Women at Work - A Time for Women Leaders to Shine

0:01To me it was important that I was passionate about what I did and so my career is crazy. The threat of it is around HIV and social justice and caring for the vulnerable. So when people say, oh, I want to have your career, I'll say there's no way you could even recreate that if you wanted to because I didn't have a map laid out.

0:24And I think if I hadn't stumbled into HIV, I don't know if I'd be the leader I am today. I think that if you're really passionate about something, leaders also emerge because it was so important to me that the communities around me had a voice and had the best care they can. You're listening to Women at Work from Harvard Business Review. I'm Amy Gallo. And I'm Amy Bernstein. Sheila Davis is the CEO of Partners in Health.

0:53The non-profit sends its doctors and nurses to poor and underserved places throughout the world to provide medical care. Its staff also mentors nurses in those communities and hires and trains locals to be healthcare workers. Sheila started at Partners in Health in 2010 as a nurse and nurse coordinator, responding to the earthquake that devastated Haiti. A few years later she headed up the organization's response to the Ebola outbreak in West Africa.

1:20After that, she went back to Haiti, which had just been hit by Hurricane Matthew. When we were trying to come up with the right person to talk to about leading through a crisis, we couldn't imagine anyone, you know, better suited to that. Yeah, I mean, healthcare is in many ways a female-dominated field, and yet we don't often hear from healthcare leaders who are women, and especially not nurses. And more than almost anyone...

1:50we've ever talked to, her career has been punctuated by crises. Yeah. And it's been made by crises in a way. Yeah. And for those of our listeners who are leading themselves, who are facing many of the same challenges, although maybe on a different scale or in a different context, it's an opportunity for them to learn from her mistakes and successes and...

2:18from her reflections on her her zigzag career that led her to this moment. I spoke with Sheila on a Monday morning as we were both preparing to start our work week. So Sheila, thank you so much for coming on the show today. Thanks for having me. So tell me a little bit what was your weekend like? Are you in the midst of this crisis having weekend days or is every day the same for you?

2:45You know, every day is the same. We have a call in every morning, 9 a.m. Eastern time, where we have our 11 sites around the world call in and we do our daily COVID update. So that's from like 9 to 9.30. And then from 9.30 to 10, we have our Massachusetts update. And then from there is just a variety of calls from trying to secure protective equipment on the line with distributors. We're trying to get different testing available, talking to teams around the world, talking to a lot of states in the US. So it's every day is pretty much the same. We don't tend to have the same weekends as we used to, unfortunately. Yeah. Is that typical? I know you've worked through other crises. Does this feel typical in terms of the constant communication and work?

3:37Yeah, this is actually a little different. During Ebola outbreak in West Africa, I spent most of my time physically in West Africa. So I was leading the response but was on the ground, so was having calls back with people here. But certainly was in much more of the thick of things. And with this new position, CEO just started last June or July 1.

4:01I'm a step removed, which has been hard in some ways for me, but COVID is so different than any of our other responses, Ebola, earthquake, cholera, because all of us are grounded. So it's a really different type of situation and we're all connected virtually now and by phone.

4:21I'm curious though, because I know you started your career as a nurse. Yes. And you know, obviously caring for people directly, specifically people with HIV early in your career. And I'm curious at what point do you remember a moment where you're like, oh, I want to be in leadership. Did you have your eye on that early on?

4:39No, I actually didn't. And I think becoming involved in HIV at the very beginning of the HIV epidemic, a lot of us were very young nurses, 24 when we started. And in a very short amount of time, we were the experts, which, very young in our career, which is strange looking back. So I don't think...

5:00leadership was something I was looking for, but within kind of rising very quickly because of being an expert in a very young field kind of forced that. And then I think because I was so passionate about HIV and AIDS and social justice, et cetera, I tended to just move around as opportunities arose where I thought I could make an impact. And then often that was bleeding kind of into leadership positions.

5:30but remained as a clinician up until 2014, so still did a combination of both. Yeah. And did you find that transition challenging to make both personally for you, but also professionally, where people open to a practitioner taking on leadership roles?

5:47I think in health organizations, it's pretty common, obviously. I think the nurse-doctor dynamic was certainly present through all of my career, and I think that's gotten better. But there is still the dynamic that in a room of physicians and nurses, even if the nurses are the more experienced, the physicians will often take control or be the one who speaks first, or there's a dynamic globally of physicians teaching nurses.

