paying all these huge bills, and we’re not paying once. We’re paying through our taxes. We’re paying through our co-pays and deductibles. We’re paying because all of these health care costs are coming out of our paychecks. We just don’t see it. We haven’t seen significant rises in income over the last 40 or 50 years because it’s been going into healthcare. We each have a role to play. When your kid has a cough or cold, they don’t need a huge percent of the time. They don’t need antibiotics, so don’t go and demand those antibiotics. If you have a little back pain, you don’t necessarily need the MRI the day you started getting a little twinge in your back. There are things even we individually can do to help our healthcare system get better. Tying that all together and getting a bigger vantage point: writing the book was more about organizing my own thoughts. Now, of course, having the chance to share it, especially with people who are new to healthcare like the tech industry (which has been really, really fun) as well as with trainees, students, residents, fellows, pre-meds even. A lot of people have been giving my book to their nieces and nephews who were thinking about a career in medicine, so that’s been really fun. That’s been really gratifying.

 

Sanjula Jain  18:26  

I think that’s so powerful. For what it’s worth, I assigned a couple of segments to my students over at Hopkins because, to your point, healthcare is so complicated. Where do you start? Where do you learn the context? Anyone coming into the industry or switching between sectors in the industry has to have a frame of reference of why this system is the way it is. What’s the origin story to be able to then come up with a solution? There is no good textbook, but your practical view of how you’ve laid it out is a great toolkit.

 

Vivian Lee  18:55  

Thanks for doing that. I’ve been visiting some classes and doing some of these talks. It’s been fun, and it’s inspiring because that’s what this next generation wants to do. They want to come in and help fix healthcare, which is fabulous.

 

Sanjula Jain  19:06  

One of the premises in your book that resonated with me was this idea of silos. You basically say we all have a stake in this game. Payers, providers, patients, we all have a role to play to make it better. How do we actually bridge those silos? What’s going to move the needle to break those barriers down?

 

Vivian Lee  19:22  

At the end of the day, the main area of focus has to be improving the health of our patients. When we lose sight of that, then we go back into our silos. We become Health System A or Clinic B or Insurer C, but the focus has to be centered around the individual as the patient. I borrowed an idea called “co-producing health,” meaning that the model for the delivery of healthcare is that healthcare systems, clinicians, physicians, need to work with patients to co-produce health together. So much of health is determined by what we eat, how we sleep, whether we’re taking the medications that are recommended for us, for example, so it needs to be a partnership between the two. If we can engage the patients and their providers together and create that as the central team, which a lot of these digital health solutions can do a lot to advance, then everything falls out from there. Then you have patients who understand and who are engaged in their care, who can not only participate in terms of preoperatively getting themselves to a better state to get into an operation but also be able to better understand how they can prevent readmission. We could get more alignment around health. Then we simply have to remember that healthier people cost a lot less. If our focus is on how do we get to that better health—whether it’s through public health, through prevention and primary care, or even around in the tertiary areas, just engaging people so they can prepare better—that’s going to be the key driver.

 

Sanjula Jain  21:05  

You mentioned COVID accelerates the trends and the pace of change, which I cannot agree with more. As you think bigger picture now to the post-pandemic health system, you mentioned the early career students and those who are wanting to have an impact in health care, what do you see as the new competencies or areas of focus that the next generation of leaders will need to come up with the right solutions and strategies?

 

Vivian Lee  21:28  

That’s a huge question. COVID has taught us that our current health system is completely broken. It’s made it apparent that a fee-for-service model of health care has made our health systems very vulnerable. They were laying off millions of healthcare workers early in COVID because the elective patients weren’t coming in. That model wasn’t sustainable whereas the businesses like the Medicare Advantage businesses, Military Health System, the VA where those groups were being paid a fixed amount of money to care for their populations, those folks did very well through COVID and they were able to invest those dollars in looking after their patients, especially those with chronic diseases or those who are elderly at home and so on. We’ve learned from the pandemic that we need to accelerate the move toward a value-based health care system. The skills leaders need to be successful in leading a value-based model of care are probably not that different from what they used to be, but they would include (1) an understanding of the factors that most improve health outcomes, that most prevent hospitalizations and are more focused on the public health and primary care and preventative side, (2) how to use data and predictive analytics to identify which patients need the most focus and need the most care, and then (3) how to create a system that is inclusive of all populations. One of our biggest challenges in this country is inequities. That’s the reason why our overall mortality, infant mortality, maternal mortality, life expectancy are low. It’s not because the highest end isn’t high enough, it’s because our average is so low because we have so much disparity in this country. That’s the other important skill set that the next generation has to bring to the table: how can we build a health care system that is more equitable, that addresses the needs of all of our communities and all of our populations?

