Ep 36: Overcoming Systemic Barriers to Care

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 the CommonSpirit Strategic Innovation team. It’s going to be a special edition where we have the dynamic trio behind one of the largest health systems in the country’s innovation efforts, so I’d like to welcome Christine, Anu, and Manoja. Welcome, ladies. Why don’t we start with some brief introductions? Christine, I’ll kick it over to you to tell us a little bit about what you do at CommonSpirit.

 

Christine Brocato  0:49  

Wonderful. Thank you, Sanjula, for having us. I’ve really enjoyed listening to some of the previous episodes and I’m excited to talk a little bit about what we do. I’m Christine Brocato, System Vice President for Strategic Innovation. I focus on external partnerships, mostly with technology and services companies. Some of the specific categories I focus on are our population health, health equity, behavioral health, and new care models. When we think about partnerships, we are at the front end of that. As we evaluate partnerships, we’re usually on the front end of monitoring trends, finding the companies, performing the diligence, negotiating the contract, and then ultimately looking to incubate the solution in our organization and understand if it’s a good fit. I am a career healthcare person, so I’ve been in healthcare my entire career, and I’ve been on several different sides of the industry from medical device and biotech to the provider and airspace.

 

Sanjula Jain  1:55  

Wonderful. I’m excited to dig more into that momentarily. Let’s kick it over to Manoja to introduce herself.

 

Manoja Lecamwasam  2:01  

Thanks, Sanjula. I’m happy to be here, too. I’m Manoja Lecamwasam. I’m part of this innovation team and I’m responsible for intellectual property at CommonSpirit Health. We look at that as the internal innovation of our employees, stakeholders, and Life Sciences innovation that is either external or internal. By training, I’m a molecular microbiologist, but I have been doing innovation and tech transfer and intellectual property management in academic medical centers and in community hospital systems.

 

Sanjula Jain  2:35  

Great to have you. Last but not least, the newest member of the team: Anu.

 

Anu Anuradhika  2:41  

Hi! Thank you for having me, Sanjula. We’re very excited to not only share our stories, but the story of our team, which I think is going to be a lot of fun. I’m Anuradhika. I’m a part of the strategic innovation team along with Christine and Manoja. Much like Christine shared, I also manage our external partnerships with a lot of innovative companies out there focusing especially on the verticals of alternate care settings, more patient monitoring technologies, insurer tech, and personalized care models, so I’m really excited to be here and eager to dig in.

 

Sanjula Jain  3:13  

Wonderful. One of the things I was most excited about, and why I wanted all three of you to come together, is because innovation is a big lift. It means a lot of things to a lot of different people and I think your team dynamic is something to be admired by others because you’re really well integrated with bringing a lot of different perspectives and viewpoints, which I think makes a stronger team. It would be interesting to first start with how you all think about the “charter” or “key objectives” of the Strategic Innovation group within the health system.

 

Manoja Lecamwasam  3:50  

As we talked about, we like to challenge the status quo and look at how we can improve access to care and offer new avenues to grow and to serve, especially in this rapidly changing healthcare environment. We strongly believe that successful innovation depends on our ability to build and form partnerships and coalitions across industry collaborations. For innovation to be successful, we need to overcome systemic barriers to care, such as health disparities due to social determinants of health and issues with access to care by marrying social community services with medical care and finding innovative ways of how we can do that. Along that line, we also like to think about how we can serve each person in a more personalized manner and move away from the one-shop-stop mentality. This is not just looking at it from a genomic/proteomic perspective but on how you personalize the care. Most of all, what’s interesting and a common theme for all of us is to look three to five years ahead and see where the industry is going, where we think our organization is going, and then if we can bring those capabilities in today. Some of these might not be ready to where they need to be, but can we work with these technologies and companies to build what we want in the future so that we are ahead of the change? That’s a common theme in a lot of the innovation we do.

 

Sanjula Jain  5:22  

Let’s make that really real: You all are evaluating different technologies or innovations out there in the market, where do you start? What is the process of diligence and market research look like? Getting into the point where it’s truly integrated into the DNA of the system.