6:17and when there's very qualified nurse educators, but you would never see the other way around. So more and more we see that nurses are in leadership roles globally, but still nowhere to the extent we really should be. You know, nurses provide 80% nurses and midwives of the care globally, but are I think it's 20% or less than 20% in leadership roles, which is too bad for many reasons, but also because I think nurses typically have very systems oriented people and a very team oriented people. Our education is not competitive in the same way physician education is. We're not battling for residency spots. We all kind of rise together. So nurses don't typically put themselves out there as leaders. So it's kind of a cultural shift as well to do that.

7:07Yeah. And you mentioned gender plays a role in that. Has that been your experience? Yeah, definitely. I think when I first started working in West Africa for Ebola, obviously leading that effort for partners in health, it was clear as a woman and as a nurse, there were some battles I had to fight to be able to be at the right tables and kind of own the leadership even when it was challenging for myself.

7:33I learned a lot during the Ebola crisis, certainly, that I think prepared me for the CEO role that I don't think I would have ever put myself forth for that position had I not had that experience during Ebola in West Africa. And do you feel like thinking about Ebola, thinking about AIDS, thinking about our current crisis, do you think these give more opportunities for women like yourself or nurses to step up and assume those roles or is it making it more challenging?

8:02You know, I think it depends if you look at the countries that are having the best results of or the most kind of aggressive, maybe public health approaches New Zealand and other places against us a lot of women leaders and You know, I think women leaders are there all the time We're just not illuminated because I think it's during a crisis maybe when women shine although I think we're there all the time shining but I think for some reason It's really apparent when something requires somebody who's very communicative, a big team approach, when there's a lot of empathy and compassion needed, not that a lot of our male colleagues don't have that, but I think women shine in those circumstances because of our relational abilities and crises need relational approaches regardless of what it is.

8:55I want to hear a little bit about your experience with the Ebola crisis. I'm curious what you learned as a leader personally in Ebola that you're using right now. Yeah, I realized fairly quickly as a leader that there is kind of two things important. One, really letting people shine. And I think disasters really bring out the best in a lot of people.

9:21not the best in some people. And under pressure and under stress, you really see, I think, leaders emerge. And I think you can see who's able to take things on very quickly, but doing it in a way that's inclusive, not building silos. And there's some excellent leaders who are great, but they exist in a silo. And in emergencies in particular, you can't be in a silo. So I think one really letting people emerges leaders and being available but not micromanaging but also being able to make a decision when you have to. Yeah and that's something we've written articles about this lately at HBR and I've heard leaders personally struggle with is knowing I want to collect

10:07input, I want people to feel they have a say. And yet sometimes I just have to make the decision. How are you balancing that right now? Yeah, you know, it's tough. And I think I always say to people, you know, I'll have your back 100%. So if you're putting a good effort and you're working really hard and you need to make decisions, I'll have your back in those decisions because decisions have to be made rapidly. And if you have good people around you, then you know that they make decisions maybe different than how I would make it.

10:36But ultimately, if it's getting where we need to go, I think you have to be fine with that. And I think because of being a nurse, I'm less driven by having to have it go my route. As long as we get to where we're going, I'm fine. And I know sometimes I step into early and sometimes I step into late, but I think I try to look for feedback from the people I work with closely and say, if you think I'm micromanaging, you need to say something to me, and I'll explain why, or I'll say, you know what, you're right, and I'll step out. I think communication is key, but being able to say, we're a team. I'm never going to throw you under the bus, and we'll figure this out together. And I think when I feel the most successful as a leader is when I see the team is all supporting each other, and it is very much a, I'll step in and help.

11:25And we say partners in health don't stay in your lane, you know, because people will say stay in your lane and we say, you know, don't stay in your lane because we want other people's input and we want people to be nimble. That doesn't mean that there's not lines of responsibility and lines of decision making, but this is.

11:43It's a team sport and I think, you know, very few decisions can be made in isolation. So when someone's hired in to be a leader at PAH, I always say, you know, I don't want you to stay in your lane. I want you to be respectful and give your opinion and listen to other people. But this is too important and there's too many lives at stake. We want people's voices to be heard. Sheila, you mentioned that.

12:07You did feel some of the bias as a nurse and as a woman. One of the things we talk about a lot on this show and a lot in HBR is about the double mind, the idea that women more than their male counterparts face the need to be both warm and nice, which are typically feminine traits as well as competent and tough, which is what we expect leaders to be. And yet it's very difficult to be both those things. Do you think about that?

12:37Double bind much as you're leading yeah, you know this really resonates with me because I think it's also the nurse being the nice one so it's interesting when I was asked to apply for this position and it was internal and external search so.