 

Sanjula Jain  23:33  

Absolutely. Speaking of skill sets, thinking about your own journey, you trained clinically with a data orientation and now you’re leading all the systems-level change and thinking about technology. How have you gone through that journey yourself as you think about your different progression points? Were there certain skills you had to intentionally seek out to build or different trainings? How did you think about your evolution?

 

Vivian Lee  23:55  

As I mentioned at the beginning, I wasn’t particularly focused on a specific destination. I don’t think I was ever thinking particularly about an evolution, but in whatever stage of my career I always dove deeply into whatever I was doing. In the earlier parts of my career, for example, I was an MRI radiologist, very focused on research in terms of developing new MRI techniques for cardiovascular, kidney function, and other areas. I was intensely focused on it. At one point I had a lab with three R01 grants, did a lot of publishing. I think that is what led to my election to the National Academy. I was super interested. When it came to thinking about, “Okay, how do we actually improve research across an entire institution? That’s an interesting question. What are the important skills and toolkits we need to provide to our researchers so they can be super successful?” Extending from beyond myself and my little Mr world to “Oh, how can I help the people who are doing discovery science all the way to people who are doing population implementation science and what tools do they need?” I studied that carefully and that’s what led me to business school, to do the EMPA, because I felt like there were more skills I could learn. That was incredibly helpful, whether it was strategic planning all the way to operations. How to improve efficiencies, for example, all the way to crisis communication. How do we communicate more effectively about what we want to do? Then I got into the question of our broken healthcare system. Why is our health care system so broken? What is it about the financial model? What is it about how we run? Then I started thinking about what could make a difference. What could leapfrog us from this current situation into a world in which we challenge the existing paradigms in a disruptive way? I actually think the technology can do that. I’ve immersed myself in that. I’m actually studying data science now. I’m trying to do a little coding in Python. I’m not a coder at all, but I’m trying to learn a little bit just for fun, just to understand a little bit. That’s been the way I’ve thought about everything. I deeply immerse myself in whatever it is. Amazingly, these things that seem completely unrelated and disconnected, actually have served as a strong foundation for me. I use lessons from each of these different phases in my life in unexpected ways. I’m a champion of not being overly programmed and overly directed, or at least that’s how I’ve ended up.

 

Sanjula Jain  26:32  

Building on that, what role did mentors play at different points in your journey?

 

Vivian Lee  26:36  

That’s a really interesting question because you’ve asked the question with “mentor” as opposed to “role model.” I’ve had some wonderful mentors, whether it’s on the research side, people who have taught me about MRI and how to do research. I learned a lot from Bob Grossman—who was my chair and then my CEO and Dean at NYU, and he’s still there—about how to lead an organization, especially in a very data-driven way. I’ve had more people who may not be “formal mentors” but people who have taught me things and lots of different dimensions of skills and insights since that time. I wish I had more mentors, more people who I could say, “Formally, that is the person who has personally guided me along my entire life,” but more I’ve been the beneficiary of lots of good people supporting and providing good input and good advice and good feedback along the way.

 

Sanjula Jain  27:32  

Maybe it’s the academic orientation. Similarly, I think I have a lot of teachers more than an actual mentor, so it sounds like you probably fall in a similar camp there. You talked a little bit about your origin story in Oklahoma and being one of the only Asian Americans in that community. At what point did you think your experiences or opportunities were different because you were a female leader? Did that ever present itself in any way?