 

Christine Brocato  5:39  

I think of it as a recipe. It’s like one part this, one part that in a specific sequence. If you can get that all right, then we’re likely building a successful partnership. First is getting ahead of the trend and thinking through where the market is going. Where do our patients want to be? What’s their preference? We also need to understand where we need to be and pull that in. If we can pull that in three to five years ahead of time and start to incubate that, that’s the first part. The second part is thinking through who might be a good partner. There are so many fantastic, emerging companies out there so it’s about having the discipline to understand if it’s a right fit for us. It’s not just about the product, it’s also the fit with the leadership team. Can they work with a company like CommonSpirit? Then a big piece of it is defining the goals. Right up front, really understanding the success metrics that we want to move and getting a lot of alignment, not just internally, but with the partner to say, “Listen, we’re probably going to look at every data point under the sun, we all love data, but there has to be three that means the success of this pilot to be able to move forward.” We need to understand what hurdle rates we’re going to meet with each of these metrics to move forward. That’s a really critical part. If you miss that part, things can get messy towards the middle and the end, so we spent a lot of time trying to define that success. The last part, which is critical, is finding the right operational leader and making sure that person is with us from the very beginning as we get through the process so that, when we’re in pilot or incubation mode, there’s this nice handoff where we can start to step away and they can start to claim ownership of the program. Success for us is when we see leaders in big meetings say, “This is my project. This is mine,” and we’re like, “Nice!” Success is when it’s baked into the DNA of the company. That’s a success for us.

 

Anu Anuradhika  7:40  

To tag on to that, Sanjula, where we take great pride as a team is to serve that connective tissue. We want to make sure that when we are partnering with companies, we are able to help them understand the ever-changing and very complicated at times healthcare environment (the regulations and all those things). On the other hand, internally, we are able to bring these ideas as potential solutions to operational leaders who are living with the consequences of something which is not efficient or having these gaps and operational opportunities. Being that connective thread who can translate the language of the external ecosystem to the internal operations and have the operations feel the ownership of the solution and could run with it is the sweetest spot. We take the greatest pride in when both parties feel like they were able to meet each other in the middle and we were able to make that transition seamless for both parties.

 

Sanjula Jain  9:05  

You both are making it sound so easy. Let’s play that out a little bit further. CommonSpirit has been a leader in the provider market in particular. You guys have partnered with groups like Lyft, behavioral health companies, social services companies— the full gamut. What does the process actually look like in terms of how the three of you work together in your respective teams? From the time of sourcing a potential partner and then actually bringing them into the organization? Unite Us, for example, or Concert Health are two organizations you’re working closely with. Walk us through an example of how the three of you have worked together to work through one of those partnerships.

 

Christine Brocato  9:44  

Over time, what’s nice is that we’re all building different types of expertise. When something falls into home health, for example, I’d be going to Anu saying, “How do I think through this?” or “Are you going to take this through? I will support you.” We’ve kind of built those functional areas and it’s kind of just happened organically. It’s a function of the projects we’ve taken on. We built the expertise, but also the passion areas that we bring to bear because of our personal experiences with health. The Concert Health project was fascinating because that came from the markets. We’re usually on the streets, meaning we’re talking to our clinicians on the ground floor level. We had PCPs telling us,—this was before COVID—“I am seeing increases in mild to moderate depression and anxiety in my panel.” Usually, there are about three people I can refer to in the community that I feel comfortable with. When that doesn’t happen, I start to take it on as a good doctor. I start to spend a little bit more time understanding why they’re not coping. We knew we needed to do something because our doctors are working with patients in that way anyway, so we started to assemble an internal team to say, “What would we do to address that? How do we think about addressing these spikes in depression and anxiety? How do we also take the burden off of our staff?” The PCPs are like, “Listen, if you bring it up to me, I will kill you. Make me log on? It is not happening.” One, the feedback was incredibly strong and consistent. Then we started to formulate an internal team to evaluate that. That’s when we started to realize this collaborative care model where the PCP is still at the forefront of the care but working with the therapist and looking to treat a patient holistically, that’s what we want to do. We want to unburden a PCP but also recognize that she wants to stay at the center of the care too. That model made sense from a flow perspective and it made sense from an economic perspective because there are reimbursement codes for collaborative care. Instead of paying $150 to go to a traditional therapist, it’s just your copay because you’re there at the visit anyway. All of those parts started to come together and then we went out to find a partner that would be a good fit for us. There are a lot of fantastic organizations practicing collaborative care, there are a lot of health systems that do their own program, but what made sense with Concert is collaborative care is all they do. They know it inside and out. That’s the type of bench strength we needed. We needed therapists who could answer the call, could be flexible, English and Spanish. The diligence started to prove that they not only had the right model but, in terms of a leadership team, they were willing to almost teach us how to do collaborative care the right way. All those pieces started to come together for the partnership and we’ve been really excited. I was looking at the data the other day. For the patients who use the program, 80% have never received mental health care before. That means it’s their first time, probably for two reasons. One, their PCP is saying, “Hey, you’re having trouble coping. Why don’t you talk to my associate here and she can help you unpack what you’re feeling?” It’s this nice, validated handoff. The patient just has to say, “Sure,” and pick up the phone. That’s part of it. The other part of it is COVID and maybe people realizing issues they hadn’t had before as a result of what we’re experiencing. It’s been well-timed and we’re super excited about the data we’re seeing.

