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Today, on Episode 5 of the podcast, Meg speaks with Dr. Shikha Anand, Chief Medical Officer, Withings. Among other subjects, Dr. Anand talks about the importance of understanding full patient context when addressing health, her career in both the public and private sectors, peer mentorship, and the hurdles and opportunities for healthcare in the home.
Show Notes
Episode 5 - Dr. Shikha Anand: Upscaling Health in Context
Today, on Episode 5 of the podcast, Meg speaks with Dr. Shikha Anand, Chief Medical Officer, Withings.
Meg and Shikha discuss Shikha’s enduring drive to build a better healthcare system that fits patients’ lives; how she surprised herself after a fruitful and fulfilling career in non-profit health; what she learned about making an impact; the opportunities for healthcare in the home; the importance of peer mentorship; and her framework for what she looks for in new hires.
About Shikha Anand, MD, MPH:
Shikha Anand, MD, MPH, is currently Chief Medical Officer, Withings. In this role, Shikha leads Withing’s clinical strategy, overseeing research and regulatory processes and developing solutions for medical professionals.
Dr. Anand has over 15 years of experience developing innovations and systems that improve health. Her leadership experience includes public health, research, consumer health technology, and clinical informatics. Before joining Withings, Anand served as the Chief Medical Officer at Well, a personalized guide and consumer health platform powered by a proprietary, AI-driven “health engine” to help members reach their health goals. She also led health innovation initiatives at Federally Qualified Health Centers, Aetna/ CVS, with state and federal agencies, and Walmart’s Care Clinics.
Shikha completed a general pediatrics fellowship and a Master's in Public Health at Boston University School of Medicine.
Further Reading:
Episode Credits:
The Game-Changing Women of Healthcare is a production of The Krinsky Company.
Hosted by Meg Escobosa.
Produced, edited, engineered, and mixed by Calvin Marty.
Theme music composed and performed by Calvin Marty.
©2021 The Krinsky Company
Creators & Guests
Host
Meg Escobosa
Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.
Producer
Calvin Marty
A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.
What is The Game-Changing Women of Healthcare?
The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.
Shikha Anand: How do you build the healthy choice into people's lives and that's different for different people. So you really need to understand their context. For me, all health begins wherever you are, and it's so rooted in your context. It’s not the big decision of which cardiothoracic surgeon you choose. Sure. This is an important decision. It's the small decisions of, do I sit or do I stand, do I have the cake? Do I not? But those are the things that will ultimately drive your health.
John Parsons: You're listening to the Game-Changing Women of Healthcare - a podcast, celebrating courage, perseverance creativity, and vision, in the pursuit of healthcare innovation. Join host Meg in conversation with some of the most inspiring and forward-thinking women working in healthcare today. Meg goes behind the scenes to uncover previously untold stories of struggle and success in a notoriously complex and highly regulated industry. As the worlds of healthcare and technology continue to converge. And as women take on increasingly more important roles in both, these are timely tails that deserve to be told. And now here's your host, Meg Escobosa.
Meg Escobosa: Hello everyone, and welcome to the Game-Changing Women of Healthcare. I'm your host Meg Escobosa. Today, we have the pleasure of talking with Dr. Anand, who is the Chief Medical Officer at Withings.
Shikha Anand: We make connected-health devices. Really what we focus on, is how we bring better health measurement into the home. And then how we turn those measurement insights into insights for health improvement.
Meg Escobosa: Dr. Anand previously served as Chief Medical Officer for Transformation at Aetna CVS, National Medical Director for Walmart, Chief Health Officer for The National Institute for Children’s Health Quality, and Pediatric Director at the Whittier Street Health Center in Boston. Shikha is also a pediatric hospitalist with Tufts Medical Center. Welcome, Shikha! We’re so happy to have you here!
Shikha Anand: Hi Meg, thanks for having me. I'm delighted to be here.
Meg Escobosa: You have covered quite a bit of ground in your career. Having worked in the clinical setting, a public health for a payer and even consumer health technology. Can you take us through how you arrived at where you are and what has guided you throughout your career?
Shikha Anand: Absolutely. So I went through medical school at a relatively young age. I finished just after my 25th birthday. And really what's driven me through the course of my career is thinking about how we can better design a system that serves both people, consumers, patients and doctors and healthcare systems better. And so that passion has led me on a meandering journey, but really with this hope of achieving true access to health improvement for a variety of different populations. And so I began my career as a researcher. I began in academia at Boston university.
I did a general pediatrics fellowship there and got a master's in public health and learn how to do good quantitative and qualitative methods. I very quickly realized that I don't have the patience to be a researcher. I have a lot of respect for my colleagues who do this, but for me, spending five years on a hundred-person, randomized controlled trial was a novel effort, but not one that really I had the patience for.
So I came out into a role in community health where I felt like I could make quicker changes on the ground. I could do more iterative testing. And I began as the pediatric director at the Whittier Street Health Center in Roxbury. And really there was able to fulfill one small piece of my mission around helping families with lower financial means achieve optimal health.
