Gaurava Agarwal, MD: Too often, we reserve the label of leader for someone with a fancy title before their name.

Logan Pause: But great leaders are everywhere in our midst.

Gaurava Agarwal, MD: I'm Gora Agarwal, but everyone calls me G.

Logan Pause: And I'm Logan Pause.

Gaurava Agarwal, MD: On Anatomy of an Everyday Leader, we believe that everyone has the potential to be a great leader on a healthcare team.

Logan Pause: To find out what it takes and what it means to lead in healthcare, we talk to people from around Northwestern Medicine who are doing just that.

Gaurava Agarwal, MD: Whether you've just started your career in healthcare or are a seasoned professional, have a leadership role or hope to take one on someday, this podcast is for you.

Logan Pause: Join us as we peel back the layers of leadership to ultimately make healthcare better.

Gaurava Agarwal, MD: It is great to be here with you, Logan. We get a chance to talk about one of our favorite topics in leadership. And to do it with you is a real pleasure for me.

Logan Pause: You know, I'm really excited about the opportunity to do this podcast with you, G, to learn from you, and also from some of our outstanding colleagues here at Northwestern Medicine. I'd love to just start getting to know a little bit about you, your leadership framework, and how your past experiences have helped shape the leader that you are.

Gaurava Agarwal, MD: Sure. So, I am an organizational and occupational psychiatrist. And so, basically, all that means is I help workers and workplaces reach optimum potential. And, you know, when most people think of psychiatrist, they might think of somebody like Sigmund Freud and they think about, you know, love. And it's interesting for me, I care about relationships, but I very much have always been motivated by the impact that work has on people, both in a positive and negative way.

And that comes from the fact that I'm the son of immigrants. My parents came over here in the late '70s, landed in a small southern Illinois town on the border of Kentucky, Indiana, and Illinois. And my dad's brother-in-law was an engineer in a coal mine, and he got him a job. And so, that's where we landed in a very tiny, small little southern Illinois town. And this Indian coal miner who'd never done that in his life started working down there. And that's where he raised his family until we moved to West Virginia. And so, much of my childhood was centered around work.

My dad worked a ton in the coal mines. He squirreled away a little bit of money, working all this overtime and ended up buying a motel. And my mom, my sister, and I spent most of my childhood working at the motel. Between that and the fact that my mom would tell you that school was my job, I felt like work was what we did all the time. Probably due to that, I've always sort of been interested to see what work can do to someone's life. Again, both in a positive and negative way.

Over time, I ended up becoming a coach, a wellbeing and leadership coach, and really saw that the benefit of helping leaders would be great, and how one of the best things we can ever do for any worker is to make sure that they have a good boss. And that really is the inspiration behind why I can't wait to learn from our leaders on how they do this every day. I'll leave it at that. Turn it back to you, Logan. Tell us a little bit about yourself and what are your inspirations and your motivations.

Logan Pause: I've been at Northwestern Medicine for seven years. Prior to that, I spent a decade and a half in professional sports where I was a professional athlete for just over a decade and went into coaching and to management and had the opportunity to pivot outside of sports and come into healthcare and think about physician leadership development through the lens of a professional athlete.

I am now a Program Director of Executive Development, where I work with leaders and teams across our organization to help them pursue better and help them reach their full potential as leaders and as individuals. Most of my mental model and my approach to leadership has been shaped by my background of being in sports. That's from a young age, growing up in North Carolina and playing at University of North Carolina at Chapel Hill. And then, spending my entire playing career with the Chicago Fire. So, that's a little bit about me and who I am and the work that I do.

Gaurava Agarwal, MD: I remember when they first told me that we had a professional athlete from UNC. I had a feeling it might be Jordan. Those who know me know that I'm a Michael Jordan fanatic, and he sort of inspires how I think about leadership. So, I was super excited to meet you, especially because I don't think we do a good enough job in healthcare learning from other disciplines and bringing the best of what we can learn from business, what we can learn from sports, and taking those concepts and applying them to our healthcare fields. And I think we are better for having your unique perspective to how one reaches the highest levels of performance.

Logan Pause: Yeah. Appreciate you saying that. G, tell me a little bit about how your background and your training shape your view specifically of leadership.

