Own the Role You Have (Stop Thinking About the Next) | Novartis CEO Vas Narasimhan

I think it's easy to get too fixed kind of in your career as well. And yet I think to be open to possibilities that a decision in one direction could open three other decision doors in another direction.

By bringing me back to India. Many times in my youth, particularly my mom, she would always take us back to say you've had these extraordinary opportunities to get to the US to get an education. What could you do for the world? Like what could you do to impact the world with the opportunities that you've been given?

Talk about getting thrown into the maelstrom. It's easy to coach new CEOs about these things, but when you go through it and it's the first time it's your name and seeing all of that, it's jarring.

Hey, look, Steve, I always say we stand on the shoulders of giants. And I think about the journey of my grandparents coming from really small villages in southern India, farming villages. My parents making the grand trek from India to the United States, and then growing up as an immigrant kid in Pittsburgh, Pennsylvania, a steel town, but it was a steel town back then. And they put inside of me the values that I think I cared for today. You try to impact the world in a positive way. You do it with humility and kindness. You're always trying to learn about yourself and learn about the world. So, it's been, I'm very grateful for all that they've done.

Good research. Yeah.

My mom is a brilliant, brilliant person and she managed to raise three boys while being a nuclear engineer at Westinghouse while still trying to make ends meet. So I think that was really important for us to see, right growing up. And then my father having come from nowhere to come all the way up to the executive ranks. Even during his career he would make multiple steps where really high-risk steps, leave his job, get another degree, bet on himself again and again, always with this kind of boundless optimism, and I think that carried through into me as well.

Well, you know, I think it was, but we had a beautiful community there in Pittsburgh. Actually, my parents helped found a temple there. And I actually grew up, even though I was growing up in the United States, I grew up really grounded in Indian culture, Hinduism. Books I now still quote like the Bhagavad Gita were important in my upbringing. So, I always had a sense of belonging there. But of course, at that time, there wasn't large immigrant communities in these places where I was going to school. So a big focus was yeah just trying to fit in. You know sometimes it was funny, I would only know the words for things and the language I learned first which was Tamil not English, and always trying to catch myself when the kids would then laugh at me. I mean little things like that, but it was still a wonderful childhood.

You know, I think my parents instilled in me this idea by bringing me back to India many times in my youth, particularly my mom. She would always take us back to say you've had these extraordinary opportunities to get to the US to get an education. What could you do for the world? Like what could you do to impact the world with the opportunities that you've been given? And going back and seeing that of course especially at that time in India you would be seeing that there are millions, hundreds of millions of people without those opportunities, and so I was left with that thought that I've had the privilege to have these opportunities, it's not a given, just a luck of the draw in many ways, and then what can you do with that to make the world better.

I think very early on, if you probably saw in the history even in college, I went to Africa and I went to West Africa and I went to the Gambia, to work with the Red Cross, and probably it was that experience that more than any other really instilled in me this desire to pursue medicine and public health.

Well, first I want to make a call out there. You know, when you go back to Kolkata, that was actually the first trip my wife and I took and we had only been dating for like 3 months and we ended up working with street children and child laborers in Kolkata together. So, think about a love story. That was like an interesting place to kind of, but we it was a crazy, crazy time then in Kolkata but we managed and it was incredibly rewarding. And then as you said, to be part of the first HIV AIDS treatment effort in Africa and Botswana was extraordinary. But you know through those experiences I also saw that in many of these ways, management, leadership was not very evolved in public health and so I think my first step into the business world was very much motivated by that desire to learn how to lead, learn how to make change happen at scale because I think the history is that usually a great physician is just thrust into a leadership role without any of the experience, and that's what I was observing on the ground. So that's where the initial inclination came from. Now I had no idea I would end up being a CEO. It was always like I'm going to go to business and come back to public health and then one thing led to another.

Genuinely?

But you had you had a whole series of management roles, we'll come to your evolution of your career from 2005 onwards over at Novartis. But I would have thought that it would have been at the back of your mind.

Sorry Vas, You're one of the smartest people I know, how did you not spot that?