And really tried to redesign the systems that surround them to provide better care. I have three children and my rule of thumb has always been that the care I provide should be even better than the care my children receive. Despite all of the contexts that people have when living in poverty. I spent about five years doing that.
It was wonderful. I designed some innovations on the ground, including a fruit and vegetable prescription program, where I was really able to think about food insecurity and the relationship between health and health care and in a really deep way. This was in 2004. So really a long time ago, right at the beginning of this food is medicine movement.
And then I became really interested in how you scale these innovations because it's clear that they need to be personalized at the level of the patient and the family and the community and the health center. And in this case, the farmer's market and that my statistical methods training didn't really help me evaluate the results of the programs I was designing.
So I spent about the next five years working. In quality improvement and looking at large-scale federal programs and how we could use different statistical methods to understand the impact of these more targeted interventions that took into account the context of the family and the community, and the other factors that surround the person. And that was a really interesting journey. A lot of great nonprofit work with state and federal and local government. And then I was actually on a trajectory to be the CEO of this nonprofit. And I thought that I would look at my options before I took this job that I would keep for the next 15 or 20 years.
And in the course of that search, my desire to really help people who are medically underserved, led me to go work at Walmart, the fortune one to be a leader in their care clinics. And I surprised everyone, most of all, perhaps myself. And it was a really kind of interesting leap of faith. But in my national work I had felt that rural medicine wasn't coming along at the same speed as urban medicine, really largely because of the challenges of the lack of population density that might drive something like a federally qualified health center. And I thought if I joined Walmart, you know, who is in every rural community, it's Walmart and so who better than they to redesign primary care for the rural underserved.
So with that mission in mind, I came over into the private sector and I've actually been there ever since, not at Walmart, but we can talk about, about the private sector piece in a moment.
Meg Escobosa: Oh, wow. Great. Yes. Well, you know, and this may feel like it's a digression, but I would love to hear also, just from your personal experience, your experience with being a child of Indian immigrants. And what that is like, were you born and raised here or did you, were you born elsewhere? And then when did you realize that your family's culture was different from other kids in school? And how has that informed your approach to medicine and how.
Shikha Anand: Yeah, absolutely. So I was born in the U S I'm from New Jersey, only the strong survive and lived there until I went off to college.
I knew from a very young age. So I actually am technically English as a second language, even though I was raised here, my parents worked, my grandmother raised me. My grandmother doesn't speak English, even though she's lived here for now, 50 some odd years. And so I learned Hindi before I learned English. And so I knew very early on that my culture was different. I can't tell you exactly when and certainly with a name like mine, you know, my name is Shikha. And every class I was ever in, there were four Jennys and, you know, there were no other Shikhas. I waited on Romper Room for her to call my name. She never called my name. So, you know, I knew I was different very early on.
And so in terms of how that relates to my health and healthcare, I don't think I really understood that until I was in medical school. And we started talking about medical ethics. And our medical ethics were very Eurocentric. So I can recall a conversation in which we were being coached to, to really push end of life discussions and to really do it in a Eurocentric way.
And I recall raising my hand and saying, “well, wait a minute. That's actually not how we do it in my culture. We do this in a really different way. And one, we don't think of death as a tragedy because I'm Hindu and we believe in reincarnation and to. I have this type of conversation in our context.“
And it seems to me entirely false as a doctor. So for someone in this moment of their life to have a conversation that's kind of antithetical to their cultural context, the more personal side. I think part of my motivation in being in medicine was this real fascination with sociology and the context in which people make their health decisions and superimposed on top of that, my mother has a disease called retinitis pigmentosa, which leads you to blindness. And so my mom, I think became legally blind when I was in high school. Know it's difficult for me to map this against my medical understanding at this point in my life. But I think it was when I was in high school. And so she stopped driving.
And going through that profound social change from this woman who had been incredibly independent and now was losing her independence in a profound way, without real social or psychological support or without really a human-centered approach to care. It seemed that everyone was looking for a cure, which of course was great. And this is sttill an incurable disease. Maybe my mother is still blind, but no one was looking to sort of buffer the impact of this really profound change for our family. And it made me really fascinated about how you could create a system that honors the humans that had the health, rather than just honoring the medicine.
Meg Escobosa: Wow, beautiful framing to guide your whole approach, to thinking about these [00:09:30] problems. And since lovely speaking about empowering patients and people in their own wellbeing, health care in the home has become a huge topic in recent years. Thanks to the coronavirus pandemic, for sure. That's certainly broadened it and the need for the health industry to really adapt to giving care in the home or enabling care in the home.
What are the biggest challenges from your perspective in delivering effective care in the home?
Shikha Anand: Yeah, I think there are a few different challenges that I would call out. One is really, for us as doctors, as professionals. Getting used to this idea of providing care out of our usual context, right?
