Alishahal Macknojia
University of Houston
Houston (29.7° N, 95.3° W)

featuring Sanjula Jain, Executive Director of Research and Advisory, The Health Management Academy, Washington, D.C. (38.9° N, 77.0° W)

Dr. Sanjula Jain is the executive director of research and advisory at The Health Management Academy (The Academy) based in Washington, DC. Prior to cultivating a fixed interest in any one field, Dr. Jain was a pre-med student at Rice University, where she earned her degree in psychology and ecology and evolutionary biology. After graduation, she immersed herself in The Academy, first as a part of a health services fellowship and then in a governance position. After teaching and working at Emory Healthcare while concurrently earning a PhD in health services research and health policy at Emory University, she returned to The Academy to lead the organization’s research arm. She discussed her journey with Longitude.site contributor Anu Dwarumpudi, a biochemistry and molecular biology graduate from Rice University.

While her path may seem planned to onlookers, Dr. Jain didn’t always envision herself in the field of healthcare management. Though she comes from a family with an entrepreneurial background, she saw herself working in the high impact field of healthcare due to her love for the sciences. She originally envisioned herself as a physician, but she began to diversify her interests in college. During her last semester of her senior year, she conducted 30 to 40 informational interviews with various roles ranging from physicians to administrators to clinical researchers, as well as with professors and colleagues. One of those interviews led her to speak with the cofounder and CEO of The Academy. Through this conversation Dr. Jain was introduced to the field of health services—the organization, financing, and delivery of healthcare—which eventually led to her initial role at The Academy where she supported peer-learning programs for the CEOs and boards of trustees of large health systems and various research projects. On the recommendation of mentors, she then decided to research PhD programs, and she conducted informational interviews again. Her efforts and doctoral degree resulted in the work she does today as the head of research and advisory services at The Academy, where she is responsible for the thought leadership of research efforts to help guide the strategies of the nation’s largest health systems and most innovative healthcare companies.

According to Dr. Jain, she would not have been who she is today without the guidance of the many mentors she encountered, all with unique backgrounds. The relationships she has built with them were organically formed; she did not have to be upfront in actively seeking them or asking

if they would mentor her. These mentors instilled in her a unique sense of curiosity, as she puts it, and posed questions that encouraged her to think in a way she had not before. A recurring theme in Dr. Jain’s career is best characterized by “having conversations with people and really trying to understand their experiences and what you can learn from their path.” Dr. Jain has moved forward with her career by building relationships. What I took away from her interview was that when you are open to sharing your thoughts with anyone and willing to accept theirs, your relationship can naturally arrange itself into a mentorship.

Highlights from the interview:

How did family, community, and life circumstances create a general expectation or a role for you? What was expected of you growing up, and did you adhere to it or stray from that?

I was raised with two guiding principles. One is whatever you do, do something that you’re passionate about and something that you can always give your full self to. And the second was, do something that makes a difference or has an impact on the community, however you define that to be.

My parents never told me, “Be this, or do this.” It was always “Explore your passions. Figure out what it is, and go do something from there.” That’s pretty much all that was expected of me. Because of those expectations, I’ve only ever done things that I’ve been passionate about. I’ve never done something just for the sake of doing things.

Did you always envision yourself doing what you do at The Health Management Academy?

Not at all. I started off studying pre-med. My family is very entrepreneurial, both my parents have started several small businesses and accounting firms. In my mind I said, “I don’t really want to do business, but I love science, and healthcare has great impact,” so when I narrowed it down by process of elimination, I envisioned myself as a physician. I didn’t know why; I didn’t really know anything else beyond that. And then as I kept going, all my activities stopped aligning to it. I started diversifying my interests. There came a point at which I said, “I don’t think that being a physician actually is what I’m passionate about and doesn’t cater to those diverse interests.” Then at that point, I didn’t actually know what that meant, or what I wanted to be, and I started talking to different people to learn alternate paths.