 

Sanjula Jain  13:53  

If I hear you correctly, a lot of the process is identifying the market need, laying out what those core objectives you’re trying to solve for are, finding potential partners that could fit that boat, narrowing it down, then tracking these metrics to see how it’s working. There’s this lingo in the industry around “death by pilot.” CommonSpirit delivers and touches patients. Where do you go from there? What’s the process of scaling it across different markets or selecting which markets are the best fit for it so it’s touching a broader group of patients? Or getting your clinicians on board. What are the downstream things you’re thinking about across the team?

 

Anu Anuradhika  14:32  

This happens a lot, Sanjula. Going back to your question of how we know, it’s just the divide and conquering that happens organically all day long between the three of us. We believe that if the pilot stays with innovation or in that piloting phase for a long time, it doesn’t let the solution shine and become what it could be, so we are very diligent when we think about the piloting. Going into it, we are very sure what we’ll be tracking, what data we’ll be measuring, what are the potential success factors. A pilot is more of an exploration of how those data pans roll out. It’s not a surprise like, “Hey, let’s just start the pilot and we’ll see how it goes.” We are very diligent in how we plan the pilot and the operational support around it. What happens organically is that, by the time something is getting to that mature phase in the piloting, we’re already getting a lot of interest from the other markets because they’ve heard about the solution, they’ve heard about the impact. To take an example, the maternal-child health program that we launched early in the pilot phase, the impact to the mothers and the impact on the length of stay, the key models for getting the patient engagement was so immense that we saw markets actually reaching out to say, “Hey, that pilot is happening in California, when can I have it in my state? Where could I go from it?” There’s a lot of organic traction that happens in the pilot phase and that lets you get involvement from the right clinicians, right stakeholders (if it’s a population health initiative, get them involved), and make sure we are thinking about expansion from an IT angle, an integration angle, a patient reach-out/communication angle. That was all being done methodically in parallel as a pilot is getting to that maturity. Once we are at that side where the results are in and the impact is pretty visible, then it’s all about taking it and scaling it as rapidly as possible so the majority of our patient populations could benefit from that solution.

 

Manoja Lecamwasam  16:42  

What’s also really important as we’re doing it is to keep in constant communication and share the successes and the results with the organization so you don’t do a pilot for six months and then do it. You tell people you’re doing a pilot, have some moments when you discuss with the clinicians and the operators about how it’s going so people are aware of it. If it’s successful, then you already have people who know about it. We also don’t try the pilot in one place that’s geographically the same. We try to look at different places to set up our pilots so you get information more holistically about how a company or a technology would fit a certain population or a certain state. Not necessarily the same result comes from doing it somewhere else. Keep making sure your internal network knows about what’s going on. When you’re negotiating for a pilot, we also try to see if we could look at a larger agreement so, if the pilot is successful, you don’t have to ensure every single place on a case-by-case or a site-by-site basis. You already have a template and then you can just add on the interest of people, which is just an operational agreement kind of thing, but that could take a long time. Those are some of the best practices we try to include when we do this work.

 

Sanjula Jain  18:04  

Really what you’re doing is challenging the status quo, which is not easy. That’s what you’re doing day in and day out. What are some of the challenges or the most difficult aspects of making these changes and bringing people along both internally and externally?

 

Manoja Lecamwasam  18:20  

It’s really interesting when you’re looking at something that comes down the road. You believe that something is going to be important in five years because the evidence is there. In healthcare today, people are dealing with consuming issues that matter to them at this moment. There are so many things that needed to get done today, so much money that’s needed to take care of things that are happening day-to-day that to take money or resources or attention away from those things to plan for something in the future is difficult. It’s difficult in any industry, so one of the biggest challenges we have is to go to our operators and our clinicians and say, “Look at this technology, this looks really interesting. The future is here.” How do we, while you’re completely overwhelmed or enveloped in what you’re doing right now, start to think about how we can look at this technology to help something that’s happening to you right now so that, as we start to build that foundation, we’ll be ready when it’s being used a lot more. If you look at precision medicine, for example, it’s very well established in academic centers through research and the work that’s done but, for it to be really successful, it needs to be in the communities because care happens in the communities. A community physician, however, doesn’t have the time to sit and look at the science and go through all the articles and know what’s right and what’s evidence base. If you ask someone in a community, you’ll see that precision medicine is not right for primetime, but if we don’t build infrastructure and we don’t invest today and we don’t look at how it could be used in the future then—when the time is right—we will be behind the eight-ball and it will take a lot more time to build it up. It’s the effort you have to put in today to something that is in the future but educate people in such a way that we can see the big picture. The education part is one component, but then to work with all of the resources around you—philanthropy and grants and funding—to really do something today as an example so those results are there, off of which you can piggyback when you need to implement it within the organization.

