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 for this episode joined today by Cheerag Upadhyaya, Clinical Associate Professor of Neurosurgery, and Chief Transformation & Business Strategy Officer. Cheerag completed neurosurgical residency at the University of Michigan, complex and minimally invasive spine fellowship at the University of California San Francisco, and research fellowships at the Howard Hughes Medical Institutes / National Institutes of Health and the Robert Wood Johnson Clinical Scholars Program resulting in a Masters in Science from the University of Michigan. He recently completed his MBA from MIT Sloan where we met as classmates and had fun negotiating a car in one of our classes. Cheerag is a member of the Executive Committee for the AANS/CNS Spine and Peripheral Nerve Section as well as a member of several associations. He has been awarded the Scoliosis Research Society Edgar Dawson Traveling Fellowship and AANS/CNS Spine and Peripheral Nerve Outcomes Committee Award. Cheerag was also elected to the Editorial Board of the Journal of Neurosurgery: Spine in 2021.

Cheerag, It is such an honor to have you with me today!

Cheerag Upadhyaya: Oh, thanks, Naji . It’s a very, uh, humbling, uh, intro.

Naji Gehchan: Well, every time we chatted about this podcast and this episode, you kept telling me with such humility that you have nothing interesting to tell, and I know you have a ton. So why don’t we start with your personal story. Can you tell us a little bit more what got you to where you are today?

Cheerag Upadhyaya: so I’m the, the son of, uh, immigrants, uh, from India. Um, they. , they came here. My father came here in the late 1960s, um, actually because he wanted to, to be a physician. So he did his medical education in India and then came to the United States for a residency, um, and then decided to stay here.

Um, and, uh, that experience I think, transfers a lot to me. Uh, you know, understanding what my father and my mother. Went through as they made that transition from India to the United States and the drive and determination that he had and my wo mom had about wanting to take care of patients really. And so that served as a very early inspiration in terms of just work ethic.

But also in terms of what I wanted to do with my life. And so I knew early on I wanted to become, um, a physician. Um, that was just a, a core part of who I was as I was growing up. I just didn’t know what I wanted to do. . That was the, that was the part I didn’t know what part. My dad is a ob, uh, G Y n. And so I, I saw a lot of, or heard about a lot of things that he did.

Um, so surgery was somewhat interesting to me at the time, but I really just didn’t know. Um, but I put my head down, worked, went to college and, and then went to med school. And as I. Went through medical school. I really enjoyed, um, surgery. I loved just working with my hands. I loved the clinical aspects of, uh, leading a team, right?

To, to be able to operate successfully and safely, you have to be able to help everybody around you perform at a certain level, right? Um, so that the patient is taken care of really well. And that really attracted me. There was something about that that just, um, Connected. Um, and so I pursued surgical training and ultimately, um, neurosurgical training, um, and then ultimately spine as you, as you already outlined.

Um, the other aspect though that I wanted to explore was, you know, inquiry. I wanted to understand, okay, how can you not only make an impact on our patients, Today, but how do you start impacting patients? Um, uh, in terms of future, right? Extend yourself, scale yourself up as a, uh, individual. And research is one avenue.

And I looked at basic science, but I realized that basic science. Which was the Howard Hughes, um, n i H program, um, wasn’t, didn’t connect with me. Um, and that’s where the clinical research came in, uh, with the Robert Wood Johnson Foundation Fellowship. And then the M B A actually was a way to sort of understand how to connect the dots when it comes to.

Clinical outcomes research, but how do you actually implement that Right. Within large health systems, right. Within organizations, it’s, uh, it’s actually a, something I’m seeing more and more of now that you and I finished the program, that there’s a disconnect between understanding the data. In understanding how to actually operationalize the data, implement it for best practices.

And so that, you know, brought me back to academics, um, here at U N C as a way of being able to function within a large health system and work with partners and neurosurgery, but within the larger health system as well. Thanks for sharing,

Naji Gehchan: uh, part of your story with us. Uh, ed, I know as we were just telling you, are we connecting, you told me you might be called for the operating room.

Uh, as we are recording, I’d love to get your thoughts actually about this. You talked about it, about this readiness, really constant readiness to deliver in high stress environment, not only you, but also the team around you. How, how do you. .

Cheerag Upadhyaya: Yeah. So it’s it, I learned this from my faculty at the University of Michigan.