That’s also indicative of what my pre-med journey has been, because I’ve been interested in various things from policy to law to medicine. Finding an intersection between all of those has been a struggle. So hearing you talk about that, I definitely relate to that. Did you have someone who acted as a mentor who helped cultivate your variety of interests?

I would not be who I am without the amazing mentors in my life. If I looked back as far as high school, I’ve had many mentors—with entirely unique backgrounds—along the way. I never actively sought them out asking “Will you mentor me?” It was always organic. It was always someone I looked up to for having a unique job and/or someone I could bounce ideas with. Every mentor of mine instilled in me a different sense of curiosity and posed questions to me that pushed me think in a different way, and if I were to reflect on that, I’d say that each of those people helped me put those pieces together. For that I will be eternally grateful.

What led to your current position, and what does that position entail?

At the end of my senior year, I was still thinking pre-med. I decided that I wanted to do the infamous gap year, because I still didn’t quite know what I wanted to do. I kept asking people at Rice about other paths, such as policy or business, but I didn’t get a lot of great answers. I spent my last semester of senior year probably doing 30 to 40 informational interviews with different people at the Texas Medical Center, professors, and different people who connected me to those people. By happenstance, actually through a Rice connection, I did an informational interview with someone in DC who worked at The Health Management Academy (The Academy), where I work now. He was explaining what he did, and I didn’t understand any of it. He was using all this terminology that I truly knew nothing about, but it sounded interesting. He asked me about my interests, and one thing led to another, and I was connected to the CEO of the company. I was intrigued by the CEO’s background. He was a PhD in chronic disease epidemiology and an MBA in finance but was running this healthcare company. I was just going into this conversation trying to learn, “Oh, what do other people do in healthcare?” And one thing led to another and the next thing I knew I was flying up to DC.

Next thing you know, I’m going through a whole day of 16 interviews, and I didn’t know what I was interviewing for. In the end, The Academy CEO offered me a Health Services Fellowship. The fellowship was a hybrid Chief of Staff role with a research component. I travelled with the CEO. I did all these meetings with him from a business point of view—how he ran the business, how he managed [the] executive team, how he interfaced with clients who were these really influential senior leaders. And that’s also where I was introduced the concept of health services.

Health services, in [the] way that I was taught, is anything that relates to the organization, financing, and delivery of healthcare. For context, let me tell you what The Health Management Academy is, and I’ll go back to my current role. We’re a 20-year-old company, and the purpose of the company is to provide executive peer learning and leadership development for the senior leaders and C-suite executives of large health systems and innovative companies.

As part of my fellowship, I traveled to what we call executive forums such as the Chief Medical Officer forum, and I would hear what they were working on in regard to physician alignment and compliance issues. I would also meet with Trustees and understand how health systems CEOs work with their Boards to make governance decisions. I always said I had the best job in the world because I was getting paid to learn and rotate through all these different people and basically be in a room with the most powerful people in healthcare, to observe and absorb what they have to do, what they’re responsible for, [while they were] making these really big decisions—sometimes decisions I knew about before they were publicly known. That’s what I did my first year: I learned a ton. That’s where the whole world of healthcare opened up to me, and from there I took on some other roles. I was then promoted to direct the educational programs for Governance—which includes CEOs and Boards of Trustees.

I was still debating medical school, but I also started questioning what other graduate paths I could consider. A lot of my mentors at the time told me, “You should look at an MBA and go the business route.” “Why [do] I want to go to graduate school?” was a question I had never quite asked myself. When I would be in these meetings with CEOs, I would always be thinking, “How did they come up with that decision? How did they know that was going to work or not work? How did they come to that conclusion?“ I didn’t feel like, even if I had 20 years of experience, that I would be able to contribute to that conversation and make a recommendation to a leader without having something to back it up with. So one of my mentors asked, “Have you thought about getting your PhD?”

