The following is a conversation between Dr. Shahed Alam and Edith Elliott, the co-CE0s of Noora Health, and Denver Frederick, the Host of The Business of Giving.

Denver: Noora Health seeks to improve outcomes and strengthen health systems by equipping family members with the skills they need to care for their loved ones. They envision a world where patients and their caregivers are a core component of healthcare delivery, and family member training is a standard of care.

And here to tell us more about this work and their plans for the future are the co-CEOs of Noora Health, Dr. Shahed Alam and Edith Elliott. Welcome to the Business of Giving.

Edith Elliott co-CE0s of Noora Health

Edith: Thank you. Thank you so much for having us. We’re really excited to be here. 

Shahed: Thank you, Denver.

Denver: Let me start with you, Edith. Share with listeners the history of the organization and the circumstances that led to its formation.

Edith: Absolutely. So, our history is a bit unconventional. How we started probably isn’t your typical startup story, but Shahed and I met while we were in graduate school. So, Shahed was getting his medical degree at Stanford, and I was getting a degree in International Policy, and we met as part of a course at Stanford called Design for Extreme Affordability, which was hosted out of something called the D School.

And we were both really excited to learn more about Design Thinking and dive into that world while we were there and had the opportunity… but did not intend… to start an organization. We really saw this as a course that we wanted to take and then go back to our lives, so to speak. But we were introduced to this brilliant physician in India and a health system in India, and a massive problem emerged and was shared with us, and that was that you have these incredibly overcrowded, overwhelmed hospitals and health system. You have doctors and nurses who are desperate to do whatever they can to support patients, but have very little time to provide proper aftercare. 

And so that moment when you’re leaving the hospital, which is also called discharge, is extremely rushed, and you’re handed a piece of paper with discharge instructions you may or may not be able to understand and a bag of pills, and you’re told good luck. And then you have this incredibly compassionate, capable, untapped resource– the family member, who’s there.

And so we were presented with this, and we used Design Thinking to really peel apart how could we rethink the way that patients and their families are moving through the system.  How could we better support nurses who are doing the volume of the work during that discharge moment?  How can we better support the system in a way that the hospital is able to manage without us being present? Because again, at the time, we were students; we did not have a plan to create an organization and have a backbone that could support that. 

And so that’s really where we started… it was with prototypes and with testing in that hospital and surrounding facilities and with a nurse, who now actually runs our entire nurse training team and division, and it was very organic. The ball started to roll, and the next thing we knew, we found ourselves with this idea that we didn’t come up with. 

Again, it just developed organically through a lot of conversations and interviews with patients, families, caregivers, hospital administration, you name it, and really taking that beginner’s mindset and taking a big, big step back and thinking about how to support the various stakeholders within the system. And it just has grown from there.

“I think if we were to have health systems be judged more on outcomes, for example, like: What is it that we’re actually trying to get out of healthcare systems in terms of improving health? Then they might look to family members as an obvious and important resource.”

Denver: Sounds like it was meant to be, Edith. No question about it.

Shahed, let me ask you this about, I guess, the imbalance we have in the global healthcare system because when you take a moment and reflect on it, how have we overlooked family members? They’re the ones who love and care for their patients more than anybody else, but we somehow have not had them part of the equation. What is it about us, as a society, that has allowed that to happen?

Dr. Shahed Alam co-CE0s of Noora Health

Shahed: That’s a really great question actually, and I guess it’s complex, I think. When we talk about our work, I think the unique thing that we’re trying to bring about in the focus is: How does the healthcare system support family caregivers? Because the healthcare system itself has a role, but that often is not fulfilled, and I think the main thing that’s missing is the system itself is not necessarily aligned to think about that critically, and doesn’t necessarily have the tools and maybe the ways in which that can happen effectively. 

And it’s also the healthcare and health systems, in general, are incredibly complicated services that involve so many factors, and I think this just ends up being one of those things that seems like a “nice to have” rather than a critical part of healthcare delivery. But if some effort gets put behind it, it’s seen as maybe like a customer service initiative, or just a patient education or a discharge teaching initiative.