Um, and there’s a few factors that I’ve always taken with me, right? So the first is you, you have to really be good at your job, right? Yourself, right? Uh, you always have to put the patient first. Um, and then the other thing that. Learned in that. I, I understood it from my faculty in terms of the training and, and I jokingly say as I grew up in, in, in medicine, um, but it was emphasized in everything we learned at M I t, which is you have to create.

Um, a safe space for folks, right? Um, and you also have to, um, empower folks, right? So let me give you a small example. Um, every time I do an operation, one of the things that I, when you’re doing a spine surgery, for example, is you have to check and make sure. You’re operating on the right level, right? Are you operating on what level of the spine?

Um, and the spine has a lot of vertebra. And so if you’re in a rush, it’s easy to get off one level. Um, and that is something that obviously you don’t wanna do, right? You wanna operate on the level where the patient has the pathology. And so when I check the level with an x-ray, I stop and ask everybody around the room before I say anything.

Look at the. Double check if that level matches the level that we thought we were going to do from the initial timeout consent process and so forth. And I do that for a couple of reasons. One is I wanna make sure that everybody’s engaged, everybody’s part of the team. The second thing is I want to convey to everybody that.

if you see something that you feel that we’re at the wrong level, speak up, say something, right? Um, I want you to say something, right? If I’m driving it completely all the time, then folks are gonna be passive part of the process. And I think you can’t get the best out of everybody when they’re passive in the process versus if you actively engage them in the process.

And I think that it makes a huge impact on patient care. And I gave an operative example, but I think the same. Is very true in the outpatient realm. The same is very true in the inpatient realm and frankly, from what you and I learned at m i t I think it’s true, you know, outside of healthcare, right. And, and, and business as a whole.

Yeah. You, you

Naji Gehchan: took me back in time to my residency and, and actually we had this issue in operating room and um, unfortunately after the operation, the. Told me that she knew, but she couldn’t say it because the, the head of department was operating actually. So, you know, going back to this, uh, how, how do you lead these teams efforts?

You talked about, uh, creating the safe space. How, how do you do this? How do you ensure there’s a safe space? And if I wanna challenge a little bit more, I don’t know if in your career you had this, did you build this safe space after a leader who, before you actually did not have this s culture and how you dealt with this?

Cheerag Upadhyaya: Uh, I think it was, it was a, it was the opposite. I, I was very fortunate in my career as I, as a trainee, as a medical student, as a resident, as a fellow to even in the research space, um, at the n I h, at the Robert Wood Johnson. Um, I think it was, I was very, very fortunate. I was surrounded by mentors who, um, Created this environment.

And so for me, and again, I couldn’t describe it right. I couldn’t describe it, you know, when you, when you talk about like, um, what we learned at school, right? Uh, with psychological safety and, you know, some of the work that was done at Harvard in terms of Amy Edmondson, it wasn’t, it wasn’t something that I could describe.

It was just the way that they led and. Created this environment where they had high standards, they had high standards, but it wasn’t about getting upset with people or, or, um, getting, um, mad at people or, or, or, or demeaning people. It was about helping folks setting very high expectations. I think it’s, you know, you, you, uh, you and I were talking about this, right?

Setting expectations, clearly articulating those expectations. so folks know where to go and what they need to do, but then giving people the support and then appropriate feedback, right? Um, and then being humble enough to know that it’s a team effort. Somebody has to lead the team, but ultimately you still need the team to work.

Um, and, and that humility was something that, um, also translated across many, many of the mentors that I’ve been fortunate to work with, uh, over the.

Can you share one of,

Naji Gehchan: uh, the stories, uh, potentially where things might have gone wrong, uh, and how you dealt with this. Uh, I’m really looking at, you know, those mistakes that can be life-threatening actually in your job. And as you’re saying, as you’re talking about creating this psychological, safe environment, how do you deal in mistake with mistakes in a, in a different, uh, ,

Cheerag Upadhyaya: you know, it, uh, that’s a great question.

I, I, dealing with mistakes I think is hard. I think the natural reaction that we all have, or the vast majority of us have is to ignore the mistake. Right. To, to put your head in the sand. To, to, to just not think about it. Right. And when I’ve worked with, um, residents, when I work with medical students, um, younger faculty, I try to explain to them that that’s been my initial reaction as well.

Right? There, something happens and you want to, to run away from it or hide it because it, it’s hurts, right? As a, as a clinician, as a surgeon, you always want the very best for your patient, and when things don’t go right, even if it is something that is within the profile of known complications and things like that, you, you take it personally.