 

Christine Brocato  20:52  

I would add that the challenge is systemic but also personal. When we talk about health systems, they were built to not have risk. They are built to be completely stable. We are in the business of saving lives, so there’s a lot of structure so that the whole thing could be incredibly predictable, stable, not have any risk, and not change. Then here we come along and we are in the business of driving change, so there’s natural friction with this systemic nature we’re in. Unlike other industries that have dedicated R&D departments, health systems don’t have that. The innovation function functions like R&D. We are also trying to change individual hearts and minds of decision-makers, and everyone can reach a decision to change for different reasons and different motivations. Finding out those pieces often takes time. Some people are “show me the bottom line” type of people, some people are “I just care about the quality scores” type of people, and then there are still others who need to know that it’s been super validated by half of healthcare before they want to act. There are different points to that but, at the end of the day, it’s our work to set the vision and try to capture why we would want to introduce this change because we’re all unified by sincerely wanting to provide a patient with a better experience. That’s one thing we all have in common. If we can connect to that, that’s where we start. Then to get to the big yes, we start with really small yeses. Can you take a meeting? Would you look at the data? Would you consider a demo? If you start to get to some of the little yeses, they can build up to ultimately the bigger yes, which is, “I want to be the sponsor. I want to own this.” It’s a small process and it’s different every single time.

 

Sanjula Jain  23:04  

That’s very well said. Inherent in what you and Manoja are talking about, Christine, is actually a really big tension in the industry that we’re seeing. This whole idea of “pace of change” where you have all this innovation, scientific discovery, technology, these new companies, and then the “established players” like the traditional health system model and the regulatory environment and their reimbursement schemes. They’re kind of at odds with each other. What’s always stood out to me for systems like CommonSpirit and the work you all are leading is you’re trying to bridge those two worlds together and have them meet each other somewhere in the middle. What is it about the culture of the organization or how you’re viewing the landscape where you’re able to overcome that inherent systemic barrier where it’s not that easy to innovate within a health system environment if you look at what’s culturally been ingrained in how we think about healthcare?

 

Anu Anuradhika  24:05  

We all have to acknowledge that regulation and the constraints in healthcare around privacy, patient data preferences (1) exist, (2) they’re not going to change anytime soon, and (3) they exist for a reason. We start with that acknowledgment. Then the job becomes not so much as “how do you fight those,” it’s more about “how do you bring the innovators along to have that lens as they start creating a solution?” The most frustrating part is when you have a wonderful solution and then you’re down the road and ahead and then you realize, “Well, regulatory, you can’t do this because of those constraints.” We try to pair up with them early in that code development phase so we can guide and help them maneuver, be it compliance, be it legal, be like IT, data, privacy, all of that so that we are bringing that lens to them as they seek to change the status quo and seek to create innovative solutions for healthcare. Then it’s not only in the journey but also being by their side as they go through it time and again because what happens then in that process is (A) they get to create solutions with that mindset but, more importantly, the organization gets to understand the solution in that different light. Going back to the meeting of the minds, you’re making sure both parties are able to see each other in that common spot where we are cutting down the barriers from the compliance side and the regulatory side for the innovators. We are also making a culture come up and rise to the occasion when needed, to know that I have to make XYZ adjustments or have to compliment it in a certain way. When they both come together, that’s where the win happens. We always acknowledge where healthcare is today, but we are also motivated by where we want it to be tomorrow, so it’s living between the two and making sure you’re constantly going from point A to point B. Even if it has a snail’s pace, it’s happening. The change is constantly happening.

 

Sanjula Jain  26:20  

Another piece that underlies your effectiveness is this idea that the three of you don’t embody what we stereotypically perceive as the traditional head of innovation. The way innovation is described in the industry is like the tech, Apple, Microsoft, wonky, computing, making an app world, or maybe you’re highly clinical and you’re coming up with some new therapy, and there’s a lot of things in between that. Each of you brings a really unique vantage point, perspective, outside-in from the roles you’ve held in the past and your personal upbringing and immigrant experiences and different things in how you view the world that gives you a different lens on how you think about innovation. Talk a little bit about that. I know one thing the three of you have in common, which I think is so powerful, is that you grew up as immigrants. How has that shaped your lens towards healthcare?