You are a very smart guy. Although you're the second smartest person in your marriage from what I can see. Your wife's got more Harvard degrees than you.

But you kind of found it easy to talk to smart people on a smart level but actually hence you mentioned the scientists but on a broader level not everyone's got your IQ Vas, you know, and did you find it hard to relate to the rest of us the mere mortals of us out there.

Autonomy, mastery and purpose. Yeah. So Daniel Pink's work and we've I've talked to Daniel now still ongoing for many years. I still believe he's got it. For most people once you pay them enough, it's not paying them more is not going to motivate them even more. But it's the idea that they're working for something that's bigger than them. That they have the freedom to do that work which we later called unboss and then the opportunity to grow as people. You should really be talking about mission and purpose three times more than anything else. I mean many people have talked about this. Simon Sinek, Adam Grant, many of the leaders that I really think again Adam Grant. Yeah, you know, start with why. Leaders start with why. And you should be talking about the why we're doing the work three times as much as the what and the how because that's what really can motivate people. But the art of it is not just the big P purpose always. I've learned over the years it's not the big P purpose always. You also got to bring it down to the little P purpose. I love the story of people who work in our manufacturing facilities cleaning the facilities. And when you ask them why do they do what they do at Novartis, they say we're saving people's lives. Yeah. Because they've connected the work they do in that facility to the bigger purpose. And so you have to be able to make those connections. It's not enough just to say let's reimagine medicine because somebody in our organization seven eight levels down has to understand what that means for them.

Absolutely. And my best friend as well, but I think throughout the ups and downs, we've been on this project, whether it's the streets of Kolkata, whether it's the hospitals of Africa. Now, interestingly, both as biopharmaceutical CEOs. I haven't, I'm not sure if it's true, but I think we might be one of the few or the only married couple that's both CEOs of public companies, maybe in the world, which is kind of incredible thing. Um, yeah. So, it's been extraordinary and I would be nowhere without her. Uh, for sure.

Yeah, I think early on when the boys were young, we have two incredible incredible boys. Early on, actually I took the lead. She was traveling. She was a McKinsey expert. She was traveling around the world working on projects. I was kind of muddling my way through as best I could trying to get the kids to daycare. Then, you know, she took the lead on the kids and my career at Novartis really blossomed. And then, look, when the opportunity to become a CEO came up, we talked with the boys and we said, 'Are we willing to do this as a family?' And my boys said, 'We want to make this happen for our mom.' And so, we figure it out. I mean, and so it's not always easy. I don't have a magic formula to make it happen, but we figure it out.

Yeah, it was interesting. But you know, I am very grateful. I was there. I was there for 18 months, 20 months. But in that time, I learned so much for somebody who'd never been, you know, done an MBA or knew anything. I didn't know what a balance sheet was. I didn't know anything about P&Ls and valuation. And I'd been trained in medicine. And then I learned all of that and I got to apply it in the business world. I think of it as I learned another language. Like you have to as leaders you have to be able to speak different languages, you have to speak medicine, public health, finance and business, and you have to be able to communicate and I learned that.

I wasn't exactly sure, you know. And that's the point, young people shouldn't be sure. I mean, I think people watching should know these were all just experiments. I was in my kind of late 20s. I was like, go, let's give it a shot, right? Maybe McKinsey will lead to something or maybe I'll just go back to medicine. And I had no idea where it would go and I had no idea that McKinsey would lead to Novartis, right? So then when that happened and then suddenly I was sitting in Basel, Switzerland working for a pharmaceutical company. Suddenly my mother was asking me what exactly is the plan right now? So I thought you were going to, you know, be working at a hospital. You're a Harvard Medical School grad. I'm with your Mom, this is where I was going with your history.

So, I love this - huge decision. You've had this unbelievably expensive education. I'm sure you got a loan the size of a ... Well, maybe you didn't. So, you've made the decision to go to McKinsey to learn more and then you've ended up at Novartis 2005?

Tell me how that process worked and the decision making, did you make that more of a decision or were you just winging it still?

Um a whole series of roles between 2005 and late 2017 early 2018 when you became the CEO. Tell me about some of the great decisions you made in that period and tell me some about some of the howlers where I presume you learned also a lot.