12:54I had had a lot of opinions and and I was in the leadership team and so when the recruiter called to say like what do you think the next leader should be and I very much had a lot of opinions I was throwing it in and and she said would you ever apply and and I honestly thought I would not have a chance because one being a nurse not being a physician just didn't see that in the horizon but threw my hat in because I wanted my ideas to be heard and then it just kept going on and on and when it was announced, and a lot of people were, you know, internally of the organization were saying, oh, we're so glad, you know, you're so nice and get along with everybody. And I remember saying to a friend of mine, a colleague, and saying, you know, I hope that that isn't the reason why I was chosen, because I'm nice, because everybody should be nice. Like, hopefully it's more than that. And she was very sure, and instead of course not. But I do think there is this

13:52struggle of how to be a decisive leader. And one of my mentors during Ebola who was phenomenal and in public would always say, yep, yep. And then call me up later and say, you know, you totally handled that wrong. Like you should have done this and this. And I 100% appreciated that. And he would say, you need to be perceived as a leader.

14:15and that's where this decisiveness and being willing to make a decision at the right time was really important. And I think I'm probably more decisive and will make more decisions than other counterparts because one, I lived it on the other side for so long when people didn't make decisions and it was just this constant kind of swirl and I knew how frustrating that was. So with my team and the people I work with the most closely, I've been really clear that I very much want to decentralize leadership. So I eliminated the executive leadership team in Boston. The site leaders at all of our country sites are now they make up the leadership team. So I definitely.

14:57put that out there and got a lot of caution from people saying, you know, you shouldn't do that. It's not a good idea. And, you know, you're responsible, but you're, you know, you're giving up your control. And we just started this leadership council in October and we're figuring it out as we go along, like what scope of decision making is there. But it's been a phenomenal process. And I 100% know that I did the right thing. But I'm surprised at Sheila now versus Sheila five years ago and Being really willing, you know to make decisions when I think it's best but also admitting when I shouldn't have or Mistakes that are made and still most the vast majority are collaborative decisions But I I will do that in a way that I'm even surprised myself Yeah, so Sheila five years ago would not have made those changes

15:53No, I probably wouldn't have made those changes, but I probably would have done it in a purely collaborative way, but realizing now that... you can't have a consensus of 20 people making decisions. And I certainly want input and do things like that. But I think I probably would have not have had the confidence to step in and say, actually, this is a decision that I have to make versus this is one the council is making. So I think I'm clearer about that than I would have ever have been before. As a CEO in a crisis, you're making high stakes decisions quite often.

16:30And we've talked previously on the show about the bias around women making decisions that they tend to be judged more harshly if they make mistakes. How do you navigate that bias against you or potential bias against you that you're not equipped to make these decisions because you're a nurse or because you're a woman? How do you think about that? I think there is definitely in terms of business and fiscal decisions and things like that. I do think women are looked at differently.

16:57of, you know, are you making the best decision? You know, during my interview process, I said, I don't have an MBA. I certainly have managed huge grants, have done things like that. But I also know what I'm good at and what I'm not good at and have a strong group of people around me to bounce things off of. And I think knowing my limitations allows me to ask for help. So I see it, someone is a strength of being able to say, you know what, I can figure out this, but I'm not the best person to do that.

17:27and I don't see it as a leader that you have to be an expert in everything. I think you need to know what you're good at and know where you need to surround yourself with good people and the areas that you're not the strongest in and have the humility to listen, I think, to others, but also understanding that I'm ultimately responsible.

17:46Yeah. I'm curious, were there mistakes you made around decision-making during Ebola that made you or even went as a nurse working with HIV patients? Was there mistakes you made that you now keep in mind as you make decisions now? Oh, yeah. I mean, I think, you know, we always remember our mistakes more than our successes. I make mistakes every day. I mean, still every day. And I think I learned the cost of inaction.

18:12Waiting too long or waiting for the perfect. And you don't have that luxury in most places. And so the decisions I regret are ones where I didn't do action quickly enough. So I know that has to be balanced with the right decisions. But by far, the ones that haunt me are where I didn't do something as quickly.

18:36Or I wanted to get, you know, it to be a perfect plan or this and you just can't do that. And one thing that pH is, is you just jump in. You just have to jump in because it's never going to be perfect. Right, right. Taking action that quickly, of course, requires lots of difficult conversations. Is there, I imagine you're having difficult conversations every day, but is there one particular one that you.