Gaurava Agarwal, MD: I watched the impact work had on my family. My parents went in one generation from cleaning toilets in a motel and working in a coal mine to having two children that were physicians. And so, you saw the benefits of that hard work and dedication can have. At the same time, all that work was hard and it had negative consequences, whether it's simple things like, you know, when you work 12, 13 hours in the coal mine, day after day, year after year, there's certain physical things that I could see my dad's body would break down in certain ways. Our chance to relax and go on vacations was pretty minimal. I mean, we were home all the time, just working.

I became a psychiatrist whose clinical practice was taking care of the professionals that had become impaired. So, what that means is they can no longer work safely because of various mental health issues like depression, substance abuse, or behavioral issues. Burnout was a part of that. I helped rehabilitate these professionals, whether they were doctors or lawyers, judges, pilots, police officers, firefighters. And I enjoyed helping them get back to a place where they could function. But as I started hearing their stories over time, I said, is there something I can do around prevention so they never have to see someone like me? And that really resonated with me and ultimately led to doing a lot of wellbeing work in healthcare in my current role as Chief Wellness Executive at Northwestern Medicine to help take care of the wellbeing of our entire 40-something-thousand-person workforce.

I remember first getting this job and telling our CEO that I only used to work with physicians for wellbeing. And I am a physician, so I get them. That wasn't super hard. But now, you want me to think about the wellbeing of everybody. And the thing that I felt like everybody can use, again, is a great leader, a great boss, someone that helps them reach their potential, someone who sees them and appreciates them for what they bring to work every day, because as you know, this work is not easy and that's never going to change. Having leaders to help us with the difficulties of this work so that we can provide the best care for our patients seems the most central thing we could ever do if we really cared about the wellbeing of our workforce.

Logan Pause: I'd love to unpack what is a great leader, you know, from your perspective. Do you have an example from your past in terms of growing up or in training? Who are the examples that helped pave the way for how you think about leadership?

Gaurava Agarwal, MD: Yeah, I mean, I wasn't kidding. For a six-year period, I watched every single Chicago Bulls game because I truly felt like Michael Jordan epitomized great leadership, which led to great performance—obviously, six straight championships. And I sort of studied how he led by example. All the stories suggested he did everything he asked others to do. He believed in high expectations and high standards, but he first started with himself and said, "I'm going to put in the work and come join me in putting in that hard work." He had this thing called Breakfast Club where he'd bring a couple of teammates in every morning and they'd go work out together. And I felt like that made a great deal of sense to me.

I think, over time, I have actually associated great leadership with courage, probably more than everything else. I had certain professors in medical school and residency. Everyone is pretty good, very talented. But I felt like the folks that had courage, that could speak up when others were too afraid to do so, really were able to reach higher potentials for themselves, but maybe far more importantly for their team. They weren't willing to just be nice. They were willing to push you a little bit. Build your trust. They had to build trust with you if they're going to push you. So, they would build that trust, but then they would push. Because they said, "Hey, you know what? I believe that we all want the same things, which is to provide the best care for someone in front of you who might be your mom one day, who might be your spouse one day. They deserve the best care." And so, I really have found courage to be one of the most differentiating traits from a leader.

Logan Pause: Those are really good points and maybe, at some point, MJ can come on and be one of our guests. And we could debate whether he is someone that has, you know, I think your language of great leadership. I think he was a highly effective leader in his space and I love the examples that you get around, you know, setting an example in high standards.

But I also think, you know, there's cost to that sort of leadership that I think it's important to acknowledge. And all of his teammates, they loved winning and lifting trophies and being a part of that, but I'm not sure that the way that MJ went about it would be always considered great. I think it was effective.

Thinking back at some of my experiences, I grew up and school was hard for me. I am dyslexic, and school was a real big challenge. At a young age, I realized I was fast and pretty good at sports. And that became my outlet and that became my fuel, really, in terms of running from the academic struggles.

But from a very early age, I just was constantly thinking about what made teams good and why I could play for one coach. And I felt like I had the confidence and I was doing a really good job in performing and why I could play for another coach. And I felt like I was what's described as two left feet, which just means you're just kind of tripping over yourself. Those coaches that were relational and invested in those people around them, I think had the ability to connect in a way that brought out the best and inspired us athletes at the time to be the best we possibly can be. So, that would be one thing that I believe to be a really important attribute to leadership is those leaders that are relational, that know their team, that know their family's names and the birthdays and the things that drive each of the team members.