 

Vivian Lee  27:59  

Oh, just a few times. I was already Bob Grossman’s vice chair in the Department of Radiology and when he asked me to be the Vice Dean for science, the Chief Scientific Officer at NYU with him—which was a real honor—I was pregnant with our fourth child. We went through this period when we were the new leadership team and we went to a whole bunch of these town halls to meet all the different parts of the medical system center, which was pretty large and pretty complex. It would be me and these five guys who were all a little bit older than me, a decade or more. There I was progressively becoming more and more obviously pregnant and, in the end, waddling on to the stage for these town halls. When I started in that role, I went through a period where I would avoid reflective surfaces because if I saw myself in the mirror I would start to laugh. People talk about imposter syndrome and not looking the role. I did not look the part. When I first matched in my residency program, I started out in surgery at Duke and I was the first woman to match in that program in many years in general surgery. There’d been some other women who had transferred in, but I was the first one to match there. I remember when I went in to pick up my white coat and what I thought were going to be white pants. I was handed some white triangular skirts. I said, “Can I wear pants?” They were like, “We don’t have pants for women,” so there pretty much all along the way I was fairly aware of that. I can’t tell you how many meetings I’ve gone into where I’m the only woman.

 

Sanjula Jain  29:48  

As you know, I’ve spent a lot of time working with health system C-Suites. One of the studies we did—these numbers might be slightly outdated—but we looked at the percent of health system CEOs that were female and then female with a clinical degree. If I remember this correctly, the numbers were close to about 19% of health system CEOs were female on average.

 

Vivian Lee  30:09  

When I first started in Utah, I think I knew the numbers. It was something like 12% of medical school deans were women and 10% of hospital CEOs were women at the time when I started, so 19% is already almost double. It’s terrible. It’s super low. I’m just saying it’s way better than when I started.

 

Sanjula Jain  30:26  

Good point. I guess it’s relative. Yes, we are slowly but steadily making some progress there. To your point, it’s a different patient population at Utah, too. Being an Asian female leading this large organization in their communities, how did you navigate that? How did you get them to take you seriously?

 

Vivian Lee  30:48  

First of all, it’s important to remember that women make up the majority of health care decisions for their families. I haven’t actually seen any of the original research, but people often say 75% of the health care dollar, the decisions on how to spend those are made by the women in the family. If you’re going to lead a health care delivery system—or anything in healthcare, for that matter—effectively and you want to connect with the most important constituents, then you need to be sure you are attuned to your customers. That’s true whether it’s gender or racial or ethnic or cultural backgrounds. We have to be sure that our leaders and the people who have influence over the products, the businesses we are building, and the people we are serving are representative of our customers. That’s really, really important. It doesn’t exactly address your question about how to get people to take me seriously, but from a broad perspective, we need more women and much more diversity at the table in healthcare. That may be one of the reasons why our health care system isn’t serving everyone’s needs as effectively because we don’t have that representation right now.

 

Sanjula Jain  32:06  

You mentioned four daughters and you have a husband who also has a really impressive career. From what I understand, you split your time between two to three different cities. How do you juggle the personal with professional given everything you have on your plate?

 

Vivian Lee  32:23  

There’s this cartoon where there’s a hen and then there’s a row of hens and chickens sitting in a circle around the hen and the hen is juggling these eggs. Have you seen this cartoon?

 

Sanjula Jain  32:33  

I have not.

 

Vivian Lee  32:35  

Okay. One of the chickens on the side is saying, “I love how she juggles family and career.” Do you get it? Anyway, sometimes when I look at that hen juggling I’m thinking, “Yeah, that’s me,” and they are eggs! They’re fragile. I’m glad you didn’t say balance because I’m often asked about work-life balance and I think balance isn’t really the word. Personally, what sustained me is that, first of all, I have a great family, a great husband and great kids. Also, I love what I’m doing. I love what I’m doing at work. I just think it’s super interesting. I think I’m the luckiest person in the world. Pretty much in every job that I had, I feel so blessed that I’ve been able to do really, really interesting things. Then I love my time at home. I love my family. We may not have the most organized household, my kids’ socks did not always match, but the most important thing is to really love what you do.

 

Sanjula Jain  33:28  

Absolutely. From a personal front, do you have any hobbies? Or what is your go-to decompression tactic when you need time for yourself after a long day or week?