Everyone gets comfortable sort of in their own home. And if you're a doctor who's practiced in an office for the past 30 years, that feels like your home base for provision of care. So I think this is really about us stepping out of our comfort zones and with that understanding where contact is required and where it's not.
This is a really interesting thing, because I'm curious as we go forward in medical education and training for me, the way in which I know that is from doing years of physical exams. And it's actually quite a higher order skill to know when I need to see a patient or when I see someone on video, someone who looks like they may need more acute therapy that comes for me from walking into thousands of exam rooms and feeling what's happening with the patient.
And so I I'm curious how that will play as people train more and more with telemedicine or spend more of their careers in telemedicine. But I do think that there is both a getting into, out of your comfort zone. That's important, but also acquiring that skill where you realize where a physical presence is necessary -that's a big challenge. And then the other big challenge I'll call out is, is really data synthesis, data aggregation. We have always had been primary care in particular, data coming at us from all sides. Now people have many devices in their homes, which may not even connect to each other. They may be on different platforms, and so how do we pull all this data to get a complete picture of health? If they're in different verticals or they're coming in in different ways? I think this is a huge challenge as we go forward.
Meg Escobosa: Yeah, that's a really, really good point. And do you see anything coming that's potentially going to enable and help around and provide innovation there.
Shikha Anand: Yeah, absolutely. I think there are a few different pieces. I mean, obviously there's a bumper crop of different apps and software devices where people can aggregate their data. A lot of them by the big tech platforms, I think that will really help us drive forward. I know Apple's personal health record is an attempt to do this and even combine your clinical data,and I think that's a really important step for. For context, I was in fellowship in the 2000s. And at that point I was really excited about the personal health record. I thought this was the next coming and everyone was going to have their own record and ported around with them. And so now it's 20ish years later and I'm still still on the same band.
So it probably tells you both, but I'm a bit of an optimist stuff, and also the change might be slower than expected. So I would put that in that context, but I do think that's really important. And then the other piece is that connected devices are getting more sophisticated. Certainly the company I work with now, we take great strides to make sure that the data is synthesized and aggregated is available through an open API so that patients can download it and import it into other apps and so it makes that synthesis much, much more seamless than it has been historically.
Meg Escobosa: Could you tell us a little bit more about Withings and your role and what you guys are trying to accomplish?
Shikha Anand: Absolutely. So Withings, we make connected health devices, we started with a scale in 2009, the first smart scale and are a leader in that class, but really what we focus on in this period is how we bring better health measurement into the hall. And then how we turn those measurement insights into insights for health. Now, one of the challenges of data in our era is people have so much data in front of them about their health. It's incredibly difficult to make heads or tails of it.
So if you do an EKG on, you know, we have ScanWatch, our watch has an EKG on it. If you do an EKG every day, What do you make of it at the end of the month? Right? There's this huge question for consumers. So we're on this journey to both add the number of insights that are available to you, either on your wrist or in your home or wherever you are, and then also layer on population health insights.
So how does this compare to other people? And then on top of that, if you would choose to improve, what are some really easy things that you can do? And then the final, I think the last mile is really offering you clinical care when you need it. So in many of these cases, you have the insights and that's wonderful, but if your watch is telling you, it looks like you might have atrial fibrillation, most people are going to worry. And if you have a primary care doctor, that's great. I'm a primary care doctor. I absolutely want you to go back to the person you have the relationship with. That's the best possible care, but if you don't. Then we can offer it to you in our app so that you can, in this moment of fear, that you're having actually be served by someone who has expertise, rather than being forced to read a whole bunch of articles on the internet. And someone will definitely tell you you're dying and someone else will tell you you're fine and you're not sure.
Meg Escobosa: Disaster catastrophizing everything. That is an amazing resource that you connect your customers to clinical care.
Shikha Anand: We don't yet, but we’re about to, we’re very close.
Meg Escobosa: That's super exciting. And what can you share some of the effort that's gone into making that possible? Cause that seems like a really big leap, a new direction, or at least advancing the big vision. Can you describe some of the things that you may have had to overcome or some of the things that have been...
Shikha Anand: Yes. So on the product development side, we have an extraordinary team of engineers who are incredibly innovative. And so it's amazing. We think of ideas and we build machines to support them.
And it's a really fascinating process to be part of. And so on the hardware side, it's really about how do we navigate the regulatory process. And it's really interesting how much, the words matter in this context. So, you know, you may be able to speak to a nonclinical indication, but not able to speak through a clinical indication. Even though when I look at them as a doctor it's potato-patato, that seems to be the exact same thing to me. So that's a really fascinating process of getting through the regulatory process, which is very valuable and very necessary to protect consumers. So no pushback against the process, but it's a learning curve in its own right. And then on the innovation side, around our app, historically, we've really focused on measurement and how we can provide the best-in-class data to our consumers. And now we're really thinking about how we can help people develop health insights, and then how we can help them unlock better health.
So this requires the theory of behavior change. It requires motivating people. I mean, most people know if you eat three slices of cake after dinner every night, your way probably won't go down no matter who you are. The question is how do you get people to do the thing that's better for their health?