 

Manoja Lecamwasam  27:18  

It’s actually really interesting when you come as an immigrant from a developing country and you see the health disparities and the health inequities. Personally, my mother was the first woman from her village to go to medical school. When she practiced medicine, she didn’t see herself as a physician apart from who she was as a person. I remember going to the grocery store and she was buying groceries for her patients who couldn’t afford it so, when they came into the clinic the next day, she would have something. She was looking at social determinants of health way before we thought about that in the developed world, but that is how medicine was practiced in the developing world because you couldn’t separate the care from where that person lived. When we look at innovation and health disparities and wanting to make sure everyone has health equity, those experiences of seeing what health inequity really does to a society and how—even in little ways—you can do your part to make it better are the motivations that allow you to look at the big picture, bring in new experiences, and—even if you fail—to keep going. You should come in every day knowing that there is a purpose because whatever we do and put in place is going to help a person who might not be able to help themselves without this service or this technology or this innovation that we are presenting. I think that makes all of those issues and the frustrations worth it because you need to have a purpose. That’s what is needed to do work like this in an industry that’s somewhat resistant to change at this moment.

 

Christine Brocato  29:19  

I love that so much. I’m the first American on either side of my family. My dad’s from a rural village in Spain. My mom is from a really small island in the Philippines. We came here and ended up settling right outside of Oakland, California in a small suburb. It was a really diverse community. Even before I knew the term “social determinants of health,” I knew in my bones that, if you were a person of color, there was a chance you were not getting the same access to health care and that there were social factors. Before I had the words, I saw it in my friends and in my neighbors. It drives a couple of things in us: One, a lot of these terms get very academic. I’m heartened that we’re talking about it. I’m heartened that this year we’re all talking about health inequity, but our backgrounds make that real because, when people talk about the Medicaid population, those were my neighbors so, if I can’t see it flying with them, then it doesn’t. It grounds us in the reality of who we’re working for. The other thing is it also creates a sense of deep empathy for the challenges people face because we have experienced those personally and have been in communities to see that play out.

 

Anu Anuradhika  31:01  

That all resonates so much. I think that’s a shared fabric. We’ve all lived our lives where the difference between the haves and the have nots has been really clear, be it Manoja coming from Sri Lanka, me from India, and Christine and her exposure to the Oakland community. One very tactical way it manifests in our work is making sure that any technology, any innovation we’re bringing is helping bridge the gap and not further it more. You see a lot of solutions based on the assumption of high health literacy, based on the assumption of access to Wi-Fi, based on the assumption that people will have all these luxuries to meet those decisions and access care differently. When we are evaluating those solutions and those technologies, we are constantly looking at how this is going to help bridge that gap and not further it more. We all feel very strongly and very passionately about doing our two cents, our job in connecting and bridging that gap.

 

Sanjula Jain  32:15  

I think that is so powerful. I loved what you said about the “shared fabric” because I think that and the tremendous passion and unity you guys have as a team really connects you, and to do all that you do so well. I’m curious, do you guys have healthy debates or contentious debates internally amongst the trio? When you’re super riled up about something and you’re like, “Oh, no, we need to do it this way?” What is that like?

 

Christine Brocato  32:38  

I would say it’s more like group therapy. There’s a lot of group therapy. We have a team meeting every week and it quickly devolves into a support group of sharing and trying to help each other and brainstorming together about how do we figure out problems and work to overcome barriers.

 

Sanjula Jain  32:58  

You’ve all shared a little bit about your lens of what shaped your interest and influence in healthcare. Shifting gears a little bit then, as you think about your foray into healthcare leadership (and this could be pre-CommonSpirit days), do you consider it to be more accidental or intentional in the different roles you’ve held? What was the first time you viewed yourself as a leader?

 

Anu Anuradhika  33:30  

It’s a combination of both. It was definitely intentional because growing up I had a lot of passion for healthcare and medicine. I’m a clinical pharmacist by background, so I trained to be one, so that was definitely intentional. Everything that happened since then has been a combination of (A) following my heart where I wanted to go next and (B) being open to opportunities. I went from being on the research side to starting my leadership journey on the business side, doing a lot of strategy, provider care teams, then being a part of the startup, and now in this innovation world. That has been a combination of not being scared to take on something that was entirely new. The tactic I follow is “if there’s something that makes me really scared and anxious to take this on, then that’s the right thing to do.” That’s always been the driving force and the guiding one, so where I am today is probably a combination of (A) being at the right time, having wonderful people who helped me and showed me what other opportunities did exist, but (B) my love for medicine and my desire to be in healthcare is very personal and was very intentional to begin with.

 

Sanjula Jain  34:43  

That’s great. How about you, Manoja?

 

Manoja Lecamwasam  34:45  

My foray into healthcare is accidental because I thought I was going to be a bench scientist doing research. It was a good accident but, once I got into healthcare, I would say that my leadership is intentional. With a position of leadership, you have to be intentional about how you present your vision and your values and how you help your team and talk about what you want to do as a team, so that part of it is definitely intentional. I’m aware of how I am and what I need to do when I’m with my team.