But really thinking about the family as a critical part of the healthcare delivery team and supporting them to be successful in that journey, that approach is just not really incentivized by the health systems in general and how they’re structured. I think if we were to have health systems be judged more on outcomes, for example, like: What is it that we’re actually trying to get out of healthcare systems in terms of improving health?  Then they might look to family members as an obvious and important resource.

And you do see some of these organizations like, let’s say, Kaiser in California, that has done a lot in terms of approaching this problem in this way. And again, because when you start with the end result of what a healthcare system is trying to do as improving health outcomes in mind, then I think this becomes much more clear as a solution and something to focus on.

But unfortunately, I think in healthcare systems around the world being outcomes-oriented is difficult. It’s difficult to measure it; it’s difficult to kind of design a whole system around, and so we don’t do that, and I think for that, that’s one of the reasons. Otherwise, I think again, like it’s just such a complex service delivery environment, and this just gets missed out as one of the things that, again, is just not a priority, and in the whole grand scheme of things, maybe is not the most important thing that a healthcare system should be focusing on.

Denver: Yeah. It sounds to me that sometimes they probably just put the information out there and their obligation has been fulfilled, and it’s whether anybody looks at it or reads it or acts on it, that’s secondary. We had it there, and it’s really up to people… and that doesn’t do it. 

You know, I should ask this early on in terms of: Shahed, what countries are you operating in now, and how many people have you been able to serve?

Shahed: So, right now, we’re working across India, Bangladesh, and Indonesia. India is where things started, as Edith mentioned, and that’s where the vast majority of our work and impact to date has been. And we’ve trained more than 3 million caregivers. 

Denver: Wow. 

Shahed: And just this year itself, we’re actually hoping to almost double that. So, this year is a really ambitious year for us here at Noora.

“This is not task shifting, this is just uplifting and augmenting what’s already happening in many cases, what the family members are already doing, just making sure that they feel equipped and they have the adequate skills to perform those things.

Denver: Yeah, early innings.

Edith, what were some of the initial challenges you faced when you introduced this program, and what were some of the lessons you learned from those experiences?

Edith: Some of the initial challenges, there were logistical challenges: What is the best way to introduce this information and repackage it? Where should we engage family members? Is it best to do it in a separate room, or actually better to do it in the ward where people already are? Sort of those.

But those were the kind of not-easy-to-figure-out things, but things that we could tweak and continuously iterate on. But the more complex challenges were sort of harkening back to what Shahed was just talking about: The health systems are not designed to think about this in a holistic way, and changing the mind and the attitude of the system is a very difficult thing to do. And so, we really had to focus on: How do we solve an acute problem that the nurse is experiencing?  How do we solve an acute problem that the doctor or the hospital administrator is facing?  And how do we make this sustainable and something that is possible to roll out within these health systems? 

And so, in these busy environments, asking a nurse to do something in addition to the tremendous amount of workload that she or he already is doing, that’s a big ask. And so, thinking about how can it be reframed so that this is not additional work, but is a re-thinking of work that’s already happening, and if possible, a time-saver in the long run for this particular individual; and so getting pretty granular there was very important.

And additional challenges— one of the things that we’ve had to do is really think closely and carefully about what we feasibly can teach a family member within the amount of time that we have, whether it be in that session that takes place before or after visiting hours, or in the ward that a trainer, a nurse typically, or other healthcare professional, is providing to the family and to the patient.  

And then if we have the ability to continue to engage with that person, what can we continue to enforce through mobile messages and other means? And distilling down and thinking about what should live with the medical professional because this is not task shifting, this is just uplifting and augmenting what’s already happening in many cases, what the family members are already doing, just making sure that they feel equipped and they have the adequate skills to perform those things. 

So, figuring out what’s driving suffering, death, dying, what can we reasonably teach a family member within that period of time, and really focusing on the top things, but a challenge is always that the health system will want us to do more  once they see the impact and the benefit,… and so trying to stay really hyper-focused and say, “No, these are the key things because we know these will drive the health outcomes that we want to see” and not let it become too complex. 