19:01been thinking about lately or you've had to have lately and what have you taken away from that? Yeah, we've really struggled with getting the personal protective equipment just as like in the US and Europe. We're constantly being outbid to get it in our sites around the world because there's same thing happened during Ebola when the US bought up all their protective equipment and didn't need it. Now, obviously people need it. So it's a different scenario, but we're a small NGO compared to huge you know you know people buying this personal protective equipment so the very beginning of this because of what happened in Ebola I think we jumped on things and ordered things before others did because we were saying we can see what's going to happen and it's coming and so we we.

19:47you know, had to say, okay, you know, spend the six million, spend the eight million, put those orders in and our procurement team and supply chain team run by a young woman is phenomenal. And she's up all night negotiating, talking to Korea, talking to whoever, trying to get materials to the sites and making those decisions, knowing that if we don't raise that money to back that up, it's a huge problem because we're, we support.

20:13ongoing care. We're not emergency. We support ongoing care in all of these countries. And if we leave, no one else is going to come in to continue to have labor and delivery and treat oncology and things like that. So having to go out on a limb and say, yep, we're going to raise the money and spend money before we have it is super anxiety producing. But we've done it and, you know, we figure it out. But that's a challenging thing. You mentioned that you are working every day, seven days a week. And it sounds like a lot of your team are too. How are you thinking about preventing burnout for yourself and for your team? Yeah, you know, this is something that is challenging because I think if it's for a few weeks, you know, everybody

20:58buckle down and and but you know the novelty as we all know is worn off and people juggling kids at home and I was a single mother so I have such empathy for people who are struggling to figure this out by themselves which I had to do and so we're trying to really be kind to each other and the leaders I have are all meeting with their teams we're trying to do things like virtual happy hours We're trying to do ways of connecting, of spending time together, funny things, memes and all of this. We just started talking about we're in the marathon now because also the US at some point will come down, but that's just when it's going to be really hitting hard in other places.

21:42Our peak hasn't even remotely hit. So we're thinking about, you know, are we protecting times and say, particularly for the leaders who can then be passing it down to their teams of, you know, you've got to take one day off a week.

21:55And you just need to sign it out to everybody else. And if there's an absolute emergency, we will text you. But we're just starting to talk about that because we know we have to because this is it's a long haul. And, you know, when when I would come home from West Africa, home was my refuge because I could after my 21 day of quarantine, I could be with my family, I could go to a restaurant, I could do things like this. And now there's no refuge here. So home is not our place where you can let go and let loose.

22:24because it's just such a weird time in our personal lives as well. So I'm trying to be very deliberate about saying, you know, we need to come up with some plans. How do we want to do this?

22:35hiring, trying to get some temp staff in if we have to to do some things. But it's a challenge because I know that people's lives are being so impacted at home with family members who have COVID or battling with no daycare. And I don't think we've figured it out yet, but trying to. Gosh, I have to say I got chills when you said home used to be a refuge that feels so true for so many people right now that we're mourning that loss in a way.

23:04I do want to ask about women's careers because one of the things I keep hearing expressed is that this crisis inside organizations may damage women's careers because a lot of the time and effort and resources that went into programs for women or mentorship for women are sort of going to go by the wayside because of cut budgets, limited time.

23:28I'm curious how you're thinking about that at PIH. Are you concerned about the careers of the women who work for you? Is there anything you're doing in particular? Yeah, you know, we have a university. We started in Rwanda called the University of Global Health Equity. It's a master's program in global health delivery, but there's also a medical school and there's soon to be a nursing school. But in the first medical school class, it's two-thirds young Rwandan women.

23:51and that was done purposefully to say we need more young women who are physicians and in Rwanda and in every other place and so we're continuing to talk about even in the midst of crisis how do we make sure these things continue and so we're still planning on the you know the second cohort beginning and if we have to do it virtually and catch up later we're going to do that and We really have tried to do a nurse leadership. We started a fellowship for nursing leaders throughout Partners in Health because to be able to highlight what they're doing, because there already were phenomenal leaders, but no one ever shined a light on them. So we did the first cohort and the second one was supposed to start and we're gonna just do it virtually and just say, we maybe can't do the same level as we did before, but we're not gonna stop because life needs to move on and more than ever, we need phenomenal women leaders.

24:45Like now is not the time to stay in the background. I think it's up to us to be creative then and make sure that we're creating other opportunities for women to receive mentorship and to have the chance to shine and putting people in positions where they may not be 100% ready, but saying, you know what, we'll talk on the phone every day if we need to, but you can do this. You can take this leadership role and we'll help you through it because this is an opportunity.