It's not the right thing in all contexts, but cake is good. And if it's a good cake, cake is good. Right. So how do you get people to think about these kinds of short goals and accomplishments with the same enthusiasm that they think about? The joy of eating a slice of cake is really the problem we're trying to solve.
Meg Escobosa: And it's a tough one. I mean, you're not alone. There's so many folks trying to address this challenge. We have such a huge amount of diabetes in this country that sort of is what inspired also the fruit and vegetable prescription. Is that not just making good quality fruits and vegetables available to people in urban settings that didn't have access.
Shikha Anand: Yes, absolutely. I mean, what I'm really proud of in that program is that. Truly human-centered design. You know, the idea for that program came from a family. The child was a teenager who was enrolled in an obesity clinic that I had designed a multi-disciplinary obesity clinic. They were really invested in eating healthier. And for the first two weeks of the month, they would eat very healthily. And then they would run out of funding. You know, they would not have enough food stamps to get through the second half of the month. And then they would eat rice and beans. They were Latino families so they would just predominantly eat truly rice and beans sometimes three times a day for the second half of the month. And so really in delving into their challenges, I realized that they didn't have the financial access, but also that their fruits and vegetables were unaffordable. And so, that was part of why they were burning through their money so quickly at the beginning of the month.
And so in some ways, like co-design this program with this family and with other families subsequently, which I'm really proud of, but the idea is definitely that it's how do you build the healthy choice into people's lives? And that's different for different people. So you really need to understand their context, which is in some ways how I got into my current role, which has helped in the home because for me, all health begins wherever you are.
And, and it's so rooted in your context. It’s not he big decision of which cardiothoracic surgeon you choose. Sure. This is an important decision. It's the small decisions of, do I sit or do I stand? Do I have the cake? Do I not? But those are the things that will ultimately drive your health.
Meg Escobosa: Everyday choices.
Shikha Anand: That's right. It's how do we accompany you on your real health journey, which is a long series of everyday.
Meg Escobosa: I know you you've thought a lot about technology and how it can bolster provider and patient relationships and improve provider quality. Can you tell us about some of the early research you did there and what design innovations or improvements you developed in support of that mission?
Shikha Anand: Yes. I mean, I think at core. Not a true technophile. And so I feel like I should say upfront. I really believe in technology as a means to an end. I believe that the heart of a provider patient relationship is really in that communication and that the technology enables better data and better care in the background so that that relationship can bubble up to the front.
And so my early research was on email communication between doctors and their patients, you know, which is, this was during my fellowship so very long time ago. And really the idea for me has been, how can I enable better quality on both sides and the innovation around that has been everything from EHR design, really thinking about how we make better operational workflows to what I do now, which is redesigning a consumer app so that people can better understand their own data, but really it's how do we make this seamless and effortless so that the real work can be done, which is really improving health and building that relationship.
Meg Escobosa: Can you talk a little bit about building relationship with a patient?
I mean, what should patients know. About what doctors are thinking, you know, maybe just eliminate for the patient out there who doesn't have a medical degree who doesn't appreciate what the doctors are dealing with everyday. Cause there's a lot of demands on primary care. Everything is coming at you. You are the filter for both prevention and then immediately addressing any health concerns that come up. So give us a little window into what that's like.
Shikha Anand: Absolutely. So I would say first - doctors are people, and so there are a lot of consequences to that, right? One is fit is really important in the same way that you don't like every person at a cocktail party. You're not out to like every doctor you meet. And so find one that you are apt to trust, and I think people don't often due diligence on this because they feel that doctors are experts and they think of us more as scientists than people. But ultimately we're your co-pilots in your health. If you don't trust the way in which we think about health, we won't get there together. Right. So it's really, really important to think about who you're trusting in the same way you would, any other relationship that you're starting, that's important to you.
I think the next piece is people don't go into medicine to get rich or get famous. It is not the fastest way to do this, despite what people may believe. And so I think every doctor I've ever met and that hundreds, maybe thousands of doctors at this point, really wants to help people with their health.
It manifests in different ways for different doctors, but, but this is the reason why you spend all of that time in school. And why you sleep in a hospital and do all the other crazy things that are in medical training, right. Have a core mission around this. So that's something for patients to understand and to kind of relate to in their interactions.
And then information is good. You know, people are afraid to ask their doctors questions. They're afraid to challenge norms. Of course there's some nuance into how you do it, right? Don't scream at your doctor. I'm not advocating for that. But you know, saying, here's my understanding, can you help me guide this decision I think is really important. And then keep in mind, no one knows your context better than you. And so it's incumbent upon us. I'm a patient also is, you know, as well as the doctor, it's incumbent upon us as patients to share our context with our doctors so that they can help us figure out what's right for us.
So, you know, if it's really important to you to have dinner with your family. And you can, your whole family only gets home at seven at night, you know, creating a diet plan in which your last meal is at six. It just doesn't work for your life. It's not the right thing for you, right? So you need to choose something else, but you need to help your doctor understand that about what's important.
