Naji Gehchan: Hello, leaders of the world. Welcome to spread love in organizations, the podcast for purpose-driven healthcare leaders, striving to make life better around the world by leading their teams with genuine care, servant leadership, and love.
I am Naji, your host, having the pleasure to be joined by Dr.Amre Nouh is a physician leader, healthcare executive, clinical researcher and innovator with a proven track record of developing and executing strategy, leading multidisciplinary teams and implementing system practices to improve patient outcomes. Amre joins Cleveland Clinic Florida as the Regional Chairman of Neurology, leading neurology care for the clinic’s neuroscience institute in the state of Florida and beyond. Amre Is a board certified neurologist and vascular neurologist. Over the past decade, Nouh has lead stroke care in CT in various roles at Hartford HealthCare, most recently as System Director of Stroke and Cerebrovascular disease. During his tenure he also served as core faculty at the University of Connecticut, Associate professor of neurology, vascular neurology fellowship director and currently is Chair of the Northeast Cerebrovascular consortium, an AHA sponsored consortium for stroke care encompassing 8 states. Amre is a fellow of the American heart and Stroke Association and has led statewide legislative efforts to improve regional stroke care focused on patient advocacy and recognition of stroke center designation for optimal patient care. Amre earned his executive MBA from MIT Sloan school of management where we first met and has served and a key opinion leader and consultant in neuroscience and stroke for various innovative projects within the neurologic care space. He is father, husband, son, brother and in his spare time a fisherman, musician, and avid reader.
Amre – It is such a pleasure to have you with me today!
Amre Nouh: Pleasure is mine Naji. I’m a big fan of your podcast and thank you so much for having me today.
Naji Gehchan: I would love first to hear about your personal story and really what brought you to become this incredible physician and specialist you are today.
Amre Nouh: Thank you, Naji. Well, I’ll first off start out by saying I’ve been very blessed. Um, you’ve shared a lot about my, uh, professional journey, but really I, uh, I was born in Vermont and, uh, grew up in the United States for several years. My parents are originally from Egypt, and, um, uh, we stayed in the US for, uh, many years in the beginning, um, in my elementary school years, and then, uh, moved actually quite a few times. I, I moved to Saudi Arabia for five years. Which was a very interesting transition. Um, this was, uh, uh, late eighties, early nineties, and then, um, moved then to Egypt.
And I stayed in Egypt for about 10 years. I actually finished my medical school there and then decided to return back to the US and started out as a, uh, clinical researcher, um, and did a, a neuroscience research, uh, tenure at Duke. And then, um, through that process, um, studied for my boards. Worked, uh, worked my way up to getting to residency training where I did that at the University of Illinois at Chicago and then went to Loyola for fellowship.
Um, and then, um, moved here, um, to Connecticut, um, where I am currently recording this and, um, about almost a decade here, I met my wife during my internship year in New York. And, um, I have to say that it’s, um, it’s been an amazing journey. I. I look back and reflect on all the things that you said while, while you were sharing them, and, uh, just a flurry of memories just rushed into my head about all the different steps and things that had to happen and things that didn’t happen that have made it possible for me to be where I am today. So I would say I’m very blessed and, and thankful, um, that, um, this is how things turned out so far.
Naji Gehchan: Thank you for sharing this,. You’re a neurologist and specifically specialized in stroke care. You manage patients in really ultimate urgencies. You have few hours, sometimes even minutes to save their lives and save their brains. I’m really interested to know how you manage this stress and responsibility personally before going to the team.
Amre Nouh: Absolutely. Um, yeah, I, I think, um, I think, uh, you know, neurology has, has evolved. I think, uh, over many years. Neurologists have always thought to be analytical thinkers. They have time to think and pontificate over things.
And as you know, um, it is a specialty that requires a lot of that. But stroke is indeed unique where you have to make quick decisions and you have. To manage that stress. Um, I found it, uh, I found it very calming to think of, um, to think of things in chunks of time and steps. So, uh, I think being disciplined with a process, uh, following a specific protocol that you have and uh, creating it out a habit out of managing your time while you’re thinking through the steps has been.