One thing I’ve learned, and it requires work, it actually, it requires a tremendous amount of intentional effort, is that you have to just confront it, acknowledge it, talk about it with your colleagues. Not in a blaming sense, right? You know, of like, this person did this or this person did that. Cuz that goes against everything we talked about a minute ago.

You’ll create an environment that isn’t conducive to safety, but to talk about it in terms of how could I have done better? How could we have done better? Right? And frame it from that perspective. Um, the, the other thing is, own it, right? So for example, if I have a patient who does have a complication, Bring that patient back, talk to them more.

Um, you know, don’t distance yourself from that patient. Um, and I think this is true, whether it’s a patient or any problem or any challenge or any mistake if you will, um, anything like that in life is that distancing yourself from it is. I think a very natural reaction, but we have to sort of fight that reaction and, and, and work through that sort of dissonance in our head and say, no, let me bring it closer to me.

And if you do that, I think you can learn from those mistakes better. And you set an example to your team of, okay, this is a space where we can talk about it, right? Where, where if you make a mistake, this is how we’re gonna handle it. And I think that’s the other, again, going back to the idea is how do you model yourself, model yourself as a leader?

Folks need to see that, right? They need, if they don’t, if they see you getting defensive or they see you running away from things, then that’s what they’re, you know, going to probably do. If they see you owning it and acknowledging it, talking about it, bringing it closer, then they’re gonna start. And I, again, it goes back to what we started with.

I think you’ll improve processes and patients care and everything. Um, dramat. So much of what we is, uh, iterative. I mean, it’s, it, it’s iterative. I mean, we talk about it in medicine, it’s the practice of medicine, right? I’m, I’ll never stop practicing medicine until I stop, right? . Um, I’m always going to be just working to better myself.

Um, and I think that’s true for life and, and business as well. Totally,

Naji Gehchan: and I love it, as you said, do not ignore mistakes. Own them. You know, and, and you didn’t go until saying, uh, like kind of, sometimes you say it’s the others’ mistake too. And I think this is kind of the worst thing that can happen when you not only disowned them, but practically say, oh, it was the operating, uh, room schedule, or it was the nurse or so, so really owning them, even if it’s.

Your mistakes, but your team’s mistake for you to create the safe place and make it better the next time. I, I love what you shared. Sh you also have a key role within your organization now, which is business strategy. So I was very interested when I read, you know, for a physician business and strategy, uh, in, in their function.

So I’d love to, uh, understand from you, how do you define business and also how you define. Yeah, .

Cheerag Upadhyaya: So, uh, it, it’s an evolving idea for me, Ashley. Uh, as I’m, as I’m getting started, this has been something that I’m still learning in myself. Um, the way that I sort of think it’s, it’s hard you don’t, healthcare as you know, right?

Is, is a business, right? Um, so much of we, you know, if, if, if it’s. It goes back to what we talked about in the, in our program when it comes to nonprofits, right. A nonprofit still has to run like a business. Right. It just doesn’t have to pay taxes. Right. Like a for-profit business does. Right. Um, so in healthcare, many of us are in nonprofits.

Um, it’s still important to run the business and run it well. So the lens through which I. Thinking about this, right, is where, what I alluded to a little while ago, which is that I want to understand those best practices that we’ve studied, right? That even you company, right? Your, your company brings out best practices, right?

You use these medications, this is the patient population, this is the best data, et cetera, but the implementation of that, Has to be done in a large corporate environment, right? Multi-billion dollar health systems have to implement these processes of care. And so for me, that is where I’m sort of thinking about it as how do I help bring management approaches?

right, to improve patient care, improve operations, um, on multiple levels, right? Whether it’s at the individual clinic level or whether it’s at the, you know, departmental level or even at a programmatic, a multidisciplinary programmatic level in terms of strategy, part of what I’m thinking about is what is the core competency, right?

What is the competitive advantage of any health system, right? And, and then, so I’m just not a big believer in. You know that there’s a fixed pie, right? Uh, one thing you we’ve learned is that there’s, there’s space in the world for a lot of folks, right? Um, we learned that over and over again with, uh, businesses, right?

I think about the conversations we had and strategy when it came to, like Trader Joe’s versus other grocery stores, for example, right? And it seems like a mundane example, but it’s, no, it’s, it’s very. Applicable to our life, right? There’s room for different health systems in the same market. But I think a lot of times folks get into this idea that it’s a zero sum game, right?