 

Sanjula Jain  35:26  

Christine, how about you?

 

Christine Brocato  35:27  

I would say that I never in a million years thought I would be in healthcare innovation. When you’re an immigrant kid, you get assigned one of three roles: you’re either a doctor, a lawyer, or an accountant. I was assigned “doctor” when I was five, but I didn’t mind at all because I knew in my heart that I wanted to affect people’s health and well-being. I just had that feeling. Even in my diary, I think the first word I spelled was “nurse,” but I accidentally spelled it “news.” I just knew I wanted to make an impact. As I grew and matured and had more experiences, I realized that it wasn’t going to be one-on-one, that it was going to be more macro. That landed me on the business side, so that whole part was accidental. Once I started to see how technology and innovation could completely help scale healthcare for all sorts of populations, that was when my heart exploded. I was like, “I just want to do more! I want to influence more and do as much as I can in my career in this vein.” That part was was very, very intentional.

 

Sanjula Jain  36:45  

I know this is a little bit of a loaded question, but at what point did you begin to realize that the leadership career journey was going to be different because you were a woman?

 

Manoja Lecamwasam  36:55  

When I was doing research in the lab, I had a very, very supportive mentor. This is not something he told me. He had a lot of women in the lab, but someone told me that, if you want to run a lab and you want to be a leader in research, then you better not get pregnant because if you get on the mommy track then you are not going to be able to lead it. Interestingly, I had my baby when I was finishing my dissertation, doing my Ph.D., and I worked. It was a tough endeavor. Putting that into the universe and saying you can’t do something because you’re doing something that is biologically amazing that you do as a human being, sets a reaction we should start to avoid.

 

Christine Brocato  37:44  

I would add to that. For me, I didn’t really notice the differences between men and women for much of my career. I looked around and thought, “I’m getting promoted just as much as my male counterparts. I’m making a difference just as much as them.” It wasn’t until I became a mom that I started to see the difference. It’s little things. In business, the pace can move really quickly. If everyone decides to meet in Ohio tomorrow, most people are saying, “What’s the content? Who’s going to take the presentation?” A working mom says, “Who’s going to do the pickup and drop off? Oh my gosh, who’s going to miss something because I can’t be here now.” All those things come into play, and that was really eye-opening for me. As soon as I had a baby, I started to notice a change and I was like, “Oh my gosh, like everything I’ve heard is so true.” I remember getting recruited from a company I thought was so amazing. I had just had a baby six months out. They said, “Why don’t you fly over and interview?” My husband was so supportive. It was my first flight after having a baby and here I was finding the lactation room in the airport and then coming in for the interview. Because I had traveled, more and more people wanted to interview me because they thought this was the one-shot, “I want to introduce myself, get to know Christine,” so the three-hour interview that I had perfectly timed became a four and a half-hour interview. By that time, I think my body was ready to explode. I felt cracks in my system. They kept saying, “Christine, do you want to use a bathroom?” I was like, “No, I don’t, because I think I’m gonna die if I move right now.” It was such a female experience that a man can’t understand. After I got the job, I was laughing and telling them about that experience and they said, “We would have scheduled in a lactation break like no problem, like any of us,” so it was really about me, like this perception that I had to hide my motherhood, that I couldn’t be honest that I had to do something so natural. My learning—and my learning during COVID, too—is that most people are more understanding. It’s really about me giving myself permission to have that balance.

 

Sanjula Jain  40:21  

That’s really great advice. Thank you for sharing that. If I could piggyback on that for a second, Manoja is celebrating two of her children’s graduations, which is very exciting. You must be very proud mom. What advice would you have for other mothers who are juggling a demanding career and a family?

 

Manoja Lecamwasam  40:38  

I want to start off from the position of leadership and how important it is to make change when you can because I hear people say, “You leave your family and your life at home. When you come into work, you need to concentrate on work.” I’m of the outlook that a person is life and work. Just because you’re in a job from 9:00 to 5:00 doesn’t mean all of the other stresses and the pressures that happened with your children and your husband and your sick parents doesn’t influence what you’re doing in the office. It could even distract you because you’re worried and trying to do something. Instead of trying to keep these things separate, how about you try to be a more empathetic leader or someone who’s aware of what’s happening? Try to have flexibility in your schedule so you can do what you need to do as a human in life. That then translates into you doing what you need to do as a human and work much better. As I said, I had my oldest daughter when I was finishing my dissertation. I was in a very new job. It was a very structured, strict job. I tell you, everyone has their kindergarten activities at 11 or one o’clock in the afternoon. If you’re a working mother living far away from a daycare, going back and forth makes those things very difficult to do. My husband was a busy person at that time because he was training as well. Our daughter was probably the only one in kindergarten that had many occasions when there was no parent, not because we didn’t want to, it was because we couldn’t make it. At that moment when I was supposed to be there, my heart was breaking at work because I couldn’t be there. I thought—if I ever had an opportunity to make a difference or was in a position where I could influence how my team or the people I work with were behaving at work—we would look at how we could introduce flexibility so women and men could be there for some of these occasions. If some of the men could take time off and go for one of their child’s activities, then the women don’t have to make that choice every single time. We would get to share this and be there for our children’s and tag team and do it. It wasn’t easy, but I think you do the best you can and then you make the changes that you want to see whenever the opportunity comes up.