Because part of the challenge is taking that complex, scary, intimidating medical information and putting it through our creative filters so that on the other side, you have something that’s sticky, relevant, digestible, and interesting for the person on the other side, the family member, who may or may not have ever interacted with the health system before. 

Denver: Where did you learn about that? Because I thought it was brilliant the way you sort of shifted providing information to giving people skills training.

Edith: Right. 

Denver: I’ve always been interested in adult learning, and that’s what you’re really doing here. But it’s adult learning under really difficult circumstances because you have a loved one who is not in the best of shape and you’re not listening sometimes. I mean, you’re so scared, you’re not processing. Have you learned anything in terms of how you can, as you just said a moment ago, communicate that information so it sticks, and people can receive it and actually be able to act on it? 

Edith: Well, a few of the learnings: Number one, you have to make sure that it’s relevant to the person in that moment, so making sure that it, of course, is in the right language that you’re highlighting.

If you’re talking about diet, making sure that you’re highlighting foods from the region that you find yourself in; that the visual materials look and feel like the communities that you’re situated within and serving. So that’s of course incredibly important, and also making sure that the information is not overly complex but also not so simple that it feels obvious and kind of too basic… and so there is a fine balance.

But the key pieces, the skills part that you’re mentioning, it’s not just giving information and giving teaching, but actually giving people tangible, actionable things that they can do to support their loved one. And that I think is the key differentiator. It’s not telling someone just basic information. This is an action that you can take that will help benefit. And in those moments, when you have people who are experiencing deep suffering or a new baby has just come into the family, or whatever this scenario might be in these critical health moments, the family member wants to know what they can do to help and to support because they’re… like you said previously, a compassionate, willing, capable resource that is right there. And so making sure that they have the skills that they want and need and the right information, is the important factor. Shahed, do you also want to add?

Denver: Shahed, do you want to add anything? 

Shahed: Yeah, I think the only thing I’ll add is in terms of skills– the important thing in the sessions that we try to bring in is demonstration. So, it’s one thing to talk about skills; it’s another thing to actually perform them and practice them, and really doing that in an engaging way is incredibly important for adult learning… and peppering that with questions as much as possible. 

What we’ve seen works is not necessarily questions that are quizzing people on the content that’s being shared, but questions that allow people to share their experience, maybe  about a certain thing. And there’s typically varying levels of experience within the caregivers that we’re training, and so bringing out some of those insights helps the connections to form between caregivers who are there as well.

And again, for adults, these ways of doing the training in a less didactic way and more engaging way allows some of these things to stick… and also just makes a really difficult and anxious time feel more connected with the people around you. 

Denver: Yeah. Cool. Let me pick up on what Edith just said, Shahed, and that was really overcoming these systemic challenges with these healthcare systems and these hospitals. I’m amazed that you’ve been able to do that. 

I think that the two fields that I always look at that you can’t change are healthcare and education, and I don’t know which one would be more difficult. But both of them are impenetrable to really be able to get in there. How were you able to work with these healthcare systems that are resource-restrained and be able to lay this down and make it part of their program?

Shahed: I think part of it starts with just everyone realizing that this seems like a low-hanging fruit and something that should be just the way that healthcare is delivered. And part of it is that I think we all have our own personal experience with this, with having taken care of a loved one and how challenging it can be… and maybe bright spots in how a health system, like a doctor or nurse or someone else supported you, and maybe some negative experiences too.

So, I think honestly, part of it is the people, the partners, the stakeholders that we pitch to each get it really quickly, so it’s not something we could be the worst salespeople and pitch things in the most sloppy way, but really at the end of the day, the core idea is one that sticks. 

And I think it all starts there that it’s truly something that no matter who you talk to, whether it’s a senior doctor who’s been doing surgeries for decades in the same facility and knows everything about their population, or an administrator who’s thinking about how to organize everything, a nurse in the wards who’s dealing with so many things, and patient and family especially, of course, but when we’re talking about convincing stakeholders, it’s everyone kind of gets it right away. And so starting from there is always a helpful place –that the basic need… and understanding that there’s a gap also in that need is helpful.