 

Vivian Lee  33:40  

My time with me is mostly my time with my family. If I have any free time when I have my free time I spend it with my kids and my husband. We go do stuff. We walk, we buy, whatever. During COVID, we were mostly biking around Manhattan, which was kind of interesting, kind of fun, kind of dangerous. It was almost surreal because Times Square was completely empty. We’re just running our little bikes up and down Times Square. It was amazing. I’d spend time with the family. I read, I try to do a little workout, that kind of thing. Then a little time with friends.

 

Sanjula Jain  34:12  

I’m trying to envision biking in Times Square right now, but it’s kind of surreal to imagine. Given your experiences thus far, is there something you believed early on in your leadership journey, some piece of advice someone gave you or whatnot, that you look back on and you’re like, “Huh, that’s not true,” or that’s not how you think about it now?

 

Vivian Lee  34:31  

Yes, although I think I recognized it at the time. It didn’t take me very long to realize it. I remember when I had a leadership role early on in my career, I was charged with building this program and developing a strategy for doing it. My approach was to bring a number of people to the table and have a discussion and get their input about it. I remember afterward, one of the leaders who was very distinguished and senior to me pulled me aside and said, “Vivian, that’s not how you lead. You can’t ask everybody what they think. You need to just tell them. That’s what a strong leader does.” I remember thinking, “Hmm, I don’t think so.” Like, for me, I want to hear the input. It doesn’t mean I have to do what you’ve told me, but the input is incredibly invaluable. Yes, there definitely have been times when I felt like maybe it’s important to stick to what works for you, and what works for me has worked out okay.

 

Sanjula Jain  35:39  

Then the converse of that, what advice would you give to your younger self?

 

Vivian Lee  35:46  

Superficially, I should have studied some economics when I was in college. I really should have. Not knowing any econ until I went to business school was silly. I wish I’d written more. One of the things I’ve learned from writing a book is it’s so helpful to write more. When I went to one of my college reunions, I remember there was a panel of writers and one of the guys said, “I wrote 1,000 pieces before I could just bang one of these pieces out in a weekend.” It takes practice. It’s just like the piano. It’s just like Malcolm Gladwell or whatever. I wish I’d done that because I think I’m an okay writer, but I wish I were a better writer. Other than that, I would say don’t sweat the small stuff. Oh, I have one other: Mario Capecchi, a Nobel winner at Utah, said something profound I always wish I had heard when I was younger. I’m going to paraphrase him, but he said it takes as much effort to work on small problems as it does to work on big problems. So why not work on big problems?

 

Sanjula Jain  36:45  

I love that. I want to land there, but you got me on the writing piece. The writing piece is really important. It’s something a lot of our colleagues talk a lot about. How do we share ideas and thoughts and foster this national dialogue in other ways? What advice would you have for anyone who is trying to hone in on writing as a skill? Are there any tips you learned from thinking through your book or other writing that you’re doing now?

 

Vivian Lee  37:10  

It’s important to understand who your audience is and to write to that audience with the right voice. All of the writing I’ve done in the past has been academic writing. My first book was Cardiovascular MRI: Physical Principles to Practical Protocols. There were quite a few equations in there. Lots of pictures, but they were pictures of MRIs. It’s very different from The Long Fix where I was targeting the general public and people who have a healthcare interest, so think about who your audience is and then write to meet those needs. I was very fortunate in the course of writing The Long Fix to meet a guy who happened to be the father of one of my daughter’s fellow hockey players from the hockey team. While we were hanging out on the weekends at these tournaments, he agreed to take a quick look at my book. He used to be an editor for major magazines, so he took a look at it and basically— it was a little bit devastating, but it was really good. He would write along the side like, “This is jargon. Boring. Boring. Jargon. Boring.” I realized, “Okay, the normal layperson does not find this fascinating so let me tighten this up and let me spruce this part up.” It was really helpful.

 

Sanjula Jain  38:34  

Vivian, thank you so much for spending some time with us today. Your story is really inspiring and I can already see every young, healthcare-interested person out there trying to channel all your philosophies, so thank you so much for sharing your wisdom.

 

Vivian Lee  38:48  

It’s nice for you to say that, but you are inspiring to all of us too, so thank you for all you’re doing.

 

Sanjula Jain  38:54  

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