 

Sanjula Jain  43:16  

Absolutely. One of the underlying reasons we started this show, Her Story, was we wanted to share these stories of what women leaders at all different stages of their career are experiencing because these are things we don’t really talk about at that point in time. Christine, a little bit to your example about maybe asking to take a lactation break. How do we build this culture where both men and women understand the breadth of these challenges so we can make systemic changes to accommodate? Anu, I didn’t want to overlook you there. How about you? At what point did you realize your career journey was going to be different because you were a woman?

 

Anu Anuradhika  43:53  

I always had a working mom. We come from a very remote part of India. My mother’s journey shaped the woman I became. At 18, in typical Indian fashion, she was supposed to get married and she defied all that. She said, “I’m not marrying.” She became the first girl in the entire state to get her master’s degree, didn’t stop there, got another one, and did not marry until much later in life. She was a working woman all her life. I used to see her get up at five, cook breakfast for the entire family (the in-laws included), come back, get immediately into the kitchen, be there until 11 doing all that. At that time, looking at her do all that, I thought, “That’s not going to be my life. I’m supposed to take it to the next level. I’m going to challenge the status quo.” When I started working and I became a mother, it was very eye-opening to me that I was falling into the same pattern. I was doing the same things my mother did. I was carrying all the weight alone, wanting to get up, having to be a perfect mother, cook a perfect meal, go to work, put in 10 hours, come back home, do it all over. The big realization was that—if I want equality at work and if I want to be teaching women—I have to start at home first, so it was a very honest conversation with my husband to say, “How are we going to do this?” Where can I take the lead and where can he take the lead? Giving myself permission to do that at home made me a much better leader because then I could walk into the workspace and look with new eyes at the divide and conquer that was happening between men and women and how to challenge it for many others to come. If you’re not in that place yourself, it’s very hard to say, “Where do you want to change for the rest of your team?” Make sure the women on your team are not compromising their personal and professional life. They can have it all. Give yourselves permission to exercise your right to ask for that equality, be it at home or the workplace. I felt like my journey started with being the rebel and questioning it. Women have been in the workforce for 70+ years now, if you think that WWII was when we started joining. To “it’s taking too long. It won’t.” Then realizing I’m actually becoming a part of the problem by doing the same things. That was a wake-up call to drastically change how I conducted myself and engaged both at work and at home. In the process, I believe I made my husband a better professional because doing his equal part at home actually enables him to go with those eyes and with those lenses into his workplace and make sure that the women on his team are also feeling supported. He recognizes where they come from and the pressures they are under and, as a support, as a leader, he can make sure he’s there for them and stand up for them. It’s a combination of calling our supporters into play and taking the charge where we need to.

 

Sanjula Jain  47:13  

That’s leadership. A common theme with all three of you is you’re challenging the status quo professionally and personally to make these little but mighty changes. I think that’s really so powerful. Thinking about the status quo, is there a piece of advice or some kind of philosophy you believed early on in your career that you no longer believe to be true?

 

Manoja Lecamwasam  47:36  

I have a very supportive husband. We talk about sharing chores and doing them together. In the beginning, I was always about 50/50. The way to a successful career and the way to be successful at work and also have a successful family life is to be able to do 50/50. With time, what I realized is I was looking for an average of 50/50 because there were moments when I was 10% and 90% and my husband was vice versa. When we looked at the times when we were doing all this work, we ended up averaging 50/50 and we both felt like we were going in the right direction and being fulfilled in what we were doing and our kids and our families, when needed, had us. Now, instead of constantly trying to find, “did he do this exactly?” and “is this job 50/50,” I try to look at the average and that has actually helped me stress less and be able to look at the big picture and feel good about where things are going.

 

Sanjula Jain  48:47  

That really resonates as a researcher who loves thinking about numbers and averages, so that’s a great little tidbit to keep in mind.