Um, every now and then you’ll encounter a patient that doesn’t follow the book and kind of throws you off track of your, your process and, uh, is trying to keep calm under that pressure and always remembering that you’re not alone. Thankfully, Um, no decisions are made in vacuums and there’s always someone around you.
So when things do kind of, um, present themselves unique or a challenge that you know is different than what I’ve seen, I tend to take a step back, take a deep breath. I think, um, there’s no shame at all in, uh, calling a friend or seeking some advice from a colleague. Um, I think that’s the most important part because ultimately, um, you know, you wanna do what’s best for the patient.
Naji Gehchan: So when you’re doing this, you’re obviously also managing a team, a cross-functional team, uh, with, with different tasks, different responsibilities. So how do you make this at this team level, ensuring coordination, agility, speed, and also continuous improvement in your patient care?
Amre Nouh: Yeah, I would, um, I would actually, uh, take that and, and maybe share with you sort of.
My strategy that’s helped me so far. Um, and what I’ve really learned over, over, uh, the past decade, uh, leading teams is really rallying everybody around the vision. You know, there’s, uh, two quotes that come to my mind, always want to talk about this, and the first one is, um, um, you know, a vision is not an idea because everyone who’s ever taken a shower has had an idea, right?
It’s the person who got out the shower, dried off and did something. That made a difference. And that’s a famous quote by Nolan Bushnell, which essentially means that you have to really, uh, be very communicative about your vision and, and you have to execute it. And to execute it, you have to have a, a pathway.
Uh, another thing that comes to mind is if you don’t know where you’re going, any road will take you there. And that’s a famous quote too by Louis Cornell. Um, so those two points together really, I would say provide a true north for the team. So on. Smaller scale of managing an acute care patient, it may not seem as as important, but on a larger scale of leading stroke teams and leading hospital divisions and leading healthcare, uh, at a larger level, everybody has to know what the true north is.
Um, and, uh, having a vision and having a plan about how that vision is, is going to, um, pull itself or evolve is really, is really key. So I think. Communicating, setting expectations and resetting expectations, um, very clearly about what it is we’re trying to achieve is really the way to go.
Naji Gehchan: I love that. So you definitely touch on, you know, my other question, which was, uh, how do you transfer the skills you learned in acute settings towards what you do now, which is leading large organization systems, improving those systems to, to better patient care? Any other learning than vision, executing on the vision, which is a key first step.
Do you have any other thoughts from a leadership skill stand?
Amre Nouh: Uh, absolutely. So, uh, you know, I, I would summarize leadership in two things. Uh, two really sentences. One is, um, for me, I felt leadership is the maturation of frameworks Plus influence and mentor maturity is a shift in frameworks nurtured by experience.
I believe that, um, any good leader needs three key characteristics. Uh, first and foremost, me. I mean, I, I’ve been blessed throughout my life so far with some really great mentors that I owe a lot of gratitude for, and I’ve been asked to mentor people, uh, as well. Um, everybody needs a coach. Um, and, um, um, I think that I’ve been, I’ve been helped to, you know, get, get out of trouble or avoid trouble.
I’ve been given some sound advice. Many times there’s a imperative action bias. We wanna jump in and do things and solve things. And, um, it’s like what Napole used to say, Don’t, don’t, uh, interrupt your enemy while they’re making a mistake. Sometimes you just have to sit back and watch and let things unfold.
And I have to say that, uh, a mentor who is not emotionally charged or is looking at things from the outside who genuinely cares about your wellbeing and your development is key. , Um, if you are even a mentor yourself, having a mentor keeps you humble and keeps you, uh, keeps you aware of what you need to do to mentor your teams.
So mentorship is almost, I mean, it’s invaluable. I know that many people talk about this. Um, but from my personal experience and what I can share is that especially as a physician, um, there’s a lot of experience and wisdom that we can gain. Uh, you know, lowering our ego levels to ask for help and to understand situations.