25:15as well, not just a challenge. Right. Great. Sheila, thank you so much for talking with me today. Sure. No, thank you. It was a great opportunity. I just want to say that conversation really moved me. Oh, so? You know, this is a woman who is dealing with life and death and at the same time finds the space for deep compassion and is learning all along the way and is making some critical distinctions and sharing them generously with us. I mean, she's remarkable. Yeah. You know, the thing I was thinking about later after the interview was her comment about how not having an MBA and not being a doctor actually made her good at her job because she knew when to ask for help. She knew what she wasn't good at. I mean, she was basically saying,

26:15I'm not arrogant without saying that. And I thought that was such an important piece of her leadership. And that came through exactly like you say, and how generous she was with the lessons she's learned and how she's, she never felt she was destined for this position. She came to it because she cared about the work. Yeah. And the ability to ask for help.

26:43is critical in a world where the complexity and the speed and the all-round urgency of every day could easily overwhelm someone who doesn't know how to ask for help. She also talked a little bit about how, particularly in the situations that she's in and her team is in, you cannot make every decision democratically. And that resonated.

27:12with me too. She really just captured all of the kind of swirling pressures that a woman in her position is under. Yeah. So Amy, maybe you've led through, you're leading through this current crisis, but you've led through previous crises too, right? Yeah. Well, I would say that I have been present in previous crises. So after 9-11, I was one of the...

27:40few remaining editorial employees at the magazine where I worked. And then in 2008, I was freshly installed in a leadership position on a brand new project in an organization and now here. So yeah, but I also have to underscore that nothing was life and death about what I was doing.

28:08So leading that team in 2008, you know, being a brand new leader, what do you feel like you learned from that experience that you're able to use now? Well, I was brand new and I knew no one on my team. So it means that you have to take the time, even in tumult, you know, even when there's so much going on, you can't catch your breath.

28:34to get to know people. It means that you have to take the time and be thoughtful about keeping all your stakeholders informed. A crisis is no excuse for not taking care of business the way it's supposed to be taken care of as in keeping stakeholders informed, giving people a chance to weigh in appropriately. And also this was a really important thing I learned is that you have to dig for all the information you can get in a compressed span of time before you make a decision. And you have to think about the now and you have to think about the near future and then you have to think about the distant future. It's that three-dimensional chess game you're playing. And so you have to be super thoughtful and you have to

29:29be able to make decisions in the moment that you have every reason to believe will stand the test of time and to do that you have to gather as much information as you can quickly. And that's asking for help by the way. You can't do that asking for help. Sure. Sheila made this really interesting point that a crisis is where women shine. What do you think of that? You know I've been seeing all these memes on Instagram and other places on the internet of the countries that have done particularly well in this current crisis and how most of them are led by women. And I forward them to my 13 year old daughter. But I do feel like she has a good point, which is that that combination of humility and the ability to listen and

30:23the sort of just the instinct to care about people and at the same time to be decisive I do think that's what a crisis mandates and there's something about that combination that most women have had to master because of the double bind of how to be both warm and competent that is both comforting and you know sort of becomes a beacon.

30:50in these dark moments, what did you think? I had a slightly different take, which is that I thought it spoke to, I agree with everything you said. So what I'm saying is additional. It also speaks to women's ability to keep 50 balls in the air. Yes, right. I mean, you cannot overstate the complexity of this moment. And we all know that, you know, we've talked about this a lot on our podcast.

31:20that it's not just the day jobs for women that you know they're coming home taking care of their families and their households and all of that and their parents and you know and and and and I think a lot of when women shine in this crisis it speaks to their ability to do 75 things at once.

31:42with a lot of competence. Yeah, it's interesting. Sheila didn't explicitly mention that ability to keep so many balls in the air, but you heard it in her story, right? Like of being a single mom of working on an HIV unit in the late 80s, early 90s. You can only imagine how many things you had to juggle in those environments. It's so embedded in who she is and how she leads that she didn't even need to mention it. But it's true. That's a really good point. Yeah.

32:12When this is all over we should take her out for dinner. Or drink at least. Many drinks. That's our show. I'm Amy Bernstein. I'm Amy Gallo. Our editorial and production team is Amanda Cursey, Maureen Hoek, Adam Buckholtz, Mary Dew, Tina Toby Mack, Erica Truxler, and Rob Eckhart. Thanks for listening and take good care.