I started researching programs and talking to program directors for another round of informational interviews. This was a big theme of my life: having conversations with people and really trying to understand their experiences and what you can learn from their path. That’s where I started looking at health services research… it’s not public policy, it’s not business, it’s kind of a gray area in between. I ended up getting connected to the Health Policy and Management department chair at Emory [University], which is where I eventually got my PhD. It was inspiring talking to this nationally-renowned professor who had this formal academic training but was applying his training in a real-world setting. He wasn’t just publishing papers, he was advising organizations on how to design their healthcare systems, both domestically and internationally. Emory fosters an applied learning experience which was, “We will teach you the principles of health economics and health services research, and how to be a good researcher, and the basics of health policy, and give you the foundation, but then it’s up to you to figure out how to apply that training and that evidence-based perspective…to drive policy or influence broader systemic change.”

After graduating from Emory, I had no plans to go back to The Academy. I was exploring other options when I got a call from the CEO of The Academy asking, “Would you come back and consider building a formal research business for us?” And that’s what I do now.

Now I serve as The Academy’s Head of Research and Advisory Services. What that really means is I manage a $5M business function and lead a team of eight individuals to produce strategic research and thought leadership catered to the C-suite and senior executives of large health systems and healthcare companies. In short, we leverage data, and our broader expertise in health services, to guide leader around current and anticipated trends – as it relates to the organization, financing and delivery of healthcare—and their implications moving forward.

I find your first position at the company to be really interesting because you’re able to put on a lot of different hats, and I think that is something that’s really unique and something that’s very valuable to have. What skills do you think were most useful for your position in general at that time?

I never really asked, “Tell me what to do.” I was someone who was going to observe and then figure out how can I initiate value and insert myself in a way that would be helpful before someone would ask. I think there was [a component of] always being super proactive and learning your environment. It was about findings ways to become so invaluable and taking it upon yourself to get things done without being told. I never waited for anyone to give me my tasks. I was always thinking ahead and asking questions when I needed clarity.

How do you think getting your PhD has shaped your career and also your current role right now?

I pursued a PhD for many reasons, but primarily wanted to develop a new technical skillset. Yes, now I can build economic models and answer complex health services research questions. But more than anything, it gave me a new conceptual framework for how to think about and approach problems. I feel like it opened my eyes into how to think analytically in a way that I had never been exposed to before. I could not do my job without it. Everyday I leverage this way of thinking in my approach in working with healthcare executives and arming them with key insights to help them make informed strategic decisions.

Can you describe the dynamics of a team that works on a project in terms of structure, organization, and other characteristics that you think are important?

The culture and structure, by design, should be highly collaborative. I like to foster a team environment in which it’s almost impossible to do your job without another person. Everyone has this objective around how do we solve the problem in the most creative, innovative ways. Personally, I treat it not as we’re doing a task but as we’re trying to solve a problem. And frame everything we do in that lens.

How have science and technology shaped the work that you do currently?

Technological advances and scientific discoveries continue to accelerate. It requires me to keep up with these new trends and the implications that might have for a health system. Whether that’s something that Apple puts out to allow you take your own ECG on your wrist or consumer being able to walk around with their genetic profile data. All those things have huge implications on how healthcare is delivered and therefore how we pay for it. And all those factors make healthcare unbelievably complex, but also makes me optimistic about a future where we can deliver a new, higher standard of healthcare.

What changes do you foresee in your specific area in health services?

I see that over time, the payment mechanisms for health care services are going to change so that it’s easier for patients and consumers to access care. I think that the new era of medicine and how healthcare is delivered is going to be highly digital and “asset-light”. Receiving most of your care in a physical hospital or physician’s office going to be a way of the past. More of your care will be delivered virtually and in ways we have yet to imagine. Every single player in the healthcare industry is going to be disrupted—how physicians are trained, how Washington runs Medicare and Medicaid, etc. Everything we do today will be fundamentally different 10 years from now, which is really exciting to think about.

Wow. That’s very different. I don’t think I expected that answer. But that’s very interesting. And I guess that’s very true because there is a lot of telecommunication for medicine for people who are in remote areas.