So that would be one of the first things. Naji, eager to hear the second . So, well, I, I, I think, um, the second one, um, which, um, which is an interesting, it’s not a novel concept at all and maybe we can spend a little time cuz I’m curious about what you think about this as well as a. As a fellow colleague, leader, and, uh, MIT alumni, um, being assertive.
I mean, um, I was reading recently a very, uh, the work by Emmanuel Smith and who kind of summarized, um, coping mechanisms, uh, into this very interesting framework and concept where we are all conditioned, um, by our design to have fight or flight responses. I mean, that’s what differentiates us from any other creatures on those ends of the spectrum.
In the center, we have verbal reason. You know, if you’re driving your car and someone cuts you off, you’re not gonna get out and, and, and fight them. Um, it’s because we have, you know, we have the, the verbal reasoning part, but over time what ends up happening because of the emotional load that is associated with a problem or a situation or an opportunity, we tend to treat things with the slider approach, where instead of the flight mode we’re in this, some people become passive aggressive and on the, um, on the flight mode, they become non confront.
And, um, you know that there’s a slider in the middle, and sometimes when you deal with a problem that’s you don’t wanna deal with, you just avoid it. You use some fancy words, you pass it on to someone else, but in reality, you really didn’t cope. You just became non-confrontational and avoidant. Or you get the passive aggressive behavior.
And we see it all the time, not only with leaders, but even with our team members and others. But true coping is being assertive and, and, and really calling things out for what they are and trying to avoid that. Either falling a victim to an abusive relationship where passive aggressiveness is the culture or the tone of the relationship, or non-confrontational, avoiding things where you can’t get anything done because people are indecisive.
I really like that and I felt that, you know, this kind of summarizes, um, really what assertiveness is very nicely. Um, and as I just said, it’s that maturity of frameworks and influence. So, you know, as we all evolve as leaders, Um, defining assertive is that way and understanding the differences and seeing it when people cope or not.
How they respond are they’re being avoidant and there’s usually some degree of emotional discomfort. So, um, I feel like that’s a under stressed area in an area that’s not really talked about amongst teams is calling out that type of behavior by reframing it in, in being assertive and avoiding those two negative trap.
Naji Gehchan: Yeah, this is, this is super important. I just said, Amber, I think you’re touching on different aspects, as you said around assertiveness. You have, making sure as a leader that you’re building this safe environment. Mm-hmm. , where people feel safe to say what they think to challenge and where, where, Honestly, honestly, confrontation is.
Like we have to confront ideas. For us to innovate, we have to say we don’t agree. We have sometimes like to go into those healthy small confrontations or fights or whatever we wanna call them within the team. But if, if we share, I think what you said in the very beginning vision, like if we know if we share the same purpose and the same values, but actually those small confrontation will help us be.
And move forward. And the risk is exactly what you said. If you’re building a culture where people will start escaping them or not sharing what they think while you cut. Lose all the value of having a diverse team or bringing new ideas. And ultimately, as a leader also, you said like, if you are not assertive and if you are starting to avoid those topic, it’s like it just ripples through your team.
So I, that’s really a great one, and I agree it’s rarely shared through this land, so I thank you for sharing it. I, I love how you framed it through assertive.
Amre Nouh: I will link it to, um, the concept that’s been discussed in many different formats. Uh, you know, being in the basement, uh, you know, like if you are, and we all, I mean, this is an area that I’ve, I’ve learned from experience that, um, you don’t have to solve this one.
All you have to do is get better by reducing the amount of time it takes you to get out of it, right? Uh, so you have a problem, or some you become emotionally charged or you become challenged and all of a sudden you’re in the basement, right? You’re panicking, you’re, you’re, you’re falling. On one side of that spectrum, you’re gonna either become avoidant or get angry, or become passive aggressive, and, uh, you need a mantra to get you outta that basement.
Many times it’s just time. Some people can meditate. Some people pick up a phone and call someone. Um, and I, I think that the lens that has always been looked at for this one is, you have to get out of this. You have to get out of this, you have to get out of this, but not focusing on, you just have to get out this sooner so you don’t dwell for days on a problem.