I think the other part of it is that we truly do try to co-create this model with the systems that we’re working with so that it best serves the people that we’re trying to serve at the end of the day.  And some of these little things like what Edith mentioned in terms of making sure that the content is customized, we’re using visuals, et cetera… that happens. 

But also just sitting there and not saying that this is the plan that we think you need to do if you’re convinced by this idea… but rather: let’s come up with the plan together, and here’s what we’ve seen works in other places. 

So, I think really going into each of these relationships with a beginner’s mindset and being able to co-develop it is helpful. And over time, what we’ve seen is that there are some core principles that are there across all of the partnerships that we have. But what that allows is for some ownership by the systems that we’re working with because this really becomes their model.

Then there’s many other ways in which we try to promote that. We, as Noora Health, don’t want this to be a Noora Health program that we’re delivering to the patients and families. Typically, we work with government health systems, so this is a government of X program that is being supported by us through some technical support and training, et cetera.

So, creating that ownership from the beginning, again, creates a much easier way of scaling things.

And the last piece of course is evidence. At the end of the day, a good idea and a good plan can only go so far, but once we’ve actually implemented it, what’s happening on the ground? How are we actually changing the outcomes that we said that this would?  And so our research and the evidence that we’ve generated helps kind of continue that cycle. And so all of the partnerships that we’ve had have grown tremendously over time, and we’ve been able to add so many more in an exponential way because of that.

Denver: Yeah. Well, that evidence is one of the reasons you can go from 3 million to 6 million people who have seen what it’s been able to do. But it’s interesting how you really build upon that existing infrastructure. You’re not coming in with a new program starting from scratch, but you’re really just trying to add on to make it as seamless as possible.

Edith, you know, if I take a look at the Noora Blueprint, if I can call that, there are a couple components of that, and one is that the organization really believes that love is the most powerful, untapped resource in healthcare. Talk a little bit about that and how you try to leverage that love to get the kind of results that Shahed was just talking about.

Edith: Yeah. You know, I think it’s a fundamental core. You know, it’s an emotion that’s universal, obviously. And whenever we talk about the work, I think it’s easy for folks to think back to a moment when you yourself were a patient or a caregiver, what you experienced, and if you’re on the caregiver side, again, that innate desire to support the people that you love. And if you’re on the patient side, the fear, the confusion… and caregiver side, fear, confusion, anxiety that you perhaps experienced in those moments. Again, this is not something that a health system would say, “Oh, I know what we’re going to do. We’re going to tap into love, that’s the ticket…” 

Denver: “…that’s the plan.” 

Edith: Yeah, “that’s the plan.” But there’s research that shows that someone sitting at a patient’s bedside and holding their hand improves outcomes. And so there’s a really powerful component to this, and what we’re trying to do is help the health system be a bit more compassionate and do it in a way that works, again, for all of the stakeholders because we’re not naive to the fact that something like this can’t be introduced unless the health outcomes on the other side are significant, and unless there is a time saving and a cost saving and all of those factors. But yes, love is a key ingredient. 

Denver: Yeah, yeah. And coming with that obviously is deep listening and building trust and all that; it’s all part of the same package when you’re doing one. They all kind of fit together. 

Edith: Exactly. 

Denver: You just talked about outcomes… that Shahed did a moment ago. Talk a little bit about how you measure the impact of these interventions.

Edith: Absolutely. In terms of impact, we can look at two things: our outputs and our outcomes. So, on the output side, we have really clear targets that we set in terms of the number of hospitals that we’d like to work in, the number of people we’d like to reach. And really we set those targets because as we mentioned earlier, we see this as something that can and should be adopted by health systems globally. 

This is not a solution that’s isolated only to India or Bangladesh or Indonesia, and we feel the need and the requirement to demonstrate that this can work in a massive volume of facilities, a large variety of types of facilities, and in some of the most resource-constrained hospitals in the world. Because if you know, X hospital can do it, then the ideas… you can adopt this for your health system in another location. So, we have really ambitious output targets. 