And that's incredible for me. I've just learned something again from this in the fact that I've had so many conversations with you about the rest of the industry about biotech. Why do you need them when you've got the big pharma and you just answered the question? It's the autonomy and the speed of action and what you can do and what you can learn and the responsibility that you as an individual in a smaller group get.

Yeah, I would imagine as part of you may have thought I really like this autonomy. I like the scale of the company. I'm going to stay with either this vaccine company with Glaxo or actually go elsewhere and become a vaccines CEO or a biotech CEO. I think it's easy to get too fixed kind of in your career as well. And I think to be open to possibilities that a decision in one direction could open three other decision doors in another direction.

Well, I think certainly when I coming back, I mean there are many of these moments as you can imagine, but you know I think one that comes to mind in that early part of the career is you know as a very ambitious leader of Novartis vaccines North America, I convinced the US government to actually have us become the number one supplier during the swine flu pandemic and we were the number one supplier we won the contracts and then that summer we weren't able to deliver initially. And I still remember the meetings with the then CEOs and chairman and that I put the whole company's reputation at risk by ambitiously signing up for these deals and then not being able to deliver and then being called in front of Congress as well to testify about it and being called by the chief of staff of the White House and oh that was a tough summer. But here's the interesting thing. I mean, what I also learned in that experience is to go to manufacturing sites and really try to talk to people in town halls and say, 'We can do this. I know we're behind. We can get there. We can get there.' And we did get there. We did deliver it.

How was it mentally for you at the time? These failures these setbacks. At the time I had one CEO saying one of the similar I was in a fetal position. I was so upset. I had another one saying I was making really bad decisions. I had high levels of cortisol. My mind was I couldn't sleep. I hear a lot. What about you?

Let's spin forward to the succession process from Joe Jimenez. 2017. Tell me how it worked. And about the decision you made to accept that role because you've already said on this podcast as well, you never expected to be the CEO.

Well I think you stay humble and grounded by traveling on Ryan Air. All due respect to the great Michael O'Leary. That's as humbling as it gets.

The first year as CEO was rough. You walked straight into a crisis. For our viewers and listeners, 3 months into the post, you had to apologize to employees and indeed you were hauled over the coals publicly with a lot of truths and a lot of untruths as well about the fact that your company had hired Michael Cohen's consulting company in February 2017, which is way before you became CEO, a 1.2 million year-long contract as well. That was perhaps in retrospect, I think very clearly, not the right thing for Novartis to do, but you had to bear the brunt straight away.

I remember talking to you about it and I'll put my hands up here you stood up you took the questions you know this wasn't your mess, but you'd inherited it as a senior member of the team that had hired Michael Cohen and now the CEO as well. Yeah, unbelievably tough.

What mistakes did you make?

Yeah it was 18 months of trial by fire. It builds a thick skin that's for sure. You need that in this job. But it's hard to build a thick skin without taking some of that.

No, I think I was at that point kind of the, you know, another thing my parents instilled in me is you stay in the ring. I mean because in the end just staying in the ring is hard enough, right? And if you can stay in the ring, stay resilient that you can overcome if you just keep getting back up.

They don't understand what it's like. But, you know, I think in I have a much more mature perspective then, but I mean, back then, I was very angry at the journalist community. I was like, why are they bashing me and it was tough.

For sure. I mean, and these were all things I kind of always knew that we needed to do and that I struggled with, I think, for because it was the pandemic, there was always a reason not to do it. A company I had grown up at, company where I knew so many people around the world and then to take out over 10% of our workforce, many people I knew was really, I think, a tough decision. Funny enough, again, I spoke to the CEO about a very similar decision that he had to make when he became CEO. Same kind of numbers, huge 10,000 plus people as well. He said, 'As long as you do it with respect and you're respectful to the employees you're letting go of and the employees who are still there and you explain to them exactly why you're doing this, then it's a much easier process.' I think to a person that I would interact with, they all understood because we really took the time to explain why, like why strategically this makes sense, why we need to focus as a pure play, why we need to simplify, why we need to streamline down the pipeline and spending that extra time saying why. I think people understood. No, this still the personal impact of individuals leaving and you know Basel is a small place so everybody knows everybody, so a lot of people, my kids friends parents, so it was a tough time. It turned out as you've seen the performance it was the right move, but that's not a given and I think it was a tough couple years.