And really progress is measured by, you know what, This happened to me. I had this really bad experience, but only took me an hour or two and I feel like I’m back to myself versus the only, this would’ve been a week’s worth of moping. Um, and it does go back to the same concept. Links into this, uh, sort of, uh, spectrum of coping and, and being assertive.
So, um, I think that’s one thing as a leader as, as you kind of gauge your own sense or your mentors tell you you’re getting better or not, is really gauging how long you spend in the quote unquote basement and how you can get out of that sooner, um, and what mechanisms you have.
Naji Gehchan: I, I love this. How long do you spend in the basement?
Amre Nouh: I mean, I’ve spent, I, I’ve renovated my basement literally in figuratively, . I mean, it’s really, it’s a, it’s a tough one. It is. I mean, we’re human beings and we are, we are gonna, we’re gonna make mistakes and we’re gonna have these problems. And a lot of times it’s not just work, you know, it’s, it’s, uh, It’s the crushing reality of all the different, um, responsibilities we have and the work life synergies and all these other things we have to deal with.
Um, but it’s also an area where I think one of the three key characteristics that goes with hand in hand with assertiveness, um, and the mentorship piece.
Naji Gehchan: Yeah. And so, so you talked about two things I would like to, uh, kind of double click on. Um, obviously you’re, as you’re saying, it’s not only work, it’s all that goes around it.
And in, in your intro you also talked a little bit about this, like the things that happened. That made you not do things or that pushed you to do things not the way you wanted to do. So I’d love to hear more about, about this. Uh, and then I will go into, uh, you talked about mistakes. I’d also love to Yeah.
Talk about this. But let’s, let’s start with the first one. So,
Amre Nouh: um, I’ll start that off by talking about the, the, the, uh, the widely shared or widely taught, the widely believed notion of work life balance. And I feel like word work life balance gives a dis surface to both your life and your work. Because essentially when you say, when I say balance, or you say balance and you close your eyes, I think we envision a scale with two sides, kind of those old school scales.
And that the word balance automatically assumes that those things have to equal each other out. So sometimes you have to, you know, Rob Peter to pay Paul and you’re gonna, you know, do a little more with work, um, at the cost of family. Your other life or vice versa, but they’re never in sync. And, um, you’re always tugging on one side or the other.
And, and we’ve always been sort of taught that we have to perfect that. But a, a mentor , ironically, has, has shared with me a very important concept and said, never say work life balance. Always say work life synergy. And there’s two incredible lessons in that sentence alone. Number one. The choice of words matters.
Um, you know, it it, it goes back to framing. If it’s framed right, uh, it’s gonna, you’re gonna think, right? Um, and the second one is using the word synergy instead of balance. And naji, I mean, you are one of the busiest people I’ve ever met as well. Um, and, uh, you’re, you know, you’ve managed a lot of things and I think this resonates with you as well.
Um, it, it all has to make sense together. You have to find ways where your work is meaningful, um, and that it is not robbing you of the joys, uh, the focus, the the being in the moment with your family, um, outside of the confines of time. Because the reality is that’s the one variable that no one has any control over.
You’re gonna still have those 24 hours and make most of them, but it’s, um, it’s framing not just to yourself, but also to your. Get them involved in what you do. Uh, share the passion with them, even if they don’t feel passionate about it and understand where they’re coming from. Um, you know, um, the way a problem is posed, uh, influences really how, how, how you solve it and how you kind of address it.
And, um, and work life balance sounds like a problem. It doesn’t sound like, it doesn’t sound like a solution, but work life, synergy.
Naji Gehchan: Yeah, I, I love this frame. When you, when you said synergy, I’ve been more drastic about this. I say like, there’s no work life balance. There’s one life we live, and like, obviously, you know, that’s even better
But yeah, it’s, and as you said, I think like the, how you frame things and the power of how you ask the questions. Yeah. Make a whole difference. I really like this idea of balance versus synergy. So if you go to the mistake, Uh, in your word, obviously dealing with mistakes has practically to be like close to zero when you’re dealing in an acute setting with a patient.