There are a lot of external forces that affect healthcare. For example, Amazon has huge implications for healthcare. The fact that our society can order their groceries from their phone instantly, means that you, as a consumer, expect that convenience in every facet of your life. Healthcare is one of the most outdated sectors. So, inherently, the dynamics of every other industry and the evolving expectations of consumers changes the game for healthcare.

What do you think is the biggest issue facing your industry currently or in the future?

Affordability. The cost of healthcare is unsustainable, and there many factors that underlie this phenomenon. There’s no single reason why it’s so expensive, but every player in the industry—pharmaceutical and device companies, insurance companies, hospitals, policymakers—has a role to play in bending the cost curve. All stakeholders must come to the table if we’re going to figure out how to make healthcare more affordable.

What advice would you give a student interested in getting into the health services field?

I would say, number one, ask questions. We so often have a tendency to feel like we need to know the answer to our own questions. If you reverse it, and you approach life where you are always asking questions…and you should be asking everyone you meet—whether they’re in healthcare or not—what they do, how they got to where they are, why they think something is the way that it is, what contributed to the status quo, et cetera. I think asking questions is what leads you to your own introspective view of what it is that you want to do, but it also opens up the doors to other fields and opportunities you wouldn’t know about. I truly would have never known about health services had I not asked questions. I was not exposed to it at Rice, but I was exposed to the people who could answer questions that ultimately led me to my current career path.

Second, take the time to actually understand the history of the US healthcare system. This will be invaluable in understanding why things are the way that they are, and how did we get to the point where we are at. Healthcare is a field where it is so easy to pass judgment and criticize. Yes, our healthcare system is lagging behind other countries. But there are many factors that contribute to why our system is the way it is, and you can’t even begin to start changing it if you don’t understand the origin of it.

I think informational interviewing is something that I’m going to be doing during my time in London and throughout my career. Do you happen to have any advice on how to best start off with that, or how to begin?

My approach to informational interviewing, which is different from networking, is actually more like storytelling …you’re seeking to understand someone’s story. Every person you meet has something unique and a valuable perspective to share, and it’s up to you to ask the right questions to uncover that story. And it’s often going to be the story that isn’t what you see on LinkedIn or on their resume. The default line of questioning is to ask “What is your job? What do you do? What is your title?” Instead you should be asking, “What motivates you? How did you get into this field?” “Did you plan on this? What was hard about it? How did this experience you did 10 years ago relate to what you’re doing now?” Asking questions about the person, rather than their job or resume, will give you so much more dimensionality to the individual’s point of view and career advice.

Did anything I ask or didn’t ask spark anything else that you think would be important for me to know?

The last thing I would leave you with is to embrace the individuality of your path. It’s okay if you can’t tell someone what you do in a word: “I’m an engineer. I’m a lawyer, etc.” There’s isn’t really a term for who I am or what I do, and I think that is so powerful. You should never feel that you’re restricted to a box that someone can put a label on you. People will always impose their ideas and views of how they think you should get to a certain path or outcome, or you may impose it on yourself. If you just do what interests you, and you continue to learn from every experience. You’ll eventually find your path. But don’t feel restricted to having to fit into a box just for the sake of having a label, because if you get focused on the label you will narrow your options.

Thank you for the advice.

When I was looking over the website and looking at what you were doing before this interview, I was trying to put a label on what you were doing. It was an instinctive move to be like, “Oh, what does this really mean?” And I think your advice of not putting it in a box or putting a label on it definitely makes sense. And understanding the intersectionality of the work you do, it’s not necessarily one thing or the other, but it’s a broad network of things.

For what it’s worth, I still struggle with it. How long did it take me to explain to you what I do? It’s not an easy one-sentence answer. If you look at prominent organizational leaders, most of them have had a varied path. The world has now become so interdisciplinary, and having a unique point of view and different experiences is actually what makes you more valuable. In healthcare, I see hospitals hiring people from Amazon and Disney, and they have no healthcare experience, but they’re bringing that person in for diversity of thought. If you look around, you’ll find that so many people’s career paths entail many diverse experiences, and those individual experiences build upon each other, and they’re not always related, or obviously related, in any way.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee.