Over its 23 year history, the Commonwealth Fund Fellowship, along with California Endowment Scholars program and Joseph Henry Oral Health Fellowship, has a proven track record of creating physician/other health professional leaders; the Alumni Spotlight interviews showcase the expertise and dedication to care for vulnerable populations as a testament of that success. Interviews have been edited for length and clarity.
Nakela Cook, MD, MPH (CFF '04)
Chief of Staff, National Health, Lung and Blood Institute/ National Institutes of Health, Bethesda, MD
Q: Can you describe your current organization and your current role? And then talk about how you got to that role.
A: Currently, I'm at the National Heart, Lung, and Blood Institute, one of the 27 Institutes/Centers at the National Institutes of Health, which is a federal biomedical research agency committed to supporting discovery science, and turning that science into health for the nation. I'm the Chief of Staff in the Office of the Director, and a Senior Scientific Officer at NHLBI. What that means, really, is that I provide institutional leadership that supports our institute director, and his vision for implementing our mission. I also provide oversight to the operations of the director’s office and provide leadership for complex, multi-disciplinary initiatives that are of high priority for the institute.
It was a very interesting journey to get here; it was not linear journey. I always knew I wanted to become a physician from my earliest days, but I did not know how all the interests that I would have would culminate into a career at NIH and at the NHLBI.
I was fortunate that the Commonwealth Fund Fellowship came along when it did, and gave me an opportunity to think about how to address some of the things I am most passionate about and even drove my desire to go to medical school – addressing health disparities and health inequities. After going through the Fellowship, I then contemplated how to integrate all these different domains. I was clinically interested in cardiology, and wanted to pursue that, and I did so after the Fellowship. I had a research interest, being an analytic person that enjoyed the challenge of the problem-solving, and I had a health policy interest that was about changing the way that health and healthcare are delivered in the country. NIH actually allowed me to bring all those interests together.
Q: Sometimes it might take years to really figure out where the best opportunity is for you to bring all of these areas of interest all under one domain. Was there anything in particular in the fellowship training that you received while you were here that helped you to be in the position you're at now?
A: There were so many things. I am not sure that I even realized at the time how much the opportunities that were afforded to me in the Fellowship would support me now in the day-to-day things I do.
One of the major things I recognize now in retrospect was the opportunity to meet leaders of different health and healthcare organizations through the Fellowship, and understand their career paths and how they approached challenges and opportunities. This was really inspiring to me. It allowed me to envision myself in a role that I'm not sure I would've otherwise thought about for myself.
I can't speak enough about the leadership development component of the Fellowship, because I think that's where I started to realize that evolving my leadership skills would be an ongoing, continual effort for me throughout my career, and that leadership development never ends. Those are the sorts of things that I think make me adaptable, nimble, and flexible in thinking about how I approach things in my current role. It revealed for me what it takes to lead, and to lead change in an organization.
Q: Was there anything that you think was missing from your training during the time—during your year with the Fellowship?
A: I don't think I'd say anything was missing, but one of the things that I would comment about leadership development is that it's ongoing and continual. What I learned in the Fellowship about leadership development is the importance of it. That is the one piece that I would say I've pursued more and more since leaving the Fellowship at every step along the way. It was an amazing foundation for me, and didn't feel leadership development was lacking, but rather requires ongoing effort. I also realized that for the type of research I was interested in doing, I had to fill other research training gaps. Thus, again, the fellowship provided a foundation and springboard for me to think about the further specialization and training I was going to need in order to meet my long-term goals. I don't think of these things as missing opportunities as the fellowship allowed me to see where I was going to have to go deeper in other areas of skills developments in order to be successful.
Q: Can you describe your leadership style and talk about a difficult decision you've made as a leader?
A: If I were to describe my style, I'd say that it's really guided by mission, vision, and strategy. That may be a reflection of where I sit right now in my career. In a government agency, we're very mission driven. I would also say that active listening is one of the things that I employ a lot, and people sometimes comment that they recognize how I really try to listen. That may be because I'm very collaborative in approach, and I appreciate multiple perspectives because I recognize that I can't see it all.
I'd probably say the most challenging decisions we have to make are funding decisions. I would say that I resonate with that challenge because one of the greatest challenges I had, in terms of a career development, was applying for a small grant when I was in Cardiology Fellowship and it didn't come through.
I had worked on it for quite a bit of time, and applied myself. I was used to applying myself and getting the results that I wanted. There were multiple reasons why it didn't come through, but it was really tough for me at a young stage in my career. I was fortunate that I had mentors who put this outcome in perspective for me and taught me the lesson of resilience.
It does bring to the fore for me the difficult nature of making funding decisions, as well as making difficult decisions about the need to close a study that we've previously funded for a variety of reasons. I recognize that it's not a decision to be taken lightly. When people feel that their perspective and voices are heard, we're actively listening, and we're navigating the challenges together, often, they can find a way to understand why the decision went one way or the other, even when the outcome isn’t what anyone would desire. Ideally, we want everyone to have the funding necessary to be successful.
Q: You mention active listening a few times. Can you describe that a little bit more as far as what you're doing as a leader when you listen to the folks around, and why that's important?
A: One of the things that I think active listening is about is making sure, number one, you have the varied perspectives in the room to even listen to. There's a piece of active listen that focuses on being very thoughtful about how you bring different perspectives to the table.
Then there's the part of active listening that actually allows people to express their thoughts and invites them in a way that people feel comfortable doing so. This may require tailoring approaches. There are some people that you want to approach one-on-one or face-to-face in order to make sure you're hearing them, and they recognize that you are listening to them. There are others that may be very comfortable conveying information in a group setting or a meeting. However, it requires taking that extra step to actually make sure that the person's comfortable enough to convey a perspective.
One thing I've seen over and over is people walk away and say, thank you for listening, even if we ultimately go down a different path than the person desired. I find active listening is about bringing the right perspectives to the table, making people comfortable enough to convey their thoughts and perspectives, and validating that you've heard their input correctly. If you then have a different perspective, active listen will facilitate being able to provide the context or the information that allows the direction in which you go to be understood by the person.
Q: What are you career goals?
A: I've always strived to be a leader in medicine and health. I still have that as a fundamental career goal. For me, it's about making an impact on people's lives. I know that, at times, it can sound lofty, but it really is what drives me. I'm particularly driven to think about disparate outcomes, and underserved populations, from the perspective of race/ethnicity, sex/gender, as well as geography. I think this is partly because of the disparities I witnessed around me as I grew up, but also because I believe this is something that we actually can address in our country and facilitate through our research efforts. I feel that these career goals have been steady for me over time. I want to continually strive to edge closer and closer to those ultimate opportunities.
Q: Let’s talk about some of the personal component of your growth and evolution over the past few years since the Fellowship. So how does your personal narrative and past experiences influence your career progression?
A: They're almost hard to separate in that way. I think my personal narrative and past experiences are interrelated with my career progression. I grew up in Bessemer, Alabama; it's a small town outside of Birmingham. One of the things that I witnessed, from an early age is the type of health outcomes and disparities that I think motivated my longer term career path. I understood early the impact of socio-economic status on health. I understood early the impact of geography on health. I understood early the impact of your race and ethnicity on your long-term health outcomes. I saw those things in my neighborhood in a way that caused me to reflect on what I actually wanted to do longer term.
I remember when I started to observe disparities being described in a very scientific, rigorous way. It was then that I recognized what I had been witnessing, and I started to latch on even more because I realized what I was observing was a real phenomenon—a phenomenon that I believe we have a responsibility to address. I felt that inner calling related to the health outcomes of my community.
I think health disparities and my resulting inner calling have guided and influenced my career progression. It was because of this that I went to medical school; it was because of this that I applied for the Commonwealth Fund Fellowship in Minority Health Policy; it was because of this that I started down a research path that examined cardiovascular disparities by site of care, race/ethnicity, and gender.
I think the personal narrative and the professional narrative do interplay with one another, and they drive that passion that I have to continue to seek more and more in my career in a way that I can give more and more toward the efforts that may improve the health of the community in which I was raised and others like it.
Q: Can you talk about mentors, mentor relationships, and how they play a role in your current position? And then also, how did some of those relationships develop?
A: Mentorship has been a cornerstone of my career. I think it's made me who I am today professionally, and it still helps to guide my trajectory and path. I've never been one to have just one mentor. In fact, a team of mentors have supported me along my career path, and they advise me on different aspects that align with different areas of their specific expertise.
I found that the team approach really does work well because I can identify when it may be best to speak to one or another because I kind of know what's coming up on the horizon, and where they may be most apt and able to advise me.
Q: There are two things I'd like to just stress a little bit that you talked about. One is that your mentors can be from different backgrounds and viewpoints—as you have different lived experiences. And I think that's something that's important because we often tend to try and identify mentors who are us, but in an older form. I think that's a really important message. And then secondly, just having a team of mentors is something that you valued, knowing that people can bring different perspectives to the same issue.
A: Absolutely. I think the first comment that you mentioned is that, I actually try not to focus identifying someone like me, that's going to mentor me. Rather I focus on identifying someone that can provide me with the insights that I may not have for myself, or that differ from individuals that I'm routinely around. Thus, often that means that I'm talking with and learning from people that are very different from me, and it actually opens my mind to perspectives and approaches in a way that I think makes me a better leader.
Q: How do you balance work and professional responsibilities with your personal life? And do you have any advice for others to try and identify that work-life balance?
A: It's a really tough question, and I think it's tough because it's a constant effort on my part. I could tell you, and others would probably even say, I don't do it perfectly. Nevertheless, I try to pay attention to the fact that I'm looking for and I'm constantly striving for an optimal work-life balance, knowing that it's a continual effort.
I think most of the Fellows and graduates of the Fellowship Program, or leaders in health or healthcare probably face similar scenarios as I do. We don't work in worlds that are traditional, 40 hours a week, 9:00 to 5:00.
I would also say that I have learned that it helps me, too, to think about work-life balance in the setting of maintaining my personal health. I make those activities for my health an equal priority to the routine things that I have to do at work on a regular basis. This requires equalizing in my mind that those activities for my personal wellbeing are just as important as the work and the mission of what I do at NHLBI.