Um, but yet you innovate. You improve patient care constantly with your teams. So even though unfortunately the stroke kind of framework, uh, and innovation with drugs, et cetera has not been as big as in other therapeutic areas, you obviously are treating better patients. Your passion is in hospital stroke, but also out outpatient care.
Yes. So I, I, I’m really interested to, to know how you deal. Zero mistakes and following the processes I choose, as you said, and at the same time trying novel ways to better treat patients. How do you, how do you deal with those two things, especially that as we’ve seen at MIT and as we many times hear, do mistake, learn from them, trial and error, but in such a high, high stake specialty, it has to be a little bit different.
So I’m eager to hear how you do this. Wow.
Amre Nouh: Um, that’s a lot. Naji. I’m going to try, I’m gonna attempt that one as best as I can. Um, it is, uh, it, it is, it is a very, um, uh, big responsibility to, uh, to, to manage, uh, patients and take care of them in any specialty. And you’re right, the tolerance level for mistakes is, is zero.
Um, you know, we always talk about the first rule of medicine is do no harm. Um, and I believe. Fullheartedly, I would say examples of, of mistakes that involve bad leaderships or bad decisions are around who was right versus what is right. Um, and the reality is that we are human beings taking care of human beings.
Um, so stakes are, are inevitable. Um, we do, you know, we try our best to avoid them by sticking to process, tricking to protocol. Um, I think what I found that helps with, with, um, learning from mistakes and, um, keeping that spirit going and, and really connecting with the human beings we are, and the ones we are caring for is emphasizing that relationship is making sure that, you know, we are, we are with best intent, going to do our best.
Um, we’re going to settle only for the. And if, and when something bad happens, an adverse outcome or something that wasn’t planned or there is some degree of error, uh, how we handle it is going to matter way more, in my opinion, over maybe nine enough time times than, than just getting to the outcome. Um, and, you know, um, I, I can, I can share with you that, um, being on both sides of that, um, a lot of times.
Um, and it goes back to this assertiveness a lot of times. Um, you know, you fall into that trap of either, you know, playing the blame game or, um, you know, which is passive aggressive, uh, and not owning the problem or being unavoiding that it wasn’t mean it was someone else, or, Oh, this only happened because someone didn’t do this part of that part.
Um, I mean, I, I could tell you that some of the best stories I’ve had with, with families and patient. Were those that did not have a good outcome. Ironically, and, and when I talk to many of my colleagues in neurosciences, we all have those heroic cases where it’s a great save. Someone was paralyzed and coming into a hospital going to be completely disabled and within hours have complete restoration of blood flow, and they literally walk out the hospital.
Those miracle cases that we see on the news and on tv, and we’re fortunate to be part of that many times. A lot of stories that I, I, I, I will never forget. And the ones that I think of often, and the ones that have helped teach me way more than the, the good outcomes were the ones that were bad outcomes.
And I actually have long, uh, you know, long standing, uh, family members, uh, patients passed away. And it was how we handled, how we handled that and how we handled the bad outcomes. So, um, I know. That’s a long answer for, for a long question, but that’s the reality of what neurosciences is sometimes. It’s such a unforgiving, uh, system, a nervous system.
And you’re right, we have made a lot of advances and what drives me, um, to continue to strive in this field is I think there’s a lot of potential still in advancing technologies and bridging the gap between good patient outcomes and, uh, the shortcomings. The human ability to, to care for these folks.
Naji Gehchan: Thank you so much. It’s not at all a long answer. It’s um, it. Pretty humbling and tough to transition to the next section. And you shared beautiful things. I love how you said who was right versus what is right, and we see it many times in medicine and, uh, everywhere, honestly, even on organizations, uh, and how to handle the, the outcome.
Thank you. Thank you Amery, for sharing this. Um, I’ll transition now to a phase where I will give you a word and I’d love your reaction to it. Okay. . So the first one we talked a lot about it’s leadership. Yes.
Amre Nouh: Um, yeah, I, I’m, I’m going to, uh, I’m going to reiterate what I said. I, I mean, leadership, you know, John Maxwell, uh, says leadership is influenced nothing more, nothing less.
