Reflections on Leadership
Lisa Simpson, MB, BCh, MPH, FAAP
I was recently honored to be part of a panel of leaders in child health at the 2019 Pediatric Academic Societies Meeting, Making Our Mark: Pediatricians, Leadership, and Impact on Child Health. When my colleague and post-doc cohort alumnus from UCSF, Elena Fuentes Afflick reached out I was thrilled. She asked each of us – Danielle Laraque-Arena (former President of Upstate Medical University), Diana Bianchi (Director of the National Institute of Child Health and Human Development), David Nichols (American Board of Pediatrics), Barbara Stoll (Dean of McGovern Medical Scholl at UTHealth) – to describe our current roles and reflect on our journey to leadership. Elena laid out a fantastic list of questions for us to ponder, and I will share my answers to these. I have also been reading a number of Sachin Jain’s recent posts with lists of lessons learned, so he inspired me to post this on LinkedIn. Thanks Sachin!
Understanding One’s Path
Diana Bianchi started off using a quote I also love from Kierkegaard: “Life can only be understood backwards; but it must be lived forwards.” As I look back on my career to date, I understand that regardless of employer, job title, or setting, the constant is always working at the intersection of evidence and action: generating evidence during my years as full time faculty in Florida and Ohio, funding research at the Agency for Healthcare Research and Quality, using research during the Clinton health reform plan and at the state level, and now helping to represent the field of health services research as the President and CEO of AcademyHealth. The other constant that emerges when I look back is the essential role that serendipity and an openness to change play in helping each of us make our path.
Was there a core value, a vision or a personal commitment that motivated you during a developmental phase of your career?
I hold a fundamental belief that we can do better – individually, as physicians, as leaders in healthcare and our communities, and as a country. Healthcare, both here and globally, continues to fall short of what we can and should expect for everyone, and especially the most vulnerable. Linked to this belief is a commitment to science, facts and evidence as a critical element for that improvement. Too much effort, time and resources are wasted on interventions that are at worst unsafe and at best ineffective, low value, and further diminish our ability to invest in other, higher value alternatives. Underpinning these two is a commitment to lifelong learning, self-examination, and a willingness to admit when I am wrong.
Are there specific competencies (knowledge, skills, attitudes, behaviors) for a leadership role in child health?
I think there are many but will emphasize two general ones and two child health specific ones.
General skills: Listening and empathy are two skills which are connected and emphasized in clinical training. As a pediatrician, you learn to listen to not just what the child or adolescent is telling you, but also the parents and/or caregivers. Listening to what is said and the silences in between, to the body language, and discerning the hidden needs and fears. In each of my leadership roles, listening has been critical in working with colleagues and staff as well as with healthcare stakeholders and policymakers. If we want evidence to matter, we need to listen carefully to the questions our users have and the values and preferences they express if we seek to understand which choices – based on evidence – will be acceptable, whether in the choice of a treatment or a policy alternative. Empathy builds on listening and is the ability to emotionally connect with our patients, our colleagues, and our audiences, to truly understand what they want and why. It is empathy that helps us frame and communicate our evidence and recommendations.
Specific skills: In my chosen career path, I have learned that as pediatricians we are often the only child health expert in a room dominated by attention to care for adults, especially those insured by Medicare, because of their dominant contribution to healthcare costs. So those of us who care for kids must consistently bring up a dissenting opinion or a novel perspective – whether it is the lifecourse perspective or the importance of social determinants. (Okay, I acknowledge that the world has woken up to the latter, but we pediatricians have known that since day one! After all, Bob Haggerty defined the “new morbidities” over 45 years ago.) However, we must balance raising our voice for children with not becoming seen as a “predictable one note” and dismissed outright. We have to expand our expertise and bring value to other aspects of the conversation as well. Thus, we strengthen our credibility and the impact of the points we make on child health.
Was there a fork in the road which directed you on a path that culminated in your current leadership role?
I really think there were three seminal moments.During my time in a joint Preventive Medicine Residency and Pediatric Infectious Disease Fellowship, I attended the 1986 meeting of the APHA (American Public Health Association) which featured an inspiring plenary talk by Ruth Roemer and countless sessions on social justice, reproductive rights, and innovations at the local level. It was unlike any meeting I’d previously attended and I was hooked – I had found “my second tribe,” in public health (after pediatrics).
The next moment came during my third year as Branch Chief for Maternal and Child Health in the State of Hawaii. I realized that many of the decisions restricting my ability to address the needs of women and children were being made in rooms that I was excluded from, that there were larger policy discussions that I did not understand. With mounting frustration, I quit and went backpacking in Southeast Asia for months. Sometimes, you just have to quit and replenish your soul.
The third moment came in 2001 and was personal, a cumulative effect of navigating breast cancer during my pregnancy with our twins and then experiencing 9/11, the anthrax scare and the sniper terrorizing DC. I was worn out. It was time to get out of town, and I took my first significant role in academia, which became an important foundation for where I am today.
What Role did Others Play in Your Journey?
I have never met a successful leader who has not been helped by many. I recently found a slide I had made to illustrate a saying John Eisenberg used a lot: “If you see a turtle on a fencepost, you know they did not get there by themselves” (insert image). In my journey, I have relied on the advice of loved ones, mentors, and women. My husband is my best sounding board helping me sort through myriad issues big and small. My mentors have helped me immensely – Jim Perrin, Hal Luft and John Eisenberg. Good mentors don’t just listen and help you figure yourself out, they also sometimes tell you when you are off base, when you’re not ready for the change you are considering. And some mentors who will remain unnamed show you how you do not want to behave. Those lessons are just as valuable. Today I have the great pleasure of paying some of that forward to others who are earlier in their journeys. Finally, women have always been an essential joy in my life growing up with three strong sisters. In my role as CEO, I have discovered the power of groups of women coming together, cheering each other on, supporting each other, and actively using our roles and networks to create opportunities for each other. During my career I have had the opportunity to work with amazing women colleagues without whom I would not have achieved so much or had nearly as much fun doing it – women like my friends Denise Dougherty, Debbie Chang or Anne Beal. The Women of Impact is a great example of women supporting each other.
Whatever your path to leadership is, I think it is important to stay humble and authentic, to truly connect beyond our achievements. That is what gives us meaning and hopefully, impact.