Meg Escobosa: Lovely. What have you learned in all of these journeys that you've taken? What have you been looking for that you maybe have just found now in this new role? I know it was fairly new, I guess, some insights about the different experiences you've had and what you've learned from those experiences.
Shikha Anand: Yeah, it's always been my goal to really understand the best levers for systems change, really a student of system design and kind of the ways in which systems interact and obviously healthcare, particularly in America is incredibly complex.
So I think I've learned a lot about the context, a lot about the financial levers at each turn. So, you know, I began my career in the care space, in healthcare administration. So really thinking about the. The unit of currency is a patient visit or a procedure. And unless you fundamentally change that, everything will be centered around more RV, use, more visits, more procedures.
And so that was a really important kind of underpinning and a learning. And then I went into to non-profit where we worked a lot on government, either state, federal local initiatives or public health initiatives, and really thinking about how that layer of government on top either aligns or sometimes misaligns incentives.
And so a lot of my early work was in obesity, and particularly childhood obesity. And it's really challenging because the burden of proof for a long-term intervention is so high that it's almost impossible to justify what's quite obvious. Clearly, you know, a lower rate of childhood obesity is going to lead to a lower rate of cardiovascular disease, 50 years down the road.
Right? I mean, this is a pretty obvious conclusion, but when you do this in a kind of controlled way, when you do a research project on this, there are so many confounding factors over that 50-year period that you actually can't prove that this is the case. You know, you can barely prove it. Now, now it's been somewhat proven, but it's not an easy thing to prove.
You need to follow the same people for 50 years and you need a big enough sample to do that. Right. And so you're saying we're not even going to start doing anything until 50 years have passed, which was a really interesting learning. And I think that's been really profound around the financial levers because, similarly, I then, you know, when I moved into the for-profit world, I was at Walmart, which is a self-insured employer, which really cares about the longitudinal health of its employees. But at the same time is, is beholden to the cost curve on paying for its own insurance. And so the immediate priority is near-term surgeries or near-term cardiac events or things like that.
Not this real deep focus on prevention. Even though, philosophically, the company very much wants to do that. That's not where the financial levers are. So there always has to be some focus on what kind of big healthcare costs are going to occur in the next year or two or three, which is a very different challenge.
Obviously that's true on the payer side as well. I think the other thing that I've learned is with this kind of focus on cost and the complexity of the system, it's very difficult for even the most mission-driven of people to maintain their kind of human-centered design principles. It is very hard to put the patient in the center of care because of all of the factors surrounding the patient.
It's something that I work really, really hard to do. And actually why I now find myself in a consumer-first company, because our goal is to put health in the hands of the consumer and we don’t really have meaningful obligations to other parts of the system. So, because we're not thinking about payer contracting, we don't have to think harder about near-term consequences than long-term consequences.
At some point, I'm sure we'll get there. But beginning with the consumer and a company that's consumer-obsessed is really refreshing after years in different parts of the system.
Meg Escobosa: Your insight about what parts of the ecosystem actually cares about just helps you do the consumer focus even better. I mean, you just, you can anticipate what the other players are thinking and can design your solution and your approach with that in mind.
Shikha Anand: Yes and to your earlier point, I think empowering patients, people is really important and the more systems, context, and knowledge we can provide for our users, the better off they'll be when they bring their information to the doctor's office. They can download their measurement results from any of our devices, into a PDF that they can bring into the doctor, but helping contextualize that is actually really important so that they understand that to have the conversation.
Meg Escobosa: What's a risk that you have taken that may have ultimately fallen flat. What did you learn from it? And how has that been incorporated to anything you've been up to today or how it guides you to?
Shikha Anand: Yeah, I think, well, first of all, I had a little bit of trouble thinking about this question and I'll confess that.
I am much more focused on skill-building and learning and iterating for the next thing. Then I am on the hard outcome. Of course, you know, I work in the private sector. There are obviously outcomes associated with all of my roles, but for me, it's really what did I get out of it. So very shortly after when I synthesize the information of what I've just done either built or failed at it's really about what did I get out of it and how am I going to make that into the next thing? But that said, I think when I joined the Walmart Care Clinic, The idea was we were going to build a system for scale, right. I joined a startup team and it was a startup nested within the fortune one.
We had 15 clinics when I joined, I left about two years later and there were 17 clinics. We had thought we might get into the thousands in a few years span and it turns out that the company as a whole, wasn't quite ready to accelerate at that pace in that moment for a variety of reasons. It's obviously a very large company.
I applaud what Walmart's doing now, but in that moment that wasn't a moment of readiness. I had left a very promising, not-for-profit career to move to the private sector. Half of my network told me I was crazy and stopped speaking to me in that process. And then two years later I found myself, you know, and I was like, well, that's okay because I chase impact.