And what that also provides us is the volume to then be able to dive into the research and have a large enough sample size to measure the health outcomes that we’re aiming to drive. And so some of the health outcomes that we really focus on are looking at behavior change and improving health-seeking behaviors, reducing readmissions and complications, and of course, the ultimate goal would then be to reduce mortality. So, if you were to boil it down very simply, it would be: How can we reduce suffering and death that is occurring in these health systems? 

How we measure that depends on the condition area that we work in, but we use very rigorous study design to analyze what a health system is experiencing before our program begins, and then how the program impacts the health system on the other side.

Now, some of those outcomes are easier to measure, and some of them are far more complex, but just to give a brief sampling: In our cardiology and cardiac surgery program, we’ve seen a 71% reduction in post-surgical complications. We actually just had a paper published that showed an 18% reduction in newborn mortality, which is pretty remarkable.

Again, depending on what type of patient population we’re looking at, there are various different parameters that we can measure. 

Denver: Fantastic. Shahed, you’re in three countries right now. You have ambition targets that go from 3 million to 6 million, but I’ve also seen this number 70 million floated around. So, tell us about the real aspirational goal… and where it’s going to be… and how you plan to scale to get to that level. 

Shahed: Yes, 70 million is the North Star for sure. I think about it first thing every morning, and by 70 million we mean 70 million people who we train through, and these are patients and family caregivers. 

What we’re planning to do is to do this through deep engagement with government health systems in four countries. Currently, we are in three– Bangladesh, India, and Indonesia,  and so we’ll be adding one additional over the course of the next five years. Six years was the full plan that we intend to hit the 70 million target, and we’re about a year and change into it. 

Essentially, the model remains fairly similar to what we’ve been doing, which is: work with these government health systems who have massive scale in terms of the number of facilities they have, health workers who work in them, and of course patients and families that visit them, and really, really be able to integrate this program within how they deliver care at the various touchpoints that they operate in.

And so for us, scale means kind of three things. The easiest way to think about scale is geographic scale. We, of course, are adding, for example, in India… In states that we were already in, we’re adding more districts… so kind of saturating the states that we’re in. We’re also adding more states in India… so kind of spreading geographically that way as well. Of course, adding new countries, that’s obvious. 

But the other two vectors of scale for us include adding being able to work at different levels of the healthcare system. So, a lot of our initial work was focused around hospitals, so secondary and tertiary care facilities in public health terms, but big hospitals with inpatient services; and now, we are shifting to not only just working in hospitals, but also working at the primary care level closer to communities.

And so a big part of our push for scaling this year specifically is getting deeper into the health systems and many of our existing partners. 

And the final one is… this is something that we feel and we know it can be impactful for any type of patient, no matter if you’re welcoming a new life into the world, or you just got a surgery, or diagnosed with a lifelong chronic disease, or just had an accident, no matter what kind of patient condition or experience you’re going through… the loved ones are there to support and need the right support, and so being able to add more types of patients that we’re able to work with. And so right now, we work across several areas and we’ll be adding many more. 

Happy to go into those details too, but that’s kind of how we’re planning to get to the 70 million. And again, it’s a big we, and that includes, of course, our partners, our government health system partners, and the nurses typically, who day in and day out, are the ones who are delivering this program to the patients and families.

“We’ve had to be pretty innovative along the way, and so having funding that’s allowed us to remain flexible and innovative that’s trust-based, between us and the donor, has been very important to our success. And we’re very grateful to the group of individuals and foundations and funders who have come to the table and partnered with us on this journey so far.”

Denver: That’s inspiring. I love these aspirational goals, and I think you guys are going to make it, but one of the ways you’re going to make it, Edith, I would imagine there’s one other aspect of scaling… and that’s financial scaling because this is not going to be cheap, I guess. So, give us a little idea in terms of your business model and the relations you have with governments and funders and others in terms of being able to get all this work done.

Edith: Yeah, so our …really core to the model and to the sustainability and scalability of this model is that the program itself is extraordinarily low-cost because we’re not introducing a new product or widget into the system. You have nurses, and other healthcare professionals are the individuals who are running these training sessions with families day to day, and they’re already employed by the health system. 

What would’ve been the largest cost is already being covered, budgeted for: plan for within these health systems, and then the additional costs that come along with the program… let’s say printed materials or needing a television in the ward if they want to use some of our video assets, and our follow up with the health system, that… typically what we’re able to do is negotiate on the front end with these health systems to either make use of funds that are part of their budget but that are otherwise not being spent, and help them spend the money on those training resources. Or we can negotiate that very small amount of funding into their budgets for the program.

And so in that way, we guarantee financial sustainability for the program in perpetuity. So, that’s a core part of and has been a core part of the learning over the years… is to make sure that there’s financially the right amount of funds set aside for the program. But then everything that we do on the Noora Health side is funded through philanthropy.

And so all of the content development, the initial upfront training, the government does cover a portion of that, of course, but we also come to the table with all of the R&D done; the materials have been created.. that is covered through philanthropy. And so over time, we will aim to increase some of the upfront training that the government is able to cover. But of course, these are very resource-limited settings typically, and so there’s going to be a cap. There will be a limit most likely there, and we’ll continue to rely on philanthropy to fund the Noora Health side of things.

And we’ve been really privileged to work with a group of remarkable funders, individuals, and family foundations, who have supported the work and really understood and believed in the concept early on and have stayed with us… and then some new funders who have made significant, very big bets on the work and on the idea and on that dream of 70 million. And so it’s been a really fun mix of folks who we’ve gotten to partner with and work with. And the majority of our funding is unrestricted, which has been really important for us because this is not an intervention that has a clear cut set of guidelines that if you do X, Y, and Z, then this will happen.

We’ve had to be pretty innovative along the way, and so having funding that’s allowed us to remain flexible and innovative that’s trust-based, between us and the donor, has been very important to our success. And we’re very grateful to the group of individuals and foundations and funders who have come to the table and partnered with us on this journey so far. 

Denver: That’s great, and I think 70 million gets people excited. Often, a lot of organizations are trying to increase by 10,000 more or something like that, but this is going to be such a systemic change. It’s just amazing!

I got a question for each of you and, let me stick with you, Edith, and that has to do with being a co-CEO at Noora Health: Why don’t you share with us some of the benefits and the challenges of such an arrangement? 

Edith: Well, the benefits are many. I think Shahed and I are very lucky, and I don’t know, we’ve been told our relationship is unique, but I hope that others can find this and that it’s not too unique because it really does make a huge difference.

The biggest being you have a partner; you have someone who in the challenging times or when the 70 million is waking you up, or whatever it might be that’s keeping up at night, you have someone who’s been thinking about this as constantly and as deeply as you have… who you can talk to about it and who you can brainstorm with. And our relationship is really built on trust and on that foundation of trust, and that manifests in many different ways, but the core is really that I know that if there’s a big decision that needs to be made, I feel fully confident that I trust Shahed’s instincts, the information that he will gather, whatever it might be to make that decision.

And even if I disagree, or think we should have taken a different path, I feel safe and confident in talking to him about that transparently, but standing alongside him to carry that decision forward. And I think especially for our team, that trust and that bond is fundamental to making this work.

And some of the challenges, I mean,…look, it would be nice if we lived in the same time zone; it would be nice if we lived in the same place right now… we used to… we don’t at the moment, but it also means we can have a 24-hour workday, which is going to be nice. 

Denver: There you go. There’s something waiting for you to look at when you get up in the morning.

Edith: Yeah, exactly, exactly. No, but I wouldn’t call this a challenge, but something that’s always top of mind is we have to make sure that we’re maintaining our working relationship and putting as much time and attention to that as we are putting toward the organizational goals and whatnot, and just making sure we’re checking in with one another and not just checking in on work, but checking in on personal life. And if we are not whole as individuals in our personal life, then it’s going to be very difficult for us to be whole as professionals as well. So, that’s always been a priority for us. 

Denver: You know, I would think that this kind of collaboration also can set a model for the rest of the team in terms of trying to work together and share responsibilities. 

Shahed, what’s your take on it? And a few other aspects, did you guys split duties? And what do you do when you have a disagreement?

Shahed: Yeah, my take is quite similar to Edith’s. Again, I will start with, for me personally, I actually stepped out of my role at Noora to finish medical school and was planning to go practice medicine in the US, but I didn’t. I’m here now talking to you today, and this is my life’s work. I hope I get to continue it as long as possible.

And a big part of my reason for coming back was just being able to work alongside Edith, and I’m really glad I listened to myself on that because I think that has made such a huge difference in my life personally. And also just being able to do something… when you find someone that you can gel with so effectively, it’s amazing to try to do something together and continue doing something together. So, I’m so glad I did that, and that’s a little bit more on the personal front and again, I guess Edith said some of that might be unique to us, but yeah, I think there are some principles here that I also feel are important.

One, I think exactly how she said, like having a partner in this where you can just like just share, and I do this pretty frequently where, like, my bar of sharing is very low with Edith. and it just helps to share and talk things through. And you always have a partner to be able to do that, and that is so, so helpful in this work because there’s just so much that comes your way. And being able to have someone where the guard is completely down and you’re really just trying to figure out what’s best for the organization; and the team is super, super helpful; and in this structure, I feel like we can do that so readily.

And the way we structure it is that we both feel that we have shared accountability across everything that happens in the organization, so both of us have essentially the same job description, I suppose, in terms of accountabilities. But at the end of the day, we do focus on different things, like how I spend my time versus how Edith spends her time in a day is different.

I look after on the external side more government relationships, and those partnerships with health systems, et cetera focus a bit more on the program development and research. Edith does a bit more on the fundraising, other external partnerships, communications, finance.

And again though, that’s really about where are we focusing a bit more of our time, but any critical decision that we take, we take shared responsibility for. So, I think that’s really important.

And that doesn’t mean that we both sign off on every decision. It just means that both of us are implicitly signing off in some ways and that we both have a mutual trust that if it’s something, a decision that I’m taking, I know that Edith will trust that… like the reason I’m taking it and vice versa. And of course, if there’s something that needs to be brought up and discussed, we try to do that.

And that also helps create clarity for the team because if the team needed to get both of us to agree to something before doing something, then that would be confusing. And rather it’s like just one of us needs to be engaged, and if we feel like we don’t have enough information, we of course involve the other. 

I think in terms of disagreements, to be honest, there’s nothing fundamental and big to date. I think part of it is that we’re just grounded on some of the more important things that we’re trying to achieve together. And so that hasn’t happened, but I think, there’s of course little smaller decisions that come up. I know they happen of course, but I don’t even remember the core content of them, again, because the bigger picture is always in alignment in some ways. 

Denver: Yeah. One thing they certainly address is a complaint that I know a lot of CEOs have, and that is loneliness. I hear it from a lot of people on the show all the time, and they indicate that they really can’t go to their board unless some of these things, or otherwise the board’s going to form a committee. And there’s some things you can’t tell members of the team, and they just say, “We never have anyone to really talk to.”   And you guys in this arrangement certainly have someone to talk to. 

Edith, I just wanted to pick up what Shahed was talking about the team, and you guys are noted for having just one of the most outstanding workplace corporate cultures around. And just share with us a thing or two in your mind that just sets it apart from other places.

Edith: Yeah, it sort of comes back to what Shahed was just saying about our shared values, and we prioritize hiring for values above anything and everything else. And so, when we interview someone, there’s of course the skills… we have to make sure that the person’s a right fit for the job, but if we have two individuals or three who would be a right fit for the role, even if someone has, you know, if their credentials are perhaps a bit stronger on paper or in the written assignment or whatever it might be, if we feel that the other individual would be a better fit for the team… and values fit for the team, then that person’s going to get the job.

Now, of course that was much easier to do when our team was small and we could interview everyone coming through, and the folks who we felt to be like really champions of that could interview everyone, but it’s become more difficult as we’ve grown. And so it’s something that we’re constantly thinking about, that we’re constantly checking ourselves on. We were prototyping a couple of different ways of having values champions across the organization who do conduct those interviews, but that really has been, I think, paramount to our success. 