We’re just competing over a fixed number of patients, and I think that there are ways of approaching and guiding programmatic development. Strategy right around that, whether it’s at the departmental level or at an institutional level, that allows the healthcare system to position itself for what it can do the very best.

Right? Um, and I think that’s my approach, at least as I’m thinking about it and as I’m getting started. .

Naji Gehchan: I love this. And yeah, you reminded me of the fixed buy bias because you talked about it and it’s one of the best biases I learned as a concept in negotiation, right? Like when, when we all fight for the same buy, who’s gonna take the bigger piece rather than thinking how to expand actually the buy and we can all benefit from it.

So thanks for sharing that. Uh, I, I would give you now one word and I would love your reaction to it. So the first word is leadership.

Cheerag Upadhyaya: My reaction to that word is, um, understanding your people, understanding who you’re leading and helping them become the best version of themselves within your capacity. Right. Um, that to me has always been sort of the way that I approach it. You know, when I interview. People, when I’m thinking about conversations that I’ve had with people, my first question or one of my early questions is, what, what do you aspire for yourself?

Right? I want to know that, um, because if I can help them achieve some of what they aspire or even better, Achieve more than what they believe they can aspire to. Right? Then I think you can really engage that person and you’re really leading them, and they’ll be with you right through the worst times. Um, but you have to be able to get them there.

I I, I learned this from. I learned this from a, a friend of mine, um, who, who recently passed, um, and, uh, at a young age, uh, she was, uh, one of my, um, early, early mentors as a resident. She was my chief resident and then faculty. Um, and I, you know, leaned on her for advice over the years. , um, uh, her name was, uh, uh, Linda Yang.

Um, and, uh, just an outstanding peripheral nerve neurosurgeon. Um, but I saw this with what she did. She would help people, everybody. Whether it was somebody in the office who, you know, wanted a nurse in the office who wanted to become a nurse practitioner but didn’t see it in themselves, and she did, and she would push them and again, support them.

And then suddenly they were like, oh my gosh, look, look what I did. Um, to, to others who, you know, no, I can’t do research. And no, I think you can. Right? You can help me with research and you’re not a medical student and you’re not a resident. You’re, you know, et cetera. But you can do research. Let me show you how you can do research, and this is the impact you can make.

Um, I think that’s when you, when you use that word, leadership, that’s what sort of pops into my head. Oh, thanks

Naji Gehchan: GaN. I, I’m sorry for your loss. And you, you’re touching a key point of mentorship, coaching, uh, which is also part of leadership. What about, uh,

Cheerag Upadhyaya: transformation, transformation.

I think the word transformation, um, the word that comes to my mind and the ideas that come to my mind are around empowerment, right? I think transformation is an opportunity to, to really empower people to move to the next level. , right. Um, to break the status quo, right? To, to, to rebuild, if you will, in a sense.

Um, I had a flavor of this, you know, in terms of some programmatic development where we were given the opportunity for transformation, right? How do you, how do you do this? Right? And, um, the way that it was most successful, the, the, the opportunities that we leveraged that were the most successful were those opportunities where we empowered people.

And allowed them to help lead the effort as well. Right. And then suddenly that transformation from the ground up was so much more powerful and so much more engaged when it came to the organization. What about health equity?

Uh, that one , that’s a challenging one. I actually, it’s, it’s near and dear to my heart now cuz I’m seeing, um, so much inequity, uh, frankly, in healthcare, um, for me. It’s, it’s a big challenge that we need to address, um, increasingly, not just in the United States, but around the world. Um, uh, but living in the United States, I, on some levels, you know, it seems like we’ve got, as we’ve talked about many times, wonderful healthcare, which we do have amazing, amazing healthcare.

But when you see the inequity, when you see patients who are not able to. Who are not able to afford care. Right. Um, and or who because of social, um, uh, determinants of health. Right. And the unrecognized aspects that social determinants of health, it’s improving, it’s getting better. We’re understanding it more.

But the impact of social determinants of health on health inequity or health equity, I think is another area. So for me, That is an area that actually I’m in very interested in, in trying to understand and explore. And it’s one of the things I’d like to understand over the next several years as part of, you know, a research, research effort when it comes to neurosurgery and spine surgery is, is exactly that, right?