Right. And I want to have impact at scale. This is why I took this role. And two years later, there wasn't a tremendous amount of measurable impact. Right? And so it left me with this sort of dissatisfied feeling and so what did I learn from that? I learned a lot about how the private sector works. How corporations work, what is similar and what is different from my prior experience, it helped me distill my mission and really think about what I'm here for and what's important to me and realizing that I really want impact and I want impact at scale, and I want it in a really equitable and consumer-centric way. And so I can go chase that. So it really told me what to chase next, and again, and again. I like to be quick and agile. I like to test and learn. And so I need an environment that supports that.
Meg Escobosa: And I get the attraction to a large organization that does have, can make an impact if they can implement your ideas or the vision. I'm interested to hear about behavior change and how Withings and your team are thinking about that, what research you're doing, or whether you're tapping into anyone outside to help you with that challenge.
Shikha Anand: So I've been working on behavior change in various iterations for about 20 years, starting with the obesity clinics that I mentioned, they used to teach motivational interviewing about 15 or 20 years ago. So we're going to rely on internal expertise to some degree. And really the question is how do we find the right secret sauce for behavior change in the context of both our devices and our app. So we'll use some classic health behavior change theory. We'll use some behavioral economics and some more gamification levers, um, you know, which are tied to both of those, but that are maybe a little bit different to really help people stay excited about improving their health. At core, every person has a will to be healthy. Right. Indeed. It's hard-coded in. So the question is how do we make it easy for people?
It's a great, it's a question I've struggled with myself and now I start my day very early. I, you know, I'm an early morning person and I start my day very early because I work at a French company. Right. And so I used to get up at four, do my email, go to the gym, settle all of these things before open of business.
And now I sort of begin my day. At open a business and immediately working. And so how do you fit it into your life? Right. And I think one of the things that'll be a challenge for us in our app is how do we understand people's contexts as it changes? Right. I haven't moved the rest of my life seems the same, but this change in my schedule has had a profound impact on my exercise regimen.
And how do we adjust to that? I think is really amazing.
Meg Escobosa: And will you guys be building in any sort of communication tools, or is the device communicating with, with users?
Shikha Anand: So we have an app and we have the watch. So we have some messaging that's available on the watch and the scale, it's fairly limited.
The vast majority of our messaging will come through the app and there are push notifications associated with that. So it'll be mostly an in-app experience, but very much supported by our devices. The great thing about having hardware as part of our business is that it's a physical reminder.
Right. So I step on the scale in the morning when I wake up, when I go downstairs for breakfast, I know I just stepped on the scale.
Meg Escobosa: Exactly. Absolutely. Motivation.
Shikha Anand: Yes.
Meg Escobosa: Maybe you can share a little bit about mentors that you've had and how mentoring has been important in your career and your own leadership development?
Shikha Anand: I come from academia and so I think my fellowship mentor, Dr. Bill Adams, who's a pediatrician still at Boston medical center was instrumental in showing me the bridge between technology and a really rich patient experience. And it's kind of thanks to that elimination that I sit where I sit now. So I deeply appreciate that.
And I've been fortunate to have a variety of mentors along the way, but. I would call out a different type of mentorship than maybe people often call out, which is one - peer mentorship is incredibly important. So when I began my career, most of my mentorship actually came from men who were really involved with their families.
Bill is a person like this, where I felt really empowered to move my career. And I really didn't want to, of course moved my family forward, but the people who I came across in early years, most of them were kind of in my peer cohort that were struggling with what I struggled with and the ones that had solved the problem in a way that didn't quite work for my context, even though, you know, everyone does it in their own era.
And I'm sure my children will say the same things about me. I guess for me, it's always been peer mentorship and it's, you know, the squad that shows up for you all the time. I mean, in my last transition to this role, you know, I had a tenured professor helped me get a lawyer to review my equity agreement.
And I had, you know, one of my closest friends from a few jobs that go from Aetna, CVS manage my existential crisis about whether or not I should be leaving a company I helped start knowing all the players as well. And so I think, you know, there are these people who come along with you who have a context that's similar to yours who are at similar levels and really know you well, and ultimately what they do is they check your decisions against your own values. And that's absolutely the most invaluable resource I can think of. And then I would say very similarly, you know, I've been with my husband now for twenty-five years. I haven't been married for all 25, but it's the people who help you make the decisions every day and remind you of what your core values are that really provide, I think, the sound just mentorship and the rest of you sort of imbibe as you go.
Meg Escobosa: And what are some of the things that you were struggling with or worried about in those early days or even just any day? I guess nowadays we're parents. I'm a parent too. And just the challenge of working and family was that one of the reasons you wanted people who had families in your network?
Shikha Anand: Yes, absolutely. The balance between work and life is important and manifest differently for different people. So it's incredibly important to me. And it's important to me as a mentor as well. I think helping people to think about how their work fits in their life and their life fits in their work, even in very early career stages is really important.