And another key part of that is if someone is not living up to those values, or if there’s a part of the work that’s not living up to those values, we have to take action quickly, and we have to make sure to address that quickly… so that’s been really fundamentally important to the workplace… 

Denver: Yeah. That’s really smart. 

Edith: …and defining that early on. 

Denver: Yeah. Absolutely, because everybody thinks it’s going to fix itself, and it never does; you just have to take the action. You’d like to add to that, Shahid? Would you like to add a thought? 

Shahed: No, I think that was great. 

Denver: Okay. Let me close with this, and I want to ask each of you this and that is to share an observation or a story of a caregiver– whether this be through the work at Noora or in your personal life– but the role that they’ve played and that you’ve witnessed.

Shahed: I can start. I’ll share a personal one because I was just reminded of this recently. This is of my mother playing caregiver to my grandmother, and I’ve been involved as well, and I was just with both of them. My grandmother is currently in Bangladesh, and my mother is staying with her. She’s had kind of a decades-long experience with a pretty difficult neurological condition and lots of doctor’s visits, lots of different varying opinions and different things to do. 

And I’ve just seen my mother play this role of keeping everything together in terms of my grandmother’s health, and she’s such a capable, skilled person and super detailed-oriented; she was a kindergarten teacher, so you can just imagine her abilities on that front. And also getting support from some incredible clinicians, like really some of the best doctors that could be looking after my grandmother. 

But still with all of that, it’s just the amount of effort it took her to really understand what to do at home for my grandmother and what was right and what was wrong… and just keeping everything together– from her food, to her activities, to the medications of course and the followup– she would kind of joke with me sometimes that: Let me come and give a lecture at Stanford while I’m in med school to your doctors because what I’m experiencing is not right. And now, she’s kind of inspired us to do that. 

Denver: That’s fantastic. 

Shahed: Yeah. So, I think that’s it. I just saw such a capable caregiver, struggle, and she had access to so many things, and that really motivates me to do what we do. 

Denver: That’s a great story. My mom was a kindergarten teacher too, and they know how to handle chaos, they really do. Edith?

Edith: Well, instead of giving an individual story, I think I’ll instead paint a picture. Anytime I’m visiting  one of the facilities where we work and have the privilege to get to sit and speak to caregivers and patients… who are in that moment of vulnerability, what you hear is exactly the story similar to what Shahed just painted his mom experienced.

And I think hearing that again and again, bedside to bedside, over so many years… and then on the other side, hearing how much relief and gratitude people have for being given information, it just reinforces how powerful something so simple… and a relatively simple act, how powerful that can be, and how momentous that can be in someone’s life and in their healthcare journey.

And so while that’s not exactly what you asked for, it’s sort of that story that Shahed shared, but some version and iteration of it across hundreds and hundreds of people. It’s powerful, every time… and of course there’s going to be a nuance that really hits you and reminds you again of a time when you were a patient or caregiver… but it’s hearing it over and over and over again that always strikes me.

Denver: Lovely way to end the show, and now I see how you guys complement each other so well. 

Edith, let me just stick with this: for listeners who want to learn more about Noora Health, become involved, or financially support this great work, tell us about your website and the kind of information they’ll find there. 

Edith: Wonderful. Thank you so much. You can go to www.noora, N-O-O-R-A, health, H-E-A-L-T-H, .O-R-G, and you’ll find more information about the places where we work. We have a lot of job openings right now. Please take a look at our careers section, and apply if you’re interested in working with us, or reach out to us if you’re interested in getting involved in some way. And of course, there’s a very prominent donate button should you choose to take that route. 

Denver: That’s the first thing I noticed. 

Edith: Yeah. 

Denver: Well, I want to thank you both for being here today, Edith and Shahed. It was such a pleasure to have you on the program. 

Edith: Thank you so much, Denver. This is just wonderful. It was great to talk to you.

Shahed: Thank you so much, Denver.

Denver Frederick, Host of The Business of Giving serves as a Trusted Advisor and Executive Coach to Nonprofit Leaders. His Book, The Business of Giving: New Best Practices for Nonprofit and Philanthropic Leaders in an Uncertain World, is available now on Amazon and Barnes & Noble.

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