And so, I love that you talked about courage, but I definitely want to add in relational as being another thing that, for me, has been a big impact in my career as I think about leadership.

Gaurava Agarwal, MD: It's a great point, and you need a whole lot less courage if you have the relationship. And so, I couldn't agree with you more. I also like what you said, because this is what this whole point of this podcast is in terms of bringing different folks in. I do think there's a misconception out there that there is one right way to lead. I don't believe that. I actually think different moments in human history require different leadership skills and personalities.

Winston Churchill was only a good leader in this one moment in time when the world needed him. At other points in his career, he was not considered a good leader at all. But those traits aligned with the moment—that, I think, is a beautiful thing. And again, authenticity is so critical to great leadership. If you're not wired like me but try to act like me, it's going to fall flat even if you're "doing the right things," it's not going to be real. And it's the same thing for me. If I try to be somebody I'm not, anybody I'm trying to lead is going to sniff that out really easily.

One of my favorite quotes is there's this issue of what is defined as a leader and people have said, "Oh, you got to have this trait, you got to have that trait." People have sort of boiled it down to the only thing that defines a leader is that they have followers. That's it. Everything else is up for grabs. And the question for you and all our audience members is how do you—using your unique skill sets, personalities, experiences—gain followers and be able to influence them hopefully for very positive things in our environment?

Logan Pause: I hope that, through this podcast, we can inspire those to really maximize and reach their full potential to both be the example that you highlighted, but then also call out something in the people that they lead and the teams that they lead to do something great, which is providing world-class healthcare, which I think is an amazing opportunity and responsibility we have.

Gaurava Agarwal, MD: One of the things that you're pointing out is that the title of this podcast is Everyday Leader, and that's super important to us. As you and I have had the privilege of getting to know lots of our workforce and seeing those pockets of brilliance, that's what we came up with, was that there are everyday leaders with no title behind their name that are doing great things.

And I think, for me, when I've looked at them and studied what causes them to really be so effective, it's that they really lean into their circle of control. They know what they have, to your point, influence on what can they do without needing anybody else to make a difference and make today a little bit better for themselves, other people and their teammates. They've leaned so much into their circle of control. And that to me is a huge differentiator, because I'm as guilty of this as anybody where, you know, I'll start complaining or whining about something that I can't do when I haven't completed fully what I could have done. And that I hope will get a chance to hear from our leadership, "Okay, in your world, how do you fully own that circle that's just yours, and how does that actually impact your wellbeing, our patient's wellbeing, and your teammate's wellbeing when you do that?"

Logan Pause: Hey, G, I understand circle of control, but can you briefly unpack what that model of circle of control is for our listeners?

Gaurava Agarwal, MD: For me, I'm sort of obsessed with it. It's this idea that there's three circles. One is your circle of control, then it's your circle of influence, and then there's things that are outside your circle of control or influence.

So, the things that are in your circle of control, you don't need anybody else to really be able to execute and do these things, because they're totally in your control. Then, the circle of influence is I may not be able to make a decision, but I can put my two cents in. I can move a couple of things around. I can make progress on some goal. But I will need other people to sort of be able to say, "Hey, this is something we want to do." I need their help to actually execute on things.

And then, there's things that are outside of our circle of control, whether they're issues globally or in our government. These are not things that I can individually control or really have a ton of influence in. What I have seen over time is those people that fully own their circle of control, the secret is the circles of control get bigger. Now, they're able to do more things because people go, "Hey, you've owned your area and now let's give you a little bit more room to work in." That's one of the greatest ways that I see people be able to make a lot more influence. And the truth is, we only have a certain amount of bandwidth. If I spend 50% of my energy and time worrying about the stuff that I can't do anything about anyway, to me, that's a wasted 50% of energy.

Logan Pause: Are there things that are consistent for all of our leaders that regardless of where you are—senior leader, aspiring leader, mid-level leader—is there something that you could say is consistently falling in that circle of control?