Just yesterday. I coached someone on taking more time off, you know, and setting boundaries as someone who doesn't have three kids and all of the obligations associated with that. But ultimately needs to sort of think about how these two things fit together, even a very early stage. So I think this is incredibly important in terms of challenges.
I think it's a challenge every day for a long time. I've had this idea to write a book that I haven't had the time for, which is around, I think women in particular, but caregivers across the board. Sometimes find themselves doing really bizarre combinations of things. I was giving part of a national lecture from the driving line and the elementary school and I was deathly afraid that I would get to the front of the line and my kids would open the doors while I was speaking. So I was slow rolling through the line. And, and, you know, as I've talked to all these women, I've met in all of these places, everyone has some kind of crazy story like this, you know, and they, they continue.
Right. And, you know, you managed to balance these really. I think so my idea in this book was really to have kind of a list of authors and then an anonymous series of essays, because nobody really wants to admit to any of this. And then just to say, for every person who's dealing with this out, Everybody else has done it and we've all survived. You'll be fine.
Everyone else has been to a board meeting with a tiny little hand printed on there. You know. We've all survived and we've all gone on to do great things. You'll be great. So I think that balance is really important for me. It's really important as I evaluate opportunities, and I encourage this when I mentor, it's really thinking about what are you willing to give up and what are you not? So making dinner is really important to me in my house. We scratch cook about five times a week, you know, five nights a week in addition to other meals that may be there. And so I work incredibly hard to preserve this and, you know, there are all sorts of other things that I might be willing to outsource that I've said, this is the thing that I don't want to, and so I'm not going to give it up and I'm going to preserve it at all costs. So I think when you think about balance, it's really what in that balance is most important to you? Is it a story at bedtime? Is it making dinner? Is it a TV show or whatever it is, right. It doesn't have to be lofty, but find the thing that matters, and the thing that matters, it usually changes that's your kids change in age, but be thoughtful about that and how that's going to fit in with your work.
Meg Escobosa: What innovation or accomplishment in healthcare are you most proud of?
Shikha Anand: I've been really fortunate to be part of a lot of really interesting and bright things.
I would still say the fruit and vegetable prescriptions were closest to my heart because it was the beginning of this idea that you could take, what one family tells you and use it to make a change in the unit.
Meg Escobosa: What should someone who's thinking about a career in healthcare, understand about the value you can contribute and the impact you can make in public health versus research versus consumer health technology, or even in the clinical setting, since you have experienced in all.
Shikha Anand: Yeah. So I think it's really important to think about what your values are or what precisely you're trying to accomplish. I mean, most people go into healthcare space because they want to improve health, but then more precisely is it that you want a deep and meaningful relationship as you might have in patient care?
Is it that you want huge impact that you might have in a corporate setting? Is it the generation of new evidence that you can find in research. Right? All of these are slightly different ways to get at the same problem, but think about what you're most passionate about and follow it. And then cases like mine, you'll follow it to all of those places and land in the right spot at some point.
But think about what it is you're solving for in a given moment and start there because there is plenty of space to contribute in all of those.
Meg Escobosa: Yeah. And, you know, you said you really look at the skills you're learning in each kind of experience as you almost do a post-mortem as a way to evaluate impact or what you contributed.
And I think that's a really healthy, nice way of looking at career because not everything is a win, but you can gain something from every experience, whether it's positive or negative, you know, there is no perfect career path. Now we're seeing like diverse experiences actually come together to fuel a really unique take on what's possible.
And so, but medicine is a more traditional path. You have to hit certain goals before you can go any further. And I'm just curious if you have any thoughts about like, when you're looking to hire or when you're looking at people that you want to include, you know, bring into a project or an initiative, how do you consider their experience and how should people think of adding to their toolkits where their skillsets in meaningful ways?
Shikha Anand: Absolutely. So I'll answer part of that with the way in which I coach my team. So when we think about annual goal setting, which we're in the middle of now in my company, I really try to think with the person, what am I trying to learn?What skills am I trying to build? And then what do I uniquely contribute that will make me really good at what I've set for us for the next year? So just taking that strengths-based approach. And so that's the way in which I evaluate opportunity, both when I'm thinking about a new opportunity and as in post-mortem, and when we say opportunity, it doesn't mean that people think of that as a new job, but new opportunities present themselves every week or month, particularly in a fast moving environment, like a startup.
So we often get asked to wear many hats. There's a decision to be made about whether or not you want to put one more head on your head and that's the lens I try to use. I'm not very good at saying, you know, not taking another hat, but I'm genuinely curious about almost anything that's put in front of me, but it's important to think in that way.
So when I hire, I hire for a few things. I hire for aptitude. Just really how much firepower does this person have? I have a lot of energy and so people who don't have a lot of energy find me exhausting. And so I'm acutely aware of that. And I try to make sure I don't, I don't hire people that are going to get sick of me on day three.