I, I don’t disagree with that. I would just add that that leadership is a, is a, is a maturation of frameworks plus influence, and that maturation, uh, comes from being nurtured by experie. So that’s what comes to mind. Health equity. Health equity, um, what in my humble opinion, health equity is offering every patient the same care you would give to a family member or to anybody else.
Um, independent of who they are, what, what their background is, where they come from, and, uh, treating them like you treat your. Mentorship, mentorship. Mentorship is sharing these nuggets of wisdom. This type of conversation that you and I are having the pleasure of having is so valuable for the people that you mentor.
And, um, I think mentorship is gold. There’s no way that anybody in any position, at any rank does not need a coach. Everybody needs a.
Naji Gehchan: The last one is spread love in organizations .
Amre Nouh: So, you know, I love that. Um, and this is why I’m a big fan of, of what you do. Naji. Um, earlier I said there’s three main characteristics of a leader, and I think that the last one resonates with this word that I’ll tell you is empathy.
Um, you know, a little bit of empathy goes, goes a long. Um, you know, um, there’s a really great book that I read recently by Moga, which is, um, Solve For Happy, and there’s a lot of great nuggets of wisdom in that. One. One that really I liked was how, uh, the author frames how we perceive the world and says, We are all movie stars in our own movies, and everybody we interact with is a supporting actor.
So right now I’m the movie star of my movie, and you’re the supporting actor. And in your world it’s vice. Um, and a little bit of empathy will help us oversee, uh, you know, not oversee the fact that, that that separate reality exists and will allow us just enough to keep our eyes and our ears open, uh, to understanding where other people are coming from.
So, spreading love in organizations has to come from empathy has to come from that ability to recognize. Sure you are the movie star of your own movie, but you have to understand sometimes that the person sitting in front of you feels exactly the same. And maybe you should play a supporting role, um, for that love to spread. Because if everybody stays as the movie star, um, the team will fall apart.
Naji Gehchan: Any final word of wisdom for healthcare leaders around the world?
Amre Nouh: It’s a journey. Um, one of my mentors always says it’s about progress and not perfect. Um, you know, if I were to have this talk with you a few years ago, it would sound very different than it is today, and I hope that we could redo this in a few years, and I’m sure you and I will have a whole different host of things to talk about.
I think there are some core things that we, we talked about. Um, I think first and foremost, talking about vision for others, having your own value system is so I. Another, uh, mentor always told me, Write down your three core values on a piece of paper and carry them in your wallet. And when you’re in the basement, take out your wallet and take out that piece of paper and look at it.
Um, and it was very interesting. I mean, it’s, uh, I’ve done it a few times, but I’m gonna be honest with you, it’s hard to do that cuz you know, once you’re panicking, if you’re, if you’re panicking and reaching for something in your pocket, , that’s not a good thing to do all the time. But, um, I think. I think that’s a great nugget of wisdom.
Um, knowing your true north, um, and reminding yourself of your true north will help keep that work life synergy going, will help prioritize where you need to, uh, channel your energy and will help build a foundation and a growth mindset for you to continue to evolve as a leader. And, um, staying humble and staying true to yourself and understanding those shortcomings will, will only help perpetuate that.
Um, I, I, I, I’ll leave with this final piece of wisdom that’s not mine, But perpetual optimism is a force multiplier that’s, uh, one of Home Powell’s 13 Rules of Leadership. And it’s true, uh, you have to have a positive mindset. Everything we just talked about, you could see the half class empty, but the half class full is always better.
Naji Gehchan: Thank you so much. I, great. And I, I love your challenge. Let’s, uh, let’s put a date in five years to rerecord whether the podcast has still here or not, but I will do it with you again in five years and we’ll chat about it, . I
Amre Nouh: love it. I really look forward to it, and, and I think it’ll be awesome. Thank you, Naji, for everything you do.
I think spreading love is important and I, I hope to continue to, to hear all the great guests you have and learn from all the episodes and, and nuggets of wisdom that you get to share with the world through, your guests and through the discussions you have. Thank you for having me.
Naji Gehchan: Thank you all for listening to spread love and organization’s podcast. Drop us a review on your preferred podcast platform
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