 

Christine Brocato  48:54  

For me, it’s about not striving for the A. When you’re raised to achieve and to be a straight-A student, that does not translate well in the workplace. For women, that’s a very different experience where we are looking to get the A by the external validation, by the promotion, by something, versus the internal validation. It took time to (1) redefine what “A” means. “A” needs to mean I’m following my personal mission and achieving my goals, and A needs to be given by me. Not anything external. For me to be happy and successful in my career, it all needs to happen based on me thinking about what I’m trying to achieve. That’s a very different way than I started in the beginning as I was like, “This is how I got an A in school. I’m just going to grind it. I’m going to grind, grind, grind,” but grinding only gets you so far. Grinding might get you from analyst to manager but, as you start to become a leader, you hit a max. What got you there won’t get you to the next place. At every single level, we have to realize that what gets us to the next place is our ability to form relationships and networks and have quality information so we can synthesize what’s going on and try to drive new ideas and solutions. You still have to grind, but it’s not just about that. That’s a huge transition as you start to take on a leadership path.

 

Sanjula Jain  50:48  

That’s such a good reminder that leadership is not only constant learning, it’s also about reflection and making those active determinations that you have to flex what you’re thinking about and focusing on in different stages of your career. That’s a really good reminder for all of us. Anu, how do you think about it?

 

Anu Anuradhika  51:05  

It’s learning the power of that three-letter magic word: ask. Growing up, that word was “yes” and that got me into so much trouble where I did not know the boundaries. You think you just need to grind, you need to grind extra hard, and you have to say yes to everything that comes. That becomes the power meter for how well you perform. Converting that three-letter word of “yes” to “ask” actually became so much better. Asking for help when needed, asking for what I needed, and not being scared to put it out there when things were not working. Now the mantra I tell everybody, like all my mentees, I tell them, “If you don’t ask, the answer is no, always, so don’t be scared to put it out there. Don’t think you have to do this all by yourself.” As a leader, I think that is one aspect you are so scared to show early on. When you start imbibing the philosophy of “ask,” it not only allows you to engage differently, it also lets the world know that—as women, we say we have to be perfect—we don’t have to be, we don’t have to know all the answers. We don’t have to say “yes” to everything. We can ask for what is needed when is needed to make our lives better and allow us to perform and contribute in the ways that are most meaningful for us as individuals and for us as team players and as leaders. It’s just changing that three-letter word from “yes” to “ask.” That probably was the biggest learning I had to do along my career trajectory.

 

Sanjula Jain  52:46  

I love that. Typically, we close by asking our signature, “what would be the title of your book,” but I can’t help myself. I’m going to suggest one for the three of you. I think you guys are like this trailblazing trio that is challenging the status quo and really shaking things up, so thank you for all the work you’re doing. Let’s close with a final question: what are you each most excited about as you think about the next 10 years of healthcare?

 

Anu Anuradhika  53:13  

We are in a very exciting phase. What healthcare has been traditionally, or all the areas where it lags, that’s all changing. There’s a lot of impetus from consumers, patients, and innovation that is happening to challenge that status quo. For a long time, we’ve been in an industry that had to do because of ABC. Now we are on the verge to become an industry like others where consumers are asking for things that they want and we get to deliver that. We are also moving away from “we can’t do this because of the payer preferences” and things. There’s a lot more room to try different things, to meet patients differently, to engage them differently, to serve them differently, and to care for them differently. I’m really, really excited about the health equity dialogue that we are having right now. That is going to fundamentally change the way healthcare is delivered in the coming months to years. To be a part of that change and to play a very minor role in that trajectory is super exciting. I’m excited about where healthcare is leading and I’m excited about the part our team and our organization conspirators will be playing in that trajectory, so lots of exciting things to look forward to.

 

Sanjula Jain  54:39  

Absolutely. Manoja, I’m curious, with your scientist firsthand, how are you thinking about it?

 

Manoja Lecamwasam  54:44  

That in 10 years we are able to give the right care to the right person at the right time in the right place and that we can do that for all people.

 

Sanjula Jain  54:55  

Very well said. Christine?

 

Christine Brocato  54:57  

I feel like, in health care, we now have the right tools to make a real dent when it comes to health disparities. Before, we didn’t have the tools. We had all these disparate pieces, so we have no excuse. We have tools now, so do we have the ability to work together to collaborate to advocate for the right policies so things can come together so we can actually do it? I’m hopeful for that. I think we can make a huge dent over the next 10 years.

 

Sanjula Jain  55:38  

With the three of you leading the charge in the realm that you’re in, I’m very optimistic that we’ll get there. Manoja, Christine, Anu, thank you so much for spending some time with me today. Really enjoyed the conversation and thank you for challenging the status quo.

 

Sanjula Jain  55:56

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