So I think that's one piece, the second piece. Thinking about that curiosity and that desire for deep and scientific learning, that's really, really important. So are you willing to go to the primary medical literature and try to find an answer to your problem regardless of whether or not you have any training in that, but are you willing to really go deep and there's an important skill from it and then agility, you know, The teams that I work with to function like teams, which means in any given moment, some of our work we'll add in some of our work will flow and every person on the team should be willing to do the job of another, to the best of their ability or support the job of another.
Otherwise the system doesn't work all that well. So when I hire, what I look for is the combination of those things. And insight into the things that I mentioned. Do you know what you're hoping to learn? Do you know what you're hoping to become just in the near term? What skills are you trying to build? Do you know what you bring into the work and where you need help?
Those are really important attributes that when I interview candidates.
Meg Escobosa: That’s a really great framework, really helpful. I know you've, you're kind of new new-ish I know it's almost a year, not quite a year at Withings, so this may be plenty that you've taken on, but we're curious, like what's the next big thing you'd like to solve or big problem you'd like to tackle.
Shikha Anand: Well, we talked a little bit about how we bridge between, and this is something I've been working on for years, but it's new in every context is how do you solve for this bridge? Right. We tend to treat people's health as the person, or we tend to conflate those. So if you have diabetes, We define you by your diabetes, but in fact, we're all people, right?
And in any given moment, our health may be waxing or waning, and it may be both at the same time. You may be in the top of your physical health, but the bottom of your mental health, right. We've seen this with some performance athletes recently, or vice-versa right. You may be in great spirits, but you may be dying.
And so how do you really think about a whole person and how do you think about. The different parts of a person simultaneously, but also their kind of trajectory in and out of different health status. So you start, okay, you've got your measurements, you've got this kind of longitudinal baseline. When things get a little bit worse, how do we add an extra layer of support?
When things get a little bit better, how do we help you celebrate? You know, how do we support those transitions is something that I've been really interested for a long time. And I feel uniquely positioned to do, and the role I have now. So that for me is really, really exciting. It's a different version of what I said before, but for me, it's really about the trajectory, right?
That's the power of an offering that has day-to-day measurement and wellness. And the ability for clinical intervention is that you can really help people move in and out of different places in their health and do multiple domains simultaneously. So that complexity is really interesting to me.
We didn't talk much about this, but I feel that inclusive design is incredibly important. You know, I mentioned my mother is blind, so there's, you know, there's people with differing abilities for a variety of physiologic reasons. And then we talked a bit about, you know, my patients and many of whom have been, you know, just have had low financial means.
And how do you think about that? And then many of them have had health literacy challenges and other challenges. So. It's an interesting thing to come in at the kind of cutting edge of health tech and think about inclusivity. And then this is, again, something I've cared about for a long time, but feel uniquely positioned to do here.
So when my team writes content, we'll write at the sixth grade, eight grade reading level, eighth grade, if there's medical content and it will be very image oriented, we'll think about people with different abilities. And so that's a challenge I'm really, really excited about is how can you bring to a really broad audience, something that is truly inclusive and still feels exciting to all of those people and engage in.
I think that's the real challenge.
Meg Escobosa: That just is so relevant for today. What's going on. We're just becoming so much more aware of access issues and health equity issues. And so it's, it's wonderful to see startups taking those issues into consideration and embracing the challenge of making things more accessible.
We are near the end of our call or interview. I'm so thrilled that we got to have this time. I have three questions. I want to ask that we ask all of our guests. When you think of innovation, what comes to mind for you?
Shikha Anand: Solving the old problems in new ways.
Meg Escobosa: What are the most exciting innovations in healthcare that you have seen from your perspective?
Shikha Anand: I'm excited about all things, health where you are. Right. So I'm excited about everything from watches to our home health station that's a scale to hospital at home, right. Really acute care in the home. So it's really, how do we deliver a health experience that kind of follows you everywhere. So not one particular innovation, but this movement is just continuing to swell and it's incredibly exciting.
Meg Escobosa: Very good. And what do you believe are the most essential ingredients to healthcare innovation?
Shikha Anand: Human centricity, for sure. Access to data and in a democratized way. So not just industry access to data, but consumer access to data - incredibly important in the healthcare space. And then really a focus on inclusion and equity.
Meg Escobosa: Thank you so much, Shikha. This has been such a delight. We really appreciate the chance to talk with you and we can't wait to follow the great success that awaits you.
Shikha Anand: It's been a true pleasure, Meg. Thank you so much for having me.
Meg Escobosa: And thank you to our listeners for joining us today. If you enjoy our show, please consider leaving a rating and review wherever you listen. It helps us reach new listeners. And if you know other folks who might enjoy it, please spread the word. To find out more about The Krinsky Company. Check out our website.
John Parsons: Thank you for listening to The Game-Changing Women of Healthcare. This podcast was produced, engineered, edited, and scored by Calvin Martin. Please take a moment to subscribe via your favorite streaming service. The game changing women of healthcare is a production of The Krinsky Company. A growth strategy and healthcare innovation consultancy.
Visit us on the web at www.thekrinskyco.com.