Gaurava Agarwal, MD: My first job is to take care of myself. I can't lead. I can't serve if I haven't taken care of myself. Now, the chances that I'm going to be able to be an effective leader is defined in any way that you want. Specifically in the ways that you defined it, which is, "Hey, I want to be somebody who's relationship-based." To be relationship-based, I got to have something left to give. So, I've got to make sure that I'm taking care of those basic needs for myself, whether it's sleep, hydration, making sure that, you know, we're getting some exercise, we're taking breaks and taking some rests so that my brain can be in a place that I can hear how you are doing, what you're about. What you need is foundational in everyone's circle of control, and frankly, no one else can do that for you. Basic things are always in our circle of control in terms of how do we treat each other. "Am I going to treat you with respect?" To your earlier examples, do I know your name? Maybe your birthdays, although I'm not going to lie to you, I don't think I'm that great with birthdays because Google hopefully can tell me when my friend's birthdays are at this point. But these sort of ways, basic ways on how you show up, how you treat other people are always in our circle of control, in my view.

Logan Pause: How would you respond if I said, "Hey, thanks. But I don't have time?"

Gaurava Agarwal, MD: I would say two things. As you know, in terms of my mental model around how you create better workplaces, we have to fix both the people and the design of work. And so when people tell me they don't have time for things that are fundamental, I would say, you've misunderstood the job. This is the job. And if you're telling me you don't have time for the job, then we've got to really look at what your time is going towards. What I can help clarify or we can help clarify together is time we are spending not doing the basic fundamentals of the job. That is difficult. And some people might be listening and say that's a little pollyannish, but I actually do believe that. That's not just on the leader. But again, it's also on our organization to say, as we look at your schedule, if this is what you're spending your time doing, but we are telling you this other leadership stuff is what we want you to be doing, then we have to create the conditions that allow that to happen or facilitate that they can happen, and you also have to make that a priority.

Logan Pause: I'd love to hear are there any failed experiences in your professional life that have helped shape how you think about leadership, specifically as we think about resilience?

Gaurava Agarwal, MD: One of the things we talk a lot about is growth mindset. Unfortunately, the setup to get into med school is you can't have failed that often. That's just the facts of how hard it is to get into school. And so then, when we get there and the real world sets in, and particularly when we're doing patient care, it's not an exam that I can study for and get a hundred percent on. There are wins and there are losses. And there's the natural history of disease. And so, a huge part of our training is beginning to unlearn that a hundred percent is the only acceptable thing.

In fact, if I'm getting a hundred percent on everything, I'm not doing it right. If every pilot I run is successful, that just means I'm setting myself up to succeed and I'm too afraid to pick a challenging pilot that might not work. I'm causing my team not to be able to learn from those failures. And that mindset shift happened over a long period of time, to be honest with you, because it was far easier to just get it right and get the hundreds and the gold stars that we were used to.

And I would say that taking care of patients was the initial place where I couldn't save everybody. And having to come home and say, "What else could I have done? Did I not do enough?" Then, as I started taking on administrative roles and having other people that I was responsible for, whether they be at the level of a student or trainee, or actually having junior people that reported to me, realizing that it's one thing to know these concepts, it's another thing to practice them. And so, you know, I've been burnt out many times in my life. And that's probably why I got really interested in healthcare burnout, is like if I can't figure this out, it's not going to be a very long career for me.

And so for me, I was trying to see what was causing me to get burned out. What could others have done when they were leading me to have burnout. And then, I watched myself sometimes be too hard on a trainee or be too hard on people that I serve. That still happens to me, to be perfectly honest with you. You rightly called out that if my ideal is Jordan, not everybody wants to be led by Jordan, how do I figure out how to cater my leadership style to each individual.

Again, I have to be true to myself and my values. There is this 70% of me that is me and how I lead and think about the world. But I've realized that the 30% I have to be flexible with and take that time to understand who I'm leading and what they need from me and what their goals are, because if their goals aren't to win championships, then I have to know that. Because to push them to win championships isn't going to work very well. So, I have failed over and over again on this issue, and I continue to fail to be perfectly honest. But each time, I hope that I spend some time reflecting on the failure so that I can squeeze the juice out of the learning.

My biggest thing I tell my son now is I don't care if you fail. I do care if you didn't learn anything from that failure. And we keep making the same mistakes over and over again—that, I'm not okay with.

Logan Pause: G, I love that.

Gaurava Agarwal, MD: So Logan, one of the things I know we talked about was this issue of when a leader says, "When can I do this? I don't have time for this." For me, this is when we can use a concept called a workplace determinants of wellbeing. These are basically the way we design our lives, our careers, and the way we design our work. So, there's little nuggets about how we design things that influence whether we can achieve the outcomes we want, including wellbeing.