I cry every time we have a phase three win. It doesn't surprise me because I mean many of these projects I've been with since 2013, 2014, or I started them or I know the teams and most of them sadly don't work right. And when you have one that really changes, in the case of Kisqali, the whole shape of breast cancer therapy, or Pluvicto prostate cancer, you know again cancer chronic myelogenous leukemia. I mean it's an extraordinary moment and it's not just those. I mean one of my favorite ones happened last November we discovered and successfully developed the first new malaria drug, coming back to my time in Africa, in 25 years. And so for me flashing back to sitting in a hospital in Tanzania and watching children die of malaria, knowing my company has provided Coartem to 1.2 billion people and then making that next discovery. Of course you cry because you put your whole heart and soul into this work. That's the only way you can do it.

There's so many things we can be doing with our energy and our time. But one thing I've learned through this transformation process is we have to stay focused on what we're great at. Discovering developing the most cutting edge medicines. Just to give you an example, people always say why don't you get into devices, why don't you get into diagnostics, why don't you buy an AI company, and you know I think we have to stay on mission. That's the first first step. Second is it consistent with our responsibility to the stakeholders that we have. So people often ask me why do you still do malaria and leprosy and neglected tropical diseases, well that's aligned with our mission and we've made a commitment to global health for 100 years as a company. We've been the leader in global health and engaging in medicine in Africa. So we have to keep our commitments to those stakeholders. And then of course can you execute? I mean, in the end, there are sometimes things that are both of the first two things, but we're not the right company to do it. And those are tough decisions, right? You can find, I give you an example, a rare cancer medicine that aligned with our mission, consistent with our goal to deliver medicines to cancer patients, but too small to move the needle for a 60 billion revenue company. And then we have to say no. And that's hard to tell those scientists. Look, there's a biotech who's better served to do this. But those are also the tough choices we have to make.

Well, so first I don't believe that's true. Steve, you're looking great. Can we just cut that bit? But look, I would say, you know, I am I do believe and it's been consistent. And I had a great friend and coach Scott Pelton who's helped me with this now for 15 years. Mindset, movement, nutrition, and recovery. Mindset. Can you put yourself in the right mindset every day to have high impact? Think about your high impact moments. Realize you're not your thoughts and emotions. And you have to be able to observe your thoughts and emotions to be able to navigate the craziness of what we have to deal with. Movement. I think any form of movement, but being more consistent, whatever it is, and I'm a big exerciser, but being consistent has huge huge benefit. Nutrition. I always say why do you eat? So sometimes I eat for performance, sometimes I eat for pleasure, but I don't just eat to eat. And that's very easy in today's world where you're surrounded by food everywhere. So, purposeful eating. And then of course recovery. And now my biggest obsession now is sleep with all kinds of approaches to try to figure out how to sleep better because I think sleep is the ultimate medicine in the end. But I think the biggest thing on all four of those is whatever you choose to do, just pick things and do them consistently. The hardest thing is to do these things consistently because the benefits just accrue and compound. And people ask me like how do you put up with the travel and it's because I do those things every single day in some form and then over years the benefits compound.

First and foremost is helping my sons navigate their transition into college and really with my wife taking on her leadership role, I have had to learn how to become more of a lead parent. So, that's really on my mind. I mean, I want to make sure they have the next step sorted out. And then of course at some point like what's next for me and I think one of the hardest things as a CEO is you can only go into this 200% 300%. I have no idea when the moment will come but when the moment comes it's like yeah now what? I mean, I've had the greatest job I could have ever imagined in my life. Had unbelievable impact on the world, on Africa, on the planet, on medicine. So, that's kind of a daunting challenge, I have to say. And I don't have any insight. Maybe I'll come back to you, Steve, for some advice since you seem to know me really well. You can counsel me on whatever.