When it comes to the social determinants of health and how that drives inequity in health outcomes. Um, I do think that there’s an opportunity to a, again, go back to management though, right? How does an organization. Interact and, and interface with other community stakeholders, right? As a way of helping build up capability when it comes to the resources that we can offer, the community, the environment, you know, our, the people around, um, to improve health inequity.

The last one

Naji Gehchan: is spread love and organizations.

Cheerag Upadhyaya: So , I. I think I, I was fortunate to participate in a, um, and I really love your podcast. I love your podcast because you unan unashamedly, I don’t even know if, if that’s the right word, I think, right. But just right there, you throw it out there, you use the word love, right?

And I think. I think that that is an important concept. I was fortunate to participate in, um, uh, physician leadership, or, sorry, a healthcare leadership forum, um, at Intermountain Healthcare. Um, and it was led by, uh, one of the former CEOs of Intermountain Healthcare. His name is Charles Sorenson. Wonderful gentleman, wonderful gentleman.

Very humble. Um, exemplified much of what you and I have talked about this morning. and one of the speakers that he had brought was another executive at, um, the, uh, Intermountain former executive Inter Intermountain Healthcare. And he exac he said that he, he emphasized that he’s like, you know, leadership is love.

As well, right? As all these other things we’ve talked about and that hit home, um, when I heard that a few, this was a few years ago before the, before all this pandemic and everything we’ve been living through it hit home. And, and he went through and he described, and I thought this was very insightful.

He went through and he described, you know, that we don’t, you know, we use the word love, but you know, you know, if you go back to certain culture, You know, for example, I think you talked about the Greek and the, uh, Greek culture and antiquity, right? They had. They, they put different words around different types of love, right?

And that I think is sometimes lost in our modern world. That you can love the people around you, and it doesn’t have to be all this other stuff. It can truly be a love of mission, a love of watching people grow and become the best versions of themselves. But I think that is an important part. That is something that is lost at times, I feel in the modern era.

And I really appreciate what you’re trying to do here, which is bring some of that back, you know, into the conversation, right? As a way of, um, helping improve business, but also frankly, improve people’s lives. Right? Because, you know, work is such an important part of everybody’s life. and if you feel good about going to work, right?

That’s, that’s a good thing, , when it comes to life in general, right? It shouldn’t be consuming, but it should be fun and enjoyable and, and, uh, and uh, and help you grow as an individual and feel like there’s dignity to that, right? That you’re coming home. And I think if you don’t have love in that conversation, and I think the type of love that we’re talking about, right?

It, it begins to, um, you lose some of.

Naji Gehchan: Thank you so much, uh, SHA for saying this. It means so much for me. And yeah, hopefully we’re bringing a little bit more of this love, you know, not the ro romantic love. We only think about when we hear the word love, but all the other pieces of love, of humanity, life, work, and humans.

Uh, any final word of wisdom for healthcare leaders around.

Cheerag Upadhyaya: Uh, you know, it’s one thing I’ve learned, um, again, I, going back to going back to our experience at m I t Naji, like, um, I build networks, um, you know, build networks, build friendships in healthcare, which I think sometimes comes naturally cuz that’s where we are.

But build networks of people outside of healthcare, right. In other industries. Um, I, you know, I mean we went through this pandemic. Right. As a, as a class , um, and, and learning from each other, um, I think it’s easy to get siloed right in, in what we do, but I think learning from each other, um, and finding and seeking out really good people like, like yourselves and so many other, other folks that we worked with as, as classmates.

Um, is, is something I’ve learned, um, has been very valuable and it actually gives perspective on the challenges that we’re all facing, right? Um, and uh, the other thing is taking the time to have good conversations. Um, I think, uh, You know, the fireside chats that we had as, um, as students, um, were probably some of the most impactful things for me personally.

Um, just to learn from each other, the humanity that people bring to the table, um, as well. And it gives perspective on, on, on our mission. So that, that’s just, uh, just my 2 cents in additional, obviously everything else we’ve talked about.

Naji Gehchan: Awesome. Thank you so much again, uh, for being with me.

Cheerag Upadhyaya: Thanks, Naji. It was a pleasure and I look forward to seeing you in person here in, uh, next month.

Naji Gehchan: Thank you all for listening to spread love and organization’s podcast. Drop us a review on your preferred podcast platform

Follow us on LinkedIn and connect with us on spreadloveio.com. We’re eager to hear your thoughts and feedback. Most importantly, spread love in your organizations and spread the word around you to inspire others and amplify this movement, our world so desperately needs.