For instance, if I design my workday where I can't eat lunch, I can't take a break for water, then I shouldn't be surprised that come 2:00 PM, I'm a little cranky. I may not want to put in the extra time to get to know you, my patient, or whatever the case may be. And so, in that case, rest and recovery and breaks are what we call workplace determinants of wellbeing. And I look forward to asking questions of our guests about what are those little determinants of wellbeings that matter to them the most, that they feel like matter to their teams the most, that help them achieve high potential. I don't know if you have other examples of workplace determinants of wellbeing.

Logan Pause: I think what is important for me or for, I believe, our audience to hear is the difference between leadership and management. There's a lot of do-based activity and responsibilities as it applies to managers and management. But as we start to move into the space of values-based leadership, what I see is we talk about being authentic, we talk about continuously learning other behavioral attributes that are values within our leadership structures, humility, demonstrating flexibility, understanding, doing the right thing, empowering others. Maybe at another episode we can get deeper into this, but I think what is important for our audience and people to know as I believe values-based leadership are really about the soil and tending the soil and what that means to be a leader.

So, I appreciate you sharing about the work determinants of wellbeing. I hope that our audience feels inspired and encouraged in their environment to see what they can control, to learn something new, and to have the opportunity to get better every day.

Gaurava Agarwal, MD: I love that. Well, I know when we invite our guests on for the rest of the season, we'll probably do some rapid fire questions to end each of our episodes. So, I think it's only fair that we answer some of those questions ourselves. So, let's jump into some rapid fire questions. Logan, what was your first job?

Logan Pause: Laying baseboard in a corporate office buildin for a buddy of mine in his father's construction company.

Gaurava Agarwal, MD: Love it. Mine was—I told you we had that motel—and so, cleaning rooms was one, but the one that I remember first was we had a Coke machine outside. And so, my job was to fill the Coke machine up and take out the quarters. And man, that was so fun. Like Goonies is one of my favorite movies. And so, just collecting all those quarters jingling, I just felt like I was in my own little Goonies movie. That was my first job. The cleaning the toilets part was way less fun though.

Logan Pause: That's good.

Gaurava Agarwal, MD: If you hadn't chosen a career in healthcare or soccer, where might have you landed instead?

Logan Pause: I thought I was going to coach college. I mean, at the end of the day when I was young and coming through, I thought that when I was done playing, I was going to go back and coach college team. I live in a small college town. Outside of that, maybe a chef, maybe open up my own restaurant.

Gaurava Agarwal, MD: That's what I like about you. That's what I'm going to do when I retired.

Logan Pause: What about you? Outside of your career in healthcare, in psychiatry, in wellbeing, where would you have landed?

Gaurava Agarwal, MD: Yeah. I'll never forget this. I wanted to go to Baylor College of Medicine. And I was at my interview day in college trying to, you know, trying to secure my spot. They had us interview with a current med student there. And she asked me, "What if you don't get in? What if you don't get into med school? What do you do?" And I'd just sort of blurted out, "I'd go teach, I'd go teach high school, maybe a professor." I remember going back to my hotel room and I was like, "I'm pretty sure that's not the right answer."

I'm pretty sure they want you to say, "And I love medicine so much that I'm going to take a year off. I'm going to do research, I'm going to apply again." But it just didn't even occur to me, because I've always thought I was going to be a teacher or coach, sort of. As you said, I still think that's true. If I wasn't doing this, I'd be teaching.

Logan Pause: It's wonderful that you've been able to package all of those different aspects into your role in terms of being an organizational psychiatrist, being chief wellness executive, and also being an organizational leadership coach. So, I love that.

Gaurava Agarwal, MD: It's career crafting. In all seriousness, how does one craft a career based around your strengths, what are you good at, what do you love doing? Because I think those two things are oftentimes the same. If you love it, you're going to be great at it.

Logan Pause: G, I learned something new from you every time I speak with you. So, thank you for your time, for your generosity. Thank you to the listeners out there. We appreciate you, and we're excited for what's coming down the road.

Gaurava Agarwal, MD: Thank you for listening to Anatomy of An Everyday Leader.

Logan Pause: Subscribe to the show wherever you get your podcasts so you don't miss an episode.